Changes in emergency and primary care use after adding virtual physicians to HealthLink BC's 8-1-1 program

Health human resource constraints in Canada have left millions of patients without timely access to primary care (PC), leading many to attend emergency departments (ED) to see a doctor. We evaluated changes in service use and costs resulting from the addition of virtual physicians to HealthLink BC's 8-1-1 program. Visits to ED and PC within 30 days and healthcare costs were measured with time series data from 445,630 telehealth users. The virtual physician intervention was associated with 16.14 (p = 0.001, 95% CI = 25.95-6.33) fewer ED visits and 106.14 (p < 0.001, 95% CI = 74.78-137.49) more PC visits in 30 days per 1000 patients. Patients above age 15, without a known chronic illness or existing relationship with a PC provider, had higher PC follow-up and patient-paid medical travel costs; healthcare system costs were neutral over a year. Long-term health outcomes from increased PC follow-up and variability in the amount of medical travel costs paid by patients will be important economic parameters to consider in Canadian health policy evaluations.