Virtual care: Use of physician mental health services in Canada

  Back to Virtual care: Impact of COVID-19 on physician mental health services

December 15, 2022 — As the COVID-19 pandemic emerged and public health measures reduced social contacts and interrupted normal life, the mental health of individuals who experience anxiety, depression and psychological distress was negatively impacted.Reference1,Reference2 Simultaneously, many health services moved to virtual modalities,Reference3 including those for mental health, replacing in-person services.Reference3 While physician mental health services increased overall, access to virtual services was not equal across the country and the population.

This report describes trends in the use of virtual care by phone or video for patients with a diagnosis of anxiety or depression in 5 provinces (Ontario, Manitoba, Saskatchewan, Alberta and British Columbia) between April 2019 and March 2021. It also describes the corresponding physician payments for these services. In this report, a mental health service is defined as a visit with a family physician, pediatrician or psychiatrist, where the diagnosis on the claim is for anxiety or depression. To learn more, download the data tables.

Use of physician mental health services rose at the onset of the pandemic

Despite lockdowns and restricted access to in-person care, the number of services provided for a diagnosis of anxiety or depression increased steadily over the first year of the pandemic. From January to March 2021, the total (in-person and virtual) number of physician services for mental health increased by 15% (502,007 services) compared with the same time period 1 year earlier. Also during this period, physician payments for mental health services rose by 16% ($43,298,648). See the data tables for details.

Total number of physician services for a diagnosis of anxiety or depression, by modality, selected provinces, April 2019 to March 2021

This image is described below

Between April and June 2019, there were 3,209,758 in-person, 49,639 virtual and 3,259,397 total physician services for anxiety or depression.

Between July and September 2019, there were 3,060,197 in-person, 52,554 virtual and 3,112,751 total physician services for anxiety or depression.

Between October and December 2019, there were 3,174,289 in-person, 56,313 virtual and 3,230,602 total physician services for anxiety or depression.

Between January and March 2020, there were 2,916,960 in-person, 358,903 virtual and 3,275,863 total physician services for anxiety or depression.

Between April and June 2020, there were 1,188,034 in-person, 2,146,534 virtual and 3,334,568 total physician services for anxiety or depression.

Between July and September 2020, there were 1,577,589 in-person, 1,842,577 virtual and 3,420,166 total physician services for anxiety or depression.

Between October and December 2020, there were 1,611,003 in-person, 2,004,853 virtual and 3,615,856 total physician services for anxiety or depression.

Between January and March 2021, there were 1,613,373 in-person, 2,164,567 virtual and 3,777,940 total physician services for anxiety or depression.

Note
The figure includes Ontario, Manitoba, Alberta, Saskatchewan and British Columbia. Data for Saskatchewan from April 1 to June 30, 2020, is under-reported because physicians who were part of the Pandemic Physician Service Agreement during this time did not submit claims for the services they provided.

Source
National Physician Database, 2019 to 2021, Canadian Institute for Health Information.

Although in-person interactions were reduced, mental health care remained in place due to a considerable uptake of virtual care services. The proportion of these services that were delivered virtually increased sharply at the onset of the COVID-19 pandemic; in 2019–2020, virtual services accounted for 4% of mental health services provided by physicians, while in 2020–2021, they accounted for 57%. Across all 5 provinces, physician payments for virtual mental health services increased from $29 million in 2019–2020 to $621 million in 2020–2021.

More virtual care in higher-income and urban neighbourhoods

In the first year of the pandemic (April 2020 to March 2021), patients across all income levels and neighbourhoods accessed virtual care; however, the proportion of services delivered virtually varied. More virtual care was delivered in higher-income and urban neighbourhoods. Though slight gradients were seen among income quintiles for all types of virtual physician services,Reference4 the gap between the lowest and highest income quintiles was larger for virtual mental health services. The difference in use ranged from 3% to 5% for all services,Reference4 and from 7% to 14% for mental health services.

A difference in use of virtual mental health services also existed between urban and rural/remote neighbourhoods. On average, 53% of mental health services for patients in urban neighbourhoods were delivered virtually, compared with 47% of mental health services in rural/remote neighbourhoods.

Proportion of payments for physician services for a diagnosis of anxiety or depression delivered virtually, by income quintile, selected provinces, April 2020 to March 2021

This image is described below

In Ontario, the proportion of physician services for anxiety or depression delivered virtually was 58% for Q1 (the lowest income quintile), 63% for Q2, 64% for Q3, 67% for Q4 and 71% for Q5 (the highest income quintile).

