Virtual care: Enhancing access or harming care?

Hardcastle, Lorian; Ogbogu, Ubaka

doi:10.1177/0840470420938818

Cited by 95 publications

(121 citation statements)

References 7 publications

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“…20,21 Concerns have been raised about virtual visits, including privacy, continuity of care and equity of implementation. 21,22 An Ontario pilot study of virtual care showed that, when provided with a choice of audio, video or text messaging on an integrated platform, more than 90% of visits occurred using asynchronous, secure text messaging followed by audio, yet there are no billing codes for text messaging. 28 Despite extensive use of virtual care in the COVID-19 pandemic, [23][24][25][26][27] the appropriate role of virtual care remains to be determined.…”

Section: Discussionmentioning

confidence: 99%

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

Glazier

Green

et al. 2021

CMAJ

297

342

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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.

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Section: Discussionmentioning

confidence: 99%

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

Glazier

Green

et al. 2021

CMAJ

297

342

View full text Add to dashboard Cite

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“…videoconference or telephone) has rapidly expanded to meet patient needs and physical distancing guidelines during the COVID-19 pandemic [ 1–3 ]. Before the COVID-19 pandemic, virtual care was often used to provide medical care to older adults from rural and distant communities in Canada; however, it is now being used routinely in urban settings [ 1 ]. Although virtual care is a way for clinicians to continue caring for patients throughout the COVID-19 pandemic, certain factors (e.g.…”

Section: Introductionmentioning

confidence: 99%

Factors associated with virtual care access in older adults: a cross-sectional study

et al. 2021

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Background virtual care has been critical during the COVID-19 pandemic, but there may be inequities in accessing different virtual modalities (i.e. telephone or videoconference). Objective to describe patient-specific factors associated with receiving different virtual care modalities. Design cross-sectional study. Setting and Subjects we reviewed medical records of all patients assessed virtually in the geriatric medicine clinic at St. Michael’s Hospital, Toronto, Canada, between 17 March and 13 July 2020. Methods we derived adjusted odds ratios (OR), risk differences (RDs) and marginal and predicted probabilities, with 95% confidence intervals, from a multivariable logistic regression model, which tested the association between having a videoconference assessment (vs. telephone) and patient age, sex, computer ability, education, frailty (Clinical Frailty Scale score), history of cognitive impairment and immigration history; language of assessment and caregiver involvement in assessment. Results our study included 330 patients (227 telephone and 103 videoconference assessments). The median population age was 83 (Q1–Q3, 76–88) and 45.2% were male. Frailty (adjusted OR 0.62, 0.45–0.85; adjusted RD −0.08, −0.09 to −0.06) and absence of a caregiver (adjusted OR 0.12, 0.06–0.24; adjusted RD −0.35, −0.43 to −0.26) were associated with lower odds of videoconference assessment. Only 32 of 98 (32.7%) patients who independently use a computer participated in videoconference assessments. Conclusions older adults who are frail or lack a caregiver to attend assessments with them may not have equitable access to videoconference-based virtual care. Future research should evaluate interventions that support older adults in accessing videoconference assessments.

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“…• Concerns about virtual visits include difficulty building rapport and risks to follow-up and continuity of care. 6,7 -Continuity of care results in lower costs, hospitalizations, and mortality in the long term. 8,9 • Diagnostic error is difficult to assess.…”

Section: Contextmentioning

confidence: 99%