Virtual care use during the COVID-19 pandemic and its impact on healthcare utilization in patients with chronic disease: A population-based repeated cross-sectional study

Abstract

Purpose It is currently unclear how the shift towards virtual care during the 2019 novel coronavirus (COVID-19) pandemic may have impacted chronic disease management at a population level. The goals of our study were to provide a description of the levels of use of virtual care services relative to in-person care in patients with chronic disease across Ontario, Canada and to describe levels of healthcare utilization in low versus high virtual care users. Methods We used linked health administrative data to conduct a population-based, repeated cross-sectional study of all ambulatory patient visits in Ontario, Canada (January 1, 2018 to January 16, 2021). Further stratifications were also completed to examine patients with COPD, heart failure, asthma, hypertension, diabetes, mental illness, and angina. Patients were classified as low (max 1 virtual care visit) vs. high virtual care users. A time-series analysis was done using interventional autoregressive integrated moving average (ARIMA) modelling on weekly hospitalizations, outpatient visits, and diagnostic tests. Results The use of virtual care increased across all chronic disease patient populations. Virtual care constituted at least half of the total care in all conditions. Both low and high virtual care user groups experienced a statistically significant reduction in hospitalizations and laboratory testing at the start of the pandemic. Hospitalization volumes increased again only among the high users, while testing increased in both groups. Outpatient visits among high users remained unaffected by the pandemic but dropped in low users. Conclusion The decrease of in-person care during the pandemic was accompanied by an increase in virtual care, which ultimately allowed patients with chronic disease to return to the same visit rate as they had before the onset of the pandemic. Virtual care was adopted across various chronic conditions, but the relative adoption of virtual care varied by condition with highest rates seen in mental health.

Understanding the Experience of Geriatric Care Professionals in Using Telemedicine to Care for Older Patients in Response to the COVID-19 Pandemic: Mixed Methods Study

“…However, for geriatric psychiatrists specifically, there was a more seamless transition to virtual care due to the nature of their clinical practice that has always been more amenable to the use of telemedicine technologies, which differs from geriatricians and geriatric nurse practitioners. For example, the physical examination is usually not necessary to complete a psychiatric assessment [ 30 , 31 ]. Meanwhile, the main challenge for geriatric psychiatrists was using telemedicine technologies with older patients with severe cognitive impairment.…”

Association Between In-Person vs Telehealth Follow-up and Rates of Repeated Hospital Visits Among Patients Seen in the Emergency Department

“…JAMA Network Open. 2022;5(10):e2237783. doi:10.1001/jamanetworkopen.2022.37783 (Reprinted) October 25, 2022 7/12 Downloaded From: https://jamanetwork.com/ on 10/31/2022…”

Are primary care virtual visits associated with higher emergency department use? A cross-sectional analysis from Ontario, Canada

“…11 Other studies suggest that virtual care use during the COVID-19 pandemic was higher among patients who were sicker, suggesting it supported care continuity when COVID-19 cases were high. 1,33 In US studies, virtual care often includes a high portion of video unlike in Ontario where most virtual care was delivered by phone. 3…”