Ann Fam Med. 2022 Apr 1;20(20 Suppl 1):2863. doi: 10.1370/afm.20.s1.2863.
Context: On March 14, 2020, the Ontario, Canada health insurance plan approved COVID-19 physician virtual billing codes; family physicians (FPs) rapidly adopted a new model of care. Virtual care may remain post-pandemic; however, its future should be informed by evidence that considers access and continuity. Objective: 1) to determine FP virtual visit volumes and patient characteristics and 2) to explore FPs' perspectives on virtual visit adoption and implementation. Study Design: Mixed methods: Secondary analysis of health administrative (HA) data and semi-structured qualitative interviews with FPs. Setting or Dataset: London and Middlesex County, Ontario, Canada. HA data through ICES, Ontario entity holding data. Population studied: FPs and their patients. Outcome Measures: Volumes of FP in-person and virtual visits during early pandemic; characteristics of patients receiving care; FPs' perspectives on adopting and delivering virtual care. Results: Overall visit volume dropped by 36% during first wave, recovered to pre-pandemic levels by October 2020. Sharp in-person visit drop of 73% and virtual visit uptake from 0.08% of total visits to 57% within two weeks of March 2020. FPs described this initial drop in volume as patients not seeking care and practices lacking PPE. The move to virtual care was largely to telephone visits. Patient characteristics compared to pre-pandemic, the proportion seeking care were older (46 vs 50 years), more vulnerable (38% vs 41%), and more multimorbidity (33% vs 41%). This was consistent with FP reports that healthier patients stayed away, routine care deferred, sicker patients needed to be seen. FPs believed most vulnerable patients had access to care but cautioned highly vulnerable such as those homeless did not have cell phone access or a safe place to receive calls. Rural FPs reported access issues because of lack of high-speed internet. FPs attributed success of virtual care to the continuity in relationships they had with patients that were established in person pre-pandemic. Conclusions: FPs moved rapidly to virtual care. FP offices remained open despite PPE concerns but overall volumes dropped initially. Vulnerable and sicker patients received care but FPs expressed concern for highly vulnerable and rural residents. FPs believed they could offer patient-centred care over the phone but indicated the importance of maintaining in-person care to build relationships.
背景：2020 年 3 月 14 日，加拿大安大略省的医疗保险计划批准了 COVID-19 医生虚拟计费代码；家庭医生（FP）迅速采用了新的护理模式。虚拟护理可能会在大流行后继续存在；然而，它的未来应该基于考虑到获取和连续性的证据。目的：1）确定 FP 虚拟就诊量和患者特征，2）探讨 FP 对虚拟就诊采用和实施的看法。研究设计：混合方法：对安大略省伦敦和米德尔塞克斯县的卫生行政（HA）数据进行二次分析，并对 FP 进行半结构化定性访谈。HA 数据通过安大略省的 ICES 获得，该实体持有数据。研究人群：FP 及其患者。观察指标：大流行早期 FP 的现场和虚拟就诊量；接受护理的患者特征；FP 对采用和提供虚拟护理的看法。结果：第一波疫情期间，整体就诊量下降了 36%，到 2020 年 10 月恢复到疫情前水平。2020 年 3 月两周内，现场就诊量骤降 73%，虚拟就诊量从总就诊量的 0.08%上升至 57%。FP 描述说，这种就诊量的最初下降是因为患者没有寻求护理，而且实践中缺乏个人防护设备（PPE）。向虚拟护理的转变主要是通过电话就诊。与大流行前相比，患者特征是年龄较大（46 岁对 50 岁）、更脆弱（38%对 41%）、合并症更多（33%对 41%）。这与 FP 的报告一致，即健康的患者回避，常规护理推迟，病情较重的患者需要就诊。FP 认为，大多数脆弱的患者都能获得护理，但告诫说，无家可归者等高度脆弱的患者没有手机访问权或接收电话的安全场所。农村 FP 报告说，由于缺乏高速互联网，存在获取护理的问题。FP 将虚拟护理的成功归因于他们与患者之间在大流行前通过亲自就诊建立的关系的连续性。结论：FP 迅速转向虚拟护理。尽管存在个人防护设备的担忧，但 FP 办公室仍保持开放，但最初的就诊量有所下降。脆弱和病情较重的患者得到了护理，但 FP 对高度脆弱和农村居民表示担忧。FP 认为他们可以通过电话提供以患者为中心的护理，但也表示维持亲自护理以建立关系的重要性。
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