Chronically ill Canadians’ experiences of being unattached to a family doctor: a qualitative study of marginalized patients in British Columbia

Abstract

BackgroundUnattached patients do not have a regular primary care provider. Initiatives are being developed to increase attachment rates across Canada. Most existing attention paid to patient unattachment has focused on quantifying the problem and health system costs. Our purpose is to qualitatively identify the implications of chronically ill patients’ experiences of unattachment for health policy and planning to provide policy-relevant insights for Canadian attachment initiatives.MethodsThree focus groups were conducted with marginalized chronically ill individuals residing in a mid-sized city in British Columbia who are unattached to a family doctor. We use the term marginalized as a descriptor to acknowledge that by virtue of their low socio-economic status and lack of attachment the participants are marginalized in Canada’s health care system Focus groups were structured as an open conversation organized around a series of probing questions. They were digitally recorded and transcribed verbatim. Thematic analysis was employed.ResultsTwenty-six individuals participated in the focus groups. The most common chronic illnesses reported were active drug addiction or recovery (and their associated symptoms), depression, arthritis, and hepatitis C. Participants identified life transitions as being the root cause for not having a family doctor. There was a strong sense that unsuccessful attempts to get a family doctor reflected that they were undesirable patients. Participants wanted to experience having a trusting relationship with a regular family doctor as they believed it would encourage greater honesty and transparency. One of the main health concerns regarding lack of access to a regular family doctor is that participants lacked access to preventative care. Participants were also concerned about having a discontinuous medical record due to unattachment.ConclusionsParticipants perceived that there are many benefits to be had by having attachment to a regular family doctor and that experiencing unattachment challenged their health and access to health care. We encourage more research to be done on the lived experience of unattachment in order to provide on-the-ground insights that policy-makers require in order to develop responsive, patient-centred supports and programs.

Assessing the performance of centralized waiting lists for patients without a regular family physician using clinical-administrative data

“…These patients often rely on walk-in clinics and emergency departments to access primary care [1, 2]. Certain types of patients at higher risk of encountering barriers when accessing primary care, such as youth, recent immigrants, and patients with low incomes, little education, and/or low social support, are more likely to be unattached [3, 4].…”

“…To address this issue, several Canadian provinces have implemented centralized waiting lists to coordinate supply and demand for attachment to an FP. These waiting lists are used to centralize requests for FPs in a given territory and match patients with physicians according to urgency of medical need and availability of primary care workforce [1, 21]. …”

Peer helpers’ struggles to care for “others” who inject drugs

“…As might be expected, marginalized populations have been particularly affected by declining government expenditures on health care and physician shortages (Asanin & Wilson, 2008;Crooks, Agarwal, & Harrison, 2012;Khandor et al, 2011;Palepu et al, 2013). Furthermore, well publicized linkages between what are presented as "life-style choices" and illness position those who do not make "correct" choices as irresponsible citizens.…”

A comparative analysis of centralized waiting lists for patients without a primary care provider implemented in six Canadian provinces: study protocol

“…Canadian primary care providers’ role goes beyond providing primary healthcare and preventive care [28] as the structure of healthcare systems positions them as the “gatekeepers” to secondary and tertiary care [29–31]. Access to healthcare for unattached patient is therefore limited in Canada [32]. …”

“…These waiting lists generally aim to centralize unattached patients’ requests for a primary care provider in a given jurisdiction and to match unattached patients with providers, based on availability of primary care workforce and, in some cases, medical need [32, 44]. …”