Is virtual care a cure for Canada’s ailing healthcare system? | CBC News

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Lesley Campbell walks out of the emergency department at Michael Garron Hospital in East Toronto cradling her right arm.

“I fell off my bike,” he said, looking at his white cast. “Accidents happen.”

He said that for some ailments, such as a broken bone, it is necessary to go to the hospital, but for other less serious things, there must be an alternative.

“For a lot of other things, like a minor concussion or whatever, or a sprain, it would have been nice to ask what do I do now.” Campbell said. For a child with a fever, for example, “I could easily call to get some advice on the spot. The doctors can see it on video, and it would be wonderful not to have to go downtown.”

“It saves time, it saves energy and it definitely saves gas,” said Zahir Mohammed, who was also leaving Michael Garron Hospital. But while it may be convenient, he said he’s not a fan of virtual care. Instead, Mohammed said, he would prefer to see his doctor in person, so he could better explain his symptoms and ask questions.

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“Sometimes, through the virtual, you can’t just express those kinds of things, so… there’s more of a chance that it’s going to be misdiagnosed.”

Virtual care is broadly defined as the delivery of health care services through electronic means, such as telemedicine, online video consultations, and remote monitoring. During the COVID-19 pandemic, seeing a doctor via video conference or phone has proven to be a convenient way to access care.

The pandemic led to the growth of virtual care

Many provinces in Canada have turned to virtual care to take the pressure off their overburdened healthcare systems. Hospitals have been able to divert patients from overcrowded emergency rooms, and it has been used to deal with problems caused by shortages of health care workers across the country and long waiting lists for emergency physicians. family.

But despite the increasing use of virtual care during the pandemic, there is now pushback from Ontario, the country’s most populous province, and its doctors’ association.

Even before the pandemic, various platforms had been offering virtual doctor appointments, including Telus Health, Maple, Babylon, Tia Health, and Rocket Doctor. Some platforms bill provincial health plans, while others charge a user fee.

Dr. William Cherniak is an ER physician in Markham, Ontario, and founder of Rocket Doctor, one of several platforms that offer virtual doctor appointments. He says such services offer greater accessibility for patients in rural areas, as well as those who can’t find a family doctor. (Philip Lee-Shanok/CBC)

With COVID-19 restrictions and overcrowded hospitals and clinics, Dr. William Cherniak, an emergency room physician in Markham, Ontario, north of Toronto, and founder of Rocket Doctor, said it was an opportunity.

“Virtual care was not simply something we tolerated during the pandemic because it filled the gap where doctors couldn’t see patients in person, but it’s something Canada lacked for many years because it wasn’t in our public funding. … and we are only now beginning to understand its potential,” he said.

Cherniak’s virtual care company has partnered with Georgian Bay General Hospital in Midland, Ontario, in a trial of a new service that gives patients an alternative option to the ER.

Most people who go to the ER have minor illnesses or injuries that could be treated virtually, he said, leaving the emergency department for those with more serious illnesses or trauma.

“We have a huge crisis in the health care system with exhausted doctors who don’t want to practice medicine, patients losing their family doctors, and we have doctors who want to see patients virtually and are willing to do so.”

But in Ontario, Cherniak said, a change in policy has resulted in fewer doctors interested in signing up to provide such services.

Virtual care takes a backseat in Ontario

A new medical services agreement between the provincial Ministry of Health and the Ontario Medical Association (OMA) went into effect on December 1, with a new virtual care funding framework. While the new schedule of benefits for medical services made the temporary virtual care billing codes permanent, the new pricing structure, fees, and payment parameters of the Ontario Virtual Care Program have new limits on what OHIP will cover , the province’s public health insurance plan.

Sylvia Jones, Ontario’s health minister, said now that the worst of the pandemic is over, the need for virtual care isn’t as urgent.

“We need patients to be in front of their doctors more regularly,” Jones told reporters last month. “We need family doctors who see patients in person. When that parent is worried, when that caregiver has questions, the first place they should be able to go and have access is their primary care doctor.”

Dr. Rose Zacharias, president of the Ontario Medical Association, agrees that virtual care is not meant to replace in-person care.

