Shifts in office and virtual primary care during the early COVID-19 pandemic in Ontario, Canada

Abstract

BACKGROUND: Globally, primary care changed dramatically as a result of the coronavirus disease 2019 (COVID-19) pandemic. We aimed to understand the degree to which office and virtual primary care changed, and for which patients and physicians, during the in itial months of the pandemic in Ontario, Canada. METHODS: This population-based study compared comprehensive, linked primary care physician billing data from Jan. 1 to July 28, 2020, with the same period in 2019. We identified Ontario residents with at least 1 office or virtual (telephone or video) visit during the study period. We compared trends in total physician visits, office visits and virtual visits before COVID-19 with trends after pandemic-related public health measures changed the delivery of care, according to various patient and physician characteristics. We used interrupted time series analysis to compare trends in the early and later halves of the COVID-19 period. RESULTS: Compared with 2019, total primary care visits between March and July 2020 decreased by 28.0%, from 7.66 to 5.51 per 1000 people/day. The smallest declines were among patients with the highest expected health care use (8.3%), those who could not be attributed to a primary care physician (10.2%), and older adults (19.1%). In contrast, total visits in rural areas increased by 6.4%. Office visits declined by 79.1% and virtual care increased 56-fold, comprising 71.1% of primary care physician visits. The lowest uptake of virtual care was among children (57.6%), rural residents (60.6%) and physicians with panels of ≥ 2500 patients (66.0%). INTERPRETATION: Primary care in Ontario saw large shifts from office to virtual care over the first 4 months of the COVID-19 pandemic. Total visits declined least among those with higher health care needs. The determinants and consequences of these major shifts in care require further study.

Exploring the use and challenges of implementing virtual visits during COVID-19 in primary care and lessons for sustained use

“…The ease, satisfaction, and moderate comfort in using the various existing virtual care modalities reported in this study might have facilitated the 59.9% sharp rise in adoption upon the emergence of the pandemic. Our findings are consistent with a recently published study that reported a 56-fold increase in virtual visits’ uptake during the pandemic compared to the pre-COVID-19 period [ 25 ]. The reported dramatic shift in primary care providers’ use of virtual care during the pandemic exhibits primary care’s resiliency in utilizing various virtual modalities and demonstrates a capacity to adopt simple digital tools quickly.…”

“…Conversely, in rural communities, just 45.7% of households have equal access [ 27 ]. Glazier and colleagues reported that rural residents were among those with the lowest virtual care use at 60.6% during the pandemic [ 25 ]. Another review conducted by Li and colleagues in 2020 underscored the need to address virtual care’s technical capacity in rural communities [ 28 ].…”

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“…Compared with housed or the general population, a recent study using ICES databases (similar data source for the present study), 22 found that during March to July 2019 (pre-COVID-19), there were on average 7.66 visits per 1000 people/day to PCPs in the province of Ontario (the setting of our study), while in our participants overall, there were on average 14.34 person-year visits (or 39.3 visits per 1000 people/day) to PCPs during 1-year pre-randomization. This finding suggests that our study population tended to accumulate more visits to PCs than the general population.…”

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“…Indeed, family physician visits were down by over 50% in the first part of the pandemic. 14 Furthermore, many school immunization programs have been interrupted due to COVID-19. Indeed, we have lost the 2020-2021 vaccination years for school-aged children.…”