Observational studyCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne2023
Association between virtual primary care and emergency department use during the first year of the COVID-19 pandemic in Ontario, Canada.
Abstract readObservational Study
In one paragraph
Observational study in CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed
–field-weighted citation impact
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
8 citing papers in PubMed.
- Virtual Care Provision and Emergency Department Use Among Children and Youth.JAMA network open · 2025Article
- Changes in emergency and primary care use after adding virtual physicians to HealthLink BC's 8-1-1 program.NPJ digital medicine · 2025Article
- Media depictions of primary care teleconsultation safety: a thematic analysis of UK newspapers.The British journal of general practice : the journal of the Royal College of General Practitioners · 2024Article
- The Clinical Resource Hub Telehealth Program and Use of Primary Care, Emergency, and Inpatient Care During the COVID-19 Pandemic.Journal of general internal medicine · 2024Article
- Trend control charts for multiple sclerosis case definitions.International journal of population data science · 2024Article
- Changes in reasons for visits to primary care after the start of the COVID-19 pandemic: An international comparative study by the International Consortium of Primary Care Big Data Researchers (INTRePID).PLOS global public health · 2024Article
- Virtual Visits With Own Family Physician vs Outside Family Physician and Emergency Department Use.JAMA network open · 2023Article
- Virtual care and emergency department use.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2023Article
Corrections and comments
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Authors and funding
11 authors.
Nadine ChamiEconomics, Policy, & Research Department (Chami, Nastos, Shaikh, Wright, Weir, Kantarevic), Ontario Medical Association; Division of Gastroenterology and Hepatology (Shah), University Health Network; University of Toronto (Shah, Kantarevic); Department of Anesthesia (Tenenbein), University Health Network; Department of Anesthesia and Pain Medicine (Tenenbein), University of Toronto, Toronto, Ont.; Department of Family Medicine (Lougheed), University of Ottawa, Ottawa, Ont.; Section of Emergency Medicine (Lougheed), Northern Ontario School of Medicine, Thunder Bay, Ont.; University Health Network (Mizdrak); Department of Family and Community Medicine (Mizdrak), University of Toronto, Toronto, Ont.; Goderich, Western University (Conlon), London, Ont.; Botnar Research Centre (Wright), University of Oxford, Oxford, UK; Hospital for Sick Children (Wright); Institute of Health Policy, Management and Evaluation (Wright), and Canadian Centre for Health Economics (Weir), and Department of Economics (Kantarevic), University of Toronto, Toronto, Ont.; Institute of Labour Economics (Kantarevic), Deutsche Post Foundation, Bonn, Germany nadine.chami@oma.org.
Hemant A ShahEconomics, Policy, & Research Department (Chami, Nastos, Shaikh, Wright, Weir, Kantarevic), Ontario Medical Association; Division of Gastroenterology and Hepatology (Shah), University Health Network; University of Toronto (Shah, Kantarevic); Department of Anesthesia (Tenenbein), University Health Network; Department of Anesthesia and Pain Medicine (Tenenbein), University of Toronto, Toronto, Ont.; Department of Family Medicine (Lougheed), University of Ottawa, Ottawa, Ont.; Section of Emergency Medicine (Lougheed), Northern Ontario School of Medicine, Thunder Bay, Ont.; University Health Network (Mizdrak); Department of Family and Community Medicine (Mizdrak), University of Toronto, Toronto, Ont.; Goderich, Western University (Conlon), London, Ont.; Botnar Research Centre (Wright), University of Oxford, Oxford, UK; Hospital for Sick Children (Wright); Institute of Health Policy, Management and Evaluation (Wright), and Canadian Centre for Health Economics (Weir), and Department of Economics (Kantarevic), University of Toronto, Toronto, Ont.; Institute of Labour Economics (Kantarevic), Deutsche Post Foundation, Bonn, Germany.
