Virtual care more effective with your own family doctor rather than an outside physician: study

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A new study has found that those who saw their family doctor virtually were less likely to visit the emergency department in the next week, compared to those who had a virtual care visit with a doctor they had never met before.

“This study sheds light on how different types of virtual care impact downstream healthcare use—our findings show that the relationship between a patient and their virtual care doctor makes a difference,” Lauren Lapointe-Shaw, a physician at the University Health Network said in a press release. Lapointe-Shaw is lead author of the study, which was published Wednesday in the peer-reviewed journal JAMA Network Open.

"Within an existing and ongoing relationship with a physician, patients are less likely to go elsewhere for further care.”

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Researchers looked at roughly 5.2 million Ontario residents who had a family doctor and utilized virtual care at some point between April 2021 and March 2022. During this time period, around 4.1 million in the cohort had a virtual care appointment with their own physician, while around one million had a virtual care appointment with an outside physician as opposed to their doctor.

Patients from the two groups were matched by age, sex and other aspects to properly compare them, creating a cohort of 1.8 million patients.

The study found that patients receiving virtual care from an outside physician were 66 per cent more likely to visit an emergency department in the next week compared to those who had a virtual appointment with their own doctor.

They were also 25 per cent more likely to then have an in-person visit with a doctor within seven days, and 88 per cent more likely to have another virtual visit.

When researchers performed a secondary analysis comparing two cohorts of 30,000 patients, they found that the risk of extra emergency department visits increased when comparing patients who had a virtual visit with their own doctor to those who used a “direct-to-consumer” telemedicine option.

“Direct-to-consumer” are virtual walk-in only clinics, meaning every interaction is on-demand without an in-person exam and likely with a brand new physician.

In this study, researchers found that 30,000 patients who used a direct-to-consumer option were nearly three times more likely to visit the emergency department within 7 days compared to 30,000 patients who used their own physician.

During the pandemic, we saw an explosion of virtual care, a trend that opened up new access for patients but also brought a slew of questions, with many experts expressing the fear that virtual care might replace in-person care, to the detriment of patients.

The results of this new study suggest that virtual care is a more effective tool when it is facilitating an ongoing relationship between patient and doctor.

It’s important to note that researchers only looked at virtual care appointments undertaken by Ontario residents who did have a family doctor, meaning that all of the patients who booked a virtual appointment with an outside physician already had a family doctor.

Researchers acknowledged that the data doesn’t reveal why someone with a family doctor might turn to a virtual care appointment with an outside physician instead, but theorized that this could be related to access challenges with their family doctor, convenience or other unknown factors. It’s something that needs further research, authors said.

Those who chose a virtual care appointment with an outside physician were more likely to be younger, often lived in a large urban area, more often had these virtual visits on weekends and had made fewer visits to their family doctor in the last two years.

Right now, there are more than 6.5 million people without a family doctor in Canada.

“Virtual care done right can improve timely access to care—both for people who do and don’t have a family doctor,” Tara Kiran, a family physician at St. Michael’s Hospital of Unity Health Toronto and a co-author of the study, said in the release. “But if it’s not integrated with in-person care, or delivered by someone who has access to your health history, there is a risk that we’re adding more churn to the system.”