Project 460276

The COVID-19 pandemic triggered widespread changes in the delivery of pediatric primary care. Many primary care practices functioned at reduced capacity or switched to mainly virtual modes of care delivery. Families reported difficulty accessing timely primary care when their child was sick and barriers to receiving important preventive care, including immunizations and developmental surveillance. Further, emergency departments reported difficulties managing the many children who might otherwise be seen in pediatric primary care. Leading healthcare organizations, providers and policy-makers are challenged to promote the right balance of in-person and virtual care while maintaining high quality, timely, and accessible care. There is little existing evidence on who should be seen in-person and for what conditions while considering the convenience and other potential benefits of virtual care. Our study aims to understand the impact of the pandemic on the performance of the primary care system with the shift from in-person to virtual care. We will use data from Ontario's children to measure the extent to which virtual vs. in-person primary care delivery is associated with 1) care accessibility, as measured by after-hours access and inappropriate use of emergency departments for low urgency concerns, 2) population health outcomes, including the timely identification of developmental and health concerns, and 3) quality, safety and patient centredness of care. We will specifically examine how these outcomes vary by primary care model (e.g., fee-for-service, comprehensive care models) and in those at risk for barriers to care including refugees, those living in rural areas, and families with high social risk (teenage mothers, parental mental illness, low-income). This research will inform guidance on how best to incorporate virtual care in pediatric primary care for Canada's 7 million children and adolescents while ensuring it is high quality, accessible, and equitable.