Abstract
Background
The changes in outpatient care delivery during the COVID-19 pandemic represented a natural experiment which allows us to compare outcomes and evaluate the impact of physician-patient continuity after different types of outpatient encounters.
Methods
Retrospective cohort study using data from 5 linked healthcare databases in Alberta to capture all healthcare encounters (virtual or in-person) for 3.84 million community-dwelling adults between March 1, 2019 and February 28, 2023.
Results
The proportion of adults having at least one outpatient encounter with a physician per annum was relatively stable between 2019 and 2023 (94.1–93.4%), although approximately half of the encounters were virtual during the pandemic. Patients having outpatient encounters (virtual or in-person) with unfamiliar physicians were younger and healthier (had fewer comorbidities, were less likely to be taking medications, and had less frequent healthcare contacts in the prior year), but outpatient encounters with an unfamiliar physician were associated with more ED visits, hospitalizations, or other outpatient encounters in the subsequent 7 days compared to outpatient encounters with a familiar physician. The increased incidences were similar early and late in the pandemic and whether outpatient encounters were virtual (40%, 77%, and 21% increased hazards in the first 18 months of the pandemic and 28%, 71%, and 20% in the last 18 months) or in-person (40%, 143%, and 26% in the first 18 months of the pandemic and 34%, 131%, and 24% in the last 18 months).
Conclusions
Outpatient encounters with unfamiliar physicians were associated with higher subsequent healthcare resource use than encounters with familiar physicians both early and late in the pandemic and whether they were virtual or in-person. Continuity of care in the outpatient setting is important even during a pandemic, both during the emergent and the stable phases of the pandemic, and whether encounters are virtual or in-person.