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Canada has been slow to implement virtual care relative to other countries. However, in recent years, the availability of on-demand, “walk-in” virtual clinics has increased, with the COVID-19 pandemic contributing to the increased demand and provision of virtual care nationwide. Although virtual care facilitates access to physicians while maintaining physical distancing, there are concerns regarding the continuity and quality of care as well as equitable access. There is a paucity of research documenting the availability of virtual care in Canada, thus hampering the efforts to evaluate the impacts of its relatively rapid emergence on the broader health care system and on individual health.
We conducted a national environmental scan to determine the availability and scope of virtual walk-in clinics, cataloging the services they offer and whether they are operating through public or private payment.
We developed a power term and implemented a structured Google search to identify relevant clinics. From each clinic meeting our inclusion criteria, we abstracted data on the payment model, region of operation, services offered, and continuity of care. We compared clinics operating under different payment models using Fisher exact tests.
We identified 18 virtual walk-in clinics. Of the 18 clinics, 10 (56%) provided some services under provincial public insurance, although 44% (8/18) operated on a fully private payment model while an additional 39% (7/18) charged patients out of pocket for some services. The most common supplemental services offered included dermatology (15/18, 83%), mental health services (14/18, 78%), and sexual health (11/18, 61%). Continuity, information sharing, or communication with the consumers’ existing primary care providers were mentioned by 22% (4/18) of the clinics.
Virtual walk-in clinics have proliferated; however, concerns about equitable access, continuity of care, and diversion of physician workforce within these models highlight the importance of supporting virtual care options within the context of longitudinal primary care. More research is needed to support quality virtual care and understand its effects on patient and provider experiences and the overall health system utilization and costs.
Canada has lagged behind other countries in its uptake of virtual care as an integrated component of the health care system [
The slow uptake prior to 2020 may be explained by multiple regulatory and physician compensation barriers, with few provinces providing a billing mechanism to physicians for virtual consultations [
In addition to community-based physicians adapting their brick-and-mortar practices to include virtual care provision, the new fee codes for virtual visits provide an opportunity for the development of on-demand, “walk-in” virtual clinics that provide low-acuity, low-complexity care disconnected from existing physician-patient relationships. Some of these services are funded through provincial health insurance plans while others charge patients or are funded by supplemental private insurance plans directly.
Concerns have been raised that these services encourage episodic care, potentially contributing to fragmentation and poor continuity [
Despite these concerns, there is no existing research that catalogs the availability of these clinics or the services they offer. We conducted a national environmental scan to determine the availability and scope of virtual walk-in clinics offering synchronous appointments and prescriptions without the requirement or expectation of a longitudinal physician-patient relationship. We cataloged the services advertised by these clinics and determined whether they operated through public or private payment.
We used a structured Google search to identify virtual walk-in clinics across Canada, as we assumed this as one of the primary means that prospective patients would use to identify, locate, research, or connect with these services. We conducted a preliminary search on March 15, 2020, and a secondary search on June 2, 2020, to update and verify our initial results.
We compiled a list of words related to virtual health care and general medical care, from which we developed groups of search terms. Each term consisted of 3 words, with the first being Canada, the second relating to virtual care, and the final relating to the physician or clinic.
We analyzed 18 search terms for their strength in identifying virtual clinics. This process involved entering each term into Google, tallying the number of relevant sites listed, and analyzing 10 result pages per search term. Following this, we organized terms based on their strength; of the 18 search terms analyzed, the 6 strongest terms were selected. These were then combined using Boolean operators to form the following final search term:
To be included, the identified clinics had to meet the following criteria: (1) be based in Canada; (2) have a practicing medical doctor capable of remotely prescribing medication (ensuring all the services included for data extraction functioned as complete alternatives to traditional walk-in clinics and family physician appointments); (3) provide virtual visits through synchronous communication of some form (ie, phone, video, SMS text messaging); and (4) have English language websites. We excluded clinics that provided virtual services only to patients already enrolled with an associated brick-and-mortar clinic and those not providing primary care (eg, cancer clinics). Although such clinics provide care through virtual media, we felt their dependence on a preexisting physician-patient relationship and focus on specialist care largely differentiated them from their virtual walk-in counterparts.
