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Primary care office visits in Ontario declined by almost 80 per cent during the first months of the COVID-19 pandemic but virtual visits increased more than 50-fold


Primary care has changed significantly since the beginning of the pandemic in March 2020, but older and sicker Ontarians experienced the least changes in care, according to new research from ICES, a non-profit research institute that uses population-based health information to produce knowledge on a broad range of healthcare issues, and Unity Health Toronto.

The new study published in the CMAJ shows that in the first few months of the pandemic, primary care office visits in Ontario declined by 79.1 per cent and virtual care (telephone and video visits) increased 56-fold, making it the most common kind of care. Before the pandemic, virtual care played a relatively small role in healthcare in Ontario.

“Initial reports from primary care providers during the pandemic in both Canada and the United States showed major disruptions to care, decreased payments, challenges keeping offices functioning, lack of personal protective equipment and widespread uptake of virtual care, but we didn’t know how COVID-19 had affected in-person office visits,” says Dr. Rick Glazier, senior scientist at ICES, researcher at the MAP Centre for Urban Health Solutions at St. Michael’s Hospital and lead author of the study.

The researchers examined primary care physician billing data from March to July 2020 and compared it to the same period in 2019. They found:

  • Total primary care visits decreased by 28 per cent from 7.66 to 5.52 per 1000 people per day.
  • Older and sicker Ontarians experienced the smallest decline in total visits and rural residents experienced an increase in total visits of 6.4 per cent.
  • Virtual care (telephone and video) made up 71.1 per cent of all visits.
  • Total office visits declined quickly in March 2020 and increased in the months following but were not back to baseline levels by July 2020.

“Our findings are reassuring because the groups with the highest care needs, including those over 65 and those with higher morbidity maintained higher levels of care. At the same time, there was an overall decrease in care, and we don’t know how much of that decrease was for care that could reasonably be deferred and how much was for care that was needed but missed,” says Dr. Tara Kiran, senior author of the study, family doctor at St. Michael’s Hospital of Unity Health Toronto and scientist at ICES.

Telephone and video visits are currently being financially compensated by all provincial and territorial governments; however, it is unclear whether and how it will be supported after the pandemic.

The researchers add that primary care is considered the cornerstone of most health systems worldwide, and in higher-income countries, primary care visits are about 30 times more frequent than hospital admissions. Health systems with greater availability of primary care are associated with increased access to care, reduced health inequities, better outcomes and lower costs.

The study “Shifts in office and virtual primary care during the early COVID-19 pandemic in Ontario, Canada,” was published in the CMAJ.

Author block: Glazier R, Green ME, Wu FC, Frymire E, Kopp A, 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 healthcare 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 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 healthcare 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 Providence Healthcare, St. Joseph’s Health Centre and St. Michael’s Hospital, 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.


Deborah Creatura
Communications Strategist, ICES
[email protected]

Media Strategy, Unity Health Toronto
[email protected]

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