December 10, 2023

Virtual care clinics in Ontario had a limited impact on diverting patients out of emergency room departments during the COVID-19 pandemic, according to a new study.

The study, published Monday in the Canadian Medical Association Journal (CMAJ), found that although virtual care clinics in Ontario were intended to alleviate the strain on overstretched emergency facilities, many of these patients still ended up heading to the emergency room for care.

“The shift to virtual care was intended to maintain safe access to medical care during the pandemic, it occurred despite lack of evidence regarding the comparability of in-person and virtual care models,” co-author Dr. Shelley McLeod, a clinical epidemiologist at Sinai Health, wrote in a press release.

In the early stages of the pandemic, when physical distancing was strongly encouraged, it was difficult to arrange a nonurgent, in-person health-care visit, according to the study. In response to this, in the fall of 2020, the Ontario Ministry of Health funded $4 million to a program involving 14 virtual urgent care initiatives across the province.

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The program was intended to support emergency department diversion of patients with less severe health problems and reduce the need for in-person visits.

Click to play video: 'Pediatricians warn virtual care reduction could worsen ER crisis'

Pediatricians warn virtual care reduction could worsen ER crisis

In order to find whether the pilot program made a dent in diverting patients away from emergency rooms, the researchers looked at more than 19,500 virtual urgent care visits across Ontario from December 2020 to September 2021.

Of all patients in the study who went to a virtual care clinic during this time, 12.5 per cent went to the emergency department within three days and 21.5 per cent within 30 days of the first visit.

The study found the most common complaints for patients who had a subsequent emergency department visit after their virtual care appointment were fever and abdominal pain, with COVID-19 being the top known diagnosis.

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And, patients seen by a virtual care clinic provider with no further referral were more likely to have an in-person emergency department visit within three, seven and 30 days, the study stated.

“We found that the overall impact of the provincial virtual care pilot program on subsequent health care utilization was not significant. Patients referred promptly to the emergency department by a virtual care clinic provider had rates of health care utilization similar to those of patients who presented in person to the emergency department,” the researchers stated in the study.

Millions of dollars could have been better spent

The authors of the study suggest that virtual urgent care providers were not able to provide a comprehensive physical examination and may not have had access to laboratory tests, imaging and the patient’s previous medical records. This may have limited their ability to accurately diagnose certain conditions, meaning patients then went to the emergency room for care.

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Another reason emergency rooms continued to overflow during the pandemic is that low-acuity visits are not the root cause of crowding, according to Dr. Catherine Varner, an emergency physician in Toronto, who wrote an editorial on the study.

“In a system facing unprecedented crowding, the millions of dollars and health human resources needed to run Ontario’s pilot program arguably could have been better spent on a program tailored to patients or regions more likely to benefit,” she stated.

The study found that patients accessing virtual care services tended to be middle-aged, female, well-educated, predominantly English-speaking and urban residents of high socioeconomic status, suggesting that there may be inequitable awareness of and access to virtual care services.

Click to play video: 'Patients pleased with virtual physician visits amid COVID-19 pandemic'

Patients pleased with virtual physician visits amid COVID-19 pandemic

“The study’s authors found that people with good access to care received more care for low-acuity complaints,” Varner wrote. “With strained health-care resources, Canada’s health care systems cannot afford redundant interventions that benefit mainly people who already have good access to care.”

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In order to better utilize virtual care, the study’s authors recommend targeting rural populations and children.

For example, the study found that two pediatric virtual care sites helped divert patients from acute care pediatric hospitals, which was critical when pediatric hospitals were overwhelmed by children with respiratory infections.

“These findings highlight the need to better understand the inherent limitations of virtual care and ensure future virtual care providers have timely access to in-person outpatient resources for follow-up, to reduce subsequent emergency department visits and ensure the appropriate use of emergency department services,” the study concluded.

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