{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T04:45:07Z","timestamp":1782362707146,"version":"3.54.5"},"reference-count":18,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2025,6,2]],"date-time":"2025-06-02T00:00:00Z","timestamp":1748822400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000241","name":"Physicians' Services Incorporated Foundation","doi-asserted-by":"publisher","award":["Graham Farquharson"],"award-info":[{"award-number":["Graham Farquharson"]}],"id":[{"id":"10.13039\/501100000241","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Juravinski","award":["Innovation fund"],"award-info":[{"award-number":["Innovation fund"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Access equity has been raised as a fundamental concern with virtual care, both as it was used during the SARS-CoV-2 pandemic as well as its future applications within health systems. These concerns have not yet been substantiated with quantifiable data. We conducted a comparison of healthcare utilization and access across all dimensions of the Ontario Marginalization Index between virtual care and in-person care in the province of Ontario.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>We conducted a retrospective observational study using ICES databases in the Province of Ontario between March 14, 2020, and March 13,2022. We identified all virtual and in-person visits using billing codes. All visits were linked to their individual postal dissemination area for which there was census data from the Ontario Marginalization Index. Dissemination areas were divided, according to their categorization within each marginalization dimension, and visit rates were calculated for both populations.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>A total of 93,363,194 visits were included as part of the final analysis. Significant differences in virtual healthcare utilization were noted between the most and least marginalized populations within each dimension. This effect was not observed by visits for in-person care. The only exception was that racialized, and newcomer populations had higher virtual care utilization among the most marginalized.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Interpretation<\/jats:title>\n<jats:p>This data is the first that uses a large retrospective dataset and seems to confirm concerns for access inequity among the most marginalized populations. These differences much be part of policy considerations for the future of virtual care use.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0323303","type":"journal-article","created":{"date-parts":[[2025,6,2]],"date-time":"2025-06-02T17:50:19Z","timestamp":1748886619000},"page":"e0323303","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["A retrospective evaluation of access equity in virtual care during the COVID-19 pandemic: A 2-year review and comparison of visits in Ontario, Canada"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6752-3485","authenticated-orcid":true,"given":"Shawn","family":"Mondoux","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4690-7930","authenticated-orcid":true,"given":"Frank","family":"Battaglia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anastasia","family":"Gayowsky","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natasha","family":"Clayton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caillin","family":"Langmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Miller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alim","family":"Pardhan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie","family":"Matthews","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Drossos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keerat","family":"Grewal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,6,2]]},"reference":[{"issue":"1","key":"pone.0323303.ref001","doi-asserted-by":"crossref","DOI":"10.9778\/cmajo.20200311","article-title":"Virtual care use before and during the COVID-19 pandemic: a repeated cross-sectional study","volume":"9","author":"RS Bhatia","year":"2021","journal-title":"CMAJ Open"},{"issue":"6","key":"pone.0323303.ref002","doi-asserted-by":"crossref","DOI":"10.1503\/cmaj.202303","article-title":"Shifts in office and virtual primary care during the early COVID-19 pandemic in Ontario, Canada","volume":"193","author":"RH Glazier","year":"2021","journal-title":"CMAJ"},{"issue":"3","key":"pone.0323303.ref003","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1177\/1357633X231194382","article-title":"Equity in virtual care: a mixed methods study of perspectives from