Report shows high satisfaction with virtual care, but N.S. not ready to make it permanent

Most patients and doctors want to see virtual care made permanent, but its future in Nova Scotia remains in limbo.

Survey data compiled in a recent report to the province shows the vast majority of patients and doctors have been satisfied with virtual care since last March, when it was made billable for all doctors.

The report was prepared by Stylus Consulting, the firm headed by health-care consultant Mary Jane Hampton. It was submitted to the province in March and made public at the start of July.

The aim of the report was to determine whether virtual care helped patients and doctors avoid the need for in-person visits, thereby avoiding contact and possible transmission of the coronavirus.

To that end, the report's authors concluded it was an effective strategy, but the findings also provide some insight into a service that is likely to remain in use, in some form or fashion, post-pandemic.

This spring, the province launched a virtual care pilot program for people who do not have a family doctor or nurse practitioner. At that time, Health Minister Zach Churchill had already seen the consultants' report, and told CBC it made clear that virtual care is necessary.

But the government is still in talks with Doctors Nova Scotia over the details of a permanent program.

After several extensions, the virtual care fee codes for doctors are now set to expire March 31, 2022.

A spokesperson for the Department of Health and Wellness said an evaluation will be completed before the fee codes expire, and the findings of the consultants' report will be considered.

Doctors likely under-reported virtual visits

In a survey conducted by the provincial health authority, doctors said they used virtual care for 80 per cent or more of their appointments at the height of the COVID-19 lockdowns in 2020, but that number does not match up with MSI billing data.

Between March 1 and Dec. 31, 2020, only 18.5 per cent of physician services were billed as virtual care, the report says.

The report authors said they believe the tally of physician services is reliable, and the proportion of virtual care was under-reported.

Dr. Heather Johnson, president of Doctors Nova Scotia, said she does not understand the discrepancy. 

"That's a piece of the puzzle that's missing right now," she said.

She said she would need to see the raw data to come up with an answer, and gaining access to that "is a conversation we'd like to have with our other partners."

Virtual care satisfaction, by the numbers

Patient satisfaction was measured using survey responses collected by Canada Health Infoway, a federally funded non-profit that tracked health-care experiences across the country during COVID-19, and the Canadian Medical Health Association.

National survey results from Canada Health Infoway show patients preferred phone consultations (92 per cent were either somewhat or very satisfied) over video or messaging (83 per cent were somewhat or very satisfied).

The report notes that in physician responses to a Nova Scotia Health survey, a "dominant theme" was "a very high level of patient satisfaction and desire to continue offering this pathway to care."

The same survey found more than 80 per cent of physicians who responded were satisfied or very satisfied using virtual care because of improved efficiency of care, ease of billing, improved followup, greater scheduling flexibility and patient appreciation.

But doctors didn't find the service was perfect. With video calls, some raised issues with connectivity, infrastructure and ease of use. With phone calls, negative feedback included patient distraction.

Overall, more than 90 per cent of surveyed doctors said they want to continue using virtual care after the pandemic, as an option alongside in-person visits. 

Those results match up with Johnson's experience.

"I don't think most of us went to medical school to talk on the phone or on Zoom all day, but certainly as a way to communicate with patients it's a very good tool," she said.

Similarly, patients seem to want virtual care as an option, not an imperative. The data from Canada Health Infoway shows more than half of patients who were satisfied with virtual care still wanted their next visit to be in person.

A tool for doctor recruitment

Johnson said if Nova Scotia creates a virtual care model that competes with those of other provinces, it could be an effective recruitment tool.

"Most provinces are going to continue with some form of virtual care and what that looks like will probably evolve over the next six months," she said.

"[It could be] something to be able to say to new graduates, who are very tech-savvy … 'we have this platform for virtual care.'"

Further study needed

The report authors suggest further study in a few areas, including an apparent disparity in the use of virtual care between rural and urban Nova Scotia. Proportionally, virtual care was less common in rural settings than in urban areas.

Johnson said she thinks virtual care should be continuously studied to look for ways to improve it, but she does not think it should hold up the implementation of a permanent program. Any program should be adaptable to allow for new information and new technology to be introduced, she said.