As part of the response to the COVID-19 pandemic, health care organizations across Canada have cancelled elective and nonurgent clinics as a measure to reduce the risk of exposing patients to COVID-19. To provide safe, timely, and accessible ambulatory care, health care providers have adopted virtual care in Canada and globally.
Virtual care can be defined as any interaction between patients and members of their circle of care that occurs remotely, using any form of communication or information technology, to facilitate or maximize the quality and effectiveness of patient care.
Virtual care is novel and nuanced compared to in-person care. Virtual Care has significant benefits to patients, health care systems and society at large by offering patient-centered care.
Virtual care also helps increase health care capacity by optimal use of health care professionals’ time, infrastructure, and reduced per capita health care costs.
Virtual care is more relevant during the COVID-19 pandemic because it provides access to medical care that is timely, convenient, efficient, and safe with reduced risk of transmission.
Despite all these advantages of virtual care, it is important to ensure that virtual care continues to provide equitable access to health care.
Virtual care has the potential to remove some of the current barriers to health care regarding availability, accessibility, and affordability.
Geographical distance, travel burden and out-of-pocket expenses are some of the largest barriers to ambulatory health care access, and virtual care has exciting potential to address these.
However, sociodemographic characteristics such as age, sex, gender, level of education, and English proficiency, as well as socioeconomic status indicators such as race and ethnicity, can impact one’s ability to access and use the technology needed for participating in virtual care.
Virtual care has the potential to provide access to people who live in more rural areas, who tend to have lower socioeconomic status, are older, and have lower levels of education, but only if the patient can access video and audio equipment, spend the time to use and troubleshoot the equipment, and learn to use programs and hardware they may have never used before. There is a need for engagement and commitment from all stakeholders in the health care system to ensure that virtual care can successfully provide equitable access, closing the gap between rural and urban health care.
There are diverse types of Virtual Care and Platforms
Secure messaging, secure email, and secure video conferencing are some of the most used virtual care modalities. These services can be delivered on multiple platforms and devices. The platforms are broadly divided into regulated and unregulated categories. Regulated platforms are those that comply with Canada’s federal Personal Information Protection and Electronics Document Act (PIPEDA), as well as provincial and territorial privacy laws that apply to health or medical records, such as Ontario’s Personal Health Information Protection Act (PHIPA).
For the virtual care provider, the choice of platform may depend on the features offered, such as secure messaging, video conferencing, patient portals, integration into electronic health records (EHRs), and integration with other remote monitoring devices and applications. Before finalizing a decision on a platform, we recommend that practitioners seek clearance from their own organization’s privacy and security officer if available. Each organization and individual provider will have a unique set of circumstances, resources, and abilities. It is essential for each provider to develop familiarity with the platform selected by their organization.
It is important to ensure that the appropriate precautions are taken by the physician and the patient to ensure the privacy of health care information. For additional information on privacy, security, and data stewardship considerations relating to digital health technologies in the outpatient setting, clinicians should consider guidance from the College of Family Physicians of Canada and the CMPA or from local or regional professional associations.
The coronavirus disease 2019 (COVID-19) pandemic is thought to have increased use of virtual care, but population- based studies are lacking. We aimed to assess the uptake of virtual care during the COVID-19 pandemic using comprehensive population-based data from Ontario.
Research in this field has been done based on the following methods: This was a repeated cross-sectional study design. They used administrative data to evaluate changes in in-person and virtual visits among all residents of Ontario before (2012–2019) and during (January–August 2020) the COVID-19 pandemic. They included all patients who had an ambulatory care visit in Ontario. They excluded claims for patients who were not Ontario residents or had an invalid or missing health card number.
After comparing monthly or quarterly virtual care use across age groups, neighborhood income quintiles and chronic disease subgroups. They also examined physician characteristics that may have been associated with virtual care use.
Results: Among all residents of Ontario (population 14.6 million), virtual care increased from 1.6% of total ambulatory visits in the second quarter of 2019 to 70.6% in the second quarter of 2020. The proportion of physicians who provided 1 or more virtual visits per year increased from 7.0% in the second quarter of 2019 to 85.9% in the second quarter of 2020. The proportion of Ontarians who had a virtual visit increased from 1.3% in 2019 to 29.2% in 2020. Older patients were the highest users of virtual care. The proportion of total virtual visits that were provided to patients residing in rural areas (v. urban areas) declined significantly between 2012 and 2020, reflecting a shift in virtual care to a service increasingly used in urban centers.
The rates of virtual care use increased similarly across all conditions and across all income quintiles.
Interpretation: It shows that Ontario’s approach to virtual care led to broad adoption across all provider groups, patient age, types of chronic diseases and neighborhood income. These findings have policy implications, including use of virtual care billing codes, for the ongoing use of virtual care during the next wave of the pandemic and beyond.