Virtual care expansion in Ontario fails to extend specialist reach to distant patients

Despite the expansion of virtual care in Ontario prompted by the COVID-19 pandemic, specialist physicians did not expand reach to patients living at great distances from where they provided care, found new research published in CMAJ (Canadian Medical Association Journal). https://www.cmaj.ca/lookup/doi/10.1503/cmaj.250166

"We found that widespread availability of virtual care, accompanied by remuneration changes, was not associated with substantial expansion of specialists' practices to serve patients who lived farther away," writes Dr. Natasha Saunders, a pediatrician at The Hospital for Sick Children (SickKids); adjunct scientist, ICES; and associate professor, University of Toronto, Toronto, Ontario, with coauthors.

About 18% of Canada's population lives in rural areas, but only 2.2% of specialists practise in these regions. It has been widely suggested that virtual care could increase access to health care for people in rural areas.

To understand if changes in virtual care in Ontario - which included billing codes and technological infrastructure to enable physician use - extended reach of specialist care, researchers compared driving distance and driving time between patients and physicians in a pre–virtual care period (January 1, 2019, to November 30, 2019) and a virtual care period (January 1, 2022, to November 30, 2022). The study included more than 11 000 specialists and more than 5.3 million patients who had over 25 million visits during the virtual care period.

The researchers did not find meaningful changes in distance between patients and specialists, except in psychiatry, where there were modest changes across all measures.

"If virtual care is to increase access to specialty care for rural patients, efforts are required to identify and target other barriers for virtual care, one of which could be that providers refer to specialists within their own self-contained networks," the authors write. "In other words, rural patients may not be referred to specialists who are far away because their provider is not aware of them. Centralized referral systems could pool patient referrals and match patients to specialists."

The authors also suggest considering patient preferences could increase use of virtual care among patients who may have health conditions or transportation or time challenges that would make virtual care a better option.

"To make virtual care more accessible, especially for patients living in rural areas, attention should be paid to other factors such as referral patterns and the role of patients in determining the type of visit they prefer," the authors conclude.