Virtual nursing project in Nunavut shows improved outcomes

In response to the pandemic, health systems across Canada quickly pivoted to launch or expand virtual care options. Since then, health systems have been recognizing how virtual care can address the diverse needs of patients and healthcare providers to deliver safe, timely and equitable care.

In 2020–2021, the Government of Canada provided funding to the provinces and territories to enhance technology and infrastructure that would facilitate the delivery of virtual care, to evaluate the impacts of virtual care or to establish policy supports for virtual care. As a result, provinces and territories implemented a wide range of initiatives.

To share the successes and challenges of these initiatives and to inform future virtual care policy and delivery, the Canadian Institute for Health Information (CIHI) conducted interviews across the provinces and territories.

This included Nunavut, where we found high patient satisfaction with the Virtual Nurse Practitioner Chronic Disease Program.

While Nunavut has deployed telehealth services to its 25 communities for more than a decade, with equipment provided in every health centre to facilitate patient–provider communication, a strong foundation in primary care has been difficult to achieve due to challenges such as recruiting and retaining staff.

To address gaps, the new Virtual Nurse Practitioner (NP) Chronic Disease Program has been piloted to support patients at home, offering an adaptable model of care delivery that leverages NPs.

The program has a dedicated NP workforce providing chronic disease management in nine communities, where they meet patients virtually at minimum every three months and can have virtual specialist consults to support patient care. The program provides an opportunity for patients to be screened for chronic diseases and cancer, including cervical and colorectal cancer, hypertension and diabetes.

Program results/successes from data collected between October 2021 and October 2022:

• 358 new referrals were registered in October 2022, compared with 121 in December 2021. Nearly half of patients (45 percent) had three chronic diseases addressed per visit.
• Between 27 percent and 42 percent of newly referred patients were not up to date with screening for chronic diseases or cancer. Of these patients, more than 90 percent became up to date after their first intake appointment.
• Chronic disease biomarkers showed a statistically significant decrease following program enrolment. Patients at higher risk (e.g., uncontrolled diabetes, significantly overweight) saw the greatest benefit, with a larger average decrease in their biomarkers.
• 96 percent of patients were satisfied with their overall experience; 93 percent of patients indicated that they had received the same quality of care with the NP virtually as with an in-person visit; and 94 percent felt that their cultural values had been respected during their appointment.
• 97 percent of patients felt that there was a positive change to their quality of life, and 94 percent felt that their chronic disease was better managed since seeing the NP virtually.

Overall, the program’s success highlights the value of integrating NPs in virtual care to improve access to primary healthcare, and it provides an adaptable model for other jurisdictions across Canada that deliver care to rural and remote populations.

While virtual care has long been a part of our healthcare landscape, Canada has historically lagged behind our international peers in its adoption. New findings from the 2022 Commonwealth Fund (CMWF) International Health Policy Survey of Primary Care Physicians show impressive advancements during the pandemic.

Canadian physicians increased their adoption of certain digital health tools – gains that now approach the CMWF country average, resulting from a concerted focus on virtual service delivery.

The 2022 CMWF survey examined the similarities and differences in access to care between Canada and 9 peer countries; it was conducted online between February and September with almost 1,500 physicians. Findings show the following:

• 93 percent of Canada’s primary care physicians are now using electronic medical records (EMRs), up from 73 percent in 2019, similar to the CMWF average (93 percent).
• 84 percent are satisfied with practising virtual care, compared with 68 percent of their international peers.
• About 1 in 4 (27 percent) use remote monitoring or connected medical devices to monitor patients with chronic conditions, which is higher than the CMWF average of about 1 in 5 (19 percent).
• 38 percent are now electronically exchanging patient clinical summaries with doctors outside their practice, up from 25 percent in 2019; and 55 percent are exchanging laboratory and diagnostic test results, up from 36 percent in 2019.
• Compared with the CMWF average, fewer Canadian primary care practices can communicate electronically with other practices, even though most (76 percent) have access to regional, provincial or territorial information systems.
• More practices now offer patients options to request appointments online, communicate via email or a secure website about a medical concern, and view patient visit summaries online compared with 2019 (Figure 1).
• Physicians reported that virtual care has had a positive impact on improving the timeliness of care and the effective assessment of mental and behavioural health needs of their patients.

The success of new initiatives like the Nunavut NP program and the growth trends demonstrated through the CMWF survey reflect the positive impact of focused efforts to increase technology adoption. Although they bring Canada more in line with its international peers, there are likely further gains that need to be made to fully integrate virtual services as part of Canada’s health systems beyond the pandemic.

Please visit www.cihi.ca/en/virtual-care-in-canada for additional information on virtual care services across Canada.

Alya Niang is a Communications Specialist, Canadian Institute for Health Information.