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Virtual care during the COVID-19 pandemic has been good for the environment and has saved patients money, according to a new study.

Telephone visits, rather than in-person visits to the doctor, resulted in a significant reduction in carbon dioxide emissions and patient travel-related expenses, such as gasoline, parking, gengraf generic or public transit costs in the province of Ontario, Canada.

Dr Blayne Welk

“You hear a lot about how appropriate virtual care is and how it’s applied in patients who receive it, but you don’t really know much about it from a practical perspective,” lead author Blayne Welk, MD, associate professor of surgery at Western University in London, Ontario, told Medscape Medical News.

The findings were published October 20 in JAMA Network Open.

Emission Avoidance

“One of the reasons I was motivated to do this study was to determine, from a patient’s perspective and also from an environmental perspective, if there were any benefits to virtual care,” said Welk.

“Prior to the pandemic, less than 2% of patient visits with physicians took place virtually or over the telephone. But when the pandemic began in March 2020, it triggered a rapid transition to virtual visits. During the time period we were studying, patient visits were almost exclusively telephone-based, so over 90% of the encounters were a phone call,” he said.

From March 2020 to December 2021, the investigators conducted a population-based, cross-sectional study using linked administrative databases from Ontario’s healthcare system. The province has a population of approximately 14.7 million people.

“All residents of Ontario use a publicly funded healthcare system. Every time a physician saw a patient for a virtual care encounter, they were able to bill the government to be reimbursed for that visit. This generated a record that the patient was seen by a physician for virtual care,” said Welk.

During the 22 months of the study period, 10,146,843 patients had 63,758,914 physician virtual care visits. This total represented a mean of 6.3 virtual visits per person during the study period, or 3.5 virtual visits per person per year.

The mean age of the patients was 44.1 years, and slightly more than half of the patients (n = 5,536,611; 54.6%) were women.

Virtual care was associated with estimated savings of 3.2 billion km in patient travel, 545 million to 658 million kg of carbon dioxide emissions, and $569 million to $733 million CAD (US $465 million to $599 million) in expenses for gasoline, parking, or public transit.

Carbon dioxide emission avoidance and patient cost savings were more apparent for patients living in rural areas, for those with higher comorbidity, and for patients older than 65 years.

“The information we obtained in this study adds another dimension to continuing virtual care,” said Welk.

In-Person Visits

“Part of my motivation for doing this study was to really show that virtual care has a role in our healthcare system, and I think everyone is coming to that conclusion now.” Physicians are being asked to practice medicine in a more environmentally sustainable way, and this study suggests ways to follow through, he added.

“So, rather than me having a patient drive 500 km round trip to come see me for an in-office visit, if it can be done safely and appropriately virtually, then virtual care is a good option to offer the patient. They save money on gas costs, they save time, and as a physician, I get to contribute to decreasing a bit of the burden on the environment,” said Welk.

Of course, not all visits to the doctor can be done virtually. “This is not a vote to say no one should ever see their physician in person,” said Welk. “Obviously, there are lots of reasons why you still need to see your doctor in person. But virtual visits would be well suited for routine follow-ups where you are reviewing labs or CT scans or other imaging tests.”

Other visits, like an annual physical exam with the family physician, or a first appointment with a specialist, will still need to be in person.

“Obviously, emergency and urgent presentations are better suited for in-person care in most cases, rather than virtual care. But I think every physician, in their practice, will be able to determine which patients are appropriate to fit into a virtual care model. Our study results just reinforce that there are some fringe benefits from virtual care,” said Welk.

As a urologist, Welk has many patients with voiding dysfunction or urinary symptoms. He is able to see many of them virtually.

“Some patients might have a yearly follow-up, where I will be reassessing how their urinary symptoms are going, and in some of those situations, a physical exam is not necessary, I can just talk to them about their urinary symptoms over the phone. If there is anything concerning, then I might need to invite them in for an in-person visit, but if there isn’t, and if things are going well, then potentially our phone call can replace the in-person visit,” he said.

Remote Areas

Commenting on the study for Medscape, cardiologist Johanna Contreras, MD, a heart transplant specialist at Mount Sinai in New York City, said, “Maybe in remote areas, telephone visits would have a place, but not here.

Dr Johanna Contreras

“Telephone visits are not good for me to do,” she continued, “because as a heart transplant specialist, I need to get blood, I need to get testing done. For certain diseases and certain situations, yes, it’s perfect, but not for all diseases,” she said.

“For example, if I do some tests on a patient, and all the test results are normal, but the patient is far away, I’m not going to bring the patient back to my office to review the tests just to tell them that everything is normal.” In such cases, Contreras calls the patient without charging for the call. “Also, I have many Hispanics in my practice, and if the patients don’t speak English, it’s very important for them to come, because sometimes when you tell them something, they may not understand. So, I have to write things down and take special care to explain things to them. That’s hard to do with a telephone visit,” she said.

“If you live in a remote area, where you have to travel far to see a doctor, maybe it’s a solution, at least some of the time. So in a rural area where you don’t have many options, it may be a good alternative,” Contreras said.

The study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health and the Ministry of Long-Term Care. The study was completed at the ICES Western site, where core funding is provided by the Academic Medical Organization of Southwestern Ontario, the Schulich School of Medicine and Dentistry, Western University, and the Lawson Health Research Institute. Welk and Contreras reported no relevant financial relationships.

JAMA Netw Open. 2022;5(10):e2237545. Full text

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