Abstract
BackgroundThe COVID-19 pandemic led to a dramatic shift in the delivery of outpatient medicine with reduced in-person visits and a transition to predominantly virtual visits. We sought to understand trends in visit patterns for ambulatory care sensitive conditions (ACSCs) commonly seen in internal medicine clinics.MethodsWe included adult outpatients seen for an ACSC between March 15th, 2017 and March 14th, 2021 at a single-centre in Ontario, Canada. Monthly visits were assessed by visit type (new consultation, follow-up), diagnosis, and clinic. Time series analyses compared visit volumes pre- and post-pandemic. Proportion of virtual visits were compared before and during the pandemic. Patient and visit factors were compared between in-person and virtual visits.Results8274 patients with 34,021 visits were included. Monthly visits increased by 15% during the pandemic (p < 0.0001). New consultations decreased by 10% (p = 0.0053) but follow-up visits increased by 21% (p < 0.0001). Monthly heart failure visits increased by 43% (p < 0.0001) whereas atrial fibrillation visits decreased. Pre- pandemic, < 1% of visits were virtual compared to 82% during the pandemic (p < 0.0001). Less than half of heart failure visits were virtual whereas > 95% of diabetes visits were virtual.ConclusionsWe found a significant increase in overall visits to internal medicine clinics driven by increased volumes of follow-up visits, which more than offset decreased new consultations. There was variability in visit trends and uptake of virtual care by visit diagnosis, which may indicate challenges with delivery of virtual care for certain conditions.
Highlights
The COVID-19 pandemic led to a dramatic shift in the delivery of outpatient medicine with reduced in-person visits and a transition to predominantly virtual visits
After the declaration of COVID-19 as a global pandemic, new temporary billing codes were issued on March 14th, 2020, which allowed physicians to be renumerated for outpatient visits conducted via telephone or videoconference at the same rate as an in-person visit which facilitated the widespread adoption of virtual care [3, 10]
Patient visits meeting the following criteria were included: 1) main visit diagnosis was an ambulatory care sensitive conditions (ACSCs) to an internal medicine clinic; and 2) visit occurred during the study time period
Summary
The COVID-19 pandemic led to a dramatic shift in the delivery of outpatient medicine with reduced in-person visits and a transition to predominantly virtual visits. The COVID-19 pandemic led to rapid changes in the delivery of healthcare services to meet patient needs throughout the pandemic while reducing the risk of Within Ontario, a Canadian province with a population of 14,500,000 and universal health insurance, adoption of virtual care was low before the pandemic [5, 6]. No study to date has assessed the COVID-19 pandemic’s impact on visit trends and utilization of virtual care across multiple internal medicine ambulatory care sensitive conditions (ACSCs). By assessing changes in outpatient visits for several ACSCs across a single institution, we can understand the relative impact of the pandemic and virtual care on different conditions. These findings may highlight areas where virtual care is better suited than others. Understanding care patterns for multiple ACSCs may help organizations plan future allocation of resources within an evolving healthcare environment in the ongoing pandemic with the goals of preventing clinical deterioration and avoidable inpatient visits
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