Attaching Patients In Primary Care Through Centralized Waiting Lists: Seven Canadian Provinces Compared

Abstract

Canada has the lowest rate of attachment to primary care providers among OECD countries, which makes access and continuity of care problematic. To address this important issue, seven Canadian provinces have implemented centralized waiting lists (CWLs) for unattached patients in primary care. Introduced at different times, no two provinces' CWLs are exactly alike. The main goal of these CWLs is to reduce the number of unattached patients. In some provinces, CWLs also serve to monitor primary care activity or prioritize vulnerable patients. Societal pressure and broader primary care reform influenced the implementation of the CWLs in each province. Monitoring, in terms of data collected and purpose, differs between provinces. The interprovincial comparison enables identification of strengths, weaknesses, opportunities and threats during implementation and at each step of the CWLs: registration, patient assessment and attachment. Common issues with CWLs across provinces include the importance of monitoring to facilitate implementation, the need for specific measures to ensure access for vulnerable and complex patients, and the shortage of primary care providers.Attaching Patients In Primary Care Through Centralized Waiting Lists Breton et al. Key Messages• CWLs have been implemented in seven Canadian provinces to attach patients to a primary care provider, with large variations between provinces in the design and management of CWLs.

Uptake in the practice of medical assistance in dying (MAiD) and involvement by physician speciality over time in Nova Scotia, Canada

“…Whether the specifics of the family physician workforce in Nova Scotia, or nationally, affects MAiD uptake and access remains to be seen. This is an important area of study given the proportion of patients with no family physician or limited access to their provider 32,36,37 . Future research on MAiD in Nova Scotia could be directed at gaining a better understanding of the demographics of physicians involved in MAiD, including such aspects as payment models, gender, and years in practice.…”

The PUPPY Study – Protocol for a Longitudinal Mixed Methods Study Exploring Problems Coordinating and Accessing Primary Care for Attached and Unattached Patients Exacerbated During the COVID-19 Pandemic Year

“…Analyses of pre-COVID-19 prescription dispensation, centralized waitlist, physician billing, and inpatient and outpatient hospital discharge data has already begun to examine effectiveness of centralized waitlists for a related study, (17) as part of an ongoing program of research into access and attachment. (29)(30)(31) As part of the PUPPY Study, we will expand this analysis to explore changes across pre-COVID-19, COVID-19, and post-pandemic periods. Harmonized indicators of health care utilization (e.g., primary care, emergency, hospitalization, and potentially avoidable inpatient care), and primary care attachment indicators (primary care provider attachment, continuity of primary care), and primary care service provision (e.g., frequency and type of primary care encounters, continuity of medication dispensation for maintenance of chronic conditions) will be measured across the three participating provinces.…”

“…Most Canadian provinces have therefore developed strategies including centralized waitlists for unattached patients and dedicated clinics to address this concern. [15,16]…”

Improving Access to Family Medicine in Quebec through Quotas and Numerical Targets

“…In fact, the proportion of Québecers without a family doctor had remained stagnant since 2003 (Statistics Canada 2013). Media reports and public concerns about access to care led to the implementation of the centralized waiting list (Guichets d'accès pour la clientèle orpheline) for unattached patients in 2008 (Breton et al 2019). Over time, issues with discrimination against the selection of certain types of patients surfaced and there was pressure to ameliorate the attachment process (Breton, Gagne, Gankpe 2014).…”