Does socio-economic status or having a chronic condition affect whether family physicians accept a new patient? A Nova Scotia population study

Abstract

OBJECTIVES:To determine whether socio-economic status (SES) and presence of a chronic condition are associated with the response a prospective patient receives when seeking a family physician (FP).METHODS: Scripted telephone calls (indicating higher or lower SES and presence or absence of a chronic condition) were made to all 327 FP offices in Nova Scotia (NS) requesting an appointment. The main outcome measures were the responses to callers seeking a FP: being accepted for an appointment or being offered further assistance if not accepted (e.g., walk-in clinic, alternative provider, and telehealth), as well as the callers' perception of the experience as positive, negative, or neutral.RESULTS: Only 9.9% of offices accepted callers as new patients. There were no statistically significant differences by SES or chronic condition in the proportion of calls resulting in an appointment. Callers indicating high SES were more likely to be provided further assistance than those with low SES (p = 0.06), and callers indicating a chronic condition reported a better overall experience than those without (p = 0.03).CONCLUSION: First contact accessibility for prospective new patients was low across NS. Lower SES was associated with fewer offers of additional assistance than higher SES. This is particularly troubling since those with lower SES may need additional support as they may have less access to resources and networks that could provide support. This study signals the need to improve general and equitable accessibility to primary care providers.KEY WORDS: Primary health care; general practice; chronic disease; social class; access to health care; health equity La traduction du résumé se trouve à la fin de l'article.

Access to episodic primary care: a cross-sectional comparison of walk-in clinics and urgent primary care centers in British Columbia

“…Therefore, it is possible that these same-site episodic services are more financially rewarding to offer than an expansion of longitudinal services. The mechanisms that enable increased access to episodic care, potentially at the expense of longitudinal care access, are worrisome for a number of reasons: (i) there is evidence that people experiencing barriers to health equity are over-represented among the total population of those unattached to longitudinal care (Marshall et al., 2017 ; Lavergne et al., 2022 ); (ii) episodic primary care has been observed to have fewer patient and system-level benefits (Baker et al., 2020 ; Lofters et al., 2023 ); and (iii) ultimately to be more costly than longitudinal primary care (Bazemore et al., 2018 ). In this region, where access is inadequate and there are shortages of primary care providers, researchers should examine how episodic care acts as a barrier to improving access to longitudinal care.…”

Telephone outreach by volunteer navigators: a theory-based evaluation of an intervention to improve access to appropriate primary care

“…Interviews with family doctors prior to designing the intervention revealed a reluctance to accept new patients with social needs or mental health diagnoses that extended beyond their medical competence or comfort. This reluctance may translate into reduced efforts by clinic staff to attach new patients [ 29 ]. The volunteer navigators helped bridge the gap between the clinic and the community by making multiple contact attempts outside of office hours and informing patients about the consequences of not attending the first appointment, which came as a surprise to many.…”

Telephone outreach by volunteer navigators: a theory-based evaluation of an intervention to improve access to appropriate primary care

“…This reluctance may translate into reduced efforts by clinic staff to attach new patients. [30] The volunteer navigators helped bridge the gap between the clinic and the community by making multiple contact attempts outside of o ce hours and informing patients about the consequences of not attending the rst appointment, which came as a surprise to many. The fact that all those surveyed attended their rst visit and that almost all enrolled formally with the assigned family doctor suggests that integrating patient navigators to the process of assigning patients to new doctors could reduce signi cantly the rate of persons being returned to the centralized waiting list.…”