Effects of Virtual Care on Patient and Provider Experience of the Clinical Encounter: Qualitative Hermeneutic Study

Background: Virtual health care has transformed health care delivery, with its use dramatically increasing since the COVID-19pandemic. While it has been quickly adopted for its convenience and efficiency, there has been a relative lack of in-depthexploration of its human impact, specifically how both patients and providers experience clinical encounters.Objective: This analysis aims to identify and explore themes of change in how patients and providers in a geographicallydispersed renal service described their experiences with virtual care, including those changes that occurred during the COVID-19pandemic.Methods: Hermeneutics is an interpretive research methodology that treats human experience as inherently interpretive,generating meaning through interactions with others in specific, historically conditioned, social contexts. A total of 17 patientsand 10 providers from various disciplines were interviewed by phone as part of a study on health care implementation in thecontext of a kidney care service in northern British Columbia, Canada. The interview data were analyzed using a hermeneuticapproach, which emphasizes careful attention to reported experiences in relation to the relationships and contexts of care.Results: During analysis, the interdisciplinary team identified themes related to changes in the clinical encounter and how virtualcare influenced perceptions of care among both providers and patients. We organized these themes into 2 categories: the structureand content of the encounter. The structure category included the convenience for patients, who no longer had to travel longdistances for appointments, as well as changes in care networks. For example, communication between specialist services andlocal primary care providers became more crucial for ensuring continuity of care. The content category included issues relatedto trust-building and assessment. Providers expressed concerns about the difficulty in assessing and understanding their patients'physical and social well-being beyond laboratory results.Conclusions: Patients in the study appreciated the convenience of not needing to travel for appointments, while still having theoption for in-person contact with local providers or specialists if their condition changed. Providers were more concerned aboutthe loss of visual cues and sensory data for assessments, as well as the reduced opportunity to build relationships throughconversation with patients. Providers also described changes in the locus of control and boundaries, as patients could join phoneencounters from anywhere, bypassing traditional privacy and confidentiality boundaries. The study offers a nuanced view of theeffects of virtual care on clinical encounters in one setting, seen through the experiences of both patients and providers.