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Association of Virtual Care Expansion With Environmental Sustainability and Reduced Patient Costs During the COVID-19 Pandemic in Ontario, Canada

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME
Key Points

Question  How much carbon dioxide emissions and patient travel–related costs were reduced by the expansion of virtual care during the initial 22 months of the COVID-19 pandemic in Ontario, Canada?

Findings  In this cross-sectional study of more than 10 million patients and 63 million virtual care visits, virtual care was associated with avoidance of 3.2 billion km of patient travel, 545 to 658 million kg of carbon dioxide emissions, and $569 to $733 million (Canadian [US $465-$599 million]) in expenses for gasoline, parking, or public transit.

Meaning  Findings of this study suggest that these environmental and financial benefits may continue as virtual care is maintained as part of the health care system.


Importance  There is a growing focus on environmental sustainability in health care.

Objective  To estimate the environmental and patient-level financial benefits associated with the widespread adoption of virtual care during the COVID-19 pandemic.

Design, Setting, and Participants  This population-based cross-sectional study obtained data from linked administrative databases in the universal health care system of Ontario, Canada, from March 2020 to December 2021. Participants included all people with a physician claim for at least 1 episode of virtual care.

Exposures  Patients were stratified by age, socioeconomic status quintiles, Charlson Comorbidity Index, and area of residence (rural or urban).

Main Outcomes and Measures  The primary outcomes were total travel distance and estimated travel-related carbon dioxide emissions avoided owing to virtual care visits. Different model assumptions were used to account for electric and hybrid vehicles and public transit use. The secondary outcomes were estimated patient costs (gasoline, parking, or public transit expenses) avoided.

Results  During the 22-month study period, 10 146 843 patients (mean [SD] age, 44.1 [23.1] years; 5 536 611 women [54.6%]) had 63 758 914 physician virtual care visits. These visits were associated with avoidance of 3.2 billion km of travel distance and between 545 and 658 million kg of carbon dioxide emissions. Patients avoided an estimated total of $569 to $733 million (Canadian [US $465-$599 million]) in parking, public transit, and gasoline costs. Carbon dioxide emission avoidance and patient cost savings were more apparent in patients living in rural areas, those with higher comorbidity, and those who were older than 65 years.

Conclusions and Relevance  Results of this study suggest that virtual care was associated with a large amount of carbon dioxide emissions avoided owing to reduced patient travel and with millions of dollars saved in parking, gasoline, or public transit costs. These benefits are likely to continue as virtual care is maintained as part of the health care system.

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Article Information

Accepted for Publication: September 4, 2022.

Published: October 20, 2022. doi:10.1001/jamanetworkopen.2022.37545

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2022 Welk B et al. JAMA Network Open.

Corresponding Author: Blayne Welk, MD, MSc, Department of Surgery and Epidemiology and Biostatistics, Western University, St Joseph's Health Care, 268 Grosvenor St, Room B4-667, London, ON N6A 4V2, Canada (bkwelk@gmail.com).

Author Contributions: Dr Welk and Mr McArthur had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: All authors.

Acquisition, analysis, or interpretation of data: Welk, McArthur.

Drafting of the manuscript: Welk, Zorzi.

Critical revision of the manuscript for important intellectual content: McArthur, Zorzi.

Statistical analysis: McArthur.

Obtained funding: Welk.

Administrative, technical, or material support: Zorzi.

Supervision: Welk, Zorzi.

Conflict of Interest Disclosures: Dr Welk reported receiving personal fees for consulting work with BD Company outside the submitted work. No other disclosures were reported.

Funding/Support: This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health and the Ministry of Long-Term Care. The study was completed at the ICES Western site, where core funding is provided by the Academic Medical Organization of Southwestern Ontario, the Schulich School of Medicine and Dentistry, Western University, and the Lawson Health Research Institute.

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Disclaimer: The analyses, conclusions, opinions, and statements expressed herein are solely those of the authors and do not reflect those of the funding or data sources; no endorsement is intended or should be inferred.

Additional Information: Parts of this material were based on data and information compiled and provided by the Ontario Ministry of Health and by the Canadian Institute for Health Information.

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Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

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It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

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