Virtual services are good for the environment and patients’ pockets

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 doctor visits, resulted in significant reductions in carbon dioxide emissions and patient travel-related costs, such as gas, parking, or public transportation costs in the province of Ontario, Canada.

Dr. Blayne Welk

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

The results were published on October 20 JAMA Network Open.

Emission avoidance

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

“Before the pandemic, less than 2% of patient visits to doctors were made virtually or over the phone. But when the pandemic began in March 2020, it triggered a rapid shift to virtual visits. During the period we were studying, patient visits were almost exclusively telephone-based , so over 90% of the introductions were phone calls,” he said.

From March 2020 to December 2021, researchers conducted a population-based cross-sectional study using linked administrative databases from the Ontario Health System. The province is home to approximately 14.7 million people.

“Every resident of Ontario uses a publicly funded health care system. Every time a physician saw a patient for virtual care, they were able to bill the government for reimbursement for that visit. This created 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 received 63,758,914 virtual doctor visits. This total represented an average 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 ($465 million to $599 million) in gasoline, parking, or public spending. transfer.

Avoided carbon dioxide emissions and patient cost savings were more pronounced for patients who lived in rural areas, for those with more comorbidities, and for patients older than 65 years.

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

Visits in person

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

“So, rather than having a patient drive 500km round trip to come to my office for an office visit, if it can be done safely and appropriately in reality, then virtual care is a good option to offer the patient . on gas costs, they save time, and as a doctor I get to do my part to reduce the burden on the environment,” said Welk.

Of course, not all visits to the doctor can be made virtually. “This is not a vote to say no one should ever see their doctor in person,” Welk said. “Obviously, there are many reasons why you still need to see your doctor in person. But virtual visits would be a good fit for a routine follow-up where you’re reviewing labs or CT scans or other imaging tests.”

Other visits, such as an annual physical exam with your family doctor, or your first appointment with a specialist, still need to be in person.

“Obviously, acute and urgent care 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 suitable to fit into a virtual care model. Our research results only reinforce that it is some marginal benefit of virtual care,” Welk said.

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

“Some patients may have an annual follow-up where I will reassess how the urinary symptoms are going, and in some of these situations a physical exam is not necessary, I can just talk to them about the urinary symptoms over the phone. If there is any concern, then I may have to invite them for a personal visit, but if there is not, and if things go well, then our phone call may replace a personal visit,” he said.

Remote area

Review of the study for Medscapecardiologist Johanna Contreras, MD, a heart transplant specialist at Mount Sinai in New York City, said, “Maybe in remote areas, phone visits would happen, but not here.

Doctor Johanna Contreras

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

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

“If you live in a remote area, where you have to travel a long way to see a doctor, maybe that’s a solution, at least sometimes. So in a rural area where you don’t have many options, it can be a good option.” Contreras said.

The study was funded 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 in the ICES Western Region, with core funding 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 Network Open. 2022;5(10):e2237545. Full text

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