Virtual urgent care didn’t make a dent in diverting patients with less severe health problems from emergency departments during the COVID-19 pandemic in Ontario, say physicians and researchers.
During the early days of COVID, when physical distancing was strongly encouraged, health care largely shifted to virtual delivery instead of face to face.
In Monday’s issue of the Canadian Medical Association Journal (CMAJ), Shelley McLeod, a clinical epidemiologist at Sinai Health and associate professor at the University of Toronto, and her team published a study that assessed more than 19,000 virtual urgent care visits across Ontario from December 2020 to September 2021.
The researchers looked at how ill patients were, their later in-person visits to an emergency department and outcomes at a mix of urban, pediatric and northern settings across the province.
No magic bullet for family health crisis
Of all those patients in the study, nearly 13 per cent went to emergency in person within three days of a virtual visit, and almost 22 per cent did so within a month of being seen via video call or by phone.
“We found no overall impact of the provincial [virtual urgent care] pilot program on both subsequent emergency department visits and hospital admissions, although an important percentage of [virtual care] patients subsequently attended an emergency department in person,” McLeod and her team wrote.
Young adults, city dwellers and those from higher-income neighbourhoods accessed virtual services, and those who already had a family physician or primary care provider accessed virtual services the most, the researchers found.
In the study, the mean patient age was 28 years, 60 per cent were female and 85 per cent had a primary care provider.
Justin Hall is one of the study’s authors. He’s also the deputy chief of Sunnybrook Health Sciences Centre’s emergency department in Toronto, and leads its virtual version.
“For patients who might be having severe chest pain, or if they have great difficulties with breathing or sudden changes that might be consistent with a stroke, all of those things would be best handled in our in-person emergency department,” or by calling 911, he told CBC News in an interview in response to the study.
The virtual care service is offered seven days a week from 1 p.m. to 9 p.m., and is led by nurse practitioners and supported by emergency physicians.
Hall calls it “a great service for those who have minor injuries, minor skin conditions” and says staff can help patients find the best location for treatment and also perform simple exams, such as asking patients to move joints, assessing coughs, colds or rashes, prescribing antibiotics and treating minor injuries.
Hall said ideally, patients would be attached to family physicians or nurse practitioners in an ongoing “longitudinal” relationship for disease prevention and treatment, rather than relying on urgent care with one-off visits.
“We are not a solution to the primary care crisis,” he said. “We are, however, a way of bridging the gap.”
Pediatric virtual urgent care a strength
Dr. Catherine Varner, an emergency physician in Toronto and a deputy editor of the CMAJ, wrote an editorial accompanying the study about how virtual care fits into the health-care system now, given the staffing crisis for doctors and nurses in emergency departments.
“In a system of strained resources, we can’t afford to provide redundant care to a population that already has good access to care,” Varner told CBC News in an interview, adding that pulling emergency department providers away from the bedside needs to be avoided.
Varner says virtual urgent care can help serve children with less serious issues away from pediatric emergency departments.
Andrea Neilsen, 50, of Edmonton, used a virtual care service when she lived in B.C.’s Fraser Valley for two years. She had previously had surgery for inflammatory bowel disease and needed medication renewed.
“I just felt a little precarious not having a medical doctor to oversee my care,” Neilsen said in an interview. “I looked up their website and it was really user friendly. I had my first appointment and it was a really good experience.”
Neilsen says she’s now found a family doctor in Edmonton.
In her editorial, Varner pointed to B.C.’s Real-Time Virtual Supports program as an example of successfully providing virtual urgent care to people in rural, remote and Indigenous communities throughout the province and safely avoiding visits to the emergency department.
Dr. Michael Gardam, CEO of Health PEI, says now that the pandemic has calmed down, virtual care can be adjusted to the reality of temporary emergency department closures, a shortage of family physicians and subspecialists in the province.
“What I would love to see is that patients have far more options,” Gardam said. “It may be that for some of their visits, virtual is absolutely fine and it is more convenient for that person so why wouldn’t we?”
Varner said people without access to technology could miss out on virtual care, a gap she said still needs to be addressed.