Centralized Waiting Lists for Unattached Patients in Primary Care: Learning from an Intervention Implemented in Seven Canadian Provinces

Abstract

Introduction:Centralized waiting lists (CWLs) are one solution to reduce the problematic number of patients without a regular primary care provider. This article describes different models of CWLs for unattached patients implemented in seven Canadian provinces and identifies common issues in the implementation of these CWLs.Methods:Logic models of each province's intervention were built after a grey literature review, 42 semi-structured interviews and a validation process with key stakeholders were performed.Results:Our analysis across provinces showed variability and common features in the design of CWLs such as same main objective to attach patients to a primary care provider; implementation as a province-wide program with the exception of British Columbia; management at a regional level in most provinces; voluntary participation for providers except in two provinces where it was mandatory for providers to attach CWL patients; fairly similar registration process across the provinces; some forms of prioritization of patients either using simple criteria or assessing for vulnerability was performed in most provinces except New Brunswick.Conclusion:Despite their differences in design, CWLs implemented in seven Canadian provinces face common issues and challenges regarding provider capacity to address the demand for attachment, barriers to the attachment of more vulnerable and complex patients as well as non-standardized approaches to evaluating their effectiveness. Sharing experiences across provinces as CWLs were being implemented would have fostered learning and could have helped avoid facing similar challenges.

Family Physicians Attaching New Patients From Centralized Waiting Lists: A Cross-Sectional Study

“…Moreover, a recent study in 7 Canadian provinces found that despite variations in the design of centralized waiting lists for unattached patients, provinces faced similar challenges with capacity shortages to meet the demand for attachment and difficulties attaching vulnerable patients. 37 The study also reported that many of the provinces had limited monitoring information to evaluate their centralized waiting lists. 37 Therefore, the results of our study may provide useful insight to other jurisdictions with limited monitoring information, interested in developing strategies to encourage family physician participation in centralized waiting lists.…”

“… 37 The study also reported that many of the provinces had limited monitoring information to evaluate their centralized waiting lists. 37 Therefore, the results of our study may provide useful insight to other jurisdictions with limited monitoring information, interested in developing strategies to encourage family physician participation in centralized waiting lists.…”

Healthcare (Dis)connect – Letter to the Editor Re: Breton et al. (2018)

“…Dear Editor, I applaud Breton et al (2018) for their recent logic analysis on primary care centralized waiting lists (CWLs) in seven Canadian provinces, recently published in your journal. This is an important step towards better understanding the effectiveness of these approaches.…”

“…In our case, perhaps my family was too healthy and the needs of others were more pressing. Breton et al (2018) report that HCC prioritizes the needs of "complex/vulnerable patients" (p. 75). I support this approach, and I am pleased that those with greater need get quicker access to care.…”

“…However, some communication, guidance or other types of service from HCC would have been appreciated. Breton et al (2018) report that "the lack of a common or standardized approach makes it difficult to measure and compare the effectiveness of the different CWLs as provinces do not monitor and report the same indicators (e.g., not all provinces monitored and reported wait times for attachment) and similar indicators are often measured differently" (p. 79). Clearly, there is much more to investigate regarding CWLs.…”