Implementation and Evaluation of Virtual Care in Canadian Health Care Systems: A Scoping Review
Clinical Snapshot
PICO Framework
| P — Population | Canadian healthcare systems and their patients receiving synchronous virtual care (videoconferencing or telephone consultations), including rural/remote populations, equity-deserving groups, and various care settings (primary, inpatient, long-term, emergency) |
| I — Intervention | Synchronous virtual care delivery — real-time patient-provider interactions via videoconferencing or telephone |
| C — Comparator | No explicit comparator specified; the review maps the evidence landscape rather than comparing virtual care to in-person care in a head-to-head fashion |
| O — Outcomes | Implementation frameworks, evaluation frameworks, patient satisfaction, process outcomes, barriers and facilitators, health outcomes, system outcomes, impact evaluations, equity considerations, hybrid care models, economic impacts, and planetary health impacts |
Bottom Line
This JBI scoping review maps 208 Canadian manuscripts on synchronous virtual care implementation and evaluation, providing a timely evidence landscape following the COVID-19-driven telehealth surge. The review confirms that the Canadian virtual care literature is dominated by patient satisfaction and process outcome studies, while clinically critical domains — health outcomes, systems-level impact, economic evaluation, health equity, and hybrid care models — remain substantially underinvestigated. No quality appraisal of included studies was performed, consistent with scoping review methodology, meaning the rigour of the underlying evidence base is unknown. The review does not generate practice-changing clinical recommendations but makes a valuable contribution by identifying priority research gaps: rural and remote settings, inpatient and emergency care, equity-deserving populations, and planetary health impacts. For Australian clinicians and health system leaders, the parallels are direct — similar gaps exist domestically, and the call for standardised implementation and evaluation frameworks resonates with current RACGP telehealth guidance and the Australian Digital Health Strategy. This review should be read as a research agenda-setting document rather than a clinical evidence synthesis. Senior clinicians and health system planners should use it to advocate for rigorous, outcomes-focused evaluation of their local virtual care programmes.
Key Findings
Effect Size: Not applicable — scoping review with narrative synthesis only; no pooled effect estimates calculated
Primary Outcome: Mapping of the extent, range, and nature of evidence on implementation and evaluation of synchronous virtual care in Canadian healthcare systems across 208 included manuscripts
Nnt Or Sensitivity: Not applicable; key descriptive finding: high volume of studies on patient satisfaction and process outcomes; significant underrepresentation of health outcomes, systems outcomes, impact evaluations, hybrid care models, planetary health considerations, and virtual care use with equity-deserving populations
Confidence Interval: Not applicable — no quantitative meta-analysis performed
Clinical Application
The review does not evaluate a specific intervention for direct clinical implementation. Its primary utility is for health system planners, policymakers, and researchers seeking to understand the current evidence base and prioritise future investment. Clinicians may use the identified gaps to advocate for rigorous local evaluation of their virtual care programmes. The call for standardised implementation and evaluation frameworks is feasible and actionable at the health system level. This review is Canada-specific; however, its findings have strong relevance to Australian healthcare. Australia shares comparable challenges: vast geographic distances, significant rural and remote populations, and a similarly accelerated uptake of telehealth during COVID-19. Medicare Benefits Schedule (MBS) telehealth items introduced in March 2020 and subsequently made permanent reflect a parallel policy trajectory. The identified evidence gaps — particularly around equity-deserving groups (analogous to Aboriginal and Torres Strait Islander communities in Australia), hybrid care models, and economic impact evaluations — are equally pertinent to Australian practice. The RACGP has published telehealth standards and the TGA regulates digital health technologies; however, standardised national evaluation frameworks for virtual care remain underdeveloped in Australia as in Canada. The findings support the case for the Australian Digital Health Agency and state health departments to invest in rigorous impact evaluation infrastructure for telehealth programmes. All Canadian patients receiving synchronous virtual care via videoconferencing or telephone, with particular relevance to rural and remote populations, equity-deserving groups, and patients in inpatient, long-term care, and emergency settings where evidence is identified as most deficient
Abstract
OBJECTIVE: This scoping review examined available evidence in implementation and evaluation of virtual care in Canada. Virtual care saw recent uptake due to the COVID-19 pandemic; however, to ensure quality of care, rigorous implementation and evaluation frameworks are needed. METHODS: Peer-reviewed and gray literature were searched to determine extent, range, and nature of evidence surrounding implementation and evaluation of virtual care based on the guidelines of the Joanna Briggs Institute. Although virtual care can encompass synchronous and asynchronous modalities, this review focused on synchronous virtual care, defined as real-time interactions between patients and providers via videoconferencing or telephone. Search included MEDLINE, EMBASE, Psych Info, and CINAHL databases and national and provincial health system, professional organization, and regulatory websites. Inclusion criteria included videoconferencing or telephone and English and French Canadian sources. Citations were screened by two researchers at title, abstract, and full-text levels. RESULTS: Two hundred and eight (208) manuscripts were included for analysis. High numbers of studies on patient satisfaction, process outcomes, and barriers were identified, with underrepresentation of health and systems outcomes and impact evaluations. There were very few studies examining hybrid care, planetary health, and use of virtual care with equity-deserving groups. DISCUSSION: This scoping review identified areas of importance for future research, including the use of virtual care in rural and remote regions, inpatient, long-term, and emergency settings, hybrid care, economic and planetary health impacts, and artificial intelligence. As well, enhancing standardization of implementation and evaluation guidelines will optimize quality of care and best practice.
References
- 1.Yang, B., Leader, J., Bowes, B., Aiyer, H., Dunn, H., Adams, S. J., O'Connell, M. E., McIntyre, L., Dani, H., Johnson, R., Mendez, I., & Lovo, S. (2026). Implementation and evaluation of virtual care in Canadian health care systems: A scoping review. Telemedicine Journal and e-Health: The Official Journal of the American Telemedicine Association. Advance online publication. https://doi.org/10.1177/15305627261425160
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