Primary care in the COVID era

In Progress

Access to Health Care

COVID-19

How have Ontario family doctors’ practice patterns changed because of COVID-19?

COVID-19-related demands and restrictions have dramatically impacted health care in Canada and around the world. This project will help us understand exactly how primary care has changed in the COVID era, particularly the degree to which care has shifted from office to virtual care, and which patients are most affected by these changes in primary care practice.

Using administrative health data collected by ICES, this project will examine:

  • How practice patterns have changed – including the volume of care delivered in the office and virtually, and care continuity
  • How patterns differ by patient and physician characteristics, by geography, and over time
  • What types of care are and are not being deferred
  • How many primary-care physicians in Ontario stopped working during the COVID-19 pandemic

We will do this by comparing Ontario’s primary care physician billings data pre-COVID-19 (January 1 to March 10, 2020) to data from the COVID-19 era (starting March 11, 2020). We are also comparing primary care practice patterns during the COVID-19 era to the same period in the previous year (2019).

The results of this work help us understand whether patients with high health-care needs are continuing to receive the care they need to manage chronic conditions. Results will also identify challenges that patients are facing in accessing virtual care, and inequities in access to care (e.g. related to age, health needs, rural vs. urban).

How did primary care practice change after the pandemic?

Our initial findings were published in CMAJ in January 2021. We found that 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%). Office visits declined by 79.1% and virtual care increased 56-fold, comprising 71.1% of primary care physician visits.

Here are some more up-to-date data. Total visits returned to pre-pandemic levels by fall 2020 but a substantial amount of the care continues to be virtual. We will be posting updated versions of this graph approximately every quarter.

Did the pandemic cause some family doctors to retire early?

More recent research from our team suggests that twice as many family physicians stopped work in Ontario, Canada during the first six months of COVID-19 compared to previous years. Our findings suggest COVID-19 may have accelerated retirement plans for a subset of older physicians with smaller, fee-for-service practices. The absolute number of physicians stopping work was small, but even still, the impact on patients and communities is likely substantial. Read a pre-print summarizing our work here.

What was the impact of virtual care on emergency department visits?

In late summer/early fall of 2021, there were some concerns that family doctors were not seeing enough patients in-person and that this was causing an increase in emergency department (ED) use. However, our preliminary findings counter this narrative. Our preliminary results show that total ED visits from March 2020 to October 2021 were lower than ED visit volumes in 2019. There was no crude ecological association between the percentage of care delivered virtually by family doctors and ED visit volumes (see graph below). Furthermore, patients of primary care physicians providing a high proportion of virtual visits (80-100%) did not have meaningfully higher emergency department visits and any differences pre-dated the pandemic. You can view a summary of our preliminary findings here.

Keeping Doors Open is a project using survey data to understand changes in family physician practice patterns and what portion have had to close their doors.

In a project based at the University of Toronto Department of Family and Community Medicine, we are also trying to understand patient’s experience and views of virtual care during the pandemic.

Access to Health Care

COVID-19

Dr. Tara Kiran

A family doctor and renowned primary-care researcher, Dr. Tara Kiran investigates how changes in the health-care system impact the most vulnerable in society. In her research and practice, she develops and tests solutions to make health care more inclusive - and more effective.

Dr. Rick Glazier

A family doctor and leader in his field, Dr. Rick Glazier investigates primary care through a health-equity lens: revealing gaps in care, and examining the implications of primary-care reform for traditionally under-served groups. He is an expert in linking geographic methods with administrative health data to help identify priority areas for services and care.

Investigators

  • Dr. Michael Green (Queen's University) Principal Investigator

Staff

  • Eliot Frymire
  • Fangyun Wu
  • Alexander Kopp
  • Lidija Latifovic

Funders

  • INSPIRE Primary Health Care Research Program, which is funded through the Ontario MOHLTC Health System Research Fund
  • Canadian Institutes for Health Research

Collaborators

  • ICES
  • Queen’s University

Contact Info

Frymire@queensu.ca, Lidija.Latifovic@unityhealth.to