UBC emergency medicine researchers study concordance between virtual physician advice and subsequent health service utilization in BC

A new study found that most callers to a virtual physician triage service in BC seek the recommended health service. However, callers didn’t always use the health service advised by virtual physicians, and this varied by the type and urgency of advice provided, and whether or not the caller lived in an urban or rural region.

The study was published in BMC Health Services Research. It looked at callers to British Columbia’s 8-1-1 service who were referred to a virtual physician and advised to seek additional health services.

“People aren’t always able to follow health recommendations,” said Ross Duncan, lead author, UBC Department of Emergency Medicine adjunct professor and Learning Health Systems Data Analyst, BC SUPPORT Unit, Health Research BC. “That’s why we wanted to understand the barriers to following up on advice from virtual physicians.”

The study found that 70 percent of callers to a virtual physician triage service who were advised to go to an emergency department did so within 48 hours. The study also showed that significantly fewer callers in rural areas visited the emergency department when advised. This also suggests the need for targeted assessment of access to emergency care, particularly with regard to distance and difficulty travelling from home to the emergency department. 

Additionally, less than half of those across BC who were advised to seek follow-up care with a physician in the community did so within seven days. This was most evident in urban settings, where access to primary care is in decline. When people don’t have regular access to primary care, they often delay care until symptoms worsen and subsequently require emergency care.

“In rural regions, people may experience challenges accessing emergency departments. In urban areas, there is evidence of a lack of access to family physicians. Knowing these barriers is a vital step in our work to help people get the care they need.” added Duncan.

This study builds on a recent publication in CMAJ Open, which found the addition of virtual physicians to British Columbia’s existing health information telephone service safely directs only the most urgent callers to emergency departments, avoiding unnecessary person visits to provincial emergency departments during the pandemic.

British Columbia’s 8-1-1 telephone service, overseen by HealthLink BC, was established in 2008 to connect callers with health service navigators for health information, and nurses and allied health professionals for health care advice ranging from home management to immediate ED attendance.

Due to an increase in the volume and complexity of calls to 8-1-1 as a result of the COVID-19 pandemic, HealthLink BC, in collaboration with the Digital Emergency Medicine Unit in the Department of Emergency Medicine and the BC Emergency Medicine Network, added a service for consultation with a virtual physician in April 2020. The service, called HealthLink BC Emergency iDoctors in Assistance (HEiDi), allows 8-1-1 nurses to refer callers with urgent concerns for telephone or video assessment by off-site emergency physicians and family physicians, safely diverting patients from unnecessarily going to the ED.

Additional contributors include fellow UBC Department of Emergency Medicine researchers Kurtis Stewart, Dr. Frank Scheuermeyer, Dr. Riyad Abu-Laban, Dr. Kendall Ho and Dr. Jim Christenson, in addition to partners from the UBC School of Population and Public Health, HealthLink BC, Health Research BC and the BC Emergency Medicine Network.