Study finds telehealth improved timely access to N.B. health care during the pandemic

If there was a bright spot in the pandemic, it was pushing the province of New Brunswick to better use of telehealth, says a Université de Moncton researcher who studied the issue. 

Claire Johnson said the province lagged behind in the use of telehealth or telemedicine, which includes phone calls and virtual appointments with video technology such as Zoom. 

And then the pandemic hit. 

Primary-care providers had no choice but to get with the times, because in most cases, it was the only way for patients to get medical attention for non-urgent matters. Phone consultations, for example, increased 122 per cent during the pandemic, Johnson said.

"We know that change isn't easy and that usually, unless you have a huge catalyst like that, you can't get everybody on board overnight. It's just too difficult," said Johnson, who teaches health-care management. 

She soon began to wonder how much it was being used by doctors and nurse practitioners and whether it was having an impact on access to care — and she knew just how to measure it, since she already had a baseline. 

In 2019, before anyone had ever heard of COVID-19, she did a study with the help of some of her students, looking at timeliness of care. Since they already had the pre-pandemic data, they just had to collect the new numbers from April to November of 2020. 

Before the pandemic, physicians said they were able to see 79 per cent of patients within five days of a request for care. During the pandemic, that went up to 92 per cent. 

"So it did go from 79 to 92, so we can say that there was an improvement in timely access to primary care. We can say that, but it was not statistically significant."

And that's because the increase occurred when doctors were seeing fewer patients.

Before the pandemic, physicians reported seeing about 25 patients per day. During the pandemic, that dropped to 18 patients per day. 

So access to timely care did improve, but with a caveat that demand for service was reduced at that time, Johnson said.

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Johnson said other people's research has shown that telehealth can improve timely access to health care — even with demand at normal levels. She hopes to follow up with a third stage of her research that examines the numbers once the pandemic is over. 

But in the meantime, she believes that telehealth is part of the cure for our ailing health-care system. 

"So this gave us a chance to try it, and I think that a lot of it will stick," said Johnson. 

She said 92 per cent of the providers in her study said they'd like to continue to use telemedicine. 

Johnson said the study didn't look at patient satisfaction with telehealth, but a Canadian Medical Association survey released in 2020 suggested 47 per cent of Canadians used virtual care such as calls, email, texts or video during the pandemic.

Of these, 91 per cent said they were very satisfied with the experience.

Pre-pandemic telehealth

Johnson was surprised at how little telehealth was used in New Brunswick before the pandemic, but she said this was largely due to constraints placed on doctors.

For example, doctors couldn't bill for phone consultations, so there was zero incentive to use that approach. The provincial government changed that once the pandemic hit. 

Similarly, there were so many restrictions placed on virtual care before the pandemic that it wasn't easy for physicians to use it. 

"One of the things that I hope will last is that we open up and we become a little bit more flexible with working remotely," said Johnson.

"It's how we can influence practice with payment policy. And I think that's huge. If we want more timely access to care, in my opinion, we need to pay for it."

Doctors willing to continue telehealth

Dr. Mark MacMillan, president of the New Brunswick Medical Society, said doctors are willing to work with patients and whatever platforms the patient requests. 

He said the patient should get to choose between an in-office or virtual meeting — depending on the nature of the appointment. Sometimes, there's just no getting around an in-person visit, he said.

"It depends on the situation and the patient's preference, but most patients and most physicians are quite happy with providing care in any format possible."

MacMillan said many of his patients have told him they'd like to continue with virtual care, especially for followup appointments. As an internal medicine specialist in Fredericton, many of his clients travel a significant distance for  appointments that last 10 or 15 minutes.

Add in what could be a day off work, travel costs, child care and parking, and "a quick phone call for them is much more advantageous," he said. 

And some people don't have transportation to get to in-person visits. Virtual visits also eliminate the need to cancel appointments because of inclement weather. 

MacMillan said doctors would like to see telehealth continue after the pandemic, and the government has agreed to extend the program as is until March 2022. 

He said it will be reassessed at various intervals, but he suspects it will continue. 

"This is something that patients have come to appreciate. They have come to expect. They enjoy the convenience. They enjoy the access."

And it may be one of the few good things to come out of the pandemic, said MacMillan. 

Long-term cost savings

While it does save patients time and money, and increases access to primary care, the cost-savings aren't as significant for the physician or the system. Doctors still have to maintain an office and get paid for their time. 

But there is a cost-savings to the system, Johnson said. 

She said access to timely primary care has been proven to cut down on overall costs, since it's much more expensive to treat patients in the emergency room, and to treat conditions that have been allowed to worsen while patients waited for medical care..