Healthcare in Canada has seen an accelerated transformation in its primary care model in response to the COVID-19 pandemic, swiftly pivoting from in-person care to a more robust digital and virtual platform. Since mid-March, when pandemic control measures such as physical distancing were first recommended, there has been a surge in the use of virtual tools for primary care.

According to Canada Health Infoway, as of May 8 the nation’s primary care model has increased in the provider use of phone (15 to 40 per cent), video (3 to 11 per cent) and texting (1 to 15 per cent). In just under two months, the use of these virtual tools has evolved at a rapid pace, and signals a step towards a more permanent change in how we might seek out care in a post-pandemic world.

Farah Ahmad

“The pandemic of COVID-19 is considered a ‘tipping point’ for the adoption of virtual tools to provide primary care in Canada,” says Farah Ahmad, associate professor in the Faculty of Health at York University whose health research focus is on primary care and eHealth innovations.

Virtual health care (VHC) refers to the remote delivery of healthcare services and/or information by using information communication technology, explains Ahmad. “In other words, VHC today is the use of audio, video and texting tools between a clinician and patient synchronously or asynchronously.”

Because the pandemic has called for public health control measures such as physical distancing and has limited access to in-person primary care due to closures, Ahmad says the government and healthcare community have responded with unprecedented policy shifts for the delivery of care.

Motivated by keeping patients and clinicians safe from exposure to the virus, the push towards adopting VHC during the pandemic has been bolstered by the government’s temporary implementation of billing codes to incentivise clinicians for the use of VHC, as well as permission from professional regulatory bodies to use non-clinical virtual tools such as Zoom or Skype.

Ahmad notes that many clinicians have received professional support to rapidly implement VHC, and patients have been quick to adapt due to already established comfort levels using smart technology, and in some cases, greater accessibility (for instance, those living in remote areas).

“Yet, the rapid transitions of primary care to integrate VHC under COVID-19 circumstances is not without challenges,” says Ahmad, such as clinicians deciding what services to offer using VHC and how to ensure patient privacy, security and consent when using non-clinical virtual tools.

Despite these complexities, Ahmad says a move toward more VHC options for primary care in a post-pandemic world is a realistic forecast. The trend was already moving in that direction, she said.

On Feb. 11, before the novel coronavirus was declared a pandemic, the province’s Virtual Care Taskforce of the Canadian Medical Association (CMA), the College of Family Physicians, and the Royal College of Physicians and Surgeons released a roadmap with recommendations to integrate VHC. Within the task force, four working groups were developed to investigate barriers to virtual care and potential solutions to those barriers, resulting in 19 recommendations.

The concept of providing primary care using virtual tools is not new for Canada; however, a survey recorded in 2018 by Canada Health Infoway reported that 83 per cent of primary care physicians used electronic medical records, but the use of virtual tools to communicate with patients was low. In 2019, a Canada Health Infoway survey found that only 13 per cent, 7 per cent and 4 per cent of Canadians reported availability of electronic appointment, email messaging, and video visits at their family physician offices; however, 75 per cent, 64 per cent and 44 per cent desired these features, respectively.

Until the pandemic, most of the VHC models for primary care settings in Canada were focused on providing access to remote communities, says Ahmad. In response to the slow uptake of virtual tools, and the lack of funding for those models, the Ontario government launched a Digital First for Health strategy in 2019 with the goal of increasing capacity for virtual visits, online appointments, improved tools for frontline healthcare providers and more.

With the use of virtual tools rapidly expanding in response to COVID-19, Ahmad says the continued use of these digital resources beyond the pandemic is a likely outcome.

“Considering the current landscape of digital health advances in Canada and the synergies created under the pandemic, it is not hard to anticipate multiple new ways of integrating virtual tools for the delivery of primary care in the post pandemic era,” she said.

By Ashley Goodfellow Craig, deputy editor, YFile