Sociodemographic differences in patient experience with primary care during COVID-19: results from a cross-sectional survey in Ontario, Canada

Abstract

PurposeWe sought to understand patients’ care-seeking behaviours early in the pandemic, their use and views of different virtual care modalities, and whether these differed by sociodemographic factors.MethodsWe conducted a multisite cross-sectional patient experience survey at 13 academic primary care teaching practices between May and June 2020. An anonymised link to an electronic survey was sent to a subset of patients with a valid email address on file; sampling was based on birth month. For each question, the proportion of respondents who selected each response was calculated, followed by a comparison by sociodemographic characteristics using χ2 tests.ResultsIn total, 7532 participants responded to the survey. Most received care from their primary care clinic during the pandemic (67.7%, 5068/7482), the majority via phone (82.5%, 4195/5086). Among those who received care, 30.53% (1509/4943) stated that they delayed seeking care because of the pandemic. Most participants reported a high degree of comfort with phone (92.4%, 3824/4139), video (95.2%, 238/250) and email or messaging (91.3%, 794/870). However, those reporting difficulty making ends meet, poor or fair health and arriving in Canada in the last 10 years reported lower levels of comfort with virtual care and fewer wanted their practice to continue offering virtual options after the pandemic.ConclusionsOur study suggests that newcomers, people living with a lower income and those reporting poor or fair health have a stronger preference and comfort for in-person primary care. Further research should explore potential barriers to virtual care and how these could be addressed.

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“…This may also be due to a multitude of social and behavioral factors. First, several surveys in North America suggested that some people with acute illness did not seek medical attention and be admitted to hospitals when required 29–31 . This deficiency in care‐seeking behavior could have been compounded by deficiencies in the outpatient care setting as well, 32–34 as evident by a reduction in inpatient and outpatient visits.…”

Are primary care virtual visits associated with higher emergency department use? A cross-sectional analysis from Ontario, Canada

“…1,33 In US studies, virtual care often includes a high portion of video unlike in Ontario where most virtual care was delivered by phone. 3…”

“…2 Research has found that most patients feel comfortable with virtual care, like its convenience, and want it to continue. 3-6 However, there are concerns about the impact of virtual primary care visits on care quality including on patient safety, 7 equity in access, 8,9 effective chronic condition management, 10 and healthcare utilization. 11 Effects have been hard to untangle due to the simultaneous impact of the pandemic on care.…”

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“…A higher proportion of those with trouble making ends meet and those with lower self-rated health reported delays in seeking care. 95 Providing Care for Patients Awaiting Disrupted Surgeries and Services…”

“…118,119 Net new virtual care in Ontario was overwhelmingly done by telephone. 95 In the first four months of the pandemic, virtual primary care increased dramatically, comprising 71.1% of primary care physician visits. 92 The proportion of care delivered virtually subsequently decreased and then fluctuated.…”