Hybrid care improves access to primary care in rural Ontario

Hybrid health options are an underdeveloped, key tool for improving access to primary care in Ontario's remote communities, with a new University of Ottawa study highlighting the positive impact of in-person mixed with virtual care options have in rural regions.

Published in BMC Health Services Research, this first peer-reviewed study of such services in rural Ontario examined the experiences and challenges of clinicians and non-clinical staff within a hybrid primary care program in Renfrew County, Ontario.

The findings by Dr. Jonathan Fitzsimon and his team coupled with previous studies support the scale and spread of a hybrid approach, which could alleviate challenges like staff recruitment and retention, and equitable care access for patients, including more comprehensive, team-based primary care.

Hybrid care is an effective, complementary approach to recruiting providers in underserved areas and serves as an additional mechanism to help counter the inverse care law, where regions with the greatest healthcare needs often have the least access to services. And evidence suggests virtual care is well accepted by patients and providers, producing clinical outcomes comparable to those of traditional, in-person models."

Dr. Jonathan Fitzsimon, uOttawa's Department of Family Medicine

Researchers spoke with staff working at the Petawawa Centennial Family Health Centre – the largest county in Ontario. They also consulted Integrated Virtual Care (IVC) staff, including physicians, interprofessional health providers (IHPs), and non-clinical personnel, who predominantly found that IVC played a positive, impactful role for residents who are struggling to access primary care due to a lack of available physicians.

"In (large city)], if [patients] can't see you, they can go to the walk-in clinic next door. But it's not the case in rural settings," one physician explained. "Having this rewarding job that I can actually provide care to people who actually need care, and they can't access it properly."

While physicians found meaning by contributing to this underserved community, strong in-person support is also essential for success, particularly as increased administrative demands followed. Despite some onboarding challenges and added logistical complexity, the program served approximately 1,500 patients, individuals who otherwise would have lacked access to consistent primary care, a number that has expanded significantly since then.

"From a policy perspective, IVC is an innovative approach to address the challenge of recruiting physicians in more rural communities," write Dr. Fitzsimon and his co-authors, Shawna Cronin (uOttawa), Kush Patel (uOttawa) and Antoine St-Amant (Institut du Savoir Montfort).

The Ontario government also recently announced it is investing nearly $2 billion to connect people to a publicly funded family doctor or primary care team within four years.

"These findings, and future evaluation findings may be relevant when considering alternative physician compensation and employment models. In addition, considering the health human resource supply of IHPs, particularly Nurse Practitioners, is an important consideration for future potential expansion," they add.