Virtual Care and Health Care Access: Pragmatic Evaluation of Implementation, Acceptance, and Use in General Practice and Aged Care Homes.

Background: Health care access plays a central role in reducing inequities across populations. Virtual care can mitigate these inequities by facilitating more inclusive and accessible health care delivery. In residential aged care homes (RACHs), virtual care has the potential to enable timely and efficient access to general practitioners (GPs) for residents. However, as context, technologies, and users are complex, the implementation, acceptance, and use of virtual care technologies in RACHs remain challenging. Objective: This study aimed to evaluate the barriers and facilitators to implementing, accepting, and using virtual care technologies to connect residents with GPs for health care delivery in RACHs, and to identify benefits, unintended consequences, and opportunities for optimization. Methods: We conducted a pragmatic, cross-sectional qualitative study guided by interpretivist principles. Semistructured interviews were undertaken with 32 participants (11 GPs, 11 RACH nurses, 3 practice managers, 5 residents, and 2 carers). Data were analyzed inductively using reflexive thematic analysis and mapped deductively to the Systems Engineering Initiative for Patient Safety model to examine sociotechnical interactions influencing virtual care delivery. Results: Our investigation revealed that barriers to implementing, accepting, and using virtual care technologies to deliver care to RACH residents were more pervasive and salient in participants' accounts than enablers. While barriers were found across all Systems Engineering Initiative for Patient Safety domains for GPs, most of the barriers for residents and carers were identified in the "people" and "organizational" domains, and in addition to these, "technology and tools" domain for RACH nurses. Although many barriers are common across the people (eg, resistance to using new technology), technology (eg, inadequate system integration), and organization (eg, logistical challenges) domains for RACH nurses and GPs, our study revealed unique barriers to virtual care delivery for residents and carers (eg, interruptions and potential to exclude residents from conversations) whose views are often absent from existing literature. Our findings also revealed that there is no standardized virtual care consultation process between RACHs and GPs-a key concern strongly associated with the identified work system barriers. While virtual care was seen as beneficial, participants identified some unintended consequences to patients (eg, loss of doctor-patient relationship), clinicians (eg, additional workload), and health care organizations (eg, infection control). Conclusions: Virtual care can improve access to timely, high-quality general practice services in RACHs, but its potential is constrained by sociotechnical, organizational, and workflow challenges. Addressing system integration, usability, staffing, training, and policy gaps, including funding and billing structures, will be crucial to realizing the benefits of virtual care. This study provides new evidence to inform design, implementation, and policy decisions supporting equitable virtual care delivery aligned with Sustainable Development Goals 3 and 10.