Guest Column by Dr. Diane Duff RN PhD
Virtual health care has been around for a couple of decades in Canada, but we have struggled to make virtual visits a mainstream part of primary health care delivery (family doctor and nurse practitioner visits).
Privacy concerns, lack of digital expertise or connectivity by both patients and clinicians, and lack of approved “fee for service” funding have all delayed implementation of virtual health services.
In a recent study by the Canadian Medical Association, it was noted that less than two visits in every one thousand (1.5/1000) were done using virtual technology. This means the vast majority of visits to the doctor or nurse practitioner were conducted as face-to-face office visits or less commonly via home visits.
Virtual health care is an umbrella term that encompasses phone visits, videoconferencing visits, and email or text/chat visits that can be done synchronously (at the same time, using two-way communication); or asynchronously (at different times; more like writing and replying to an email or letter and then responding back and forth over a period of time).
So, what is wrong with just continuing face-to-face primary care office visits? Office visits require patients and practitioners to travel and coordinate times. For children and frail, elderly patients, this usually requires the support of one or more family members. Even without the COVID-19 pandemic, having sick people travel and congregate in a doctor’s office is not ideal.
Even if people were to be able to physically distance to two metres (six feet) in waiting rooms, surfaces and people may still be contaminated through touching, sneezing, and coughing.
Primary care face-to-face visits in doctor and nurse practitioner offices should be reserved for vulnerable people who must be seen and physically examined, such as babies, people who lack technology, or individuals that require hands on examination or care.
During the COVID-19 outbreak, office visits may facilitate transmission of this highly contagious virus before, during, and after overt symptoms are present and will lead to greater community spread.
Fortunately, most primary care practitioners in our counties have greatly increased the number of virtual visits they are offering and the Ministry of Health has fee-for-service codes to support virtual care.
COVID-19 may be the catalyst that helps us finally close the gap between consumer demand for virtual services and primary care provision of these services. It may also help non-attached or non-rostered people (people without access to a family doctor or other primary care clinician) have access to basic health care without having to use the Emergency Department (ED) or walk-in clinics to receive care.
While ED and walk-in care can fill an immediate need, these are expensive ways of delivering primary care and many people, especially older patients, need continuity of care in order to self-manage their ongoing or chronic illnesses.
In our counties, almost 50 per cent of people are non-rostered with a primary care provider in our community.
Kudos need to be sent to the Haliburton Highlands Family Health Team. They have not only offered their services to do COVID-19 assessment and testing but have also extended their services to many unrostered individuals in our community during the pandemic so that they do not have to visit the Emergency Department.
Other virtual primary health practices and services in Ontario have also reached out to offer virtual primary and specialist services, should we need their support.
As an unrostered patient myself, I recently decided to try out one of the virtual online options. I signed on to the virtual care site and 15 minutes later I was registered, had finished an asynchronous chat visit, and a prescription had been sent to the local pharmacy of my choice. The service was quick, efficient, and free. While virtual visits may not be for everyone, most of us at least have a phone, and they may reduce the pressure on our existing primary care services.
For more information about virtual health care, check out https://access2022.ca/ (Diane Duff is a nurse based in Haliburton County)