![]() Office, home and virtual visits were limited to 1 per patient per physician per day. 1, 2020, onward, specific codes for virtual care using video through the Ontario Telemedicine Network were introduced, at the usual rate for office care (Appendix 1). 15, 2019, video visits with patients in their home or other locations were also supported. Throughout both the 20 study periods, the Ontario Telemedicine Network supported video visits in secure, physical host sites. The temporary codes did not distinguish telephone from video visits and did not include asynchronous care such as email or text. Virtual care was defined as any primary care physician billing for telephone or video visits using either the temporary new virtual care codes or existing telemedicine codes. 8 Office and home visits were defined using relevant billing codes. We included only comprehensive primary care physicians, defined as those meeting minimum visit levels, billing mainly primary care codes and providing a diversity of core primary care services. We aimed to understand the degree to which office and virtual primary care changed, and for which patients and physicians, during the initial months of the COVID-19 pandemic in Ontario, Canada.įor this study, primary care physicians were defined as family doctors and general practitioners, but not pediatricians or general internists. It is also not known which patients and physicians were most affected by the challenges to office-based practice or the change to virtual visits. 5, 6 The degree to which virtual care - such as phone calls, video visits and secure text messages - replaced in-person office visits is not known. Initial reports from ongoing COVID-19-related surveys of primary care providers in Canada and the United States showed major disruptions to care, decreased payments, challenges keeping offices functioning, lack of personal protective equipment and widespread uptake of virtual care. ![]() ![]() 14 (Appendix 1, available at In mid to late May 2020, the province undertook a phased resumption of certain in-person health professional services and surgeries. 4 The Ontario Ministry of Health and the Ontario Medical Association negotiated the addition of temporary billing codes in the province’s schedule of benefits to facilitate virtual care, effective as of Mar. 19, health care providers and organizations were directed to stop or substantially reduce all nonessential or elective services until further notice. 15, Ontario’s Chief Medical Officer of Health issued a directive to ramp down elective surgeries and other nonemergent health services, and on Mar. 11, 2020, the World Health Organization declared COVID-19 a global pandemic. 2 Despite the centrality of primary care to health care systems, little is known about how it has been affected by coronavirus disease 19 (COVID-19). 1 Health systems with greater availability of primary care are associated with increased access to care, reduced health inequities, better outcomes and lower costs. Primary care is considered the cornerstone of most health systems worldwide, and in higher-income countries, primary care visits are about 30 times more frequent than hospital admissions. The determinants and consequences of these major shifts in care require further study. Total visits declined least among those with higher health care needs. ![]() INTERPRETATION: Primary care in Ontario saw large shifts from office to virtual care over the first 4 months of the COVID-19 pandemic.
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