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Patients who see a family physician at a virtual walk-in clinic are less likely to see the same physician again in-person, and twice as likely to visit an Emergency Department (ED) within 30 days, according to a new study led by a team from UHN, ICES, Women's College Hospital and Unity Health Toronto.
A funding structure change introduced during the COVID-19 pandemic led to the rapid expansion of virtual walk-in clinics across Canada. Though the intention was to fill a gap in primary care needs, there is some concern over the quality of care provided through virtual walk-in clinics and a lack of data on how patients use this form of health care.
A recent agreement on fee reductions for doctors offering virtual care outside of an ongoing primary care relationship in Ontario has forced many walk-in clinics to cut back on virtual services.
"This study comes at a time when our healthcare system is already facing immense pressure and many patients lack access to a primary care physician," says lead author Dr. Lauren Lapointe-Shaw, adjunct scientist with ICES, General Internal Medicine physician and scientist at UHN.
"The findings show that virtual-only walk-in care may not be addressing these gaps and could in fact be contributing to more strain on the system," adds Dr. Lapointe-Shaw, who's also Innovation Fellow at the Women's College Hospital Institute for Health System Solutions and Virtual Care, and an assistant professor of Medicine with the University of Toronto.
The study, published in the
Journal of Medical Internet Research, included 132,168 patients who had visited a family physician at one of 13 virtual walk-in clinics from April 1 to Dec. 31, 2020, compared to all Ontario residents who had a virtual appointment with any family physician – in most cases, these were with patients' regular family physicians. The findings show that:
One limitation of the data is that the researchers could not distinguish between video and phone visits, which may have differing levels of accessibility and outcomes. The study also included clinics that could be identified in health administrative data – this is a subset of all virtual walk-in clinics operating in Ontario.
"Most patients who have acute concerns need to be seen in person and have a physical exam, so it's not surprising that a virtual-only assessment would result in more churn and a higher number of visits," says co-author Dr. Tara Kiran, adjunct scientist at ICES and a family physician at St. Michael's Hospital of Unity Health Toronto.
"Ideally, these virtual-only clinics should be evaluated by independent third parties to understand their impact on patient outcomes and health system costs."