The availability and use of virtual care increased significantly during the COVID-19 pandemic. Ontario residents made use of platforms like Maple or Rocket Doctor, which allowed them to connect to a primary care physician from the comfort of their home.One study showed that the use of virtual visits in Ontario increased by 5600% in the first four months of the pandemic when compared to the same period in 2019.
The increased reliance raised concerns about virtual care adversely affecting quality of care. Others questioned whether patients would substitute emergency department visits when in-person care options were unavailable.
However, arecently published study in the Canadian Medical Association Journal puts some of these concerns to bed. The study shows that patients did not use emergency departments as a substitute for in-person visits with their family physician during the pandemic when those same physicians offered virtual care consultations.
Unfortunately, despite the growing evidence about the use of telemedicine and high patient satisfaction scores, the Ministry of Health has been increasingly cutting funding to virtual care. For example, in December 2022, the government significantly reduced the fees doctors can bill the government for one-off video and telephone consultations. The move was meant to encourage face-to-face interaction based on concerns that physicians were leaning too heavily on virtual care. The move resulted in many physiciansno longer offering their services through online platforms or over the phone.
Hospital run virtual Emergency Rooms could soon be facing the same fate. Provincial funding was to run out on March 31, 2023, but a last minute deal has granted a three-month funding extension. Unfortunately, Unity Health Toronto hospital network, which had partnered with two other hospital systems to run a virtual emergency room, will be winding down its online service despite the funding extension. University Health Network, which partnered with Unity Health and Sunnybrook Health Sciences Centre, will continue to offer the virtual ER without Unity Health. The University Health Network stated that it would keep offering a virtual ER, regardless of provincial funding, while Sunnybrook Health Sciences will continue its partnership in the program until the end of June, when the extension ends.
The virtual emergency room programs have been instrumental in diverting patients, saving them from unnecessary and lengthy visits. In turn, traditional physical emergency rooms are not as overwhelmed with high volumes, especially during staffing shortages. The University Health Network estimates about 85% of patients seen virtually do not need to come to a hospital. This translates to more than 3,000 patients who avoided an unnecessary trip to the emergency room.
Ontario residents can still make use of theHealth Connect Ontario (also known as Health811), which replaced Telehealth Ontario in April 2022. It is a free service available 24/7 by phone or online that connects residents to a registered nurse for advice on next steps like making an appointment with a doctor, visiting a clinic, or going to the hospital.
Primary care is considered the cornerstone of health systems worldwide. Health systems with greater availability of primary care have increased access to care, reduced health inequities, better outcomes, and lower costs. Yet, despite this evidence, the future of virtual primary care in Ontario seems uncertain.
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