Steve NastosEconomics, Policy, & Research Department (Chami, Nastos, Shaikh, Wright, Weir, Kantarevic), Ontario Medical Association; Division of Gastroenterology and Hepatology (Shah), University Health Network; University of Toronto (Shah, Kantarevic); Department of Anesthesia (Tenenbein), University Health Network; Department of Anesthesia and Pain Medicine (Tenenbein), University of Toronto, Toronto, Ont.; Department of Family Medicine (Lougheed), University of Ottawa, Ottawa, Ont.; Section of Emergency Medicine (Lougheed), Northern Ontario School of Medicine, Thunder Bay, Ont.; University Health Network (Mizdrak); Department of Family and Community Medicine (Mizdrak), University of Toronto, Toronto, Ont.; Goderich, Western University (Conlon), London, Ont.; Botnar Research Centre (Wright), University of Oxford, Oxford, UK; Hospital for Sick Children (Wright); Institute of Health Policy, Management and Evaluation (Wright), and Canadian Centre for Health Economics (Weir), and Department of Economics (Kantarevic), University of Toronto, Toronto, Ont.; Institute of Labour Economics (Kantarevic), Deutsche Post Foundation, Bonn, Germany.
Shaun ShaikhEconomics, Policy, & Research Department (Chami, Nastos, Shaikh, Wright, Weir, Kantarevic), Ontario Medical Association; Division of Gastroenterology and Hepatology (Shah), University Health Network; University of Toronto (Shah, Kantarevic); Department of Anesthesia (Tenenbein), University Health Network; Department of Anesthesia and Pain Medicine (Tenenbein), University of Toronto, Toronto, Ont.; Department of Family Medicine (Lougheed), University of Ottawa, Ottawa, Ont.; Section of Emergency Medicine (Lougheed), Northern Ontario School of Medicine, Thunder Bay, Ont.; University Health Network (Mizdrak); Department of Family and Community Medicine (Mizdrak), University of Toronto, Toronto, Ont.; Goderich, Western University (Conlon), London, Ont.; Botnar Research Centre (Wright), University of Oxford, Oxford, UK; Hospital for Sick Children (Wright); Institute of Health Policy, Management and Evaluation (Wright), and Canadian Centre for Health Economics (Weir), and Department of Economics (Kantarevic), University of Toronto, Toronto, Ont.; Institute of Labour Economics (Kantarevic), Deutsche Post Foundation, Bonn, Germany.
Paul K TenenbeinEconomics, Policy, & Research Department (Chami, Nastos, Shaikh, Wright, Weir, Kantarevic), Ontario Medical Association; Division of Gastroenterology and Hepatology (Shah), University Health Network; University of Toronto (Shah, Kantarevic); Department of Anesthesia (Tenenbein), University Health Network; Department of Anesthesia and Pain Medicine (Tenenbein), University of Toronto, Toronto, Ont.; Department of Family Medicine (Lougheed), University of Ottawa, Ottawa, Ont.; Section of Emergency Medicine (Lougheed), Northern Ontario School of Medicine, Thunder Bay, Ont.; University Health Network (Mizdrak); Department of Family and Community Medicine (Mizdrak), University of Toronto, Toronto, Ont.; Goderich, Western University (Conlon), London, Ont.; Botnar Research Centre (Wright), University of Oxford, Oxford, UK; Hospital for Sick Children (Wright); Institute of Health Policy, Management and Evaluation (Wright), and Canadian Centre for Health Economics (Weir), and Department of Economics (Kantarevic), University of Toronto, Toronto, Ont.; Institute of Labour Economics (Kantarevic), Deutsche Post Foundation, Bonn, Germany.
