The pandemic has radically changed the way Ontarians get appointments with their family doctors, with office visits dropping by almost 80 per cent and virtual-care visits jumping by a whopping 5,600 per cent, a new study shows.
“The change in care from personal to virtual was expected but the magnitude was a surprise, especially the precipitous decline in in-person visits,” said lead author Dr. Rick Glazier.
To get a sense of the pandemic’s impact on primary care, researchers from ICES, an independent, non-profit research institute, and Unity Health Toronto compared billing data from 2020 to 2019, looking specifically at the time period from March to July in both years.
They found that the number of office visits per 1,000 per day went to 1.57 from 7.53, for a drop of 79.1 per cent.
The number of virtual visits per 1,000 people per day went to 3.92 from .07, for an increase of 5,608 per cent.
Total primary care visits — including those done in-person and virtually — decreased by 28 per cent. The number of visits per 1,000 people per day went to 5.51 from 7.66.
Senior author Dr. Tara Kiran said it was reassuring to see that those with the highest care needs maintained higher levels of care.
“Sadly the pandemic has generally widened gaps in equity and many people are not getting the support they need. But our findings suggest that primary care was preserved for those who needed it most. We found the people who were older and sicker had the smallest reduction in overall primary care visits,” she said.
Provincial and territorial governments are currently paying primary care physicians for telephone and video visits, although the future of this type of care after the pandemic is unknown, the paper said.
Ontario last year introduced temporary billing codes for phone and video visits. The provincial government and the Ontario Medical Association are discussing permanent codes for virtual care during negotiations currently underway for a new fee contract.
Kiran said she would like to see the province compensate doctors for communicating with their patients by email and secure messaging.
No temporary billing codes have been introduced for that and at least one virtual-care provider is charging patients out-of-pocket for that service, the Star revealed last month. Critics say it is a violation of the Canada Health Act for doctors to charge patients for medically necessary care.
Kiran said she is also worried about the growth of “walk-in virtual care.” It’s the same idea as a walk-in clinic, but without the bricks and mortar. One long-standing criticism of walk-in care is it can deprive patients of an ongoing relationship with a physician. As well, a patient’s normal primary care provider is not always informed of what kind of care has been provided during a walk-in appointment.
“I worry that we are trading off convenience for continuity. I’d like to see virtual care being offered as part of a continuous, longitudinal relationship with a primary care team,” Kiran said.
Glazier said that Canadians appear to be highly satisfied with virtual care. Up to one-third would like virtual care to be the first point of contact after the pandemic, he said.
There is support for virtual care to be covered by employer health plans, posing challenges to continuity of care and equity, if virtual care is not publicly funded in the future, the paper said.
“If governments don’t support virtual care within publicly funded medicare, there will be few barriers to private payment for it,” Glazier warned. “That could create two-tiered care that is not in the spirit of the Canada Health Act and a parallel system that would fragment care.”
The researchers added that primary care is considered the cornerstone of most health systems worldwide. In higher-income countries, primary care visits are about 30 times more frequent than hospital admissions. Health systems with greater availability of primary care are associated with increased access to care, reduced health inequities, better outcomes and lower costs.