A team of Canadian researchers analysed the shift from office to virtual care early on in the COVID-19 pandemic and identified the degree of change in various patient populations.
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The pandemic has caused significant changes in how care is delivered, and a turn to telemedicine on a global scale is one of them. The authors of a new study (Glazier et al. 2021) set out to investigate the extent of the shift in care delivery towards virtual in the first four months of the pandemic, and identify how it had affected both healthcare providers and patients in Ontario, Canada’s most populous province, with a population of about 15 million people.
In a retrospective, population-based analysis, they have compared the primary care billing data in 2019 and 2020 over the period between 1 January and 28 July, identified those patients who had at least one visit, either virtual or in-person, over the period, and assessed how the care delivery formats have changed. It is noted that from April 2020 on, office, home and virtual visits were limited to one per patient per physician per day.
The findings of the study show that since the start of the pandemic in March and until July 2020, the overall number of primary care visits decreased by 28% compared to the same period in 2019 (5.51 vs. 7.66 per 1,000 people per day). In groups like patients who could not be attributed to a primary care physician and those with the highest expected healthcare use the reduction was the least significant (10% and 8% respectively), and in group including children and those with low expected healthcare use it was the greatest (51% and 56% respectively).
While office visits decreased by 79%, there was a 56-fold growth in telemedicine consultations, which accounted for 71% of all primary care visits. The adoption of virtual care proved to be the lowest in groups such as physicians managing 2,500 patients or more (66% of all visits), residents of rural areas (61%) and children (58%). The following groups had the highest proportion of telemedicine visits: patients cared for in Family Health Teams (76% of all visits), highest-income patients (74%), women (72%), and adults aged 65-74 years (73%).
The authors also applied interrupted time series analyses comparing the early and later halves of the COVID-19 period. The results show that the average daily visits recorded a bigger increase in the first half compared to the second half. Average daily office visits showed growth in the second half of the period, while for virtual visits the trend was reversed.
Based on these findings, the authors note the significance of the shift towards virtual care delivery across all groups of patients and physicians, with relatively small differences between the groups. They note that office visits had somewhat recovered by the end of July 2020, but had not reached prepandemic levels. While there is evidence that the groups with the highest care needs “maintained relatively higher levels of care overall”, additional attention should be given to those with lower uptake of virtual care.