Taylor LougheedEconomics, Policy, & Research Department (Chami, Nastos, Shaikh, Wright, Weir, Kantarevic), Ontario Medical Association; Division of Gastroenterology and Hepatology (Shah), University Health Network; University of Toronto (Shah, Kantarevic); Department of Anesthesia (Tenenbein), University Health Network; Department of Anesthesia and Pain Medicine (Tenenbein), University of Toronto, Toronto, Ont.; Department of Family Medicine (Lougheed), University of Ottawa, Ottawa, Ont.; Section of Emergency Medicine (Lougheed), Northern Ontario School of Medicine, Thunder Bay, Ont.; University Health Network (Mizdrak); Department of Family and Community Medicine (Mizdrak), University of Toronto, Toronto, Ont.; Goderich, Western University (Conlon), London, Ont.; Botnar Research Centre (Wright), University of Oxford, Oxford, UK; Hospital for Sick Children (Wright); Institute of Health Policy, Management and Evaluation (Wright), and Canadian Centre for Health Economics (Weir), and Department of Economics (Kantarevic), University of Toronto, Toronto, Ont.; Institute of Labour Economics (Kantarevic), Deutsche Post Foundation, Bonn, Germany.
Nikolina MizdrakEconomics, Policy, & Research Department (Chami, Nastos, Shaikh, Wright, Weir, Kantarevic), Ontario Medical Association; Division of Gastroenterology and Hepatology (Shah), University Health Network; University of Toronto (Shah, Kantarevic); Department of Anesthesia (Tenenbein), University Health Network; Department of Anesthesia and Pain Medicine (Tenenbein), University of Toronto, Toronto, Ont.; Department of Family Medicine (Lougheed), University of Ottawa, Ottawa, Ont.; Section of Emergency Medicine (Lougheed), Northern Ontario School of Medicine, Thunder Bay, Ont.; University Health Network (Mizdrak); Department of Family and Community Medicine (Mizdrak), University of Toronto, Toronto, Ont.; Goderich, Western University (Conlon), London, Ont.; Botnar Research Centre (Wright), University of Oxford, Oxford, UK; Hospital for Sick Children (Wright); Institute of Health Policy, Management and Evaluation (Wright), and Canadian Centre for Health Economics (Weir), and Department of Economics (Kantarevic), University of Toronto, Toronto, Ont.; Institute of Labour Economics (Kantarevic), Deutsche Post Foundation, Bonn, Germany.
Patrick ConlonEconomics, Policy, & Research Department (Chami, Nastos, Shaikh, Wright, Weir, Kantarevic), Ontario Medical Association; Division of Gastroenterology and Hepatology (Shah), University Health Network; University of Toronto (Shah, Kantarevic); Department of Anesthesia (Tenenbein), University Health Network; Department of Anesthesia and Pain Medicine (Tenenbein), University of Toronto, Toronto, Ont.; Department of Family Medicine (Lougheed), University of Ottawa, Ottawa, Ont.; Section of Emergency Medicine (Lougheed), Northern Ontario School of Medicine, Thunder Bay, Ont.; University Health Network (Mizdrak); Department of Family and Community Medicine (Mizdrak), University of Toronto, Toronto, Ont.; Goderich, Western University (Conlon), London, Ont.; Botnar Research Centre (Wright), University of Oxford, Oxford, UK; Hospital for Sick Children (Wright); Institute of Health Policy, Management and Evaluation (Wright), and Canadian Centre for Health Economics (Weir), and Department of Economics (Kantarevic), University of Toronto, Toronto, Ont.; Institute of Labour Economics (Kantarevic), Deutsche Post Foundation, Bonn, Germany.
James G WrightEconomics, Policy, & Research Department (Chami, Nastos, Shaikh, Wright, Weir, Kantarevic), Ontario Medical Association; Division of Gastroenterology and Hepatology (Shah), University Health Network; University of Toronto (Shah, Kantarevic); Department of Anesthesia (Tenenbein), University Health Network; Department of Anesthesia and Pain Medicine (Tenenbein), University of Toronto, Toronto, Ont.; Department of Family Medicine (Lougheed), University of Ottawa, Ottawa, Ont.; Section of Emergency Medicine (Lougheed), Northern Ontario School of Medicine, Thunder Bay, Ont.; University Health Network (Mizdrak); Department of Family and Community Medicine (Mizdrak), University of Toronto, Toronto, Ont.; Goderich, Western University (Conlon), London, Ont.; Botnar Research Centre (Wright), University of Oxford, Oxford, UK; Hospital for Sick Children (Wright); Institute of Health Policy, Management and Evaluation (Wright), and Canadian Centre for Health Economics (Weir), and Department of Economics (Kantarevic), University of Toronto, Toronto, Ont.; Institute of Labour Economics (Kantarevic), Deutsche Post Foundation, Bonn, Germany.
