Number of virtual doctor visits growing, especially among women
More research needed into effectiveness of medical teleconference house calls
On-demand house calls by Internet video teleconferencing are an increasingly popular way for B.C. patients to “see” doctors, especially females with relatively minor medical problems, a first-of-itskind study on the demographics of such users shows.
Examining 16,000 invoice billing codes submitted to the government by primary-care doctors who saw patients online over a one-year period in 2014-15, University of B.C. researchers identified the most common medical concerns underlying such consultations.
They were led by anxiety/depression, contraception, skin complaints, digestion issues including heartburn and nausea, and common colds. The next five mostcommon conditions were urinary tract infections, asthma, allergies, fatigue and herpes.
The two-year study published in the B.C. Medical Journal shows the Greater Vancouver area had the largest number of telemedicine users, but the Peace River region had the highest number of users per 1,000 residents. Two-thirds of all users were female and the mean age was 31.5.
Only the data from an Internet platform company called Medeo (now known as QHR or Quality Health Technology) was analyzed. In the first year of analysis, the number of users numbered 8,282, but in the second year it rose to 17,149 for a total of 25,431 users over a two-year period.
There is at least one other major telemedicine provider in B.C. called Livecare. And last year, an Ontario company called MedviewMD set up a video-link service for prescription renewals.
In 2014, Health Minister Terry Lake ordered a sweeping review of telemedicine because of concerns that the ever-increasing Internet video conference consultations between doctors and patients would cost the publicly funded health care system too much. (Doctors can bill the same as what they do for in-office consultations.) But no action ever resulted because the review wasn’t completed. Rather, the government pledged to conduct a virtual-care strategic plan that was not completed before the recent election.
Data obtained from the Ministry of Health on Wednesday shows that in 2015-16 (the latest period for which such information is available) the government paid $2.724 million to family doctors and specialists for 43,220 telemedicine visits. That compares with $1.21 million in 2013-14 for 16,626 services. In 2013, there were only 4,000 such consultations.
A government report a few years ago acknowledged the “fragmented, unmanaged approach to the expansion of telemedicine” has led to exploding Medical Services Plan costs and the situation needed containment to ensure quality of care.
Mental health was mentioned as the most ideally suited for virtual-health consultations.
Telemedicine was originally touted as a good way to deliver care to patients in rural and remote parts of the province where there is a shortage of doctors. But as the study shows, urban users who are comfortable with the technology like it because of the convenience. Whether or not there is any compromise with the quality of care remains an unanswered question. But the College of Physicians and Surgeons of B.C. said Wednesday it “regularly” receives complaints about deficient care provided by doctors in telemedicine models.
Study co-author Dr. Patricia Gabriel said she and her co-authors looked only at the demographics of users, not quality of care.
“The appropriate use of telemedicine is a big question that I can’t comment on because our study didn’t look at that aspect. But it is certainly seen as an easier way to access periodic health care,” said Gabriel, a family doctor and clinical professor at UBC.
Dr. Trina Larsen Soles, president of Doctors of B.C., said the priority for patients and doctors is ensuring access to care “and this is one model of care.”
“But the study doesn’t tell us anything about whether it’s effective care and I’m all in favour of getting more data to answer that,” she said.
Kimberlyn McGrail, co-author of a previous study that showed high satisfaction rates among surveyed telemedicine users, said B.C. appears to be the only province publicly funding such medical visits. They may be convenient for patients, but if there’s no continuity of care if patients see a different doctor each time, “then that’s when we could run into trouble.”
Dr. Mark Godley, who helped create Livecare, agreed, saying telemedicine has to be about more than one-off visits for prescription refills and quick consults. His company has focused on telehealth for First Nations and remote communities. In that model, doctors do make periodic visits in person in addition to video conferencing with them.
There are about 600 B.C. doctors involved in telemedicine and the college has cautioned that virtual visits can be a potentially “highstakes” matter when patients are unfamiliar to them.
Earlier this year, the college expressed its dismay with the way a handful of cases were handled and said telemedicine by comprehensive family practice groups to improve productivity, convenience and access for patients is desirable.
“(But) based on evidence reviewed by the inquiry committee to date, the care of unattached strangers in virtual walk-in-clinic models is to be discouraged.”
The study doesn’t tell us anything about whether it’s effective care and I’m all in favour of getting more data to answer that.