JMIR Publications

ABSTRACT

Background:

The COVID-19 pandemic catalyzed a significant uptake in virtual care across health systems. However, the rapid shift left unanswered concerns around the impact of virtual care on quality, particularly in primary care, and whether it was appropriate and effective. Moving forward, providers require guidance on how best to use virtual care to support high quality primary care.

Objective:

To identify and summarize clinical studies and systematic reviews comparing virtual care versus traditional in-person care in primary care by reviewing the literature across key clinical functions of primary care.

Methods:

We conducted a systematic literature search using Embase, MEDLINE, PsycInfo, Emcare, Cochrane EBM Reviews databases, and using well-known websites to search for additional systematic reviews. The Preferred Reporting Items for systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidance was followed.

Results:

219 included publications reported on 142 primary studies and 28 systematic reviews. Studies were grouped into categories including triage, medical assessment and treatment of particular conditions, rehabilitation, and counselling. Studies suggested that many primary care functions could appropriately be conducted virtually. Virtual triage is clinically appropriate and leads to fewer in-person visits when conducted by doctors or nurse practitioners compared to nurses, but overall impact on efficiency was unclear. Most studies found that virtual care was more convenient for many patients and provided care equivalent to in-person care for a range of conditions. Studies comparing appropriate antibiotic prescription between virtual and in-person care found variable impact by clinical condition. Virtual rehabilitation was comparable in most cases and counseling virtually was found to be equally effective as in-person.

Conclusions:

Virtual care is safe and appropriate for triage, equivalent for counseling, and some types of rehabilitation, but further studies are needed to determine outcomes for management of different medical conditions in primary care. Virtual care needs to be adapted to a new set of patient and provider workflows to demonstrate positive impacts on experience, outcomes, and costs of care.