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. 2024 May 20;196(19):E646-E656.
doi: 10.1503/cmaj.231372.

Public experiences and perspectives of primary care in Canada: results from a cross-sectional survey

Tara Kiran  1 , Maryam Daneshvarfard  2 , Ri Wang  2 , Alexander Beyer  2 , Jasmin Kay  2 , Mylaine Breton  2 , Danielle Brown-Shreves  2 , Amanda Condon  2 , Michael E Green  2 , Lindsay Hedden  2 , Alan Katz  2 , Maggie Keresteci  2 , Neb Kovacina  2 , M Ruth Lavergne  2 , Aisha Lofters  2 , Danielle Martin  2 , Goldis Mitra  2 , Sarah Newbery  2 , Katherine Stringer  2 , Peter MacLeod  2 , Clifton van der Linden  2
Affiliations

Public experiences and perspectives of primary care in Canada: results from a cross-sectional survey

Tara Kiran et al. CMAJ. .

Abstract

Background: Through medicare, residents in Canada are entitled to medically necessary physician services without paying out of pocket, but still many people struggle to access primary care. We conducted a survey to explore people's experience with and priorities for primary care.

Methods: We conducted an online, bilingual survey of adults in Canada in fall 2022. We distributed an anonymous link through diverse channels and a closed link to 122 053 people via a national public opinion firm. We weighted completed responses to mirror Canada's population and adjusted for sociodemographic characteristics using regression models.

Results: We analyzed 9279 completed surveys (5.9% response rate via closed link). More than one-fifth of respondents (21.8%) reported having no primary care clinician, and among those who did, 34.5% reported getting a same or next-day appointment for urgent issues. Of respondents, 89.4% expressed comfort seeing another team member if their doctor recommended it, but only 35.9%, 9.5%, and 12.4% reported that their practice had a nurse, social worker, or pharmacist, respectively. The primary care attribute that mattered most was having a clinician who "knows me as a person and considers all the factors that affect my health." After we adjusted for respondent characteristics, people in Quebec, the Atlantic region, and British Columbia had lower odds of reporting a primary care clinician than people in Ontario (adjusted odds ratio 0.30, 0.33, and 0.39, respectively; p < 0.001). We also observed large provincial variations in timely access, interprofessional care, and walk-in clinic use.

Interpretation: More than 1 in 5 respondents did not have access to primary care, with large variation by province. Reforms should strive to expand access to relationship-based, longitudinal care in a team setting.

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Conflict of interest statement

Competing interests:: Tara Kiran reports receiving support for the present manuscript from Health Canada, Staples Canada, the Max Bell Foundation, and the FDC Foundation. Dr. Kiran has also received grants or contracts from the Ministry of Health and Long-Term Care and the St. Michael’s Hospital Foundation, and grants and consulting fees from Ontario Health. Dr. Kiran has received payment or honoraria from the Canadian Medical Association, the College of Family Physicians of Canada (CFPC), the Association of Family Health Teams of Ontario, the Ontario Medical Association, and the Ontario College of Family Physicians. Dr. Kiran is the Fidani Chair in Improvement and Innovation at the University of Toronto and is also supported as a clinician scientist by the Department of Family and Community Medicine at the University of Toronto and at St. Michael’s Hospital. Amanda Condon reports receiving honoraria as the Manitoba co-lead for OurCare, in support of the present manuscript. Dr. Condon is also the Manitoba co-lead for Health Canada and the Canadian Institutes of Health Research CanTreatCOVID adaptive platform trial, and reports receiving funding for travel related to this trial. Dr. Condon is a director of the board of the CFPC. Michael Green is president and board chair of the CFPC, and board member and chair of the Fellowship Committee of AMS Healthcare Inc. Alan Katz reports receiving support for the current manuscript from the University of Manitoba. Maggie Keresteci reports receiving a grant from the Canadian Association for Health Services and Policy Research, consulting fees from Healthcare Excellence Canada and the Canadian Agency for Drugs and Technologies in Health (CADTH), and payment or honoraria from Healthcare Excellence Canada, CADTH, the Ontario College of Family Physicians, and the University of Ottawa. Dr. Keresteci also reports holding a leadership role with Emily’s House Children’s Hospice. Sarah Newbery reports receiving travel support from the PSI Foundation for attending a meeting, and from the Northern Ontario School of Medicine University for attending the CFPC’s Family Medicine Forum. Dr. Newbery is also a member of the CMAJ Editorial Advisory Board. Goldis Mitra reports holding roles with BC Family Doctors (Executive Treasurer), the Statutory Negotiations Committee of Doctors of BC, and OurCare (BC Physician Lead). Katherine Stringer reports receiving an honorarium as the Nova Scotia co-lead for the OurCare initative (paid to Dalhousie Department of Family Medicine) and support from the CFPC and Dalhousie University to travel to and attend meetings or conferences. Dr. Stringer reports holding the roles of chair of the CFPC Family Medicine Specialty Committee and chair of the Association of Academic Chairs of Family Medicine (both unpaid). No other competing interests were declared.

