Virtual care in Ontario community health centres: a cross-sectional study to understand changes in care delivery

Sara Bhatti; Simone Dahrouge; Laura Muldoon; Jennifer Rayner

doi:10.3399/BJGPO.2021.0239

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Figure 1. Monthly primary care visits by visit type (in-person, virtual) during April 2019–February 2020 (pre-COVID-19) and April 2020–February 2021 (COVID-19)
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Figure 2. Issues addressed by visit modality during pandemic period, April 2020–February 2021. DOH = determinants of health. OB or GYN = obstetrics or gynaecology.

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Table 1. Community health centres and patient characteristics

Community health centres (n = 36)^a	n (%)^b
Average number of registered patients, mean (SD)	8897 (5035)
Size of practice, average FTE for all staff, mean (SD)	28 (17)
Practice geography, urban	22 (61)
Patient characteristics (n = 173 503)^c
Age, years
0–12	14 616 (8)
13–26	21 239 (12)
27–40	29 985 (17)
41–60	47 606 (27)
>61	60 057 (35)
Sex, female	99 990 (58)
English as preferred language of service	124 547 (72)
Education, high school or less	44 651 (26)
Household income
$0–$24 999	37 343 (22)
$25 000–$59 999	22 615 (13)
>$60 000	16 314 (9)
Unknown	97 231 (56)
Living alone	22 316 (13)

^aData source: organisational survey. ^bUnless otherwise stated. ^cData source: electronic medical record. FTE = full-time equivalent. SD = standard deviation.

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Table 2. Median and mean numbers of visits, patients, issues addressed, and services provided during April 2019–February 2020 (pre-COVID-19) and April 2020–February 2021 (COVID-19)

Variable	Pre-COVID-19 (n = 396)		COVID-19 (n = 396)		Mean % change	Median % change
Variable	Mean (SD)	Median (IQR)	Mean (SD)	Median (IQR)	Mean % change	Median % change
Total visits	2901.6 (1447)	2721.5 (1764–3592)	2572 (1482)	2145 (1510–3209)	11	–21
Total patients seen	480.7 (307)	429.5 (252–617)	438.8 (257)	396 (259–552)	9	–8
Total issues addressed	6349.3 (3930)	5697 (3940–7176)	5771 (4729)	4687 (3406–6553)	9	–18
Total services provided	8976.3 (5574)	7662.5 (4735–11 675)	7596 (6417)	5799 (3866–9213)	15	–24

IQR = interquartile range. SD = standard deviation.

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Table 3. Total number of services provided during April 2019–February 2020 (pre-COVID-19) and April 2020–February 2021 (COVID-19)

Service type	Sum of service type providedPre-COVID-19 (n = 36), n	Sum of service type provided during COVID-19 (n = 36), n	% change
Written patient care instructions	3977	710	–82%
Periodic health examination	9736	2601	–73%
Well child health examination	3300	1506	–54%
Foot care	53 774	25 155	–53%
Accompaniment	7351	3768	–49%
Physical therapy	23 386	13 016	–44%
Forms completion	47 509	28 507	–40%
Preventive care	127 353	86 925	–32%
Interpretation services	18 783	13 541	–28%
Patient intake	42 629	30 879	–28%
Recommendation or assistance	104 309	125 904	21%
Postnatal care	1201	1464	22%
Health card registration	1593	1958	23%
Case management	65 805	81 043	23%
Care plan documentation	11 334	13 979	23%
Mental health care	34 160	42 207	24%
Breastfeeding counselling	2055	2653	29%
Occupational therapy	1304	1691	30%
Individual counselling	35 439	65 469	85%
Palliative care	350	1092	212%

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Table 4. Patient characteristics by visit modality

Sociodemographic variable	n (%)
Sociodemographic variable	In-person	Telephone	Text or email	Video
Age, years
0–12	18 652 (60.7)	11 271 (36.7)	518 (1.7)	263 (0.9)
13–26	21 591 (43.9)	25 078 (51.0)	1362 (2.8)	1154 (2.3)
27–40	36 415 (45.1)	41 230 (51.1)	1610 (2.0)	1465 (1.8)
41–60	58 937 (43.9)	71 449 (53.2)	2037 (1.5)	1871 (1.4)
61–75	51 762 (46.6)	57 129 (51.4)	946 (0.9)	1216 (1.1)
>76	28 708 (50.6)	27 180 (47.9)	347 (0.6)	508 (0.9)
Sex
Female	127 216 (45.3)	145 205 (51.8)	4001 (1.4)	4106 (1.5)
Male	84 591 (49.0)	83 845 (48.6)	2161 (1.3)	2031 (1.2)
Other	4258 (44.9)	4287 (45.2)	658 (6.9)	280 (3.0)
Education
High school or less	74 366 (47.1)	80 263 (50.8)	1620 (1.0)	1598 (1.0)
Post-secondary or equivalent	49 297 (44.0)	59 932 (53.5)	1120 (1.0)	1659 (1.5)
Other	92 402 (47.9)	93 142 (48.3)	4080 (2.1)	3160 (1.6)
Income
$0–$14 999	34 070 (46.3)	37 835 (51.4)	929 (1.3)	817 (1.1)
$15 000–$19 999	11 606 (46.3)	12 903 (51.5)	271 (1.1)	288 (1.1)
$20 000–$24 999	8687 (45.7)	9886 (52.0)	225 (1.2)	198 (1.0)
$25 000–$29 999	5966 (46.4)	6629 (51.6)	99 (0.8)	153 (1.2)
$30 000–$34 999	6137 (46.4)	6835 (51.7)	120 (0.9)	135 (1.0)
$35 000–$39 999	4965 (45.4)	5795 (53.0)	70 (0.6)	99 (0.9)
$40 000–$59 999	12 029 (45.4)	13 817 (52.2)	260 (1.0)	375 (1.4)
>$60 000	18 487 (44.6)	21 865 (52.8)	374 (0.9)	699 (1.7)
Other	114 118 (47.5)	117 772 (49.1)	4472 (1.9)	3653 (1.5)
Spoken language
English	157 037 (45.7)	177 566 (51.7)	4705 (1.4)	4461 (1.3)
French	6837 (47.8)	7094 (49.6)	148 (1.0)	222 (1.6)
Other	52 191 (49.9)	48 677 (46.6)	1967 (1.9)	1734 (1.7)
Household composition
Living with others	94 027 (46.0)	106 255 (51.9)	1924 (0.9)	2420 (1.2)
Living alone	28 243 (46.9)	30 634 (50.9)	630 (1.0)	702 (1.2)
Other	93 795 (47.4)	96 448 (48.8)	4266 (2.2)	3295 (1.7)
Overall	216 065 (46.7)	233 337 (50.4)	6820 (1.5)	6417 (1.4)

Supplementary Data

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