Virtual care clinics in Ontario have had a limited impact on diverting patients out of emergency departments during the COVID-19 pandemic, a new study finds.
The study, published Monday in the Journal of the Canadian Medical Association (CMAJ)found that although virtual care clinics in Ontario were intended to ease pressure on overburdened emergency facilities, many of these patients still ended up going to emergency rooms to receive care.
“The overall impact of this provincial virtual emergency care program on emergency department volumes and subsequent health care utilization was relatively small,” said lead author Dr. Shelley McLeod, clinical epidemiologist at Sinai Health, to Global News.
“On average, at each of these virtual urgent care sites, we were seeing about seven patients per day. On average, most large emergency departments see between 150 and 200 patients per day. Realistically, we’re talking about a three or four percent reduction in low acuity visits.
According to the study, in the early stages of the pandemic, when physical distancing was strongly encouraged, it was difficult to arrange a non-urgent in-person medical visit. In response to this, in the fall of 2020, the Ontario Ministry of Health funded $4 million for a program involving 14 virtual urgent care initiatives across the province.
The program aimed to support diversion of patients with less serious health conditions to emergency departments and reduce the need for in-person visits.
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To determine whether the pilot program was successful in diverting patients from emergency rooms, researchers examined more than 19,500 virtual urgent care visits across Ontario from December 2020 to September 2021.
Among all study patients who visited a virtual care clinic during this period, 12.5 percent visited the emergency department within three days and 21.5 percent within 30 days of the first visit.
The study found that the most common complaints of patients who had a subsequent emergency room visit after their virtual care appointment were fever and abdominal pain, with COVID-19 being the most common diagnosis.
And, according to the study, patients seen by a virtual care clinic provider without further referral were more likely to visit the emergency room in person within three, seven and 30 days.
“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 similar health care utilization rates as patients who presented in person to the emergency department,” researchers said in the study .
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Study authors suggest virtual urgent care providers were unable to provide a complete physical exam and may not have had access to lab tests, imaging and records previous medical history of the patient. This may have limited their ability to accurately diagnose certain conditions, meaning patients then went to emergency rooms for treatment.
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“If you have abdominal pain, a doctor is not able to give you a physical exam. They are not able to put their hands on your stomach and so our virtual care providers are not able to provide those comprehensive physical exams,” McLeod said.
Another reason emergency rooms have continued to overflow during the pandemic is that low-acuity visits are not the primary cause of overcrowding, according to Dr. Catherine Varner, an emergency physician in Toronto, who wrote an editorial on the study.
“In a system facing unprecedented overcrowding, 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 most at risk. to benefit from it,” she said.
The study found that patients accessing virtual care services were typically middle-aged, well-educated, predominantly English-speaking women and urban residents of high socioeconomic status, suggesting that there may be increased awareness and inequitable 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 we can talk to underserved communities about how we can better inform them about these programs. And then I think we need to work on the accessibility factor, thinking about these less fortunate and more vulnerable populations.
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To better use virtual care, the study 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 with children suffering from respiratory infections.
“Virtual care is definitely here to stay,” McLeod said. “There is no doubt that patients love virtual care. That’s the beauty of pilot programs: we can learn from them and determine what works and what doesn’t.
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