Impact of incentive reform and COVID-19 on primary care home visits in Ontario: a population-based interrupted time series analysis

Background — Home visits provide essential access to primary care for frail or homebound older adults. In Ontario, Canada, a 2019 policy change removed some financial incentives for physicians to conduct home visits. This was followed by the COVID-19 pandemic and rapid adoption of virtual care, potentially disrupting the provision of home visits.

Methods — We conducted a population-based interrupted time series analysis of Ontario residents aged ≥65 years during the period July 2014 to June 2024. The interruptions were an incentive reform in October 2019 and the onset of COVID-19 in March 2020. The main outcome was the monthly number of primary care home visits per 10,000 older adults, standardized by age and sex. Segmented autoregressive models estimated changes in level and trend at interruption. Secondary analyses examined differences by age, rurality, dementia status, and visit type (palliative vs nonpalliative).

Results — From July 2014 to September 2019, home visits increased by 0.14 (95% CI, 0.05-0.23) visits per 10,000 residents per month. From October 2019 to June 2020, visits decreased by 29.7% (95% CI, 26.0%-33.1%). There was no significant postinterruption trend. Nonpalliative visits decreased more sharply (34.5%) than palliative visits (21.3%).

Conclusions — Home visits decreased sharply after incentive reform and the COVID-19 pandemic, with no evidence of recovery except among palliative visits. These findings suggest a structural shift in primary care delivery. Further research should investigate consequences on health outcomes for older adults and optimal models of primary care for older adults with challenges accessing office-based care.