Transformative virtual health care

Transformative virtual health care
Delivering safe care during the pandemic resulted in a quick, burgeoning shift to virtual care. For the first time, primary care was able to offer expanded online access, allowing many patients to remain at home, avoiding lengthy travel and wait times. 

Appointments by phone, telehealth, and virtual platforms meant care could continue without lengthy disruptions, while lessening the risk of in-person COVID-19 transmission. It has also led to more on-demand care options and a revival of creative delivery solutions for outreach care. 

“Among all residents of Ontario (population 14.6 million), virtual care increased from 1.6% of total ambulatory visits in the second quarter of 2019 to 70.6% in the second quarter of 2020. The proportion of physicians who provided 1 or more virtual visits per year increased from 7.0% in the second quarter of 2019 to 85.9% in the second quarter of 2020. The proportion of Ontarians who had a virtual visit increased from 1.3% in 2019 to 29.2% in 2020,” according to Virtual care use before and during the COVID-19 pandemic: a repeated cross-sectional study.

Emerging app-based
primary health-care services 

The TELUS Health MyCare app is for Canadians who do not have access to a family physician or are in need of care outside of clinic hours. The app is marketed as a health service that “lets you see a doctor, mental health counsellor or dietitian from your phone, where and when it’s convenient for you.” 

In the United States, Amazon Care is another app that is gaining traction and is designed for families who want access to care and dedicated clinicians, with messaging about how to “build an ongoing relationship with your Care Team.” It is marketed as offering “access to a clinician seven days a week, 365 days a year. No more waiting rooms, no more travel time,” and includes on-demand visits, scheduled appointments, messaging for follow-up care and management of several chronic conditions including: asthma, anxiety, depression, hypertension, coronary artery disease, diabetes and other services. 

Amazon Care is also starting to include preventative care services: immunizations, screening, lifestyle and wellness advice, referrals and resources. For children and youth it offers well child exams, STI testing, birth control and other family planning, mental health supports and sport physicals. 

Innovative mobile outreach health care 

For those without access to technology, innovative ideas are resurfacing in the form of mobile health units—health-care delivery buses, vans, coaches, and travel teams. 

The Mobile York South Simcoe (MOBYSS) was introduced as Ontario’s first mobile mental health clinic. MOBYSS was created through collaboration with the Canadian Mental Health Association (CMHA) and Markham Stouffville Hospital.

MOBYSS helps provide adolescents with access to mental health and more preventive care services and was created “following community consultations regarding the region’s lack of mental health services for youth. The retrofitted MOBYSS RV brings services to young people, specifically targeting those aged 12 to 25. The 39-foot RV contains a private exam room, a curtained off space for one-on-one counselling and an open lounge. The bus travels to local high schools and community centres.” 

MOBYSS was inspired by The Alex model in Calgary, Alberta, another “doctor’s office on wheels” established as a non-profit combining health and social services with “integrated and accessible supports and thoughtful, comprehensive care…with a full complement of health, housing, and community programs, the Alex is a hub of supports and outreach services for people who are experiencing poverty, trauma, social isolation, or health challenges including addiction.”

In Northern Ontario there is an opportunity to expand the delivery of mobile preventative care which has proven effective based on the established model of mobile cancer Screen for Life Coach. The program continues to deliver accessible screening including breast imaging, cervical screening, colorectal kits, and resources about chronic health conditions to patients and families in remote, rural communities. 

Partnering with community and family outreach and support programs, including mobile nursing and social service teams or social housing programs, for example: Firefly, the Mobile Health Services Team at Norwest Community Health Centres in Thunder Bay, Canadian Mental Health Association mobile crisis teams, the Northwestern Health Unit Outreach Van, may also offer collaborative opportunities to deliver improved access to care where and when it’s needed most. 

The pandemic has transformed virtual health care and accelerated digital innovations. NOSM will leverage this emerging technology and further innovate models of education in Northern, Indigenous, Francophone, rural and remote medicine that lead to well-trained health-care practitioners who stay in the communities of
the North.

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