“What do you mean I can’t have a doctor? this is Canada!” – a qualitative study of the myriad consequences for unattached patients awaiting primary care attachment

Abstract

Background Patient access to primary healthcare (PHC) is the foundation of a strong healthcare system and healthy populations. Attachment to a regular PHC provider, a key to healthcare access, has seen a decline in some jurisdictions. This study explored the consequences of unattachment from a patient perspective, an under-studied phenomenon to date. Methods A realist-informed qualitative study was conducted with unattached patients in Nova Scotia, Canada. Semi-structured interviews with nine participants were conducted and transcribed for analysis. The framework method was used to carry out analysis, which was guided by Donabedian’s model of assessing healthcare access and quality. Results Five key findings were noted in this study: 1) Participants experienced a range of consequences from not having a regular PHC provider. Participants used creative strategies to 2) attempt to gain attachment to a regular PHC provider, and, to 3) address their health needs in the absence of a regular PHC provider. 4) Participants experienced negative feelings about themselves and the healthcare system, and 5) stress related to the consequences and added work of being unattached and lost care. Conclusions Unattached patients experienced a burden of care related to lost care and managing their own health and related information, due to the download of medical record management and system navigation to them. These findings may underestimate the consequences for further at-risk populations who would not have been included in our recruitment. This may result in poorer health outcomes, which could be mitigated by interventions at the structural level, such as enhanced centralized waitlists to promote attachment. Such waitlists may benefit from a triage approach to appropriately attach patients based on need.

Generating user-driven patient personas to support preventive health care activities of rural-living unattached patients

“…Our findings are also contrary to previous work, which found personas facilitated more open discussion of sensitive topics among HIV positive gay men [ 36 ]. However, the topic for developing personas in that population was around smoking cessation, this may not have had the same emotional charge and stress as has been found in unattached patients [ 37 ]. The findings from this work point to the need for integrating mitigating elements into the persona creation process, to address emotional distress that may influence the goals of the process.…”

Concordance between Virtual Physician advice and subsequent health service utilization for callers to a nurse-managed provincial health information telephone service: a time-to-event analysis

“…Primary care access challenges are pervasive and persistent in BC 15,33,38 and it is likely that this lack of access is driving at least some of the poor concordance. A 2022 qualitative study of patients seeking primary care attachment by Marshall et al describes unattached patients as experiencing additional burdens due to lost opportunities for care and having to self-manage navigation of their health information and system resources 39 . They further note that these burdens are often worse for at-risk groups.…”

Patient perspectives on the vital primary care role of community pharmacists in Nova Scotia, Canada: qualitative findings from the PUPPY Study

“…For many unattached patients, community pharmacists are a valuable resource for accessing primary care services [ 6–8 ]. Since 2019, Nova Scotian community pharmacists can prescribe for expanded minor ailments and provide renewals for 180 days for most previously prescribed medications (excluding controlled substances) [ 9 ].…”