The final report from Ontario’s independent COVID-19 Science Advisory Table says the province must better integrate primary care into the health care system.Chris Young/The Canadian Press
Ontario’s independent COVID-19 Science Advisory Table highlights the work of primary-care practitioners during the pandemic in its final report, and warns of challenges ahead as treating patients with the virus moves from intensive-care units to family doctors’ offices.
The report highlights long-standing challenges in Ontario that pose a threat, not just to the routine functioning of the health system but to future pandemic preparedness.
The province needs more primary-care practitioners to meet the growing needs of patients, says the report released on Monday. The province must also better integrate primary care into the health care system, it says, noting that there is little infrastructure in place that would allow policy-makers to share information with family doctors, trusted sources for their patients.
The report contains three related briefs: what Ontario family doctors did during the first two years of the pandemic; the factors that affected their capacity to deliver care; and the lessons policy-makers should heed to strengthen primary care as the pandemic evolves. Danielle Martin, a senior author on the report, provided expertise on primary care to the science table.
“The conversation can’t just be about hospital beds or emergency departments any more,” said Dr. Martin, the chair of family and community medicine at the University of Toronto. “We have to shore up the community.”
Ontario’s independent science table is wrapping up its work after two years of providing public surveillance reports and advice to Premier Doug Ford’s government, some of which clashed with his administration’s priorities.
The provincial government dissolved the advisory group in August and said its work would continue under the auspices of Public Health Ontario, a government agency. Applications for spots on the new committee closed Friday.
Fahad Razak, the outgoing scientific director of the old table, said the group chose the subject of primary care for its last report because of the pandemic’s severe impact on the health system’s ability to care for both COVID patients and those grappling with other illnesses.
“Our hope is that through any potential future waves of this pandemic, that high-quality primary care is a centrepiece of the response,” Dr. Razak said.
The new report, which references recent research based on Ontario Health Insurance Plan (OHIP) billing data, confirmed the total number of primary-care visits plunged at the start of the pandemic. By the fall of 2020, however, overall total visit volume had risen back to prepandemic levels in Ontario.
Many of those visits during the pandemic were done by phone or video. Patients of Ontario doctors who conducted the highest proportion of their visits virtually between February and October of 2021 used the emergency department least during that period, according to new research highlighted in the report.
That finding, contained in a preprint study that has yet to be peer-reviewed, undercut a widespread theory that, during the worst waves of COVID, Ontario’s emergency departments filled up with patients whose family physicians did not see them in person.
At the same time as their daily practice volumes returned to normal, 48 per cent of Ontario family doctors spent some of their time working at COVID-19 testing or vaccination centres in fiscal year 2021, according to the report.
However, the science table report also concluded that public health failed to take full advantage of the primary-care system during the pandemic, especially when it came to contact tracing and offering COVID-19 vaccines in family doctors’ offices. Overall, only 4 per cent of first doses and 3 per cent of second doses were administered in primary care offices in Ontario.
“People’s confidence in the vaccine often comes down to trust, and family doctors have these trusting relationships with people,” said Tara Kiran, another author of the new report and a family physician and researcher at St. Michael’s Hospital, part of Unity Health Toronto.
The report recommends making COVID vaccines widely available in family doctors’ primary-care practices, a move it says likely would encourage more people to get their booster shots. But Ontario needs to develop the infrastructure to support such a community-based initiative. Health care leaders responsible for preparing messages targeted at primary-care practitioners do not have a centralized list of family doctors’ e-mail addresses.
Primary-care relationships are also not available to all Ontarians. An estimated 1.8 million didn’t have a regular primary care provider as of March of 2020, according to research the report underscored, and another 1.7 million had a doctor who was 65 or older as of 2019.
Now, family doctors are dealing with the fallout of delayed tests and surgeries, said Dr. Martin, who sees patients three days a week in her primary care practice at Toronto’s Women’s College Hospital.
“When you keep the resources the same and you increase the demand, there will be trade-offs,” Dr. Martin said. “We have understood that around cancelled surgeries, but not in the primary-care office.”