A mixed-methods exploration of the Real-Time Virtual Support pathway Child Health Advice in Real-Time Electronically in Northwestern BC

Objectives: To explore the implementation of a provincial virtual paediatric consulting service, Child Health Advice in Real-Time Electronically (CHARLiE), integrated into the paediatric on-call schedule in Northwestern British Columbia.

Methods: Healthcare providers in Northwestern British Columbia responded to a survey (n = 72) and participated in focus groups (n = 35) and key informant interviews (n = 4) to share their experiences engaging in a healthcare model that incorporated virtual paediatric consultants in lieu of in-person local paediatrician coverage over a 28-month period. Survey data was analyzed using descriptive statistics. Themes were generated from a qualitative descriptive approach to focus groups and key informant interview transcripts.

Results: 96.1% of survey respondents who had used CHARLiE rated it as 'good' or 'very good' in the provision of overall support, while 77.6% reported that CHARLiE improved access to paediatric care. Focus group and key informant interview participants valued CHARLiE's timely, dedicated virtual bedside assessments of patients; collegiality and professionalism; amelioration of local paediatrician burnout; prevention of unnecessary transfers; and offloading of indirect patient care tasks. Video support improved provider confidence and appeared to improve caregiver trust. Suggested improvements included addressing technological barriers, enhancing providers' knowledge of local resources, and enabling continuity of care. Participants identified that virtual care does not replace on-the-ground specialist care.

Conclusions: Participants valued CHARLiE's 24/7, timely, and collegial video support. While maintaining a full complement of on-the-ground paediatricians remains the goal for some rural communities, dedicated virtual support provides access to paediatric care in smaller communities, thereby improving health equity for children in British Columbia.