In 2001 the US Institute of Medicine put forward a six-dimension concept of quality that includes the following elements of safe, effective, patient-centred, timely, efficient and equitable. One issue that gets raised that cuts across several of these dimensions is the potential for virtual care to fragment the continuity of care. In a report for the Canadian Health Services Research Foundation Reid et al. identified three core concepts of continuity:
- informational continuity – the use of information on prior events and circumstances to inform current care;
- relational continuity – an ongoing relationship between a patient and one or more providers; and
- management continuity – the provision of timely and complementary services in a shared management plan.
The episodic use of virtual care outside an ongoing relationship and with no connection to an electronic health record would undermine the elements listed above. The 2019 WHO guideline recommends client-to-provider medicine under the condition that it complements, rather than replaces, face-to-face delivery of health services. However this must be weighed against access, which is an ongoing challenge in Canada and many countries. There is a persistent shortage of family physicians in Canada. In November 2018 there were almost 2,000 advertised positions for family physicians, not including part-time and locum positions. According to Statistics Canada’s Canadian Community Health Survey (CCHS), in 2017 4.7 million Canadians aged 12+ reported that they did not have regular health care provider. Even those who have a regular provider experience wait time issues. The 2017 CCHS found that just under four in 10 persons with a regular provider could get an appointment either the same or next day when they needed one.
- Based on your experience, what approaches can be used to implement virtual care in a manner that complements the patient-physician relationship and continuity of care?
- In your opinion, how can the delivery of virtual care be optimized so that it meets patient demand for timely access to care while fitting in with the physician’s office workflow?
- What supports can be provided to Canadians so that they can take best advantage of digital health resources and virtual care options?