In Manitoba, the proportion of physician services for anxiety or depression delivered virtually was 48% for Q1 (the lowest income quintile), 54% for Q2, 58% for Q3, 59% for Q4 and 61% for Q5 (the highest income quintile).

In Alberta, the proportion of physician services for anxiety or depression delivered virtually was 28% for Q1 (the lowest income quintile), 32% for Q2, 34% for Q3, 34% for Q4 and 36% for Q5 (the highest income quintile).

In British Columbia, the proportion of physician services for anxiety or depression delivered virtually was 52% for Q1 (the lowest income quintile), 54% for Q2, 56% for Q3, 57% for Q4 and 59% for Q5 (the highest income quintile).

Note
12-month average.
Data for Saskatchewan is not shown; data does not contain the information needed to determine geographic location and income levels.
Patient income quintiles rank neighbourhoods in Canada in order of increasing affluence. The first income quintile corresponds to the lowest-income neighbourhoods and the fifth income quintile corresponds to the highest-income neighbourhoods.

Source
National Physician Database, 2019 to 2021, Canadian Institute for Health Information.

Proportion of payments for physician services for a diagnosis of anxiety or depression delivered virtually, by geography, selected provinces, April 2020 to March 2021

This image is described below

In Ontario, the proportion of physician services for anxiety or depression delivered virtually was 58% in rural or remote regions and 65% in urban regions.

In Manitoba, the proportion of physician services for anxiety or depression delivered virtually was 49% in rural or remote regions and 57% in urban regions.

In Alberta, the proportion of physician services for anxiety or depression delivered virtually was 28% in rural or remote regions and 33% in urban regions.

In British Columbia, the proportion of physician services for anxiety or depression delivered virtually was 53% in rural or remote regions and 56% in urban regions.

Note
12-month average.
Data for Saskatchewan is not shown; data does not contain the information needed to determine geographic location and income levels.
Patient income quintiles rank neighbourhoods in Canada in order of increasing affluence. The first income quintile corresponds to the lowest-income neighbourhoods and the fifth income quintile corresponds to the highest-income neighbourhoods.

Source
National Physician Database, 2019 to 2021, Canadian Institute for Health Information.

Mental health services increased among family physicians, pediatricians and psychiatrists

During the pandemic, virtual mental health services replaced and supplemented in-person care, though uptake among specialties varied by jurisdiction. The number of mental health services provided between January and March 2021 increased among family physicians (+22%), pediatricians (+39%) and psychiatrists (+16%) compared with 1 year earlier (see data tables). 

Proportion of total payments for physician services for a diagnosis of anxiety or depression delivered virtually, by physician specialty, selected provinces, April 2020 to March 2021

This image is described below

In Ontario, family physicians provided 69% of services virtually, pediatricians provided 65% of services virtually and psychiatrists provided 61% of services virtually.

In Manitoba, family physicians provided 50% of services virtually, pediatricians provided 57% of services virtually and psychiatrists provided 61% of services virtually.

In Saskatchewan, family physicians provided 54% of services virtually, pediatricians provided 44% of services virtually and psychiatrists provided 41% of services virtually.

In Alberta, family physicians provided 32% of services virtually, pediatricians provided 31% of services virtually and psychiatrists provided 33% of services virtually.

In British Columbia, family physicians provided 64% of services virtually, pediatricians provided 61% of services virtually and psychiatrists provided 49% of services virtually.

Note
12-month average.
Data for Saskatchewan from April 1 to June 30, 2020, is under-reported because physicians who were part of the Pandemic Physician Service Agreement during this time did not submit claims for the services they provided.

Source
National Physician Database, 2019 to 2021, Canadian Institute for Health Information.

In most jurisdictions, family physicians provided the highest proportion of their mental health services virtually compared with other specialties. It should be noted that this data does not provide insights on the appropriateness of virtual care versus in-person care, nor on mental health care delivered by other health care providers. 

Virtual care has been identified as a treatment modality that can help augment the accessibility of health care services. Future work on the appropriateness of virtual care and corresponding patient health outcomes will help decision-makers fully understand how to best integrate virtual services into existing health care systems.

 

How to cite:

Canadian Institute for Health Information. Virtual care: Use of physician mental health services in Canada. Accessed March 28, 2024.

If you have a disability and would like CIHI information in a different format, visit our Accessibility page.