The COVID-19 pandemic has magnified the existing shortcomings of Canada’s provincial health care systems. In addition to an ongoing lack of capacity, the cumulative pandemic-related surgical backlog exceeded 257,000 surgeries in Ontario alone as of April 19. These delays likely led to increased deaths in the province, especially in those under 45 years of age. With similar patterns to be expected across the country, reforms are clearly needed to address the structural weaknesses in our health care systems.
One positive to come out of the crisis, though, has been the liberalization of telemedicine, due in part to the contagious nature of the disease. Outside of COVID-19, telemedicine is particularly important in remote areas, where patients may otherwise have to travel long distances to see a physician. This can deter them from seeking treatment or even make it impossible for them to do so if their condition is severe.
By mid-April 2020, Canadian emergency department volumes were half of what they had been a year earlier. Some of this ER avoidance undoubtedly led to increased disease and complications in individuals who should have sought treatment. Yet according to a recent CMAJ study, reductions in certain common non-emergency complaints did not result in worse patient outcomes. What this points to is potential overuse of emergency departments before the pandemic, and telemedicine stepping into the breach. As the study points out, telemedicine “may facilitate safe delivery of care outside the emergency department for certain conditions or may be used as part of a pre-emergency department triage strategy.”
People of low socioeconomic status have been shown to use emergency departments more than others. So in addition to improving access for rural and remote patients, the use of telemedicine is reducing ER reliance and likely increasing access to health services for people of low socioeconomic status—a true win-win.
Although adopted as emergency measures by the provinces, the current liberalization of telemedicine should be made permanent, something a number of provinces have discussed, and Alberta has already committed to doing. Canadians deserve improved access to general practitioners and specialists without having to languish on waiting lists, and greater use of telemedicine is one way to help make that happen.