Dr. Lauren Lapointe-Shaw, a General Internal Medicine physician at UHN and the study’s lead author, says the results show that virtual-only walk-in care may not be addressing pressures in health care system, and may be adding extra strain. (Photo: UHN)
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 University Health Network (UHN), ICES (not-for-profit research institute), 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:
- 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 ED 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.”