Care-seeking experiences of unattached patients in the Canadian health care system: Qualitative study

doi:10.46747/cfp.7006396

. 2024 Jun;70(6):396-403.

doi: 10.46747/cfp.7006396.

Care-seeking experiences of unattached patients in the Canadian health care system: Qualitative study

Maria Mathews¹, Dana Ryan², Véronique Deslauriers³, Lauren R Moritz⁴, Jennifer Xiao⁵, Mylaine Breton⁶, Michael E Green⁷, Jennifer E Isenor⁸, Emily Gard Marshall⁹, Richard Buote¹⁰, Leslie Meredith¹¹, Mélanie Ann Smithman¹², Rachelle Ashcroft¹³, Susan Bowles⁸, Line Guénette¹⁴, Logan Lawrence¹⁵, Ruth Martin-Misener¹⁶, Lisa M McCarthy¹⁷, Beth McDougall¹⁸, Melanie Mooney¹⁹, Bobbi Morrison²⁰, Andrea Murphy⁸, Katherine Stringer²¹

Affiliations

¹ Professor in the Department of Family Medicine in the Schulich School of Medicine and Dentistry at Western University in London, Ont.
² Research Assistant in the Department of Family Medicine in the Schulich School of Medicine and Dentistry at Western University.
³ Research Coordinator in the Department of Community Health Sciences at the University of Sherbrooke in Longueuil, Que.
⁴ Research Associate in the Dalhousie Family Medicine Primary Health Care Research Unit in the Department of Family Medicine at Dalhousie University in Halifax, NS.
⁵ Clinical Research Coordinator at the Ottawa Hospital Research Institute in Ontario.
⁶ Canada Research Chair in Clinical Governance on Primary Health Care and Professor in the Department of Community Health Sciences at the University of Sherbrooke.
⁷ Professor in the Department of Family Medicine and the Department of Public Health Sciences at Queen's University in Kingston, Ont, and President of the College of Family Physicians of Canada.
⁸ Associate Professor in the College of Pharmacy in the Faculty of Health at Dalhousie University.
⁹ Professor in the Dalhousie Family Medicine Primary Health Care Research Unit in the Department of Family Medicine at Dalhousie University, and with the Nova Scotia Health Authority.
¹⁰ Senior Research Associate in the Dalhousie Family Medicine Primary Health Care Research Unit at Dalhousie University.
¹¹ Manager of the Primary Health Care System Program in the Department of Family Medicine in the Schulich School of Medicine and Dentistry at Western University.
¹² Post-doctoral fellow at the Upstream Lab in the MAP Centre for Urban Health Solutions at Unity Health Toronto at the University of Toronto in Ontario.
¹³ Associate Professor in the Factor-Inwentash Faculty of Social Work at the University of Toronto.
¹⁴ Associate Professor in the Faculty of Pharmacy at Laval University and a researcher in the Population Health and Health Best Practices Axis of the Centre Hospitalier Universitaire of the Quebec-Laval University Research Centre in Quebec.
¹⁵ Health Outcomes Scientist with the Nova Scotia Health Authority in Halifax.
¹⁶ Professor in and Director of the School of Nursing and Assistant Dean of Research in the Faculty of Health, both at Dalhousie University.
¹⁷ Associate Professor of Pharmacy and Epidemiology in the Leslie Dan Faculty of Pharmacy at the University of Toronto and Clinician Scientist at Trillium Health Partners' Institute for Better Health in Mississauga, Ont.
¹⁸ Doctoral candidate in the Department of Community Health and Epidemiology in the Faculty of Medicine at Dalhousie University.
¹⁹ Health Services Manager at Nova Scotia Health in Yarmouth.
²⁰ Associate Professor in the Department of Marketing and Enterprise Systems in the Schwartz School of Business at St Francis Xavier University in Antigonish, NS.
²¹ Head of the Department of Family Medicine in the Faculty of Medicine at Dalhousie University.

PMID: 38886083
PMCID: PMC11280697
DOI: 10.46747/cfp.7006396

Care-seeking experiences of unattached patients in the Canadian health care system: Qualitative study

Maria Mathews et al. Can Fam Physician. 2024 Jun.

. 2024 Jun;70(6):396-403.

doi: 10.46747/cfp.7006396.

