In the early months of the COVID-19 pandemic, there was an almost 80% decrease in primary care office visits in Ontario and a 56-fold increase in virtual visits, found new research in CMAJ (Canadian Medical Association Journal).
"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.
In this study to understand the impact of the pandemic on primary care, researchers from ICES and Unity Health Toronto looked at billing information for primary care from March to July 2019 compared with March to July 2020, during the pandemic. They found that
- Total primary care visits decreased by 28% from 7.66 to 5.51 per 1000 people per day
- Older and sicker Ontarians experienced the smallest decline in total visits
- Rural residents experienced an increase in total visits of 6.4%
- Virtual care (telephone and video) made up 71.1% of all visits in 2020 compared with 1.2% billed before the pandemic
- Total office visits declined abruptly in March 2020 and increased in the following months but were still lower in July 2020 than the previous year.
"Our findings are reassuring because the groups with the highest care needs, including those older than 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.
Provincial and territorial governments are currently paying primary care physicians for telephone and video visits, although the future of this type of care after the pandemic is unknown.
"Canadians appear to be highly satisfied with virtual care and up to one-third would like virtual care to be the first point of contact after the pandemic. There is support for virtual care to be covered by employer health plans, posing challenges to continuity of care and equity, if virtual care is not publicly funded in the future," the authors write.
"Shifts in office and virtual primary care during the early COVID-19 pandemic in Ontario, Canada" is published February 8, 2021.
Canadian Medical Association Journal