how private virtual care is growing opportunities for health-care providers and canadian patients

dr. hance clarke, pain medicine physician at centenary pain clinic in torontoand past president of the canadian pain society,knows the value of virtual care for patients, especially for those who would otherwise travel hours in discomfort for an in-person appointment with him.

“virtual care is so much more patient-centric than our care model was before. we talk a lot about patient-centricity. we talk a lot about making things accessible and easier for patients. and there’s no doubt virtual care has done that,” he says. while he meets patients for a physical exam at first, much of the follow-up is done virtually, offering convenience and time-savings.

“i would say 60 per cent of my practice, maybe even 70, in the pain space is virtual now. so how can i really feel comfortable about having a patient drive three hours to come and see me for a 20-minute appointment? something which is a follow-up to your medications, a follow-up to what plan we have set up and where we’re going to go.”

dr. clarke and colleagues published a study in 2021 on user engagement for a pain management app for patients with chronic painto assess its impact on those in both rural and urban locations. in the urban setting, 25 to 30 per cent of participants engaged with the app that offered symptom questionnaires and daily reflection, while rural patient engagement was 60 per cent. self-monitoring of symptoms is a key component of most pain self-management programs.

“that was a clear message that, ‘hey, if you want to deliver a broader scope of care, you want to get to the 80 per cent of our country that is still living remotely, there has to be some remote access.’ and then covid flipped it on its head and virtual care became possible.”

virtual care helps off-set physician ‘overwhelm’

dr. clarke also talks about the benefit of virtual care for health-care providers who acutely feel the physical and mental demands of the job in a health-care system that is stretched thin.

“one place physicians land often is in overwhelm. you have too many things to do and not enough time in a day to do these things. when you incorporate virtual care, it does enable you to have interactions with individuals that i think are mutually beneficial. one, because they feel grateful that you’re reaching out to them, you’re calling them, you’re jumping on a screen with them, and they’re in the comfort of their home and they can get the advice without coming to travel to you,” he says, while physicians can offer their services in an efficient and kind way, developing what often become more satisfying patient-physician relationships.

telehealth can be a way to cement the continuity of care and “longitudinal care models” that improve health outcomes.

a virtual visit also solves the problem of missing appointments because people are too ill to travel. “if people couldn’t come in or they weren’t feeling well, you wouldn’t see that person for two or three months, but you’d still be back at where you were six months ago because you never had an interaction. so this is why i continue to say it is so much more patient-centric virtual care.”

both patients and health-care providers can benefit from the virtual care that has become part of public health services.

services of private telehealth improve access

now with the rise of private virtual care companies like maple, raven and rocky, telehealth is expanding and improving its offerings. these companies are not for emergency care, but they can help off-set the numbers of people who end up going to emergency because they don’t have a family doctor or face long waits to see a practitioner and have nowhere else to go for help. they offer access to expert providers for an ongoing monthly fee, along with the varied costs of treatments, that many people are more than willing to pay.

as well, with continued care, those people receive that continuity and consistency of follow-up that walk-in clinics can’t deliver.

as dr. clarke points out, “for years, no canadian would ever think about paying for their health care. it just wasn’t something they would think about. and no canadian would even be open to the fact that they would need to pay for something. but the fact is, the public health-care system can only support what it can support.”

the population is growing and aging, which only puts more pressure on resources. in ontario alone, research by the university of toronto’s dalla lana school of public health, projects that millions more ontarians will be living with chronic illness in the next 20 years with sobering implications for the provincial health-care system.

what will this mean for health-care providers, let alone patients?

more flexibility in professional life

private telehealth can offer practitioners the opportunity for more flexibility in their professional lives, whether it’s working from a home office or combining their public clinic time with working for a private virtual clinic. career opportunities are growing.

“i think it really impacts which specialty you’re potentially going to choose,” dr. clarke says of the doors opening to medical students. “if you’re someone who likes to use your hands and do procedures and things like that, i think you gravitate to many specialties that won’t be virtual very, very soon, so surgery, any type of interventional cardiology, gastroenterology, things where you need to scope, put needles into things and put tubes into holes and all these types of things.”

however, if you are someone who wants to be an expert in an area that is very behavioural, very mental health or part of a multidisciplinary team, he adds, “you can certainly make a career by not needing to have a huge institutional overhead or whatever else is needed, and potentially you could start up a predominantly virtual practice. i think there will need to be clear rules and regulations about these things that will be evolving because we’re really at the doorstep of this framework.”

chronic pain, for example, comes with behavioural comorbidities that can lead to anxiety and depression, and need to be addressed by pain health-care teams.

in recent randomized controlled trials, dr. clarke’s team is now looking at the data in the post-surgical setting, where it was assumed that patients would much prefer in-person visits.

“but what we have found is the feedback is quite the opposite,” he says of the convenience of meeting with your pain care team from the comfort of home.

evolving medical practice changes provider roles

he also sees the opportunities that artificial intelligence (ai) presents and how it will change medical practice.

“i think that’s going to explode. so we’ve created an ai psychologist on our end. and patients are already saying, ‘well, i can log in and talk to solace, who is our ai psychological individual, anytime i want, as long as i want.’ they build relationships with these individuals. there’s virtual care, but wait till we get into that ai tech care delivery space as well.”

safety testing is underway for solace, says dr. clarke, noting the need for guardrails and protocols. the ai agent has been studied by toronto researchers for use in chronic pain treatment,with more research to come.

“one of the things i think where you will have to have strict guidelines are show us your safety framework, show us what those guardrails are so that patients can’t do things that we don’t want them to do by using your tools.”

as telehealth and ai tools evolve, roles for health-care providers will also change, requiring learning and adaptability for what’s to come.