The right care, for the right patient, at the right time, by the right provider: A value-based comparison of the management of ambulatory respiratory diseases in walk-in clinics, primary care physician practices and emergency departments

Emergency departments (ED) are specialized and costly public health services. Designed to provide care for patients with urgent or life-threatening conditions, they continue to treat large numbers of low-acuity ambulatory emergency patients (consulting for health issues that do not require being kept for observation on a stretcher). An estimated 30-60% of all patients treated in these services belong to this category, which some analysts regard as a source of emergency department overuse or misuse. Others argue that patient evaluation in the ED may be more cost-effective. The debate has been complicated by the COVID-19 pandemic, which has shifted primary care practices and walk-in clinics significantly towards telemedicine (remote or virtual consultation by phone or videoconferencing), presumably a more convenient and efficient consultation modality under the circumstances. As healthcare expenditures continue to rise, the most efficient care pathways must be identified and strengthened in order to ensure sustainable healthcare systems for all Canadians. By comparing the value (i.e. health outcomes and costs) of care given (in person or by telemedicine) in EDs, walk-in clinics and primary care practices for ambulatory emergency patients presenting with acute respiratory conditions, our research project will enable decisionmakers and policymakers to: 1) determine the most efficient care settings for this patient category; and 2) promulgate value-centred reforms whereby ambulatory patients with acute unexpected needs will receive the best urgent care at the lowest cost. We believe that this will represent a major contribution to the sustainability and adequacy of publicly funded Canadian healthcare and allow it to fulfil its mission of improving the health of the population.