physicians","volume":"31","author":"TC Guetterman","year":"2025","journal-title":"J Telemed Telecare"},{"key":"pone.0323303.ref004","first-page":"20552076221074486","article-title":"Virtual care access and health equity during the COVID-19 pandemic, a qualitative study of patients with chronic diseases from Canada","volume":"8","author":"S Chan-Nguyen","year":"2022","journal-title":"Digit Health"},{"issue":"5","key":"pone.0323303.ref005","doi-asserted-by":"crossref","first-page":"990","DOI":"10.1093\/jamia\/ocac022","article-title":"Challenges and strategies for promoting health equity in virtual care: findings and policy directions from a scoping review of reviews","volume":"29","author":"S Budhwani","year":"2022","journal-title":"J Am Med Inform Assoc"},{"issue":"4","key":"pone.0323303.ref006","doi-asserted-by":"crossref","DOI":"10.2196\/23233","article-title":"Recommendations for health equity and virtual care arising from the COVID-19 pandemic: narrative review","volume":"5","author":"J Shaw","year":"2021","journal-title":"JMIR Form Res"},{"key":"pone.0323303.ref007","unstructured":"Task Team on Equitable Access to Virtual Care. Enhancing equitable access to virtual care in Canada: principle-based recommendations for equity. [Accessed 2023 December 10]. Available from: https:\/\/www.canada.ca\/en\/health-canada\/corporate\/transparency\/health-agreements\/bilateral-agreement-pan-canadian-virtual-care-priorities-covid-19\/enhancing-access-principle-based-recommendations-equity.html"},{"issue":"43","key":"pone.0323303.ref008","doi-asserted-by":"crossref","DOI":"10.1503\/cmaj.230492","article-title":"Health care utilization and outcomes of patients seen by virtual urgent care versus in-person emergency department care","volume":"195","author":"SL McLeod","year":"2023","journal-title":"CMAJ"},{"issue":"3","key":"pone.0323303.ref009","doi-asserted-by":"crossref","first-page":"31","DOI":"10.12927\/hcq.2023.27217","article-title":"Was virtual care as safe as in-person care? Analyzing patient outcomes at seven and thirty days in Ontario during the COVID-19 pandemic","volume":"26","author":"S Mondoux","year":"2023","journal-title":"Healthc Q"},{"key":"pone.0323303.ref010","volume-title":"2021 Ontario marginalization index user guide","author":"Public Health Ontario","year":"2023"},{"key":"pone.0323303.ref011","unstructured":"Statistics Canada. Dissemination area boundary files. [Accessed 2023 December 8]. Available from: https:\/\/www150.statcan.gc.ca\/n1\/en\/catalogue\/92-169-X"},{"key":"pone.0323303.ref012","author":"Government of Ontario","year":"2021"},{"key":"pone.0323303.ref013","unstructured":"Government of Ontario. Personal health information protection act, 2004, S.O. 2004, c. 3, sched. A. 2014. Available from: https:\/\/www.ontario.ca\/laws\/statute\/04p03#BK63"},{"key":"pone.0323303.ref014","author":"FI Matheson","year":"2023"},{"key":"pone.0323303.ref015","unstructured":"Government of Canada. Social determinants of health and health inequalities. [Accessed 2023 December 8]. Available from: https:\/\/www.canada.ca\/en\/public-health\/services\/health-promotion\/population-health\/what-determines-health.html"},{"issue":"3","key":"pone.0323303.ref016","doi-asserted-by":"crossref","first-page":"697","DOI":"10.1007\/s10903-015-0237-6","article-title":"a scoping review of immigrant experience of health care access barriers in Canada","volume":"18","author":"A Kalich","year":"2016","journal-title":"J Immigr Minor Health"},{"issue":"4","key":"pone.0323303.ref017","doi-asserted-by":"crossref","first-page":"1029","DOI":"10.1007\/s10903-021-01273-w","article-title":"Immigration status as the foundational determinant of health for people without status in Canada: a scoping review","volume":"24","author":"M Gagnon","year":"2022","journal-title":"J Immigr Minor Health"},{"issue":"4","key":"pone.0323303.ref018","first-page":"3","article-title":"Healthy immigrant effect by immigrant category in Canada","volume":"30","author":"C Lu","year":"2019","journal-title":"Health Rep"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0323303","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,2]],"date-time":"2025-06-02T17:50:25Z","timestamp":1748886625000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0323303"}},"subtitle":[],"editor":[{"given":"Pasyodun Koralage Buddhika","family":"Mahesh","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,6,2]]},"references-count":18,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2025,6,2]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0323303","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,2]]}}}