Understanding the Unattached Population in Ontario: Evidence from the Primary Care Access Survey (PCAS)

Abstract

To measure primary care access on an ongoing basis, the Ontario ministry of Health and Long-Term Care implemented the Primary Care Access survey (PCAs) in 2006. The PCAs, a cross-sectional telephone survey, samples approximately 8,400 Ontario adults each year. It collects information on access to a family doctor, use of services, health status and socio-demographics. Analysis of the -2008 shows that 7.1% of Ontario' s adults were without a family doctor (i.e., unattached). The attached and unattached populations differed on socio-demographic and health characteristics. Emergency department use was similar between the two groups, but walk-in clinic use was higher among the unattached. The unattached were less likely to have used care for immediate issues but accessed care in a more timely fashion than the attached. This initial exploration of the PCAs provides a better understanding of some of the differences between the attached and unattached populations in Ontario.

Income and Regional Gradients in Being without a Regular Doctor: Does the Slope of Gradients Decrease for Those with Greater Health Needs?

“…Consistent with previous findings, econometric results suggest that individuals with no regular doctor were more likely to be male, younger, poor, a recent immigrant and healthy (Hay et al 2010;McIsaac et al 2001;Nabalamba and Millar 2007;Reid et al 2009;Sibley and Weiner 2011;Talbot et al 2001;Viera et al 2006). The presence of chronic conditions reduced the odds of having no regular doctor by 32% for those with one chronic condition and by as much as 53% for those with two or more chronic conditions.…”

“…Being without a regular doctor is influenced by a wide range of individual-, household-and community-specific factors related to (potential) access to healthcare services in the categories of contextual characteristics, needs and predisposing and enabling factors (Andersen 1995;Hay et al 2010;Lambrew et al 1996;Talbot et al 2001). A multivariate logistic regression model was used as a base model to assess the association between socio-demographic and health profiles of individuals and their being without a regular physician.…”

“…However, the finding that low-income individuals with chronic conditions are less likely to have a regular doctor than their counterparts in the richest income category suggests that future primary care programs could be targeted to enhance potential access to primary care providers, particularly for vulnerable segments of the population. Some jurisdictions, such as Ontario, have already taken measures to address timely access to primary care by shifting the policy emphasis from physician supply to strategies for shared care or flexible hours, and helping those with no regular doctor to find healthcare providers (Hay et al 2010).…”

“…There is a small but growing empirical literature on the socio-demographic covariates associated with having no regular doctor (Hay et al 2010;McIsaac et al 2001;Nabalamba and Millar 2007;Reid et al 2009;Talbot et al 2001;Viera et al 2006). Being male, a young adult, single, healthy, a recent immigrant and poor are associated with higher odds of being without a regular doctor.…”

Implanter des guichets d’accès aux clientèles sans médecin de famille à travers le Québec

“…Le mandat d'aider les patients orphelins dans leurs recherches d'un médecin de famille s'inscrivait donc parfaitement dans la mission des CSSS. De plus, la littérature est assez éloquente quant aux bienfaits d'avoir un médecin de famille, notamment en regard de la qualité des soins (ex; prestation d'activités préventives) et sur les résultats des soins (satisfaction des patients, adhésion au traitement, meilleure utilisation des services) (Jatrana and Crampton 2009;Hay, Pacey and Bains 2010;Lambrew et al 1996). Également, la Fédération des médecins de famille du Québec (FMOQ) a joué un rôle prépondérant dans le développement de la politique des GACO.…”