Against for-profit virtual care: @FamPhysCan makes the continuity of care case

One of the cornerstones of primary care medicine in Canada is continuity of care and the idea that care offered by the same family practice over the lifetime of the patient is the ideal state.

Continuity of care is also seen by primary care advocates as one of the most compelling arguments against having virtual health care services offered by for-profit private companies.

This case was recently made most explicitly by the College of Family Physicians of Canada (CFPC) in a Feb. 22 report titled: Buying Access Will Cost You: The Unintended Consequences of For-Profit Virtual Care.

The report is a direct attempt to counter the recent significant growth of for-profit virtual care in Canada. An evaluation of virtual care in Canada by CADTH published in June, 2021 listed 12 private companies offering a variety of virtual care services in Canada with most being paid on individual basis although some services are covered by private insurance or public health plans.

The CFPC report is also a followup to a CFPC policy statement “Strengthening Health Care – Access Done Right” published in August, 2021 which stressed the need for “access to high-quality, comprehensive, continuous primary care close to home …” That document implicitly questioned the growth of private companies providing intermittent virtual services detached from the relationship between patients and their family physicians.

In the new report and an accompaying news release, the CFPC detailed how the organization feels paid-access virtual care is inferior to continuous, patient-centred care which has “a host of benefits for patients including greater quality of life, better health outcomes, and lower rates of emergency department use.”

“Episodic for-profit care also jeopardizes patients’ continuity of care,” says the report. “Patients using episodic virtual care are less likely to regularly visit their family doctor. Further, providers working through for-profit solutions often do not have access to a patient’s full health record and they generally do not share information with the patient’s regular care provider to maintain continuity.”

The report cites a report from the Ontario Auditor General’s office which found patients using for-profit virtual care are less likely to be regularly seeing their family physician and that this demonstrates a lack of continuity.

The importance of using virtual care to support continuity of care with an established provider rather than for-profit services was also tacitly endorsed in the second Virtual Care Task Force report prepared by the Canadian Medical Association and the Royal College of Physicians and Surgeons of Canada as well as the CFPC.

Interestingly, Maple – one of Canada’s leading for-profit virtual care companies – also recently strongly endorsed the concept of continuity of care and that organization’s commitment to the idea.

“Continuity of care is a crucial component of effective healthcare, and in a virtual setting, the consistency and quality of care that a person receives as they transition between care settings is more seamless than ever,” stated Maple in a blog published Oct. 21.

The blog goes on to talk about informational and management continuity and argues that Maple supports both:

“Informational continuity is delivered through access to a patient’s medical history, by both the patient and provider, in order to give complete informative care via shared or electronic health records. This enables providers to view the patient’s history and build on previous treatment and diagnosis. In a virtual setting such as Maple, access to consistent patient record-keeping ensures comprehensive care during every single visit.

“Coordination of care across multiple providers, which adapts to needs over time, is defined as management continuity. Any healthcare provider interacting with the patient can collaborate with others involved, both in a virtual setting and the physical world. As more patients turn to virtual care to complement in person care, it’s important that they have control over their documentation and that’s why we’ve built in a secure medical records feature,” says Christy Prada, vice president of business development at Maple.

The blog does not address the pivotal concern of the College of Family Physicians of Canada that private companies such as Maple who offer virtual care interrupt or impede the continuity of care offered by family physicians. The CFPC statement also does not deal with the issue of the million plus Canadians who do not have a regular family physician and are thereby denied the benefits of continuity of care by a regular primary care provider – and the niche private virtual care companies could or should fill in helping give these patients the care they need. While CFPC acknowledged in their report that “for-profit virtual care services, such as virtual walk-in clinics, have acted as a stop-gap measure to improve access to care for some” it added that  “in doing so (they) present serious risks to the health care system.”

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