By Mary Giles
Photos by Bryan Gagnon

At the beginning of the COVID-19 pandemic, hospitals in Canada saw a sharp decrease in patients. Many who needed care may have stayed home out of fear of catching the virus. On the other hand, patients who were scheduled for non-urgent procedures or elective surgeries had their care postponed.

While the number of confirmed COVID-19 cases in Canada is climbing to almost 950,000, the number of preventable casualties from non-COVID-19 patients is more difficult to calculate.

Mehdi Ammi

Mehdi Ammi

Mehdi Ammi, a professor in the School of Public Policy and Administration, is a health economist and health policy researcher. He looks at the causal relationship between the organization and funding of health systems, access to high-quality, low-cost health care and population health.

Ammi’s research shows that women and lower-income Canadians had the highest unmet health-care needs before the pandemic. Things were beginning to stabilize since the early 2000s, especially in regard to equity. Health-care needs are unmet by personal choices or constraints, but also because of health care systems’ inadequacies.

“The same people are still missing out on health care in the pandemic,” says Ammi. “When early intervention appointments are delayed or cancelled, the opportunity to diagnose an early stage cancer is lost. Cancers are such that there is a clear indication of the evolution of the disease from stages 1 to 4. The trajectory of healing is based on an early stage of intervention. Patient recovery and even survival is affected when not treated early.”

Virtual Care and Regular Health Care Providers

Patients have seen changes in emergency room visits and home care. One of the biggest transformations was in remote health care.

“Before the pandemic, virtual care was not on physicians’ fee-code system,” says Ammi. “Telemedicine needed to be incorporated into the billing system. Now physicians can bill for virtual appointments. Changes in the health care systems usually take a decade, but changes were happening almost overnight with the pandemic.”

“Telemedicine has been a huge help for those with chronic conditions, even though more needs to be learned about whether quality of care has remained equivalent with such a drastic, unplanned change in care delivery,” says Ammi. “Patients now have access to virtual after-hours and weekend care. Those who are immunocompromised are concerned about contracting the virus, but they also need access to health services in person to manage their conditions.

“The other problem is access to telemedicine in the first place. Around 15 per cent of Canadians don’t have access to a family physician or primary care provider. This should be high on policy and political agendas since it directly impacts health outcomes.

“With no entry point, would-be patients without a family doctor might use the emergency department as a primary care gate. During the pandemic, those already missing out on access to the health care systems may be shut out further.”

Ammi says that during the pandemic, the unmet health-care needs of non-COVID-19 patients likely have grown. A report from the Canadian Institute for Health Information shows that 52 per cent of physician visits were online or by phone by April 2020. There was a 50 per cent drop in emergency department visits, including for concerns about cardiac events.

“The demand has been less,” says Ammi. “There is a reluctance to go in the waiting room, but the supply (from cancelled surgeries and appointments) is also less. It’s a difficult decision to take beds from non-COVID-19 patients to give to COVID-19 patients, but there has to be an equilibrium. Building hospital capacity takes time and new beds need to be staffed with trained health professionals.”

Unintended Consequences

While there was a drop in patients visiting physicians and emergency departments during the first wave of the pandemic, the full consequences of these drops are unknown. The Ottawa Hospital has a backlog of over 24,000 people waiting for breast cancer screening.

What was the outcome for patients who didn’t receive pacemakers, bypass or cancer surgeries or those with unmet diabetic or mental health needs?

“We don’t yet know the full effects of delays in acute care services on patients’ diagnoses, procedures, disease severity and outcomes,” says Ammi. “The spillover effects from the pandemic are likely to have lasting and far-reaching implications for the health care systems and the health and well-being of Canadians.”

Future of Health Care Services

“COVID-19 might be here for a long time,” says Ammi. “The vaccine roll-out has been slow and we don’t know how effective the immunization will be against emerging variants or how long immunity will last. What’s going to happen when we start reallocating resources back to non-COVID-19 patients?” The vaccine roll-out difficulties may be linked to the financial and structural transformation of public health systems that has been dramatic in the past.

“Although the health care systems have made tremendous changes in the last year, it doesn’t mean all the changes should stay. While virtual care has a place, especially for those with stable chronic conditions that can be managed without an in-person encounter, it can result in more unnecessary prescriptions and imaging. Virtual care is not a good substitute for in-person care across the board.

“Oncologists must make diagnoses announcements on Zoom to patients they’ve never met in person, possibly with family members near-by. The pandemic has forced us to make progress in health technology, but it doesn’t mean it should stay. Virtual appointments are just an extra tool in quality care.

“The main priority needs to be accessibility of care for all patients, COVID-19 and non-COVID-19. Why don’t all Canadians have a primary care provider and what can be done to improve access in an efficient and equitable manner? Increasing evidence on these matters to ultimately help improve the health of all Canadians is what inspires my research.”

Monday, March 22, 2021 in
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