No evidence enrolled patients subbed ER for virtual family doctor visits: OMA study

TORONTO — There is no evidence patients substituted hospital emergency rooms for virtual visits with their family doctors in the first year of the pandemic, a study led by researchers with the Ontario Medical Association suggests.

The peer-reviewed study, published Monday in the Canadian Medical Association Journal, is significant given recent calls to reduce virtual service over quality-of-care concerns and ER burdens, the researchers write.

OMA president Rose Zacharias says the shift to virtual primary care at the outset of the pandemic prompted questions about whether the move had placed additional strain on emergency departments.

But the research found no evidence that patients who were studied turned to emergency departments instead when their family doctor pivoted to virtual visits.

"We know that patients are re-engaging with the health-care system after a bit of a pause because of the pandemic. They are showing up sicker. We also know that we're dealing with staff shortages and burnout amongst our health care teams … we know that over a million people in Ontario don't have a family doctor and have nowhere to turn but the emergency department," Zacharias said.

"But what this clearly shows is that an assumption that doctors practising virtual care are driving up emergency department numbers would be incorrect."

Researchers analyzed data from nearly 8,000 Ontario doctors practising in family health groups and family health organizations with rostered patients.

The shift to virtual care at the outset of the pandemic was swift, with upwards of 70 per cent of primary care visits delivered virtually in April and May 2020, study data shows. A separate study found a 56-fold increase in virtual primary care visits between March and July 2020 compared to the same period in 2019.

"Anytime we shift our models of care, we want to know first and foremost that high-quality care is being protected and promoted for our patients, as well as sustainability inside our health-care system," Zacharias said.

The study published Monday looked at primary care physicians who have an established patient-doctor relationship, not virtual walk-in clinics offering one-off appointments.

Another Ontario study, published earlier this month but widely reported on in its preprint stage, found virtual walk-in patients were twice as likely to visit an emergency department within 30 days due to a lack of continuity of care.

While researchers have suggested virtual walk-in clinics could add, rather than relieve strain on the system, Zacharias says there are several benefits to virtual care when offered by a physician with an established patient.

She cited appointments to refill prescriptions, review lab results and mental health consultations as examples.

"We know that in many examples there's high-quality care that can be delivered," Zacharias said.

Several virtual walk-in clinics, such as Rocket Doctor, reported cutting back on services and an exodus of physicians from their platforms after Ontario and the OMA agreed to reduce fees paid to doctors for one-off virtual visits starting last month.

This report by The Canadian Press was first published Jan. 23, 2023.

Jordan Omstead, The Canadian Press