CUP study: protocol for a comparative analysis of centralised waitlist effectiveness, policies and innovations for connecting unattached patients to primary care providers

Abstract

IntroductionAccess to a primary care provider is a key component of high-functioning healthcare systems. In Canada, 15% of patients do not have a regular primary care provider and are classified as ‘unattached’. In an effort to link unattached patients with a provider, seven Canadian provinces implemented centralised waitlists (CWLs). The effectiveness of CWLs in attaching patients to regular primary care providers is unknown. Factors influencing CWLs effectiveness, particularly across jurisdictional contexts, have yet to be confirmed.Methods and analysisA mixed methods case study will be conducted across three Canadian provinces: Ontario, Québec and Nova Scotia. Quantitatively, CWL data will be linked to administrative and provider billing data to assess the rates of patient attachment over time and delay of attachment, stratified by demographics and compared with select indicators of health service utilisation. Qualitative interviews will be conducted with policymakers, patients, and primary care providers to elicit narratives regarding the administration, use, and access of CWLs. An analysis of policy documents will be used to identify contextual factors affecting CWL effectiveness. Stakeholder dialogues will be facilitated to uncover causal pathways and identify strategies for improving patient attachment to primary care.Ethics and disseminationApproval to conduct this study has been granted in Ontario (Queens University Health Sciences and Affiliated Teaching Hospitals Research Ethics Board, file number 6028052; Western University Health Sciences Research Ethics Board, project 116591; University of Toronto Health Sciences Research Ethics Board, protocol number 40335), Québec (Centre intégré universitaire de santé et de services sociaux de l'Estrie, project number 2020–3446) and Nova Scotia (Nova Scotia Health Research Ethics Board, file number 1024979).

Evaluation of the implementation of single points of access for unattached patients in primary care and their effects: a study protocol

“…Sharing study findings and developing recommendations will be critical to transforming the knowledge gained into plans and interventions 18 to support access to and navigation of PHC for unattached patients in the future. We will share balanced scorecard performance dashboards in real time with stakeholders from the six GAPs.…”

“…In Canada, 15% of patients do not have a regular provider. 18 To address the critical need for attachment, defined as ‘a policy intended to improve access to and continuity of care with a primary care provider’, 19 seven of the 10 Canadian provinces implemented centralised waiting lists (CWLs) for coordinating the supply of primary care providers with the demand of patients for attachment. 20 These waiting lists generally aim to centralise unattached patients’ requests for a primary care provider in a given jurisdiction and to match unattached patients with providers based on availability of the primary care workforce and, in some cases, medical needs.…”

“…The primary care provider is often the entry point to the health system. In Canada, 15% of patients do not have a regular provider 18. To address the critical need for attachment, defined as ‘a policy intended to improve access to and continuity of care with a primary care provider’,19 seven of the 10 Canadian provinces implemented centralised waiting lists (CWLs) for coordinating the supply of primary care providers with the demand of patients for attachment 20.…”

Engaging the collective voice of physicians: Optimizing participation in research and policy development in the context of COVID-19 and physician burnout

“…Despite challenges in engaging physicians with research studies, DNS experienced success during COVID-19 through integration into two Canadian Institutes of Health Research (CIHR)-funded study teams. 17,18 Both studies connected with physicians and with DNS prior to their application for funding and regularly sought input from all stakeholders on optimal timelines and approaches to engagement. DNS staff and physicians also made recommendations on data sources and identified potential data limitations.…”

Trends in attachment to a primary care provider in Ontario, 2008–2018: an interrupted time-series analysis

“…Strong primary care is fundamental to effective, efficient and equitable health care systems. 1 , 2 Attachment to a regular primary care provider, defined as formal or informal patient access to the same individual primary care provider or group of providers, 3 is associated with delivery of more preventive care, better chronic disease management and lower rates of hospital admission. 4 – 7 Lack of attachment to a primary care provider is associated with higher mortality; higher rates of emergency department visits, hospital admissions and readmissions; presentation to care with more advanced disease; and poor patient experiences.…”