Patients attending virtual walk-in clinics are twice as likely to visit the emergency department
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 within 30 days, according to a new study led by a team from University Health Network (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, and Innovation Fellow at the Women’s College Hospital Institute for Health System Solutions and Virtual Care.
“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 is also 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 December 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:
- By November 2020, the number of physicians providing virtual care at walk-in clinics was 2.5 times higher than in February 2020. These physicians were more likely to be younger and practice in urban areas.
- Patients who used virtual walk-in clinics were more likely to be young adults, female, they had fewer illnesses and lower levels of previous healthcare use, and fewer of them were enrolled to a family physician than all Ontarians who had a virtual visit with a family physician.
- Virtual walk-in patients were less likely to have a follow-up in-person visit with the same physician, more likely to have another virtual visit, and twice as likely to visit the emergency department within 30 days of the initial virtual appointment—an association that persisted after adjusting for patient characteristics such as age, sex, urban/rural status, previous healthcare use and neighbourhood income levels.
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.”
The study, “Characteristics and health care use of patients attending virtual walk-in clinics in Ontario, Canada: cross-sectional analysis” was published in Journal of Medical Internet Research.
Author block: Lapointe-Shaw L, Salahub C, Bird C, Bhatia RS, Desveaux L, Glazier RH, Hedden L, Ivers NM, Martin D, Na Y, Spithoff S, Tadrous M, Kiran T.
ICES is an independent, non-profit research institute that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting health care needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. In October 2018, the institute formerly known as the Institute for Clinical Evaluative Sciences formally adopted the initialism ICES as its official name. For the latest ICES news, follow us on Twitter: @ICESOntario
About University Health Network
University Health Network consists of Toronto General and Toronto Western Hospitals, the Princess Margaret Cancer Centre, Toronto Rehabilitation Institute, and The Michener Institute of Education at UHN. The scope of research and complexity of cases at University Health Network has made it a national and international source for discovery, education and patient care. It has the largest hospital-based research program in Canada, with major research in cardiology, transplantation, neurosciences, oncology, surgical innovation, arthritis, vision, infectious diseases, genomic medicine and rehabilitation medicine. University Health Network is a research hospital affiliated with the University of Toronto. For more information: www.uhn.ca
About St. Michael's
St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in more than 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the Hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael’s Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.
About Unity Health Toronto
Unity Health Toronto, comprised of St. Joseph’s Health Centre, St. Michael’s Hospital and Providence Healthcare, works to advance the health of everyone in our urban communities and beyond. Our health network serves patients, residents and clients across the full spectrum of care, spanning primary care, secondary community care, tertiary and quaternary care services to post-acute through rehabilitation, palliative care and long-term care, while investing in world-class research and education. For more information, visit www.unityhealth.to.
About Women’s College Hospital
For more than 100 years Women’s College Hospital (WCH) has been developing revolutionary advances in healthcare. Today, WCH is a world leader in health equity and Canada’s leading academic ambulatory hospital. It focuses on delivering innovative solutions that address Canada’s most pressing issues related to population health, patient experience and system costs. The WCH Institute for Health System Solutions and Virtual Care (WIHV) is developing new, scalable models of care that deliver improved outcomes for patients and sustainable solutions for the health system. www.womenscollegehospital.ca
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