Exploring the sustainability of virtual care interventions: A scoping review

Abstract

During the COVID-19 pandemic, virtual care has proven instrumental in ensuring the continuity of healthcare services. In the context of virtual care's growing prominence and continued use, understanding how and why virtual care interventions are sustained will help healthcare systems to better prepare for future crises. The objectives of this scoping review were to construct a conceptualization of of virtual care sustainability and to describe factors influencing the sustainability of virtual care, shedding light on the determinants that shape its longevity and continued use. Literature describing the sustainability of virtual care interventions was summarized. Details of the intervention, setting, methodology, description and evidence of sustainability, and synopsis of key findings were documented. The charted data were summarized to gain a descriptive understanding of the data collected and to establish patterns. A conceptualization of virtual care intervention sustainability focused on the concepts of fidelity and adaptability. Sustainability of virtual care interventions were conceptualized as the intervention's ability to continue to be used according to its initial design, the extent to which the intervention continued to achieve its intended outcomes (fidelity), and the ability of the intervention to evolve as the context in which it is used also evolves (adaptability). While there were various definitions of sustainability referenced, no included studies mentioned a definition of sustainability specific to virtual care. Commonalities in definitions included the continued use of virtual care and the continuation of the benefits of virtual care for some period of time. Findings indicate that there is no "one size fits all" approach to achieving sustainability of virtual care interventions, but instead identify factors that may support or hinder sustainability. Important to understanding sustainability of virtual care interventions, is the complexity of the interactions that influence it. Specifically, the factors of fidelity and adaptability are found to be important to understanding the sustainability of virtual care interventions.

Fig 1. Flowchart of included and excluded studies.