Sharada WeirEconomics, Policy, & Research Department (Chami, Nastos, Shaikh, Wright, Weir, Kantarevic), Ontario Medical Association; Division of Gastroenterology and Hepatology (Shah), University Health Network; University of Toronto (Shah, Kantarevic); Department of Anesthesia (Tenenbein), University Health Network; Department of Anesthesia and Pain Medicine (Tenenbein), University of Toronto, Toronto, Ont.; Department of Family Medicine (Lougheed), University of Ottawa, Ottawa, Ont.; Section of Emergency Medicine (Lougheed), Northern Ontario School of Medicine, Thunder Bay, Ont.; University Health Network (Mizdrak); Department of Family and Community Medicine (Mizdrak), University of Toronto, Toronto, Ont.; Goderich, Western University (Conlon), London, Ont.; Botnar Research Centre (Wright), University of Oxford, Oxford, UK; Hospital for Sick Children (Wright); Institute of Health Policy, Management and Evaluation (Wright), and Canadian Centre for Health Economics (Weir), and Department of Economics (Kantarevic), University of Toronto, Toronto, Ont.; Institute of Labour Economics (Kantarevic), Deutsche Post Foundation, Bonn, Germany.
Jasmin KantarevicEconomics, Policy, & Research Department (Chami, Nastos, Shaikh, Wright, Weir, Kantarevic), Ontario Medical Association; Division of Gastroenterology and Hepatology (Shah), University Health Network; University of Toronto (Shah, Kantarevic); Department of Anesthesia (Tenenbein), University Health Network; Department of Anesthesia and Pain Medicine (Tenenbein), University of Toronto, Toronto, Ont.; Department of Family Medicine (Lougheed), University of Ottawa, Ottawa, Ont.; Section of Emergency Medicine (Lougheed), Northern Ontario School of Medicine, Thunder Bay, Ont.; University Health Network (Mizdrak); Department of Family and Community Medicine (Mizdrak), University of Toronto, Toronto, Ont.; Goderich, Western University (Conlon), London, Ont.; Botnar Research Centre (Wright), University of Oxford, Oxford, UK; Hospital for Sick Children (Wright); Institute of Health Policy, Management and Evaluation (Wright), and Canadian Centre for Health Economics (Weir), and Department of Economics (Kantarevic), University of Toronto, Toronto, Ont.; Institute of Labour Economics (Kantarevic), Deutsche Post Foundation, Bonn, Germany.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundUptake of virtual care increased substantially during the first year of the COVID-19 pandemic. The aim of this study was to evaluate whether a shift from in-person to virtual visits by primary care physicians was associated with increased use of emergency departments among their enrolled patients.
methodsWe conducted an observational study of monthly virtual visits and emergency department visits from Apr. 1, 2020, to Mar. 31, 2021, using administrative data from Ontario, Canada. We used multivariable regression analysis to estimate the association between the proportion of a physician's visits that were delivered virtually and the number of emergency department visits among their enrolled patients.
resultsThe proportion of virtual visits was higher among female, younger and urban physicians, and the number of emergency department visits was lower among patients of female and urban physicians. In an unadjusted analysis, a 1% increase in a physician's proportion of virtual visits was found to be associated with 11.0 (95% confidence interval [CI] 10.1-11.8) fewer emergency department visits per 1000 rostered patients. After controlling for covariates, we observed no statistically significant change in emergency department visits per 1% increase in the proportion of virtual visits (0.2, 95% CI -0.5 to 0.9).
interpretationWe did not find evidence that patients substituted emergency department visits in the context of decreased availability of in-person care with their family physician during the first year of the COVID-19 pandemic. Future research should focus on the long-term impact of virtual care on access and quality of patient care.
Indexed as
COVID-19Emergency Service, HospitalPandemicsTelemedicineFemaleHumansOntarioPrimary Health Care
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