From each identified virtual walk-in clinic that met our inclusion criteria, we abstracted the following details from each site’s main pages and frequently asked questions sections and recorded them in a spreadsheet:
virtual clinic name
internet address
geographic region(s) where services are available (select province[s] or all over Canada)
enrollment type (membership, single visit, or both)
source of payment (public provincial health insurance, private payment, or mixed)
forms of synchronous communication offered (telephone, video, or SMS text messaging)
use of artificial intelligence software to check symptoms and recommend treatments
cost of membership and single visit
examples of services offered (categorizing them iteratively, adding new categories when they were discovered, and then retroactively coding previous websites)
Additionally, we extracted free text that described data sharing or relationships with the patients’ existing primary care physicians to investigate the extent to which these clinics are prioritizing continuity of care within the broader system and reflecting a prominent concern among health professionals regarding virtual walk-in clinics disrupting continuity [
We grouped similar services into service categories to streamline the data analysis. These categories included the following:
specialist services (eg, oncology, endocrinology, pediatrics, obstetrics and gynecology, and sports medicine)
individual behavior changes (eg, diet, weight loss, sleep therapy, smoking cessation, and problem gambling support)
chronic disease management (eg, chronic obstetric pulmonary disease, diabetes, and heart failure)
others (eg, hemorrhoid consultation, veterinarian consultation, emergency services, lactation consultation, and disability insurance claims/workers’ compensation requests)
We grouped virtual clinics according to the mechanism of compensation for primary care services (publicly funded, privately funded, or mixed funding) as of June 2, 2020. Virtual clinics that bill the public health insurance plan in some provinces and patients directly in others were classified in the “mixed funding” category. We compared the availability, enrollment, communication type, and services offered across funding categories using Fisher exact tests (rather than chi-square tests owing to small cell counts). We have reported statistical significance using
As all material gathered for data analysis was publicly available on the internet, no ethics approval was required.
We identified 19 virtual walk-in clinics during our initial March 15 search, 3 of which (Ontario Telemedicine Network [
Between the first and second searches, 2 virtual walk-in clinics added public reimbursement options. One of the services, Lumeca [
More than half of the services we identified offered some form of public payment, with 5 being fully publicly funded and 5 operating on a public model in some provinces and a private one in others (
Services and fee structures categorized by compensation mechanisms.
Characteristic | Compensation mechanism, n (%) | |||||
|
|
Private (n=8, 44%) | Public (n=5, 28%) | Mix (n=5, 28%) | Total (N=18, 100%) |
|
|
.002 | |||||
|
National | 7 (88) | 0 (0) | 5 (100) | 12 (67) |
|
|
Provincial | 1 (13) | 3 (60) | 0 (0) | 4 (22) | |
|
Multiprovincial | 0 (0) | 2 (40) | 0 (0) | 2 (11) | |
|
.21 | |||||
|
Membership | 5 (63) | 4 (80) | 1 (20) | 10 (56) |
|
|
Single use | 0 (0) | 0 (0) | 2 (40) | 2 (11) | |
|
Both | 3 (38) | 1 (20) | 2 (40) | 6 (33) | |
|
||||||
|
Video call | 7 (88) | 5 (100) | 5 (100) | 17 (94) | .99 |
|
Telephone | 4 (50) | 3 (60) | 3 (60) | 10 (56) | .99 |
|
SMS text messaging | 5 (63) | 2 (40) | 2 (40) | 9 (50) | .71 |
Continuity with community general practitioners | 2 (25) | 2 (40) | 0 (0) | 4 (22) | .51 |
Of the 18 walk-in clinics, 12 (67%) operated nationally, 4 (22%) within a single province, and 2 (11%) in multiple provinces. Privately funded services were more likely to be offered at the national level (7/8, 88%) than at the provincial (1/8, 13%) and multiprovincial (0/8, 0%) levels (
Of the 18 services identified, 10 (56%) required membership, 2 (11%) were single-use services, and the remaining 6 (33%) offered both options. We observed that 63% (5/8) of the private payment clinics required membership, compared to 80% (4/5) of the public and 20% (1/5) of the mixed payment clinics (
Possible communication forms consisted of video calls, telephone calls, and SMS text messaging. Video calls were the most common options across all clinics, offered by 88% (7/8) of the private payment clinics and 100% (5/5) of the mixed and publicly funded clinics. Among the 18 clinics, only 1 offered medical services and prescriptions without using video calls. This service, GOeVisit [
Only 4 of the 18 services (22%) mentioned any form of continuity, information sharing, or communication with the consumers’ existing primary care providers. Wello [
Telus’ Babylon [
Of the 18 virtual walk-in clinics included for data extraction, all except one—Outpost Health [
Allergy treatment, support for individual behavior change, and specialist physician services were listed on the websites of more than half of the virtual care clinics. The remaining services offered were listed on the websites of one-third or fewer clinics. Clinics operating on a mixed funding model (private in some provinces and public in others) advertised the greatest breadth of health care services. It is also notable that none of the private payment clinics formally listed chronic disease management in their list of services, while 20% (1/5) of the public clinics and 60% of the mixed clinics (3/5) offered this service. One walk-in clinic—Teladoc [
Examples of offered services categorized by compensation mechanisms.
