Evaluation of a Virtual Care Program for Unattached Patients in Southeastern Ontario

Abstract

Access to primary care is critical for delivering preventive and coordinated healthcare services. Individuals lacking a primary care provider often have increased healthcare needs and associated costs, utilizing the emergency department for routine medical needs. The implementation of virtual and hybrid care addresses access issues and reduces high-cost healthcare utilization for unattached patients. The studies in this dissertation have demonstrated the efficacy of virtual care programs in supporting these populations. A quantitative study assessing the budget impact of the virtual/hybrid care program for 872 unattached patients in Ontario found that the delivery of virtual/hybrid care for unattached patients could reduce emergency department visits and inpatient hospitalizations by 21% and 27.7%, respectively. Furthermore, cost savings were associated with the implementation when modeled over 5 years. Qualitative analysis involving focus groups and interviews with 31 stakeholders, including patients, healthcare providers, decision-makers, and administrators, revealed that participants reported a high level of satisfaction, largely attributing this to the convenience and perceived quality of care provided. Patients expressed a preference for a hybrid model encompassing both virtual and in-person consultations. From the provider’s perspective, there were no discernible barriers related to the adoption of technology; however, a consensus emerged advocating for enhanced administrative support to foster operational efficiency. To further validate these findings, a mixed-methods analysis was employed. Utilizing a convergent mixed methods design, this investigation combined quantitative analysis of healthcare costs and utilization metrics, yielding confirmatory and expansionary results. Specifically, the value of virtual/hybrid care cannot be evaluated on cost alone, and the complexity of the unattached population cannot be overlooked. Overall, the findings advocate for the feasibility of implementing similar programs within existing healthcare frameworks, highlighting the cost and quality benefits of virtual and hybrid care modalities for unattached patients.