Health system utilization following medical advice from Alberta's Virtual MD: a descriptive analysis

Alberta's Virtual MD program was established to enhance nurse tele-triage and divert low-acuity patients from the emergency department (ED). This study describes the use of Virtual MD and its impact on healthcare utilization.

Demographic and clinical characteristics of Virtual MD patients were compared with Health Link 811 callers and the overall Alberta population between April 1, 2022, and March 31, 2023. Virtual MD recommendations included seeing a primary care provider, going to ED/urgent care, and self-management at home. Concordance with recommendations was determined using linked health administrative data.

Virtual MD patients (n = 19,312) had a mean age of 34.8 years and were mostly female (62.3%). Compared to Health Link 811 callers, Virtual MD patients were slightly older (≥ 55 years) (20.8% vs. 25.0%). Of patients called within 4 h, 55.7% visited primary care within 14 days as advised, 60.0% visited ED within 2 days as advised and 52.5% of those advised to self-manage care at home did not use any healthcare within 14 days. Those advised to seek primary care had a higher odds [OR = 1.65 (95%CI: 1.24-2.21)] of family practice-sensitive conditions when they presented at ED compared to those advised to seek ED care. Hospitalization within 2 weeks was lower for patients advised to see primary care compared to those advised to see ED [4 h callback: OR = 0.33 (95%CI: 0.26 - 0.43), 24 h callback: OR = 0.15 (95%CI 0.08 - 0.28)].

Virtual MD effectively triaged patients, with over half following through on recommendations to see primary care, see ED, or self-manage care at home. Patients referred to primary care, but instead choosing to visit ED, were more likely to present with family practice-sensitive conditions, demonstrating appropriateness of the initial primary care advice. Overall, the Virtual MD service enables patients to access more appropriate levels of care for their healthcare needs.