Lack of association between virtual care and ED visits among enrolled patients during pandemic

Was the shift to virtual visits during the pandemic with primary care physicians associated with increased emergency department visits? A new study published in CMAJ (Canadian Medical Association Journal) https://www.cmaj.ca/lookup/doi/10.1503/cmaj.212051 found no evidence that patients with a primary care physician in Ontario visited the emergency department as a substitution for in-person physician visits.

Researchers looked at data from Ontario, Canada’s largest province, on patients enrolled with a physician, and a link to the number of emergency department visits and virtual visits between Apr. 1, 2020, and Mar. 31, 2021. They included 7936 physicians, including 2458 (31%) in family health groups (enhanced fee-for-service) and 5478 (69%) in family health organizations (blended capitation). At the start of the pandemic, emergency department visits and in-person primary care visits dropped sharply while virtual visits increased.

“We did not find evidence that enrolled patients substituted emergency department visits because of less availability of in-person care,” writes Dr. Jasmin Kantarevic, Department of Economics, Research and Analytics and chief economist, Ontario Medical Association, with coauthors. “This finding is important given concerns about virtual care adversely affecting quality of care, leading to calls to substantially reduce care delivered virtually.”

The researchers controlled for monthly and regional variation, patient complexity and other factors. There was variability between practitioners, with fewer emergency department visits linked to patients with female physicians and in urban areas. More medically complex patients, those in rural regions and those of male gender had higher rates of emergency department visits.

“Virtual care is now being described as the new normal in Canadian health care. Future research should consider evaluating the long-term impact of virtual care, and whether it improves appropriate use of emergency departments,” they write.