Virtual Urgent Care Fell Short in Diverting Emergency Visits During Pandemic


Despite its aim to reduce in-person visits, a virtual urgent care (VUC) program in Ontario, Canada found that patients seen by a VUC provider with no further referral were more likely to visit the emergency room than those who came directly to the department.

A recent study published in the Canadian Medical Association Journal revealed that virtual urgent care (VUC) had minimal impact on emergency department visits or hospital admissions in Ontario, Canada, during the COVID-19 pandemic.1 However, a significant number of study participants who initially sought virtual urgent care eventually attended an emergency department in person.

Virtual urgent care’s purpose is to assist in redirecting folks with minor health concerns away from in-person emergency department visits to decrease high volumes of patients that don’t necessarily need to be there.

The COVID-19 pandemic significantly impacted the Canadian healthcare system, especially early on when social distancing posed challenges for arranging non-urgent, in-person visits. This period witnessed an almost 80% decline in in-person primary care visits and a 50% decrease in emergency department visits, which led to a surge in the adoption of virtual care tools.

For a better understanding of healthcare use and the outcomes of VUC, researchers of the study observed both variables in comparison to similar patients who opted for an in-person emergency department visit.

Researchers used patient-level encounter data from 14 pilot programs in Ontario where individuals used VUC services. Researchers then collected the data and connected it to administrative databases, which helped them figure out how people used healthcare services and what happened in the 30 days after.

Results revealed that out of the 19,595 patients who used VUC, researchers matched 2,129 patients who were quickly referred to the emergency department by a VUC provider with those who physically went to the emergency department.

The rates of hospital admissions during the first visit (9.4% vs. 8.7%), 30-day emergency department visits (17.0% vs. 17.5%) and hospital admissions (12.9% vs. 11.0%) were similar between these two groups.

Of the 14,179 patients seen by a VUC provider without a documented referral to the emergency department, those who used VUC were more likely to have in-person emergency department visits within 72 hours (13.7% vs. 7.0%), 7 days (16.5% vs. 10.3%), and 30 days (21.9% vs. 17.9%).

However, hospital admissions were similar within 72 hours (1.1% vs. 1.3%) and higher within 30 days for patients discharged home from the emergency department (2.6% vs. 3.4%).

Authors of the study suggest that the increased use of healthcare services following virtual follow-up visits might be due to virtual clinicians facing limitations in physically examining patients.

This limitation could lead clinicians to refer patients back to the emergency department for an in-person evaluation more readily if they have persistent symptoms, they said.

It’s recommended that future research efforts should focus on identifying quality-of-care and virtual care practices care to foster a culture of continuous improvement.

Researchers suggest future investigations should highlight and examine the root causes of low healthcare use after a VUC visit as it will help determine necessary changes and improvements that will help improve these trials.

This article originally appeared in Managed Healthcare Executive.

1. McLeod SL, Tarride JE, Mondoux S, et al. Health care utilization and outcomes of patients seen by virtual urgent care versus in-person emergency department care. CMAJ. 2023;195(43):E1463-E1474. doi:10.1503/cmaj.230492
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