By Krista Kaminski and Barbara Greenwood Dufour

Virtual care is quickly transforming the Canadian health care system. Virtual care can be defined as any interaction between patients and care providers that occurs remotely, using any form of communication or information technology, and that aims to facilitate or improve patient care. Even before the COVID-19 pandemic, Canada’s experience and interest in virtual care had been growing, but the pandemic accelerated the adoption of its use.

For most of us, our first experiences with virtual care happened during the pandemic when health care providers needed to quickly come up with alternative solutions to in-person care. According to an early analysis of Canada’s pandemic response by Health Canada however, “while change was forced upon us by the pandemic it was, in many cases, long overdue.” Virtual care has the potential to improve health care by increasing access to health care and by making health care more convenient for patients.

Now that some health care decision makers have had a few (albeit very brief) moments to catch their breath, they have asked CADTH — an independent agency that finds, assesses, and summarizes the research on drugs, medical devices, tests, and procedures — what the evidence says on virtual care. With in-person care resuming, health care providers want to know which services they should continue to offer virtually, and which services are best offered in person.

CADTH has published many reports on various virtual care topics. In one recent report, CADTH searched for and summarized recent evidence-based guidelines on the appropriate use of virtual care. CADTH found five guidelines, three of which were developed in the context of COVID-19 after the demand for and use of virtual care had increased. The guidelines developed before the pandemic include one guideline on the use of remote telecommunications in stroke care and one guideline, from the World Health Organization (WHO), on digital interventions for all areas of health. The guidelines developed during the pandemic include two on virtual care in rheumatology and one on telehealth for oncology.

A recurring theme among all the guidelines is that virtual care should be a complement to, not a substitute for, in-person care. Further, they recommend that virtual care should be considered only when adequate resources and personnel are available and patient privacy can be protected. Multiple guidelines note that it’s not a one-size-fits all approach when using virtual health care with patients.

The guidelines developed during the pandemic reflect the new experiences and insights gained during that time — such as the recommendation that teleconsultation be used for rheumatology patients who must adhere to social distancing restrictions, or the guidance that rheumatologists use telemedicine for patient consultations during medication changes when normal health services are disrupted. One of these guidelines suggests virtual modes as a way to bring medical care to people who are home-bound or those who live in remote areas or underserved communities, which could benefit patient care outside of a pandemic.

For various reasons, some patients prefer not to use virtual care. There may barriers or factors that pose challenges to its use, such as issues with internet access, technical support, and infrastructure.

Users of these guidelines should keep in mind that the quality of evidence they are based on, if reported, is generally low, with consensus-based recommendations made when evidence was lacking. In addition, many of the recommendations might not translate well into Canadian clinical practice given that only 1 of the 5 guidelines is Canadian.

Future guidelines on virtual care that are supported by high-quality evidence are needed. As the research on virtual health care is rapidly evolving, living guidelines (guidelines that are updated as soon as new evidence becomes available) may be useful to decision makers seeking continued direction when using this form of care. In fact, the WHO proposed updating its guidelines as a living document.

One thing is for sure — if virtual care continues to be seen as providing increased convenience, flexibility, and time and cost-savings, patients and health care providers will continue to be interested in its use. CADTH will continue to support health care decision makers by summarizing future evidence on virtual care.

The CADTH report on virtual care guidelines is freely available at cadth.ca/virtual-care-use-primary-care-or-specialty-care-settings. To see all of CADTH’s work in this space, or to find additional reports on telehealth and telemedicine, visit cadth.ca/digital-health. To learn more about CADTH, visit our website, follow us on Twitter @CADTH_ACMTS, or speak to a Liaison Officer in your region. 

Krista Kaminski is an Implementation Support Officer at CADTH. Barbara Greenwood Dufour is a Knowledge Mobilization Officer at CADTH.