Dr. Rose Zacharias is the president of the Ontario Medical Association.  She says about 1 million Ontarians don't have a family doctor, making it difficult for them to navigate the system, especially during these times.
Dr. Rose Zacharias, president of the Ontario Medical Association, says that instead of prioritizing virtual care, the province urgently needs to license more doctors so more people can receive care in person. (Jennifer LaGrassa/CBC)

“Now we’ve stepped back, we’re looking at how we can take better advantage of virtual care and also prioritize the doctor-patient relationship,” he said. “We don’t have enough doctors for everyone to have that relationship and therefore the urgency to license more doctors, bring more doctors into this system to capture those patients within that relationship of care.”

But Cherniak said the new agreement between the Ontario Ministry of Health and the OMA will threaten many virtual care business models because doctors who conduct virtual visits, where there is no doctor-patient relationship, will receive only a flat fee of $20. Physicians who have previously seen a patient in person once in the prior 24 months will be paid the same rate for virtual care as they are for in-person care, but not for those providing “one-time” visits.

“So they’re saying, ‘Hey, we’re actually going to cut the fees in half, despite all the challenges you’re facing in fighting this pandemic,’ and it’s really unfortunate because a lot of patients are going to lose access worrying,” Cherniak said.

But some doctors see the billing change as an incentive for follow-up care to take place in the community.

Dr. Kyle Vojdani is chief of the emergency department at Michael Garron Hospital, which offers virtual care for minor ailments and sees a dozen patients a day.

“Receiving a virtual visit from a doctor in another province or perhaps… hundreds of kilometers from you, trying to coordinate follow-up management for you is difficult, if not impossible,” he said.

Studies differ on the benefits of virtual care

The WCO recently cited a report linking virtual care to added strain on the overwhelmed health care system. The report said the lack of continuity of care after virtual visits was causing patients to end up in the emergency room.

But Rocket Doctor’s Cherniak cites another study that found that 94 percent of patients who used virtual care instead of going to an ER rated their overall virtual care experience 8 out of 10 or higher. More than 80 percent said they received answers to all their questions related to their health problems and believed they could handle the problem.

People sit in chairs in a hospital waiting room.
People await treatment in the emergency department at Sainte-Justine Hospital in Montreal in January 2020. Virtual care has allowed hospitals to divert patients from crowded emergency rooms, and has been used to treat problems caused by due to the scarcity of health services throughout the country. caregivers and long waiting lists for family doctors. (Ryan Remiorz/The Canadian Press)

Another survey by the Angus Reid Institute found that half of Canadians can’t find a doctor or can’t get a timely appointment with the one they have. It also found that a third of Canadians (32 per cent) report that they primarily interact with their family doctor over the phone or via video call. And of Canadians who see their GP primarily by phone or internet, 65 per cent say they don’t care about the arrangement.

Cherniak said that unlike Ontario, Canada’s western provinces have been more welcoming to virtual care providers because they realize that people in isolated rural areas need access to timely care when they can’t get to a doctor’s office. medical.

“I mean, BC and Alberta have really doubled down on virtual care, you know, like the Alberta government gives parity to virtual and in-person services,” said Cherniak, who sees the potential in helping those who are having trouble finding a doctor. family, especially in remote areas, or those who have mobility issues that make traveling to a health care facility difficult.

Newfoundland and Labrador recently called for Requests for Proposals to provide virtual healthcare services in light of the closure of emergency rooms in the province. It also plans to explore options to expand virtual care for people without a family doctor.

CLOCK | Manitoba will get a new virtual emergency care service in 2023:

New Virtual Emergency Care Service Coming to Manitoba Spring 2023

The service was initially announced as part of the provincial government’s $200 million plan to retain, train and recruit more than 2,000 healthcare workers. VECTRS is a centralized emergency care service that will provide clinical guidance and patient transport to healthcare personnel.

“In an ideal world, yes, everyone would have a family doctor available in a mix of virtual and in-person practice. And you could get to that family doctor in a couple of days or the same day, but it’s just not the world in the one we live in,” Cherniak said.

He estimates that the 20 to 25 doctors who signed up to provide services through his platform had been seeing up to 600 patients a day, but now there is only one doctor left seeing 20 or fewer patients a day.

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