The delivery of health care has dramatically shifted due to the COVID-19 pandemic causing a move from in-person visits to some form of virtual care. In support of this move, provincial governments implemented new physician billing codes.
On Sept. 3, 2021, the B.C. Ministry of Health and College of Physicians and Surgeons sent a letter asking physicians to return to in-person patient visits. This was followed on Oct. 13, 2021, by Ontario’s top health officials also urging physicians to do the same. Their concern was that some physicians had not yet returned to giving their patients the option of in-person visits.
The letters indicated that with greater understanding of how the SARS-CoV-2 virus is transmitted and the high uptake of vaccination, the risk of resuming in-person visits was low, and not offering them may be harmful to patient care. While the provinces didn’t specify the percentage of physicians that the letters were targeting, it’s likely a small minority since most doctors have resumed in-person visits.
Benefits of telehealth
We are researchers in the areas of virtual care and digital health. For more than 20 years, we have researched the development and implementation of digital health solutions to support patients with chronic diseases and improve access to care.
Virtual care is a way to deliver health-care services using technology to remotely connect patients and health professionals. While most people think of using videoconferencing technologies such as Zoom or Skype, virtual care can also be conducted by telephone. In fact, 91.2 per cent of virtual visits during 2020 have been over the phone. Given these successes of virtual care, we believe it would be a mistake to automatically go back to the pre-pandemic ways of treating patients.
While popularized by the pandemic, virtual care is not new. Psychiatry was one of the earliest adopters of virtual care. This consisted of patient counselling through emails or chat sessions. As a result, patients were provided with greater comfort and discretion, and more timely care.
Other benefits of virtual care include bridging the geographical divide — allowing patients in small urban and rural areas access to care — and increased patient convenience. It can reduce the need for patients to take time off work, due in part to reduced travel time but also because patients are able to wait at work or at home until the appointment occurs. There is also the reduced cost and stress of not having to find and pay for parking or other transportation.
Barriers of cost, time and convenience associated with in-person appointments can be enough for some patients to delay care, which may result in downstream emergency room visits if the patient’s condition worsens. Patients who have pain or mobility limitations are often challenged by their ability to travel. Virtual care can mitigate these barriers by providing more patient-centred options.
Also, as we enter the flu season, we should not forget that virtual care minimizes the spread of infections due to sitting in waiting rooms. Lastly, virtual care may allow some physicians to offer more flexibility by taking patients visits outside of their normal office hours.
Barriers to virtual care
Critics of virtual care contend it is impersonal and can take away from the rapport between doctor and patient. Nuances that a physician picks up on during an in-person patient visit might be missed. Also, many patients may not have access to the technology or tech literacy to manage virtual care.
However, many of these barriers can be overcome. Access to the internet among Canadians aged 65 and older more than doubled to 68 per cent from 32 per cent between 2007 and 2016. In 2020, more than 27 per cent of Canadians spent 20 or more hours per week on the internet. In addition, just as physicians are taught how to assess patients in the exam room, physicians can be taught how to conduct virtual care visits during medical school.
Certain medical appointments do require an in-person visit. These include physical tests, vaccines, some specialist referrals and clinical treatments. In addition, some patients may prefer seeing their doctor in-person. And for those patients, in-person visits should still be an option. However, we should not return to pre-pandemic procedures and disregard the valuable advancements made in virtual care to improve patient-centred care and the quality of our health-care systems.
Scott Lear writes the weekly blog Feel Healthy with Dr. Scott Lear.
Scott Lear has received funding from the Canadian Institutes of Health Research, the Heart and Stroke Foundation, Novo Nordisk, Hamilton Health Sciences and the Robert Wood Johnson Foundation.
Taleen Lara Ashekian does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.