Services | Compensation mechanism, n (%) | ||||
|
Private (n=8, 44%) | Public (n=5, 28%) | Mix (n=5, 28%) | Total (N=18, 100%) |
|
Skin care/dermatology | 5 (63) | 5 (100) | 5 (100) | 15 (83) | .22 |
Mental health services | 4 (50) | 5 (100) | 5 (100) | 14 (78) | .06 |
Sexual and reproductive health | 4 (50) | 4 (80) | 3 (60) | 11 (61) | .82 |
Allergies | 4 (50) | 3 (60) | 3 (60) | 10 (56) | .99 |
Individual behavior change | 3 (38) | 2 (40) | 5 (100) | 10 (56) | .09 |
Specialist services | 3 (38) | 2 (40) | 5 (100) | 10 (56) | .09 |
Erectile dysfunction | 1 (13) | 1 (20) | 4 (80) | 6 (33) | .05 |
Chronic disease management | 0 (0) | 1 (20) | 3 (60) | 4 (22) | .04 |
Travel vaccinations | 3 (38) | 0 (0) | 1 (20) | 4 (22) | .51 |
Medical cannabis | 1 (13) | 1 (20) | 1 (20) | 3 (17) | .99 |
Naturopathy | 1 (13) | 0 (0) | 2 (20) | 3 (17) | .41 |
Othera | 2 (25) | 0 (0) | 4 (80) | 6 (33) | .03 |
a“Other” includes all services offered by <3 clinics, including the following: hemorrhoid consultation (2), veterinarian (2), emergency services (1), lactation consultation (1), and disability insurance claims/workers’ compensation requests (1).
Through a structured Google search, we identified 18 virtual walk-in clinics currently operating within Canada. This represents a 6-fold increase since 2015, when only 3 were available [
Virtual walk-in clinics provide a broad array of services, including primary care and other specialties, regardless of their payment models. Most clinics specifically advertised skin care, mental health, and sexual health services, supplementing basic primary care consultations, although less focus on mental health services was notable in privately funded clinics. Most relied on video calls as their primary means of communication; however, phone calls and SMS text messaging were also provided as communication options by most clinics.
Of the 18 virtual walk-in clinics that we identified, 15 charge patients out of pocket for core primary care services depending on the provinces where the patients resided. For example, 5 clinics were available nationally but limited public payment to patients with a valid health care card in British Columbia, Alberta, and Ontario. Conversely, 8 clinics operated on an entirely private payment model. Beyond the payment for primary care services, we noted that some clinics, namely Babylon [
Few clinics reported that they facilitated communication or data sharing with patients’ regular primary care providers (in either direction), suggesting that poor continuity of care may be a salient concern, thus reinforcing their suitability only for minor, less complicated conditions. The extensive use of virtual visits can potentially enhance access for patients who would normally face barriers when receiving primary care, such as people living in rural or remote areas, and those with compromised mobility and immune system challenges [
Early evidence indicates that although the proportion of virtual visits has decreased since the lifting of pandemic restrictions, it has not returned to prepandemic levels. It remains to be seen where the balance between virtual care and in-person visits will settle following the pandemic; however, it is unlikely to return to prepandemic levels given the substantial federal investments and level of public demand [
Our clinic searches were conducted in English only. This may have particularly resulted in the undercounting of the virtual walk-in clinics in Quebec. Second, our data extraction relied on the source material taken directly from clinic websites. Consequently, services not directly listed were not included. We may have underestimated the scope of services offered by some virtual walk-in services, as well as their potential information sharing with the patients’ existing care providers. In future, clinics should be contacted directly to determine their service scope accurately and explore whether and how they receive information from or share information with community-based physicians. Third, our reliance on Google for executing the search strategy could have potentially underrepresented or missed clinics. Future research should involve multiple individuals and use additional search engines and virtual primary care service advertisements to strengthen the results. Lastly, given that only 18 nationwide virtual walk-in clinics were identified through our Google searches, our statistical analyses were hampered by the lack of statistical power.
This environmental scan sought to characterize the availability and scope of virtual walk-in clinics across Canada. We found a rapid increase in this care model, with 18 distinct services operating across the country, 15 of which required patients to pay out of pocket for some or all services offered. The implications of the rise in episodic virtual care could have negative effects on health care equity, quality, and costs; moreover, the growth of this model should be closely monitored and regulated by policy makers.
The data that support the findings of this study are based on publicly available sources. The data set is available from the authors upon reasonable request.
This study was a student-led project and had no core funding. Funds for open access publication were provided by a Simon Fraser University Faculty Start-Up grant.
None declared.