Hybrid Telehealth Tied to Fewer ED Visits


While virtual care filled a gap in patient care, it also raised concerns about the balance between continuity of care and access to timely or convenient care. The impact of these virtual services on subsequent healthcare use, particularly in comparison to traditional in-person primary care, remained under-researched and somewhat controversial, with studies showing mixed results regarding their effect on healthcare utilization and costs.


To address this knowledge gap, a study using population-based administrative data from Ontario, Canada, was conducted. The study compared subsequent healthcare use after a virtual visit with a patient’s own family physician versus an outside family physician. The underlying hypothesis was that virtual primary care delivered outside of an existing patient-physician relationship would be associated with increased emergency department use.


Patients who had virtual visits with outside physicians were more likely to visit the emergency department within 7 days compared to those who consulted their own physicians. This increased risk was particularly evident in the first two days following the virtual visit. Additionally, patients with outside-physician virtual encounters had higher rates of repeat virtual or in-person family physician visits, though these were less commonly with their own physician. Subgroup and sensitivity analyses further supported these findings. 


The association with high-acuity emergency department visits might not solely be explained by healthcare-seeking behavior, indicating potential confounding factors. Moreover, the findings may not be fully applicable in settings where financial disincentives for outside group care exist, as Ontario residents do not pay premiums or copayments for any visit type included in this study.

VBC implications

This finding emphasizes the importance of continuity of care and the integration of virtual care within existing patient-provider relationships in VBC models. It suggests that fostering these ongoing relationships could lead to improved patient outcomes and more efficient healthcare resource utilization, aligning closely with the principles of VBC.


Lapointe-Shaw L, Salahub C, Austin PC, Bai L, Bhatia RS, Bird C, Glazier RH, Hedden L, Ivers NM, Martin D, Shuldiner J. Virtual Visits With Own Family Physician vs Outside Family Physician and Emergency Department Use. JAMA Network Open. 2023 Dec 1;6(12):e2349452-.