During the COVID-19 pandemic there was a dramatic increase in the proportion of virtual healthcare visits around the world.1,2 In Ontario, Canada, there was a 21 fold increase in virtual care at the start of the pandemic3; some specialties such as primary care rose to a 56 fold increase.4 Currently, however, the future of virtual care is uncertain.

In Ontario, the largest province in Canada, most residents have access to healthcare through the publicly-funded provincial health insurance system. Prior to the pandemic, limited coverage was available for virtual care.5 During the pandemic, Ontario, like many jurisdictions, quickly approved temporary billing codes which reimbursed phone- and video-based care at the same rate as in-person care. However, in December 2022, these temporary codes were rolled back and replaced with new billing codes which continued to reimburse video-based care at the same rate as in-person care but provided a lower rate for phone-based care.6 Similar scaling back or discontinuation of virtual care coverage has also been reported in other juristictions.7 In this context it is important to understand the benefits and risks of virtual care for adults with intellectual and developmental disabilities (IDD). This group has historically faced inadequate access to appropriate healthcare8, 9, 10 and it is imperative their needs are considered as the future of virtual care is determined.

The limited existing research on virtual care, including phone- and video-based care, for people with IDD suggests that it is appropriate for some individuals, under some circumstances, but not others.11, 12, 13, 14, 15, 16, 17, 18 Virtual care has been reported as valuable for patients with IDD who live far away from healthcare providers, patients who experience high anxiety attending in-person visits which can lead to distressed behaviours, patients who have family members or substitute decision-makers who live far away from them, patients who are medically vulnerable and benefit from reduced opportunities for illness transmission, and instances when it is important for healthcare providers to observe patients in their homes.11, 12, 13, 14, 15, 16, 17, 18 However, prior research identified challenges in cases where patients, caregivers or providers lacked access to technology or the skills to use it, if it hindered effective communication (e.g., for patients who do not communicate verbally) or the development of patient-provider rapport, if a physical exam was required, if it resulted in patients being excluded from the health encounter entirely (e.g., phone calls with the caregiver alone) or if it compromised confidentiality (e.g., lack of a private space to conduct the visit).11, 12, 13, 14, 15, 16, 17, 18

Most of this research, however, was conducted with small samples prior to and during the early days of the pandemic. It is possible that in the years since the start of the pandemic, patients and healthcare providers have grown more accustomed to virtual care and are more likely to have acquired and become adept at using the necessary technology. Additionally, little focus has been given to the experience of direct support professionals (DSPs), the paid caregivers who often support adults with IDD in the community. DSPs, also referred to as support workers or staff in different jurisdictions, work directly with individuals with IDD in residential settings, day programs and within family homes to facilitate participation in everyday life.19 They provide a wide range of services including supporting many adults with IDD to attend and participate in healthcare interactions, however, DSPs are not healthcare providers and receive little health training.20,21 The aim of the present study was to explore the experience of DSPs supporting virtual care in Ontario and describe utilization of virtual care by adults with IDD at four points in time.