More Canadians have been using virtual care since the pandemic. Is it effective and safe?

Since the rise of virtual care in Canada during the COVID-19 pandemic, patients and doctors were able to use this alternate form of care "safely and effectively," new research from McMaster University suggests.

Those who were seen in virtual care had fewer hospitalizations, fewer visits to intensive care units and fewer health-care visits, the study found. These patients, however, tended to see their own family doctor more through virtual means than patients who opted to see their doctor in-person.

Shawn Mondoux, an emergency physician and associate professor in the department of medicine at McMaster in Hamilton, Ont., led the study and says his team's findings suggest virtual care is just as safe as in-person care. Virtual care includes medical appointments or health care done remotely, such as over video or by phone.

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"It reminds us that there are patients for whom a virtual visit is an entirely reasonable form of medical visit," Mondoux wrote in an email to CTVNews.ca. "The question should not be whether one type of visit is better than the other. Instead, we should ask which type of patients are most suitable for virtual care."

Jing Bian of Toronto, one of many Canadians who reached out to CTV News about virtual care, said she has been using the service since 2020, mainly through video conference and phone, for prescriptions, following up on referrals and test results that don't require in-person appointments.

"I found (virtual care appointments) to be a good supplement to in-person care, though definitely not replacing the need for in-person appointments," Bian, 29, wrote to CTVNews.ca, adding she felt "it's only effective and safe for very minor procedures and admin."

When it comes to diagnosis, she prefers to have in-person appointments. "Besides, certain procedures can only be done in person ... etc. No AI can replace a body in biological flesh and mind."

A Canadian Medical Association Journal (CMAJ) study last month found that in Ontario, a virtual urgent care program did little to ease the strain on emergency departments. But Mondoux said virtual care isn't a replacement for in-person care.

"If patients have ongoing medical issues and have been seen in virtual care on several occasions already, it is likely time to be seen in person and have a complete physical assessment," he said. "But for quick follow ups, medication refills, surgical follow ups and even some mental health applications, virtual care remains a great choice."

The McMaster study, published in Healthcare Quarterly on Nov. 27, explored whether virtual care was as safe as in-person care during the COVID-19 pandemic. It used data between March 14, 2020, and March 13, 2022, from more than 18 million health-care visits by Ontario patients, split evenly between virtual and in-person care. Patients were grouped based on conditions such as age, gender, similar historical illnesses and their history of diagnosis.

Researchers from McMaster then reviewed patient outcomes seven and 30 days after virtual care appointments.

Patients who used virtual care "had better outcomes" than those who did in-person visits, the study suggests. Researchers said this is likely because of the difference in the severity of illness between patients who received virtual care and patients who sought care in person, although this "cannot be definitively substantiated."

While researchers couldn't account for the severity of illness of patients in this study, Mondoux said the in-person care system is probably taking care of much sicker patients than those being seen virtually.

"Taken as a whole, the rapid transition to virtual care in Ontario appears to have been done safely and effectively by clinicians across the province," the study concluded. "The prioritization of sicker patients to in-person care is likely occurring and seems to be functioning well."

In addition, researchers said patients who had several consecutive visits in virtual care "may represent a threat to quality of care."

"If you have abdominal pain, and you have seen a doc virtually a few times, at some point it would likely be very beneficial for a doctor to examine the abdomen rather than being seen virtual again," Mondoux explained in an email to CTVNews.ca.

Once rare before the pandemic, except in remote communities, virtual care became part of the response to limiting in-person interactions to prevent the spread of COVID in 2020, the study also noted. Ontario's virtual care service, known as the Ontario Telemedicine Network, comprised about 1.6 per cent of all ambulatory health-care visits in Ontario pre-pandemic. By April 2020, more than 70 per cent of all ambulatory health-care visits in Ontario were conducted virtually and more than 85 per cent of physicians were using virtual care.

For many people, virtual care is seen as more convenient in some ways since going to doctor's offices may require taking time off work, driving to an urban centre and paying for parking.

"The face-to-face trust needs to be (established) before I feel comfortable simplifying communication methods," Bian told CTVNews.ca. "I will say though, virtual appointments allow me to remain at wherever I need to be as long as there's WiFi (or a) cell signal, because outside of emergency, most medical professionals are 9 to 5 and it grants access to care for people who can't tailor their lives to the 9 to 5 schedule, and I sometimes do fall into this category because of my profession in the film industry."

Debra Cantwell, of Hamilton, Ont., says she embraced the convenience of virtual care appointments throughout the pandemic.

Through virtual care, Cantwell said she was able to get treated for urinary tract infections and her thyroid, as well as obtain prescription refills. For instance, she said she would easily connect with her doctor by phone, who would then fax in her lab requisition for urine analysis. After that, she would go to the lab to get the testing done and the doctor's office would call back one or a few days later to inform her that her prescription was ready at the pharmacy.

"This worked great for me," Cantwell told CTVNews.ca. "I am retired so older and did not want to go to the doctor's office and be exposed to different viruses and bacteria and become ill."

VIRTUAL CARE POSES BARRIERS

Mondoux notes that barriers to accessing virtual care, including technology, can exist for some people, but the situation will differ for each patient.

"There is a way to be seen that suits their life and their condition the best. As long as we know of and manage these limitations, we can choose the type of care that works best for each patient."

While the research uncovered virtual care's benefits, Mondoux says virtual care may be more challenging to access for people who live in northern Canada and in rural or medically underserved areas due to the lack of health-care services there.

"In these underserved areas, there may not be the benefit of having the choice between virtual and in-person care," he said. "This said, virtual care is likely better for these patients than having no care at all."

Mondoux, who also co-authored the CMAJ report, said the rise of private virtual care indicates that accessing care is a challenge for patients given the limited access to primary care and follow-ups with specialists.

"There is only a business market for private virtual care companies because we are not meeting patient needs in the conventional system," he said. "If we had been, nobody would be using private services in the first place. The message here is complex but is not likely one where we eliminate or restrict access to these private virtual care providers – this will only further restrict care access to patients.

"The solution is increased public care access, with better and more imaginative funding models."

Policymakers should consider incentivizing short-term, non-urgent outpatient virtual care visits to help reduce the strain on the health-care system, the researchers stated in the study.

"Given its essential role in the system over the past three years, it is difficult to conceive of a health-care system without some component of integrated virtual care," they wrote.