Opinion

Virtual care is here to stay. But what are patients’ expectations?

The pandemic has changed much of the way we live – including the way we deliver family doctor care.

When COVID-19 case counts were high, we avoided asking people to come see us in-person where possible. Instead, we pivoted to virtual care – namely care delivered by phone or video. Reducing in-person care had many COVID-19 benefits. Patients and staff were less likely to be inadvertently exposed to someone who was positive, we could better maintain physical distancing in cramped waiting rooms, and we could preserve personal protective equipment that was expensive and hard to get early in the pandemic.

Of course, there were non-COVID benefits, too. Many patients liked the convenience and appreciated not having to take time off work, arrange for childcare, commute or pay for parking or transportation.

Our research has shown that, in the first few months of the pandemic, the use of virtual care sky-rocketed, increasing 56-fold. The total number of family doctor visits fell when the pandemic was declared. But by fall of 2020, visit volumes were back up to pre-pandemic levels – only now a large portion was virtual. The amount of care delivered virtually has fluctuated throughout the pandemic with more care delivered virtually when COVID-19 case counts were high. As of this past March, about 46 per cent of all family doctor visits were virtual.

But the term virtual care can be misleading. Surveys we have done of patients in the Greater Toronto Area found that most virtual care isn’t taking advantage of newer technologies. Rather, the vast majority is done by telephone.

Our surveys have also noted some worrisome concerns related to equity. Virtual care can make care more accessible for some, for example, by reducing the need for time off work and travel costs. But it makes care less accessible for others. We found that patients who were new to Canada, who had difficulty making ends meet, or who had poor or fair health were less likely to report being comfortable with virtual-care options and less likely to want them to continue after the pandemic. Potential reasons include challenges with having a working device or phone plan, language barriers, hearing difficulties – all contrasted with the relative ease of forming a trusting rapport with a clinician when you see them in person.

Virtual care can make care more accessible for some,  but it makes care less accessible for others.

How virtual care is integrated into family practices likely will be key. In some parts of Canada, there are virtual services where you can quickly and easily connect with a doctor by phone, video or online chat at a day and time that is convenient to you. However, with these new services, you may not know the doctor, the doctor may not have access to your health records, and the doctor may not be able to schedule a follow-up appointment in person.

These types of services are controversial. They provide access to people who don’t have a family doctor or those struggling to get an appointment with the doctor they have. But there are worries about the safety and appropriateness of these virtual-only visits. New research we’ve done has found that patients accessing virtual-only walk-in services are more likely to go to the emergency department compared to patients having a virtual appointment with a regular family physician.

As we redesign a better primary care system coming out of the pandemic, we need to consider the role of virtual care and what patients will expect.

Have you used a virtual walk-in clinic? What were the reasons?

When you think about the care you want to receive from a family doctor or nurse practitioner, what options are most important to you? In person, phone or video appointments? Communication by email or secure messaging?

These are just some of the questions we ask in the OurCare national research survey. The survey is the first phase of OurCare/NosSoins, a year-long initiative we’ve launched to hear from people all across Canada about their needs, preferences and priorities for primary care.

Join the conversation and help shape what better looks like when it comes to primary care.

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OurCare.ca wants to hear from you! Take the research survey, part of the OurCare project based at MAP Centre for Urban Health Solutions, Unity Health Toronto. Participation is completely voluntary and anonymous. The survey deadline has been extended until Oct. 25.

 

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Authors

Tara Kiran

Contributor

Tara Kiran is a family physician, St. Michael’s Hospital Academic Family Health Team, and Fidani Chair in Improvement and Innovation, University of Toronto.

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