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 overall impact of this provincial virtual urgent care program on both emergency department volumes and subsequent health-care utilization was relatively small,” lead author Dr. Shelley McLeod, a clinical epidemiologist at Sinai Health, told Global News.
“On average, at each one of these virtual urgent care sites, were seeing about seven patients per day. On average, most larger emergency departments see about 150 to 200 patients a day. So realistically, we’re talking about a three or four per cent reduction of low acuity visits.”
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.
The program was intended to support emergency department diversion of patients with less severe health problems and reduce the need for in-person visits.
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.
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.
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.
“If you come in with abdominal pain, a physician is not able to give you a physical exam. They’re not able to put their hands on your belly, and so our virtual care providers are not able to provide those comprehensive physical exams,” McLeod said.
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.
McLeod believes these findings call into question the health equity of virtual urgent care services.
“There’s a lot of room for improvement here,” she said. “I think that we can talk to underserviced communities about how we can better inform them of these programs. And then I think we have to work on the accessibility factor, thinking about those less fortunate and more vulnerable populations.”
In order to better utilize virtual care, the study’s authors recommend targeting rural populations and children.
For example, the study found that three 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.
“Virtual care is definitely here to stay,” McLeod said. “There’s there’s no question that patients absolutely love virtual care. That’s the beauty about doing the pilot programs that we can learn from them, and so we can figure out what’s working, what’s not working.”
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