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New research from Schulich School of Medicine & Dentistry, Lawson Health Research Institute and ICES Western shows that the shift from in-person to virtual primary health care has removed barriers for patients during the COVID-19 pandemic.
Specifically, the shift to virtual care has helped patients who rely on public transportation and those who have difficulty taking time off work to access health care. The study also found that during waves of the pandemic, family doctors saw a higher proportion of high-needs patients, such as those 65 and older and those with multimorbidity (two or more chronic conditions).
The study, published recently in BMC Primary Carewas led by Bridget Ryan, MD, assistant professor in the Center for Research in Family Medicine, Division of Family Medicine, and Division of Epidemiology and Biostatistics at Schulich Medicine & Dentistry.
“It was encouraging to see quantitatively that patients seen during the early pandemic were on average older, with higher rates of multimorbidity and more likely to be materially deprived; in other words, patients with high needs,” said Ryan, also an associate scientist at Lawson and an associate scientist at ICES.
All physicians interviewed for the study reported that virtual care has improved access for many of their patients. “In our interviews, family doctors told us how young mothers with children don’t have to take three buses to get to their office, or how truck drivers traveling to the US can make virtual diabetes visits with their family doctor from their taxi ,” Ryan said.
Conversely, family physicians who care for highly vulnerable patients, such as those experiencing homelessness, warned that virtual care is challenging for those without access to phones. Virtual care has also been difficult for patients and family doctors in rural areas with limited access to reliable high-speed Internet.
The study, which included both interviews and quantitative analysis, was conducted in LondonOnt. and Middlesex County. Through interviews and data from ICES, the research team explored the rapid uptake and delivery of virtual care during the first and second waves of the pandemic from March to October 2020.
In-person visit volume fell by more than 72 percent in the two weeks after March 14, 2020, driven by patient and staff safety concerns and an initial shortage of personal protective equipment (PPE) in family physician offices. During the same period, virtual visits were over 56% of the total number of visits. By June 15 of that year, the number of in-person visits had overtaken virtual visits, and by October 2020, the total volume of family doctor visits had returned to pre-pandemic levels.
The study also revealed the inequity of Ontario’s different physician compensation models. Physicians who participated in the lump-sum model received core payments from the provincial government regardless of the overall reduction in total visits, while physicians in the fee-for-service model were paid only when they had a patient encounter and were more affected by an initial general decline. The delay in the Ontario government’s ability to accept fee codes for virtual visits submitted through OHIP means that fee-for-service doctors have experienced a nearly two-month delay in receiving reimbursement for virtual care.
The shift to virtual care is being seen in other Canadian jurisdictions and internationally in areas such as Australia, the United States, China, Norway, Singapore, South Korea, Sweden and the United Kingdom
“Our study found that the shift to virtual care during the pandemic was primarily a shift to telephone care rather than video appointments; it underscored for us that as we look to the future of virtual care, we must consider a method of care delivery that is acceptable to both physicians and patients,” said Ryan.
Current work focuses on the future of virtual family doctor care as the healthcare sector emerges from the pandemic.
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