By Dr. Peter Selby, guest columnist on July 10, 2021.
As the second year of the pandemic is now well underway, it’s clear COVID-19 has altered our day-to-day lives, perhaps no more acutely than how Canadians deliver and receive health care. While stay at home orders have recently been lifted in Ontario, we cannot make light of the ways technology has helped us bridge gaps, create connections and deliver essential services to Canadians throughout the pandemic. This is certainly the case when we consider the rapid adoption of virtual health care tools and services in Canada.
The onset of the pandemic caused a spike in the adoption of virtual care. In fact, a survey by Canada Health Infoway found that as of April 2021, 52 per cent of patient-reported visits with their family doctor were virtual. While these numbers have since dropped to 38 per cent of visits, this is still more than double pre-pandemic data, which showed that only 10-20 per cent of visits were virtual. While there will always be instances where in-person care cannot be substituted with virtual visits, my hope is that as prescribers, pharmacists and patients continue to discover the benefits of virtual care, the adoption of virtual care tools and services will continue to grow.
The benefits of virtual care are numerous. The most important might be that virtual care offers patients convenience. Before the changes brought on by the pandemic, patients would have to spend time traveling to and from a hospital, clinic or other facility to meet with a doctor. Surpassing just primary care, virtual care also facilitates increased access to care from specialists whose offices patients might otherwise be too far of a distance from for some to conveniently access. In many instances, there is also an economic impact, as patients often need to request unpaid time off from their employers. This can create an additional hurdle to receiving the care they need. Virtual visits can offer a solution to this problem by empowering patients to connect with their doctors from the comfort of their own homes, or even during their break while at work.
The benefits of virtual care and the digital health tools that support patient care reach far beyond convenience for patients. Virtual care can also help address the siloed structure of our health care system. For instance, leveraging an integrated e-prescribing service like PrescribeIT, which seamlessly integrates with a doctor’s electronic medical record (EMR), enables doctors to transmit a prescription electronically to pharmacists. By taking fax machines and paper prescriptions out of the equation, PrescribeIT strengthens communication between doctors and pharmacists while also diminishing the risk of transcription errors, or losses or forgeries of prescriptions.
The accurate transcription of doctor-prescribed medications is a crucial component of patient safety, especially when it comes to controlled substances like opioids. This has never been more important, given the COVID-19 pandemic has engendered an increase in opioid-related overdoses across the country. According to data from Public Health Ontario and the BC Coroners Service, an unprecedented spike in opioid overdoses is occurring in Canada during the ongoing COVID-19 pandemic, with a 25 per cent increase in Ontario and a 39 per cent increase in British Columbia.
While illicit opioid use is certainly one of the main causes for this ongoing crisis, we cannot ignore the role that prescribed opioids play.
According to Canada Health Infoway, 37 per cent of patients admitted to the Centre for Addiction and Mental Health reported receiving opioids solely from doctor’s prescriptions and an estimated two in five doctors are never notified of a patient’s drug misuse, or even notified after the patient picks up the prescription. Digital health tools like PrescribeIT can act as a solution to strengthen the lines of communication. PrescribeIT’s Rx Status feature, which indicates when prescriptions are dispensed and when they are cancelled, notifies doctors of their patients’ decisions in relation to prescriptions and medication management. Given the varied circumstances of patients, this is an extremely valuable feature for improving patient safety.
For patients who rely on prescribed opioids for pain management, access to a safe supply is integral to their day-to-day lives. However, due to the stigma that surrounds opioid use, many patients who would benefit from opioids are also struggling to receive prescriptions from their doctors. Factors such as prescription fraud and misuse can further discourage doctors from prescribing opioids to their patients.
While there is of course no catchall solution to solving the opioid crisis, e-prescribing can certainly help. It can ensure patients suffering from chronic pain, for instance, don’t get left behind. Digital health tools like PrescribeIT facilitate a level of safety in prescribing opioids by allowing prescribers to keep track of dose adjustments, maintenance and errors in dosage through EMR integration, all of which translate into reduced risk for patients.
During the ongoing pandemic, but also as we look beyond it, it is clear that as doctors, we must adapt to best serve the needs of Canadians.
While there is still much work to be done to make virtual health services more accessible and easier to integrate for health care practitioners, I have no doubt that digital solutions like e-prescribing are the way of the future and will remain important for Canadians in a post-pandemic world. How can we make this future a reality? It is imperative that we encourage education around the benefits of modernizing our health care system with virtual health tools.
Identifying the right decision makers to advocate for these changes is also the best way forward for Canadian health care practitioners and patients alike, to rectify the lack of access to digital health tools. The pandemic has certainly steepened our health care system’s biggest hurdles and while there is no immediate antidote for this, I am hopeful that with the continued adoption of and innovations surrounding virtual health tools, we are on the road to recovery in more ways than one.
Dr. Peter Selby is a senior medical consultant and a clinical scientist at Toronto’s Centre for Addiction and Mental Health and a professor of Family and Community Medicine and Psychiatry and Public Health at the University of Toronto. His research focuses on innovative methods to scale up interventions for health behaviour using technology.