• Nadine Chami, Hemant A Shah, Steve Nastos, Shaun Shaikh, Paul K Tenenbein, Taylor Lougheed, Nikolina Mizdrak, Patrick Conlon, James G Wright, Sharada Weir, and Jasmin Kantarevic.
• Economics, Policy, & Research Department (Chami, Nastos, Shaikh, Wright, Weir, Kantarevic), Ontario Medical Association; Division of Gastroenterology and Hepatology (Shah), University Health Network; University of Toronto (Shah, Kantarevic); Department of Anesthesia (Tenenbein), University Health Network; Department of Anesthesia and Pain Medicine (Tenenbein), University of Toronto, Toronto, Ont.; Department of Family Medicine (Lougheed), University of Ottawa, Ottawa, Ont.; Section of Emergency Medicine (Lougheed), Northern Ontario School of Medicine, Thunder Bay, Ont.; University Health Network (Mizdrak); Department of Family and Community Medicine (Mizdrak), University of Toronto, Toronto, Ont.; Goderich, Western University (Conlon), London, Ont.; Botnar Research Centre (Wright), University of Oxford, Oxford, UK; Hospital for Sick Children (Wright); Institute of Health Policy, Management and Evaluation (Wright), and Canadian Centre for Health Economics (Weir), and Department of Economics (Kantarevic), University of Toronto, Toronto, Ont.; Institute of Labour Economics (Kantarevic), Deutsche Post Foundation, Bonn, Germany nadine.chami@oma.org.
• CMAJ. 2023 Jan 23; 195 (3): E108E114E108-E114.

BackgroundUptake 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.MethodsWe 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.ResultsThe 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).InterpretationWe 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.© 2023 CMA Impact Inc. or its licensors.

11 keywords...

hide…