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Study shows pandemic did not cause emergency room crowding

More Ontario residents opted for virtual medical appointments during the COVID-19 pandemic
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A study carried out with input from the Northern Ontario School of Medicine (NOSM) showed that Ontario residents did not overuse hospital emergency visits during the early days of the  COVID-19 pandemic to make up for the lack of in-person doctor appointments.  

The biggest change, according to the study revealed in the Canadian Medical Association Journal (CMAJ) Monday was an uptake in the number of virtual medical appointments either by telephone or computer video link.

The study was based on data gathered between April 1, 2020 and March 31, 2021 based on Ontario patients visiting emergency departments and those who took part in virtual medical appointments. 

The research was carried out by Nadine Chami, Hemant A. Shah, Steve Nastos, Shaun Shaikh, Paul K. Tenenbein, Taylor Lougheed, Nikolina Mizdrak, Patrick Conlon, James G. Wright, Sharada Weir and Jasmin Kantarevic; scientists and physicians from several universities and health organizations, including NOSM.

The interpretation of the data was that the decreased availability of in-person doctor visits did not translate to more people showing up at the emergency room.

"We did not find evidence that patients substituted emergency department visits in the context of decreased availability of in-person care with their family physician during the first year of the COVID-19 pandemic. Future research should focus on the long-term impact of virtual care on access and quality of patient care," said the study.

According to the data, the study said the proportion of virtual visits was higher among female, younger and urban physicians, and the number of emergency department visits was lower among patients of female and urban physicians. 

"In an unadjusted analysis, a one per cent increase in a physician’s proportion of virtual visits was found to be associated with 11 fewer emergency department visits per 1,000 rostered patients," said the study.

The study noted that before the pandemic, the idea of virtual care was not a widely accepted practice in Ontario. In 2018, for example, only four per cent of family physicians in Canada were offering video visits. Things changed quickly and dramatically.

"The pandemic pushed health-care systems to rapidly implement virtual primary care; physicians in Canada were directed to restrict in-office visits and provide care virtually whenever possible. One Ontario-based study found a 5,600 per cent increase in virtual visits early in the pandemic, while in-office visits decreased by 79 per cent, compared with the same period in 2019," said the CMAJ document.

Also in consideration is whether virtual care appointments were as helpful to patients as in-person care. This was spoken to in the formal conclusion of the CMAJ study where it said future research should evaluate the quality of patient care.

"This study found that a physician’s proportion of virtual care was not associated with increases in the use of emergency departments by enrolled patients during the first year of the COVID-19 pandemic. Future research should focus on evaluating the long-term impact of virtual care on access and quality of patient care and on patient outcomes in different settings.”