Optimal Virtual Care: Patients Thrive with Personal Family Doctor

According to new research, patients who received virtual care from a doctor outside of their family care team were 66% more likely to attend the emergency department within seven days than those who received virtual care from their own family doctor.

Researchers from the University Health Network (UHN), Unity Health Toronto, and ICES conducted the study, which found that patients who received virtual care outside of an existing family doctor-patient relationship were 25% more likely to have an in-person visit and 88% more likely to have another virtual visit within seven days.

“This study sheds light on how different types of virtual care impact downstream health care use—our findings show that the relationship between a patient and their virtual care doctor makes a difference,” says lead author Dr. Lauren Lapointe-Shaw, Adjunct Scientist with ICES, General Internal Medicine physician, and Scientist at UHN, and Innovation Fellow at the Women’s College Hospital Institute for Health System Solutions and Virtual Care.

“Within an existing and ongoing relationship with a physician, patients are less likely to go elsewhere for further care,” adds Dr. Lapointe-Shaw.

The study, which was published in the journal JAMA Network Open, included over 5 million Ontario residents who had a family doctor and had a virtual visit between April 2021 and March 2022. Methods were used to match 4.1 million patients whose virtual visit was with their own physician and 1 million patients whose visit was with an outside physician.

In a subsequent study, the researchers discovered that patients who used “direct-to-consumer” telemedicine clinics were three times more likely to attend the emergency room within seven days than patients who saw their own family doctor. “Direct-to-consumer” clinics are walk-in virtual-only clinics that provide on-demand virtual care without an in-person assessment.

More than 6.5 million Canadians do not have a family doctor, and virtual care is thought to be a key entry point for patients.

“Virtual care done right can improve timely access to care—both for people who do and don’t have a family doctor,” says co-author Dr. Tara Kiran, Adjunct Scientist at ICES and a family physician at St. Michael’s Hospital of Unity Health Toronto. “But if it’s not integrated with in-person care, or delivered by someone who has access to your health history, there is a risk that we’re adding more churn to the system.”

This study’s data cannot tell us why patients who had their own family doctor choose to have a virtual visit with an outside physician. This decision could be influenced by access issues, convenience, or other factors, and more research is needed.

Nonetheless, our data support the use of primary care virtual services within the context of an established physician-patient relationship.

“Virtual visits with own family physician versus outside family physician and emergency department use,” according to the study, was published in JAMA Network Open.

For more information: Lauren Lapointe-Shaw et al, Virtual Visits With Own Family Physician vs Outside Family Physician and Emergency Department Use, JAMA Network Open (2023). DOI: 10.1001/jamanetworkopen.2023.49452