8 DECEMBER 2023IN MY OPINIONThe Evolution of Virtual Care in AlbertaClinicians in Alberta have been delivering virtual care for at least 25 years. Before the advent of high-speed internet and smartphones, in the late 1990s, clinicians were communicating with patients via video conferencing by using dedicated telephone lines connected to video conferencing equipment in provincial healthcare facilities. The technology was not ideal and required both patient and provider to travel to a facility to attend appointments. Consequently, less than 1% of all outpatient clinical care in Alberta was conducted virtually. Nevertheless, in addition to ambulatory care, some clinical areas have also developed services to enhance access to specialty care in rural regions. Some examples are; the Stroke Ambulance Service, video consultations provided by neonatal ICU physicians to newborns in distress in rural and remote regions, telepsychiatry in-patient consults between remote facilities, remote tele-rounding between urban pediatricians and outlying rural facilities, and virtual hospitals at-home care.The Covid-19 pandemic rapidly changed the landscape. Almost overnight, video conferencing tools leveraging smartphones and tablets allowed "Anytime, anywhere care" as the province entered lockdown. Patients and providers alike were advised to avoid all unnecessary physical contact. The Alberta government implemented fee codes to allow physicians to be compensated for virtual care. These initiatives immediately provided the right ingredients for virtual care to rapidly grow.During this time, several reassuring trends emerged. Initial concerns that virtual care would result in unnecessary overuse were not substantiated. While virtual care volumes increased from 2% in 2019 to 29% by 2021, the overall number of ambulatory visits remained constant, suggesting that some in-person visits were, in fact, replaced by virtual ones. Naturally, higher acuity types of care had higher rates of in-person care owing to the requirement of a physical examination. Some specialties, however, saw up to 80% of all out-patient care delivered virtually. In 2022, volumes of virtual care in the ambulatory setting dropped to 22%. This was an interesting observation, as compensation rates did not change. One can only conclude that practitioners are recognizing the limitations of virtual care and developing an awareness and understanding of clinical appropriateness.In Alberta, patients have long been advocating for virtual care from their physicians for prescription renewals, test result reviews, and other medical concerns not requiring a physical exam. A survey conducted by albertapatients.ca in February 2021 indicated that while 73% of patients are likely By Jonathan Choy, Senior Medical Director - Virtual Care, Access, and Navigation, Alberta Health Services& Patricia Chambers, RN, DC, MN Senior Provincial DirectorVirtual Care, Access, and Navigation, Alberta Health Services (AHS)Jonathan Choy
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