Glazier Richard H, Green Michael E, Wu Fangyun C, Frymire Eliot, Kopp Alexander, Kiran Tara
ICES Central (Glazier, Wu, Kopp, Kiran); Primary Care and Health Systems (Glazier, Kiran, Kopp); St. Michael's Hospital Centre for Urban Health Solutions (Glazier, Kiran), Toronto, Ont.; Department of Family Medicine, and Health Services and Policy Research Institute (Green), Queen's University, Kingston, Ont.; Health Services and Policy Research Institute, Queen's University, and ICES Queen's (Frymire), Kingston, Ont.; Department of Family and Community Medicine (Glazier, Kiran), St. Michael's Hospital, University of Toronto, Toronto, Ont.
CMAJ. 2021 Feb 8;193(6):E200-E210. doi: 10.1503/cmaj.202303.
Globally, primary care changed dramatically as a result of the coronavirus disease 2019 (COVID-19) pandemic. We aimed to understand the degree to which office and virtual primary care changed, and for which patients and physicians, during the initial months of the pandemic in Ontario, Canada.
This population-based study compared comprehensive, linked primary care physician billing data from Jan. 1 to July 28, 2020, with the same period in 2019. We identified Ontario residents with at least 1 office or virtual (telephone or video) visit during the study period. We compared trends in total physician visits, office visits and virtual visits before COVID-19 with trends after pandemic-related public health measures changed the delivery of care, according to various patient and physician characteristics. We used interrupted time series analysis to compare trends in the early and later halves of the COVID-19 period.
Compared with 2019, total primary care visits between March and July 2020 decreased by 28.0%, from 7.66 to 5.51 per 1000 people/day. The smallest declines were among patients with the highest expected health care use (8.3%), those who could not be attributed to a primary care physician (10.2%), and older adults (19.1%). In contrast, total visits in rural areas increased by 6.4%. Office visits declined by 79.1% and virtual care increased 56-fold, comprising 71.1% of primary care physician visits. The lowest uptake of virtual care was among children (57.6%), rural residents (60.6%) and physicians with panels of ≥ 2500 patients (66.0%).
Primary care in Ontario saw large shifts from office to virtual care over the first 4 months of the COVID-19 pandemic. Total visits declined least among those with higher health care needs. The determinants and consequences of these major shifts in care require further study.
在全球范围内，2019冠状病毒病（COVID-19）大流行使初级医疗发生了巨大变化。我们旨在了解在加拿大安大略省大流行最初几个月期间，门诊和虚拟初级医疗的变化程度，以及受影响的患者和医生群体。
这项基于人群的研究将2020年1月1日至7月28日全面的、关联的初级保健医生计费数据与2019年同期数据进行了比较。我们确定了在研究期间至少进行过1次门诊或虚拟（电话或视频）就诊的安大略省居民。根据各种患者和医生特征，我们比较了COVID-19之前与大流行相关公共卫生措施改变医疗服务提供方式之后的医生就诊总数、门诊就诊和虚拟就诊趋势。我们使用中断时间序列分析来比较COVID-19期间前半期和后半期的趋势。
与2019年相比，2020年3月至7月的初级保健就诊总数下降了28.0%，从每千人每天7.66次降至5.51次。预期医疗保健利用率最高的患者下降幅度最小（8.3%），那些无法确定初级保健医生的患者下降了10.2%，老年人下降了19.1%。相比之下，农村地区的就诊总数增加了6.4%。门诊就诊下降了79.1%，虚拟医疗增加了56倍，占初级保健医生就诊的71.1%。虚拟医疗利用率最低的是儿童（57.6%）、农村居民（60.6%）以及拥有≥2500名患者的医生群体（66.0%）。
在COVID-19大流行的前4个月，安大略省的初级医疗从门诊大幅转向虚拟医疗。医疗需求较高的人群就诊总数下降最少。这些医疗服务重大转变的决定因素和后果需要进一步研究。
