Ontario patients did not turn to ERs in place of in-person doctor visits, study found

Ontario patients did not turn to emergency departments as a substitute for in-person visits with their family doctor during the first year of the COVID-19 pandemic, a new study has found.

The research, released by the Ontario Medical Association (OMA) on Monday, looked at records from 7,936 family physicians and family health organizations between April 2020 and March 2021.

“We did not find evidence that enrolled patients substituted emergency department visits because of less availability of in-person care,” Dr. Jasmin Kantarevic, the OMA’s chief economist, wrote in the study.

“This finding is important given concerns about virtual care adversely affecting quality of care, leading to calls to substantially reduce care delivered virtually.”

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The new peer-reviewed study looked specifically at the number of virtual visits patients had with family doctors and the number of times those same patients visited emergency departments. It’s important to note that during the first year of the pandemic, Ontario residents were being urged to stay indoors and not go to the hospital unless it was absolutely necessary.

According to the OMA, virtual care now accounts for more than a quarter of physician visits in Ontario. This marks a substantial increase from the four per cent of family physicians in Canada who offered video visits in 2018.

While hospitals experienced pressures due to COVID-19 outbreaks and staffing shortages, the study suggests patients who had a family doctor did not feel the need to go to an emergency department if they couldn’t get an in-person appointment.

“This study shows that the unprecedented strain on emergency departments is not associated with patients being unable to see their family doctors in person,” OMA President Dr. Rose Zacharias said in a statement.

“These findings are important because virtual care, when medically appropriate, allows patients to connect with their doctor from the privacy and comfort of their own home.”

The next step, the OMA says, will be to evaluate the long-term impacts of virtual care in different settings.

Physical distancing and stay-at-home orders are forcing unprecedented change and innovation in public medicine that experts say will revolutionize how we access care. (Photo credit: Bongkarn Thanyakij from Pexels)

The research also comes months after the OMA came to an agreement with the province on a new fee structure for virtual care.

• What you need to know about the new fee structure for virtual care

Under the Ontario Health Insurance Plan (OHIP), most physicians can bill up to $80 per video visit with a patient. However, doctors can only charge this fee if they have seen the patient in person at some point in the last two years. If they haven’t seen them in person, the cost drops to $20 for a video visit and $15 for a telephone visit.

According to the OMA, telephone services will be paid by OHIP at 85 per cent of in-person care for patients with an existing relationship with a physician. Core mental health treatments via telephone will be paid at 95 per cent of in-person care.

Some virtual-only companies have said this new fee structure is forcing them to shut down. Rocket Doctor, a technology company that enables physicians to connect with patients on a digital platform, had to stop providing primary or emergency care services covered by OHIP as a result of the changes.

Kixcare, a company that offers 24/7 virtual access to pediatric healthcare experts, also had to shut down its urgent care services. Instead, the company is charging families a monthly $29 fee for access to health practitioners.

The OMA has previously said that only five per cent of family physicians in Ontario are practicing exclusively on virtual platforms. When asked about the virtual care fees back in December, the association said they believe the best care is “inside the patient-doctor relationship.”

The statement tracks with how the OMA feels more generally about virtual care being offered outside of a family physician’s office. In December, the association released a preprint study that suggested virtual walk-in patients are twice as likely to visit an ER within 30 days due to lack of continuity of care.

“Virtual-only walk-in clinics may actually be resulting in more churn, more cost to our system,” Dr. Tara Kiran, author of the study, told the Canadian Press at the time.

Advocates have argued there are many Ontarians who do not have family doctors and that virtual care can help reduce barriers for not just those patients, but also those who live in more rural communities where access to a physician is sparse.

In the first six months of the pandemic, more than 170,000 patients in Ontario lost their family doctors. This time period partially overlaps with that of the study released today.

With files from the Canadian Press.