ºìÁì½í¹Ï±¨

In 2019, virtual care accounted for between 2% and 11% of the services that patients received, depending on the province. A year later, patients received between 24% and 42% of their services virtually. In the 5 provinces for which data is available, an average of 16% of the population received 1 or more virtual care services per month.

Proportion of population that received virtual care, April 2019 to March 2021

Show text version Hide text version

Month	Ontario	Manitoba	Saskatchewan	Alberta	British Columbia
Apr-19	1%	6%	4%	3%	3%
May-19	1%	6%	4%	3%	3%
Jun-19	1%	6%	4%	3%	2%
Jul-19	1%	6%	4%	3%	3%
Aug-19	1%	6%	4%	3%	2%
Sep-19	1%	6%	4%	3%	3%
Oct-19	1%	7%	4%	3%	3%
Nov-19	1%	6%	4%	3%	3%
Dec-19	1%	6%	4%	3%	2%
Jan-20	1%	7%	4%	4%	3%
Feb-20	1%	6%	4%	3%	3%
Mar-20	9%	14%	13%	8%	13%
Apr-20	16%	19%	Not available	14%	20%
May-20	15%	18%	Not available	13%	20%
Jun-20	16%	17%	Not available	12%	21%
Jul-20	16%	15%	16%	11%	20%
Aug-20	15%	15%	15%	10%	19%
Sep-20	16%	16%	16%	10%	21%
Oct-20	16%	16%	16%	10%	21%
Nov-20	16%	19%	17%	11%	21%
Dec-20	16%	19%	17%	12%	21%
Jan-21	17%	18%	17%	12%	22%
Feb-21	16%	17%	15%	11%	21%
Mar-2	18%	19%	17%	12%	24%

Notes
Data for Saskatchewan is not shown; data from April 1 to June 30, 2020, is under-reported because physicians who were part of the Pandemic Physician Service Agreement during this time did not submit claims for the services they provided.
The sudden rise in the graph coincides with the time in mid-March 2020 when public health measures were introduced and billing rules for virtual services came into effect in many provinces.

Source
National Physician Database, 2019 to 2021 (open-year data), Canadian Institute for ºìÁì½í¹Ï±¨ Information. Data reported to ºìÁì½í¹Ï±¨as of October 15, 2021.

Not only did more people receive virtual care, but the volume of services also increased. Many commonly provided services moved to virtual delivery early in the pandemic. Virtual care visits averaged 244 services per 1,000 people per month during the first year of the pandemic (April 2020 to March 2021), compared with an average of 52 the year before. It is important to note that although these trends show a large shift to virtual care, they may not necessarily reflect the preferences of patients or physicians. Continued monitoring of how services are delivered will be important to understand the long-term adoption of virtual care by both patients and physicians.

There is a lot of debate in the health sector today about what constitutes the appropriate use of virtual care. The decision to use virtual care should be relational, meaning that it involves both providers and patients as co-decision-makers. Appropriate virtual care will always be context-specific and will require a level of digital health literacy on the part of both providers and patients that will enable them to select the best means to achieve a quality outcome. We have a lot of work to do to realize broad virtual care literacy in the health sector; this data from ºìÁì½í¹Ï±¨is a good start.— Dr. Ewan Affleck, Senior Medical Advisor, ºìÁì½í¹Ï±¨ Informatics, College of Physicians and Surgeons of Alberta

As its name suggests, virtual care involves patients interacting with physicians using technology. There has been some concern among clinicians and decision-makers that Canadians with lower incomes could be at a disadvantage in receiving virtual care because they may be less likely to have access to high-speed internet and to smartphones or other video-enabled devices.Reference3 Despite income disparities, however, our study shows that the difference in access to virtual care was modest. From April 2020 to March 2021, patients across all income levels were able to access virtual care. Access ranged from 30% for patients living in the lowest-income neighbourhoods to 34% for those in the highest-income neighbourhoods.

