Virtual primary care: Impacts and opportunities

Virtual care has become increasingly important to the primary care system in Canada.Reference1 Reference2 1 in 3 Canadians report having received primary care virtually in the past year.Reference3 Virtual care can include appointments over video or telephone, along with asynchronous services such as secure messaging. 

While the role of virtual primary care is still evolving, when applied appropriately it is an important part of a safe and equitable health care system and can improve primary care access.Reference2 Reference3 Reference4 Reference5
 

Over half of visits to the emergency department (ED) for conditions that could potentially be managed in primary care were for conditions that could be managed virtually. 

This represents 9% of ED visits in Canada. And it includes 97 conditions, such as colds, anxiety and repeat prescriptions, that could potentially be managed virtually. 

This data cannot be used to understand appropriateness of a virtual visit at the individual level — including whether virtual primary care is acceptable to a specific patient. And results vary locally: refer to Your Health System to explore results at the regional level.

Still, at a broad level, these findings reflect an opportunity to better address Canadians’ unmet needs for primary care using virtual services.

Note: Indicator results for Quebec and British Columbia exclude patients who left the ED without being seen by a physician or who left it against medical advice. These provincial results are therefore underestimated and are not comparable with results for other jurisdictions. For more information, refer to Understanding data from Quebec and British Columbia.

Virtual care can improve access to primary care by allowing patients to see a clinician without having to travel. This can particularly benefit patients in underserved areas. 

Our findings show that 13% of ED visits for patients living in rural or remote areas could potentially have been managed virtually, compared with 7% for patients living in urban areas. Applied thoughtfully, virtual care can increase equity in primary care access, reduce the carbon footprint of health care systems, and provide resources in rural and remote communities.Reference4 Reference5 Reference6

I visited the emergency department because a minor medical condition was worsening, and my primary care physician wasn’t available during the time period that I needed care. It would have been helpful to have more accessible urgent care options through my physician’s clinic. A virtual visit would have saved time and streamlined the coordination of care. — Lucksini Raveendran, Patient Partner

Implementation of virtual care solutions must be done carefully.Reference1 Reference4 Reference5 Reference7 Reference8 There are many aspects to consider: 

• Support for clinicians to implement virtual care in their primary care practices.Reference4 Reference5 Reference7 Half of clinicians using virtual care report it has increased their workload.Reference9 Common challenges include administrative and technical barriers, as well as poor integration with other systems such as electronic medical records.Reference9
• Clinician training for best practices on conducting virtual assessments and on which modality is most suited to different scenarios.
• Patient comfort with technology, cognition and ease of virtual communication.
• Patients having a choice in how to access their care, since individual needs and situations vary.
• Patients’ access to appropriate technological infrastructure. Patients living in rural and remote areas often do not have access to robust internet services due to lack of local infrastructure; however, this group could benefit the most from access to good virtual care.Reference10 Reference11 For this reason, it may be within the purview of governments to provide appropriate technological infrastructure so that access to reliable internet services is available to all Canadians regardless of where they live.Reference10 Reference11
• Continuity of care is essential for safe and efficient care. For example, patients who use “virtual walk-in” services may be more likely to visit the ED compared with those who use virtual care with their regular provider.Reference12
• Integration of virtual care into the larger health system. If success factors are not in place, virtual care services could result in increased health inequities, financial barriers for patients and inadvertent impacts on other sectors of the health care system.Reference8 Reference13

Despite challenges, many clinicians report virtual care technology enables them to provide more efficient care.Reference9 For example, clinicians and patients may communicate asynchronously, such as through secure messaging to answer patient questions or for simple follow-up care.Reference7 Additionally, clinicians can offer virtual visits to investigate whether a more thorough visit is required.Reference7

When implemented equitably and well, virtual care programs can improve access to care for Canadians in a way that also provides efficient, quality care.

In many situations, virtual care can provide access to primary care for people who might otherwise seek care in emergency rooms or even go without the care that they need. We need to continue to focus on technological improvements, provider engagement and patient awareness to enable the optimal use of virtual care across the country. — Dr. Kevin Samson, Family Physician, Ontario

This data provides an indirect system-level measure of access to virtual primary care that can be used to assess the impact of virtual care access on broader health systems. 

While visits for minor conditions contribute to higher volumes of patients seen in emergency departments, these visits are not a major driver of overcrowding there.Reference14 Rather, data about these visits provides key information for improving health systems to better meet patient needs. This data is available publicly at the regional level via Your Health System, allowing more detailed investigation of how virtual care access affects health systems. 

Additionally, these indicators cannot speak to individual patient scenarios, nor to the appropriateness of any individual ED visit. Furthermore, while virtual care is often convenient, patients should have a choice in how they visit their primary care provider. 

Overall, at a system level, we can compare these indicator results over time and/or across populations to investigate broad patterns. We can also use them to investigate potential impacts of virtual care access.

• CIHI: Virtual care in Canada
• The expansion of virtual care in Canada: New data and information
• CIHI: Connected Care

If you have any questions or would like to learn more, please send us an email.

hsp@cihi.ca