Virtual walk-in clinics could put more pressure on healthcare system: Ontario Medical Association

Virtual medical clinics could add pressure to an overwhelmed health care system, the Ontario Medical Association said Thursday, even as some patients and doctors say they are an important alternative to essential emergency rooms.

OMA reviews from pediatric hospitals, emergency departments and overall medical system Struggling to meet the needs of the triple threat of respiratory syncytial virus, seasonal influenza and COVID-19.

“Virtual clinics may actually lead to more churn and cost to our system,” said Dr. Tara Kiran, a family physician at St. Michael’s Hospital in Toronto, who was part of a pilot study comparing visit patients senior author of . Their own family doctor interacts virtually with people who have visited the virtual clinic.

The non-peer-reviewed preprint study found that patients with virtual appointments were twice as likely to visit an emergency room within 30 days due to a lack of continuity of care.

However, some patients and doctors lamented the reduced virtual care options, as doctors left the platform after the province and OMA reached an agreement to reduce payments to doctors for virtual visits beginning Dec. 1.

While the cost of a one-time visit was previously set at $37 for a small assessment and up to $60 for a longer meeting, the changes bring the cost down to $15 for a phone call and $20 for a video conference.

Advocates say virtual walk-in clinics provide more access to care and prevent them from going to emergency rooms and pediatric hospitals for less urgent matters.

Dr. Aviva Lowe, a Toronto pediatrician who has seen children from across Ontario through her virtual clinic KixCare, said she is able to provide the same level of care for a one-time appointment as a first-time patient referred to her by another doctor.

KixCare no longer offers urgent virtual care due to fee changes, which it said made its funding model unviable.

Before Dec. 1, Lowe said, its pediatrician lists had about 2,000 children a month and about 20,000 in Ontario during the pandemic.

The study and OMA failed to address the fact that the majority of patients who access virtual care platforms use them due to lack of choice, and most do not have timely access to family physicians or at all due to lack of availability, Lowe said.

“We cannot make policy decisions based on research that has not been peer-reviewed.”

“It’s not surprising that patients may show up again in the ED because of the lack of other options, but there’s certainly no evidence that virtual visits … caused them or contributed to a trip to the ER.”

More than 90 percent of parents surveyed by the platform said they would have gone to the emergency room if they had no other options, which equates to an estimated 18,400 visits diverted from the in-person system, she said.

To maintain a level of access for children, the platform has launched a paid monthly subscription for making appointments with nurses rather than doctors.

“Virtual care should be considered part of our province’s comprehensive solution for children’s health care. It shouldn’t be seen as the enemy, it shouldn’t be seen as something subpar,” she said.

“Children and families in the publicly funded health care system deserve to see a doctor in a timely manner, and we have the technology, we have the expertise to be able to do most of the work through virtual visits.”

Physician fee waivers on platforms like KixCare have resulted in many virtual clinics reducing or cutting services, making it harder for parents like Martin John to easily access care for their children.

For months, John — who says his daughter’s pediatrician was too busy to see them in time — was able to get same-day appointments through Rocket Doctor, a virtual care platform that connects patients with doctors across Ontario.

“It’s a relief to know that something is easy to find and we know it’s there, and if we have one of these non-urgent issues we can call them,” John said. “It’s So accessible and so rewarding.”

Rocket Doctors founder Dr. William Cherniak said the platform has seen a mass exodus of Ontario doctors since the fee changes began. He said his company has grown from 20 family or emergency physicians a day to three or four. He added that the number used to see 500 patients a day is now closer to 50 a day.

“Unfortunately, millions of people in the province lack access to health care,” Chernyak said. “Which is better: forcing these patients to go to an in-person walk-in clinic or directly to the emergency room, or giving them access to virtual care?”

Ottawa father Eli Kassis, who has been using Rocket Doctor to get quick medical advice or treatment for his son since early 2021, said he has been turning to the service in lieu of a family doctor but has given up on finding one. Chance.

“I’m busy, and it’s really sad when your kids have the flu or a cold. They can’t go to daycare, and we’re working on that,” he said. “I don’t think virtual doctors can completely take over, but they’re an excellent avenue for this sort of thing.”

Rocket Doctor said on its website that it must stop making appointments through its platform for family and emergency physicians and pediatricians under OHIP. Cherniak said it will continue to help patients access specialty care through an agreement with the province in October, along with services in Western Canada and the U.S. that are exempt from similar fee cuts

Under the new agreement, specialists and family doctors with special approval from the Ministry of Health can continue to provide virtual care to patients without in-person visits, as long as there is one consultation every 24 months that can be conducted remotely.

The Ontario Ministry of Health says it understands the benefits of virtual care throughout the COVID-19 pandemic, and its new agreement with OMA ensures virtual care will be permanently integrated within the OHIP insurance framework.

“Virtual care is designed to complement face-to-face care, not replace it,” the Department of Health said in a previous written statement.

OMA noted that more than 1 million patients in the province do not have a family doctor and said it is advocating for measures such as expedited licensing of internationally educated physicians to help address the doctor shortage.

This story was produced with funding from Meta and the Canadian Press News Fellowship.