There are many reasons why hospital emergency departments have been under unprecedented strain lately, but new research shows that the shift by family doctors to virtual care since the start of the pandemic is not one of them, according to the president of the Ontario Medical Association.
In a study by the Ontario Medical Association, published in the CMAJ (Canadian Medical Association Journal) on Monday, researchers found primary care physicians’ transition to virtual care was not associated with increased emergency department visits by their patients.
“There are other reasons why emergency departments are overwhelmed. It’s not because doctors have pivoted to a hybrid model and are now seeing their patients virtually as well,” OMA president Rose Zacharias said.
The study adds to growing research on the impact of virtual care, which has taken off in Canada since doctors were driven to restrict in-office visits early in the pandemic to reduce COVID-19 transmission. Many doctors began offering appointments by phone or video call.
Meanwhile, in the past year, emergency departments have struggled to keep up with demand, Dr. Zacharias said. But this has been the result of multiple factors, including burnout among health care professionals, a backlog in care, and patients showing up in greater numbers and sicker after a period of public-health restrictions, she said.
As well, there is a shortage of doctors and nurses in Ontario, with more than one million people in the province lacking a family doctor in the first place, she said, explaining the latest findings show patients who did have family doctors were not turning to emergency departments because of a decline in the availability of in-person care.
The study used administrative data to examine the proportion of virtual care Ontario physicians provided and the number of emergency visits among their enrolled patients between April, 2020, and March, 2021. It included 7,936 physicians in family health groups or family health organizations. The researchers found no association between the ratio of virtual visits and emergency visits.
But some research shows not all virtual care is the same. In a separate study, published in the Journal of Medical Internet Research earlier this month, researchers found patients of 13 Ontario virtual walk-in clinics, which offer exclusively virtual care, were more likely to have another virtual visit and less likely to have an in-person visit within 30 days than Ontarians who had a virtual visit with a family physician. They were also twice as likely to go on to visit an emergency department.
While the researchers did not study the reasons for this, lead author Lauren Lapointe-Shaw suggested a couple of potential explanations. Patients tend to use virtual walk-in clinics for new, acute problems, many of which require a physical exam of some kind, such as abdominal pain, she said. She suspects in many cases, patients may be redirected to an emergency department for that physical exam, since virtual walk-in clinics do not have a bricks-and-mortar facility where patients can be assessed in person.
Another potential reason may involve the relationship and trust between patient and doctor, said Dr. Lapointe-Shaw, who is a general internist physician at Toronto’s University Health Network and assistant professor at the University of Toronto. Patients may have less confidence in doctors they meet for the first time virtually and who do not examine them physically, and so are more likely to visit an emergency department for a second opinion, she said.
Her co-author Tara Kiran, a family doctor at St. Michael’s Hospital and Fidani Chair of Improvement and Innovation at the University of Toronto, emphasized the need to integrate virtual-care options into family care in a way that strengthens continued relationships between health care professionals and patients. That includes the increased use of asynchronous messaging, such as e-mails via a secure platform, which is highly desired by patients but not currently widely used, she said.
It’s important to avoid using virtual care in a way that fragments the continuity of patients’ care, Dr. Kiran said.
“A strong relationship between one physician and a patient has been shown time and again to have better outcomes for patients, even lower costs for the system,” she said.