Virtual Care Trends in Older Adults with Parkinson’s Disease in Urban and Rural Ontario, Canada, During COVID-19

BACKGROUND: Virtual care services increased during the COVID-19 pandemic, enabling access to physician consultations. Most studies on virtual care in Parkinson's disease (PD) have focused on tertiary centers, limiting generalizability. OBJECTIVE: To describe trends in virtual care use over time in people living with PD in Ontario, Canada, by rural and urban region of residence using health administrative data. METHODS: We conducted a population-based repeated cross-sectional study between March 2020 and August 2023, among community-dwelling people living with PD aged ≥66 years in Ontario, Canada. We used Poisson regression models with generalized estimating equations to estimate rate ratios (RR) with 95% confidence intervals (CIs) comparing virtual visit rates in urban versus rural areas across physician specialties (family physicians, neurologists and psychiatrists/geriatricians). RESULTS: Among 24,736 people living with PD in March 2020, 58.6% were male (mean age 77.6 [SD = 7.0] years), and most resided in urban areas (89.9%). Compared to urban residents, rural residents had significantly lower rates of virtual visits to neurologists (adjusted RR = 0.93; 95% CI: 0.90-0.96), family physicians (aRR = 0.73; 95% CI: 0.70-0.77) and geriatricians/psychiatrists (aRR = 0.67; 95% CI: 0.65-0.77). Over 3.5 years, virtual visits declined compared to the first 6 months for neurologists (aRR = 0.23; 95% CI: 0.22-0.25), family physicians (aRR = 0.39; 95% CI: 0.38-0.41) and geriatricians/psychiatrists (aRR = 0.45; 95% CI: 0.40-0.51). CONCLUSION: People living with PD in urban centers accessed virtual care more frequently than those living rurally. Virtual care utilization decreased over time. The sustainability of virtual care and its impact on health equity among people living with PD requires further study.