Bhatti Sara, Dahrouge Simone, Muldoon Laura, Rayner Jennifer
Alliance for Healthier Communities, Toronto, Canada
Bruyère Research Institute, University of Ottawa, Ottawa, Ontario, Canada.
BJGP Open. 2022 Sep 28;6(3). doi: 10.3399/BJGPO.2021.0239. Print 2022 Sep.
There has been a large-scale adoption of virtual delivery of primary care as a result of the COVID-19 pandemic.
In this descriptive study, an equity lens is used to explore the impact of transitioning to greater use of virtual care in community health centres (CHCs) across Ontario, Canada.
DESIGN & SETTING: A cross-sectional survey was administered and electronic medical record (EMR) data were extracted from 36 CHCs.
The survey captured CHCs' experiences with the increased adoption of virtual care. A longitudinal analysis of the EMR data was conducted to evaluate changes in health service delivery. EMR data were extracted monthly for a period of time before the pandemic (April 2019-February 2020) and during (April 2020-February 2021).
In comparison with the pre-pandemic period, CHCs experienced a moderate decline in visits made (11%), patients seen (9%), issues addressed (9%), and services provided (15%). During the pandemic period, an average of 54% of visits were conducted virtually, with telephone as the leading virtual modality (96%). Drops in service types ranged from 28%-82%. The distribution of virtual modalities varied according to the provider type. Access to in-person and virtual care did not vary across patient characteristics.
The results demonstrate a large shift towards virtual delivery while maintaining in-person care. No meaningful differences were found in virtual versus in-person care related to patient characteristics or rurality of centres. Future studies are needed to explore how to best select the appropriate modality for patients and service types.
由于新冠疫情，初级医疗保健的虚拟服务已被大规模采用。
在这项描述性研究中，运用公平视角来探讨在加拿大安大略省的社区健康中心（CHC）更多地使用虚拟医疗服务的转变所产生的影响。
进行了一项横断面调查，并从36个社区健康中心提取了电子病历（EMR）数据。
该调查收集了社区健康中心在增加采用虚拟医疗服务方面的经验。对电子病历数据进行了纵向分析，以评估医疗服务提供方面的变化。在疫情之前（2019年4月至2020年2月）和疫情期间（2020年4月至2021年2月）的一段时间内每月提取电子病历数据。
与疫情前时期相比，社区健康中心的就诊次数（下降11%）、看诊患者数量（下降9%）、解决的问题数量（下降9%）和提供的服务数量（下降15%）都有适度下降。在疫情期间，平均54%的就诊是通过虚拟方式进行的，其中电话是主要的虚拟方式（96%）。服务类型的下降幅度在28%至82%之间。虚拟方式的分布因提供者类型而异。亲自就诊和虚拟医疗服务的获取在患者特征方面没有差异。
结果表明在保持亲自医疗服务的同时，向虚拟服务发生了巨大转变。在虚拟医疗服务与亲自医疗服务方面，未发现与患者特征或中心的农村性质相关的有意义差异。未来需要开展研究，以探索如何最好地为患者和服务类型选择合适的方式。