Proportion of services that patients received virtually, by income level and province, April 2020 to March 2021

Show text version Hide text version

Income level	Ontario	Manitoba	Alberta	British Columbia
Income quintile 1 (lowest)	27%	31%	23%	40%
Income quintile 2	30%	34%	24%	42%
Income quintile 3	31%	34%	24%	43%
Income quintile 4	31%	34%	25%	43%
Income quintile 5 (highest)	32%	34%	25%	44%

Notes
12-month average.
Data for Saskatchewan is not shown; data does not contain the information needed to determine geographic location and income levels.
Patient income quintiles rank neighbourhoods in Canada in order of increasing affluence. The first income quintile corresponds to the lowest-income neighbourhoods and the fifth income quintile corresponds to the highest-income neighbourhoods. Income quintiles in the graph are labelled in order of increasing income levels, from the least affluent to the most affluent.

Source
National Physician Database, 2019 to 2021 (open-year data), Canadian Institute for ºìÁì½í¹Ï±¨ Information. Data reported to ºìÁì½í¹Ï±¨as of October 15, 2021.

Use of virtual care varied notably across patient age groups. Between April 2020 and March 2021, adults age 18 to 64 received the highest proportion of their overall services virtually, at an average of 35%. Younger and older individuals also received a significant proportion of services virtually, both at 29%. Though virtual service delivery may be helping patients access care during the pandemic, the data used in this study does not contain information on the appropriateness or quality of that care.

Proportion of services that patients received virtually, by age group and province, April 2020 to March 2021

Show text version Hide text version

Province	Age 0–17	Age 18–64	Age 65+
Ontario	27%	35%	25%
Manitoba	26%	36%	31%
Saskatchewan	33%	37%	29%
Alberta	20%	25%	24%
British Columbia	39%	45%	39%

Notes
12-month average. 
Data for Saskatchewan from April 1 to June 30, 2020, is under-reported because physicians who were part of the Pandemic Physician Service Agreement during this time did not submit claims for the services they provided.
The average for Saskatchewan is based on the months of July to March.

Source
National Physician Database, 2019 to 2021 (open-year data), Canadian Institute for ºìÁì½í¹Ï±¨ Information. Data reported to ºìÁì½í¹Ï±¨as of October 15, 2021.

For information on how virtual care impacted physician practice patterns, please see our companion release Virtual care: A major shift for physicians in Canada.

With the rapid emergence of virtual care in Canada, it is difficult to address all the questions that are out there. It is great to see different organizations like ºìÁì½í¹Ï±¨and the Centre for Digital ºìÁì½í¹Ï±¨ Evaluation connecting and working together. It’s a win for the Canadian health care system when like-minded organizations with common goals can build and grow off of each other.— Dr. Onil Bhattacharyya, Scientific Director, WCH Institute for ºìÁì½í¹Ï±¨ System Solutions and Virtual Care, Women’s College Hospital

ºìÁì½í¹Ï±¨partnered with the Canadian Agency for Drugs and Technologies in ºìÁì½í¹Ï±¨ (CADTH), Canada ºìÁì½í¹Ï±¨ Infoway, the Centre for Digital ºìÁì½í¹Ï±¨ Evaluation (CDHE) and the Centre for Wise Practices in Indigenous ºìÁì½í¹Ï±¨â€¯in our collaboration with the Canadian Network for Digital ºìÁì½í¹Ï±¨ Evaluation (CNDHE). We and the partner organizations at CNDHE are combining our expertise to support a comprehensive approach to digital health evaluations for the country that includes measurement and analysis of virtual care.

ºìÁì½í¹Ï±¨would like to acknowledge its collaboration with the CDHE and the learnings shared between organizations that helped shape this work on virtual care.

• Who was unable to access physician care at all and why? 
• Did virtual care meet patients’ needs and/or achieve optimal patient outcomes?
• What were the barriers to accessing virtual care?

• Physician billing codes in response to COVID-19
• COVID-19 Intervention Timeline in Canada
•  
• ºìÁì½í¹Ï±¨ Indicators e-Publication

• Virtual care in Canada
• Virtual care: Impact of COVID-19 on physician practice patterns
• ºìÁì½í¹Ï±¨ workforce in Canada: Highlights of the impact of COVID-19
• Impact of COVID-19 on Canada’s health care systems
• COVID-19 resources

  Back to Virtual care: Impact of COVID-19 on patients receiving physician services