Duplicates were removed and sources were screened for relevance (See Figure 1). Searches in PubMed Central, EMBASE, and Scopus generated a total of 1,396 results (See Table 1), which were pooled with items from the exploratory search. We refined the strategy for following searches to limit results to items published within the past 10 years which describe the use of patient-physician virtual visits for primary care in Canada. The first ten pages of results were screened for relevance, which generated 42 journal articles and grey literature items. Initially, we carried out exploratory searches in PubMed Central and Google using broad terms, such as “telehealth,” “virtual care,” “barriers,” and “challenges,” with Boolean connectors used to narrow the results.
38, 42 The literature search involved several phases. Our review involved two stages first, a literature search informed by the PRISMA Extension for Scoping Reviews, 40, 41 followed by a narrative synthesis using qualitative content analysis.
In order to better understand where policy shifts can promote integration of virtual healthcare delivery while mitigating potential unintended consequences of widespread adoption, we conducted a narrative scoping review 38, 39 aimed at identifying barriers to the adoption of virtual primary care in Canada.
34, 36, 37 It is unknown to what extent virtual care will be sustained as the threat from COVID-19 recedes, or how widespread adoption will impact existing health inequities. 11, 21- 23, 28- 33 Use of virtual care rose dramatically in the first six months of the pandemic, 11, 21, 23, 28- 30, 34, 35 but as restrictions eased, virtual visits declined. 5, 7, 23, 28 Provincial governments and health authorities across Canada instituted temporary regulatory changes to enable virtual care provision. The onset of the COVID-19 pandemic in 2020 and necessity of reducing viral transmission prompted an abrupt shift toward adoption of virtual care. 5, 13, 19 The same barriers could contribute to slow uptake of virtual care in Canada. 16, 19 There are also concerns about equitable access to virtual care by socially or economically marginalized populations, and about virtual services contributing to fragmentation of care. 19, 26, 27 They have identified a number of potential barriers to adoption, including: uncertainty over licensing requirements and legal liability 5, 16 risks to patient confidentiality and data security 5, 19, 26 lack of EHR system interoperability 5, 13, 16, 19 digital infrastructure limitations 16, 26 changes to physicians’ workflow and need for virtual care training 16, 26 cost to patients due to lack of virtual care insurance coverage 5, 19 patients’ low digital health literacy and lack of access to suitable communications devices or internet connectivity 3, 5, 13, 19 and preference for in-person services. 1, 2, 6, 15 International studies and reports have pointed out that adoption of virtual care involves a range of social and technical factors. 6, 9, 17, 21- 23ĭespite public interest in Canada in using virtual healthcare, and expansion of private sector virtual care services, 8- 10, 24, 25 integration in medical practices has been slow. 2, 6, 11, 12, 19, 20 Virtual care is appealing to the public, due to its convenience compared to in-person services. 2, 6, 11- 18 It is also seen as a way to meet growing demands on healthcare systems 1, 3, 6, 11- 13, 16 and potentially reduce healthcare costs. Virtual care in its various forms has been viewed as a tool for improving access to health services for people who face difficulties travelling to facilities for in-person care. 3, 7, 8 Virtual care may be provided by patients’ regular primary care physicians, or may be provided by private companies, or “virtual walk-in clinics,” where the patient has no prior relationship with the care provider. 6 Either method may include the use of Electronic Health Record (EHR) systems.
Synchronous methods, such as telephone or video-conferencing, allow the physicians and patients to communicate directly with each other, while in asynchronous methods, such as secure messaging, text, or e-mail, the physician uploads information to a platform which the patient can access. Specific technologies and approaches in virtual care vary. 1- 5 For simplicity, we refer to electronically mediated physician-patient consultations as virtual healthcare delivery, or virtual care. Use of information and communication technologies by physicians to provide patients with health services has been described using various terms, such as digital health, mobile health, telehealth, and telemedicine.
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