Integrated Virtual Care (IVC) - An innovative hybrid model of primary care, combining in-person and virtual care options, in Renfrew County, Ontario.

Abstract

Background Renfrew County is the largest geographic county in Ontario with a dispersed and diverse population. There are insufficient family physicians and other primary care providers to meet the needs of its residents. IVC aims to address this problem by enrolling unattached individuals to a family physician who works predominantly remotely. This enables family physicians from across Ontario to join the program and work a flexible schedule that aligns with their individual professional and personal circumstances.

IVC Structure The IVC family physicians are embedded within existing, local interdisciplinary primary care teams (IPCTs). Patients receive comprehensive, team-based primary care, through a hybrid of in-person, at-home and virtual care options, depending on their individual needs and preferences. Virtual care options include secure messaging, telephone and video encounters from the patient’s home, and enhanced telemedicine options at a local IPCT. Partnership with the existing community paramedicine program allows a range of at-home and remote care monitoring options for vulnerable, home-bound patients. Other physicians, nurse practitioners and interdisciplinary health professionals in each local group, provide additional in-clinic care options.

Identifying and enrolling unattached residents The Renfrew County Virtual Triage and Assessment Centre (VTAC) is leveraged to identify unattached patients who are accessing care through VTAC, with the offer of joining the IVC program extended to any additional unattached members of their household. Additional unattached residents are identified through Ontario’s Health Care Connect (HCC) program and offered attachment through IVC. Further potential exists to identify and prioritize specified groups of higher needs, unattached patients. New IVC patients complete an onboarding process that includes digital processes for the collation of their medical history followed by a review of their existing medications by a pharmacist. A medical chart and cumulative patient profile are completed prior to their first encounter with their new family physician. Patients have access to the full suite of services provided by their local IPCT. Additional nurse practitioner time is protected for IVC physicians to request in-person assessment for specific issues as required and on-site group physicians are also available to provide in-person care. Patients book appointments with their family physician by calling the front desk, or through an online appointment booking platform.

Evaluation IVC aligns with the principles of Ontario's Digital First for Health strategy. As of March 31, 2025, 6804 previously unattached residents are attached to 19 IVC family physicians embedded in three IPCTs. Formal evaluation of patient, clinician and non-clinical staff, showing impressive levels of satisfaction, have been completed and submitted for publication. IVC has contributed significantly to improving cancer screening rates, smoking cessation referrals and evidence-based diabetes care for previously unattached residents.

Conclusion Integrated Virtual Care (IVC) in Renfrew County demonstrates that a hybrid model of in-person and virtual care can deliver a highly effective and widely accepted approach to primary care in underserved communities. Findings from multiple evaluations highlight high levels of patient satisfaction, trust in IVC physicians, and broad acceptance of virtual care as a viable and effective modality. Patients reported feeling well-supported, engaged in their care decisions, and appreciative of the convenience and accessibility provided by virtual visits, complemented by in-person care when necessary. Most experienced minimal barriers to technology use, and many expressed gratitude for the reduced travel burden in accessing care. The clear ability to foster meaningful patient-provider relationships through this model reinforces the program’s efficiency and reach. All clinicians and non-clinical staff recognized and valued the role of IVC in increasing patient attachment and providing more equitable access to primary care in their communities. Physicians noted strong patient relationships and appreciated the flexibility of remote care delivery. Interdisciplinary Health Professional expressed pride in contributing to a community-focused initiative, even as they adapted to expanded roles and responsibilities. While challenges such as increased workload and integration into existing clinical teams were acknowledged, participants emphasized the importance of team-based care, leadership support, and streamlined communication enabled by technology. As IVC continues to evolve, this innovative hybrid care model may offer a scalable and sustainable solution for addressing healthcare gaps and promoting more equitable access to team-based primary care in remote, rural, and underserved communities.