Association between virtual primary care and emergency department use during the first year of the COVID-19 pandemic in Ontario, Canada.

BACKGROUND

Uptake of virtual care increased substantially during the first year of the COVID-19 pandemic. The aim of this study was to evaluate whether a shift from in-person to virtual visits by primary care physicians was associated with increased use of emergency departments among their enrolled patients.

METHODS

We conducted an observational study of monthly virtual visits and emergency department visits from Apr. 1, 2020, to Mar. 31, 2021, using administrative data from Ontario, Canada. We used multivariable regression analysis to estimate the association between the proportion of a physician's visits that were delivered virtually and the number of emergency department visits among their enrolled patients.

RESULTS

The proportion of virtual visits was higher among female, younger and urban physicians, and the number of emergency department visits was lower among patients of female and urban physicians. In an unadjusted analysis, a 1% increase in a physician's proportion of virtual visits was found to be associated with 11.0 (95% confidence interval [CI] 10.1-11.8) fewer emergency department visits per 1000 rostered patients. After controlling for covariates, we observed no statistically significant change in emergency department visits per 1% increase in the proportion of virtual visits (0.2, 95% CI -0.5 to 0.9).

INTERPRETATION

We did not find evidence that patients substituted emergency department visits in the context of decreased availability of in-person care with their family physician during the first year of the COVID-19 pandemic. Future research should focus on the long-term impact of virtual care on access and quality of patient care.

Informations de copyright

© 2023 CMA Impact Inc. or its licensors.

Déclaration de conflit d'intérêts

Competing interests: Nadine Chami, Steve Nastos, Shaun Shaikh, James Wright, Sharada Weir and Jasmin Kantarevic are paid employees of the Ontario Medical Association (OMA). Hemant Shah, Paul Tenenbein, Taylor Lougheed, Nikolina Mizdrak and Patrick Conlon are physician members of the OMA. Hemant Shah reports funding from the Ontario Ministry of Health; consulting fees from Abbvie, Gilead, Lupin and SRx Health; honoraria from Abbvie and Gilead; participation on a data safety monitoring board with Janssen; and participation with the Canadian Association for the Study of Liver. Paul Tenenbein is vice-chair of the Mount Sinai Hospital University Health Network Academic Medical Organization. James Wright reports funding from the Canadian Institutes of Health Research, the United States National Institute for Health and the United Kingdom National Institute for Health Research, as well as consulting fees from the Canadian Medical Protective Association. He is also the chair of the data safety monitoring board for the PERK2 trial. No other competing interests were declared.