Figures

Figure 1:
Figure 1:
Percentage of respondents who said they had a family doctor or nurse practitioner they could see regularly for care, and corresponding odds ratio (OR) by sociodemographic characteristic. C-statistic (AUC) = 0.693. *Individual income. Note: CI = confidence interval, Ref. = reference category.
Figure 2:
Figure 2:
Percentage of respondents who said they could see their family doctor or nurse practitioner on the same or next day for an urgent issue, and corresponding odds ratio (OR) by sociodemographic characteristic. C-statistic (AUC) = 0.572. *Cell sizes < 6 have been suppressed. †Individual income. Note: CI = confidence interval, Ref. = reference category.
Figure 3:
Figure 3:
Percentage of respondents who reported having a nurse, social worker, dietitian, pharmacist, or Indigenous cultural service provider work in the same practice as their family doctor or nurse practitioner, and corresponding odds ratio (OR) by sociodemographic characteristics. C-statistic (AUC) = 0.610. *Cell sizes < 6 have been suppressed. †Individual income. Note: CI = confidence interval, Ref. = reference category.
Figure 4:
Figure 4:
Percentage of respondents who attended a walk-in clinic 1 or more times in the last 12 months, and corresponding odds ratio (OR) by sociodemographic characteristic. C-statistic (AUC) = 0.680. *Cell sizes < 6 have been suppressed. †Individual income. Note: CI = confidence interval, Ref. = reference category.
Figure 5:
Figure 5:
Percentage of survey respondents who indicated an attribute of primary care as very (or fairly) important, in rank order by importance.
Figure 6:
Figure 6:
Percentage of respondents who said it is very important that their family doctor or nurse practitioner and the practice they work in “know me as a person and consider all the factors that affect my health,” and corresponding odds ratio (OR) by sociodemographic characteristic. C-statistic (AUC) = 0.673. *Individual income. Note: CI = confidence interval, Ref. = reference category.
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References

    1. Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. Milbank Q 2005;83:457–502. - PMC - PubMed
    1. Shi L. The impact of primary care: a focused review. Scientifica (Cairo) 2012;2012:432892. doi:10.6064/2012/432892. - DOI - PMC - PubMed
    1. Elliott J, Stolee P, Boscart V, et al. . Coordinating care for older adults in primary care settings: understanding the current context. BMC Fam Pract 2018;19:137. - PMC - PubMed
    1. Martin S, Siciliani L, Smith P. Socioeconomic inequalities in waiting times for primary care across ten OECD countries. Soc Sci Med 2020;263:113230. doi:10.1016/j.socscimed.2020.113230. - DOI - PubMed
    1. Loeb DF, Bayliss EA, Candrian C, et al. . Primary care providers’ experiences caring for complex patients in primary care: a qualitative study. BMC Fam Pract 2016;17:34. - PMC - PubMed