By Jennifer Stranges

In semi-retirement, 65-year-old Norma keeps busy with a roster of hobbies including choir, Barbershop quartet and Scottish country dancing. But when COVID-19 shut down the province, Norma, a patient at St. Joseph’s Health Centre’s family health team, had no option but to slow down.

During this time, Norma, who lives with bipolar disorder, experienced a decline in her mental health. And if it were not for virtual health care – which was swiftly made available in Ontario due to the pandemic – Norma’s family physician may not have had the chance to catch the signs and adjust her treatment.

“The virtual visits were fantastic because we were in touch on the phone on a weekly basis,” said Norma of her interactions with her family physician, Dr. Navika Limaye. “I would keep track of changes in how I was feeling and was able to report back to her.”

Dr. Limaye, who is the chief of family medicine at St. Joseph’s, said the weekly check-ins would not have been possible in-person, and the frequency of their phone appointments helped her monitor Norma’s symptoms.

“When someone with bipolar disorder decompensates, it takes a lot to get them back on track. They can end up in a crisis unit at the hospital. The phone appointments allowed us to catch the signs and prevent the decompensation.”

Norma is feeling great these days, and is crocheting, reading and having meaningful conversations with friends. She looks forward to getting back to her routine and hobbies once the pandemic is contained, but hopes virtual care is here to stay.

“I appreciated those phone calls so much.”

As COVID-19 forced non-emergency clinics and medical services to close across the country, many health care providers went online to support their patients. A recent poll by the Canadian Medical Association (CMA) showed Canadians would like to see virtual care options continued after the COVID-19 crisis subsides. They also want to see it improved and expanded. Nearly 40 per cent of Canadians said moving forward, they would like their first point of contact with a doctor to be a virtual visit rather than in-person

One major draw for virtual care is that it provides patients with flexibility, so they are not planning their day around their medical appointment. In the CMA report, 60 per cent of Canadians indicated a virtual visit as a first point of contact with a doctor would improve convenience for patients.

“It’s a great option for patients so they don’t have to go through angst of organizing child care or taking time off work to go to their doctor’s office,” says Dr. Limaye.   “It’s also great for patients with circumstances that could make it difficult to come to the doctor’s office.”

Norma said it takes her nearly two hours to travel to the hospital for an appointment, and she appreciated the convenience of her telephone appointments. The possibility of being late for in-person appointments has previously brought her a great deal of stress, she added, and avoiding stress during such a significant time in her care was a relief.

While video appointments are an innovative solution to care during this pandemic, telephone care is not new to family physicians, said Dr. Limaye. She noted that such calls were usually squeezed between in-person appointments, or done at the end of a doctor’s work day or on their lunch.

But the launch of virtual care has made telephone care more structured and measurable, and along with video appointments, has allowed care providers the opportunity to check in on their patients more frequently and to not have their schedules impacted by the nuances of in-person visits such as no-shows, late shows or patients forgetting to bring their medications to the appointment. Telephone appointments are a great virtual visit option for patients who may not be tech-savvy and have difficulty managing video call programs.

Dr. Limaye says that in-person care is still very important, and different care options are appropriate at different times.

“Sometimes a phone call is adequate, but sometimes it isn’t,” she says.  She believes investment in virtual health care will have a domino effect on the health care system.

“A little bit of investment in virtual care can have a huge pay off in terms of reducing hospital admissions to emergency departments or crisis units.”

Jennifer Stranges is a communications advisor at Unity Health Toronto.