Authors

Affiliations

¹ Professor in the Department of Family Medicine in the Schulich School of Medicine and Dentistry at Western University in London, Ont.
² Research Assistant in the Department of Family Medicine in the Schulich School of Medicine and Dentistry at Western University.
³ Research Coordinator in the Department of Community Health Sciences at the University of Sherbrooke in Longueuil, Que.
⁴ Research Associate in the Dalhousie Family Medicine Primary Health Care Research Unit in the Department of Family Medicine at Dalhousie University in Halifax, NS.
⁵ Clinical Research Coordinator at the Ottawa Hospital Research Institute in Ontario.
⁶ Canada Research Chair in Clinical Governance on Primary Health Care and Professor in the Department of Community Health Sciences at the University of Sherbrooke.
⁷ Professor in the Department of Family Medicine and the Department of Public Health Sciences at Queen's University in Kingston, Ont, and President of the College of Family Physicians of Canada.
⁸ Associate Professor in the College of Pharmacy in the Faculty of Health at Dalhousie University.
⁹ Professor in the Dalhousie Family Medicine Primary Health Care Research Unit in the Department of Family Medicine at Dalhousie University, and with the Nova Scotia Health Authority.
¹⁰ Senior Research Associate in the Dalhousie Family Medicine Primary Health Care Research Unit at Dalhousie University.
¹¹ Manager of the Primary Health Care System Program in the Department of Family Medicine in the Schulich School of Medicine and Dentistry at Western University.
¹² Post-doctoral fellow at the Upstream Lab in the MAP Centre for Urban Health Solutions at Unity Health Toronto at the University of Toronto in Ontario.
¹³ Associate Professor in the Factor-Inwentash Faculty of Social Work at the University of Toronto.
¹⁴ Associate Professor in the Faculty of Pharmacy at Laval University and a researcher in the Population Health and Health Best Practices Axis of the Centre Hospitalier Universitaire of the Quebec-Laval University Research Centre in Quebec.
¹⁵ Health Outcomes Scientist with the Nova Scotia Health Authority in Halifax.
¹⁶ Professor in and Director of the School of Nursing and Assistant Dean of Research in the Faculty of Health, both at Dalhousie University.
¹⁷ Associate Professor of Pharmacy and Epidemiology in the Leslie Dan Faculty of Pharmacy at the University of Toronto and Clinician Scientist at Trillium Health Partners' Institute for Better Health in Mississauga, Ont.
¹⁸ Doctoral candidate in the Department of Community Health and Epidemiology in the Faculty of Medicine at Dalhousie University.
¹⁹ Health Services Manager at Nova Scotia Health in Yarmouth.
²⁰ Associate Professor in the Department of Marketing and Enterprise Systems in the Schwartz School of Business at St Francis Xavier University in Antigonish, NS.
²¹ Head of the Department of Family Medicine in the Faculty of Medicine at Dalhousie University.

PMID: 38886083
PMCID: PMC11280697
DOI: 10.46747/cfp.7006396

Abstract
in English, French

Objective: To understand how lack of attachment to a regular primary care provider influences patients' outlooks on primary care, ability to address their health care needs, and confidence in the health care system.

Design: Qualitative descriptive study using semistructured interviews.

Setting: Canadian provinces of Nova Scotia, Ontario, and Quebec.

Participants: Patients aged 18 years or older who were unattached or had become attached within 1 year of being interviewed and who resided in the province in which they were interviewed.

Methods: Forty-one semistructured interviews were conducted, during which participants were asked to describe how they had become unattached, their searches to find new primary care providers, their perceptions of and experiences with the centralized waiting list in their province, their experiences seeking care while unattached, and the impact of being unattached on their health and on their perceptions of the health care system. Interviews were transcribed and analyzed using a thematic approach.

Main findings: Two main themes were identified in interviews with unattached or recently attached patients: unmet needs of unattached patients and the impact of being unattached. Patients' perceived benefits of attachment included access to care, longitudinal relationships with health care providers, health history familiarity, and follow-up monitoring and care coordination. Being unattached was associated with negative effects on mental health, poor health outcomes, decreased confidence in the health care system, and greater pre-existing health inequities.

Conclusion: Having a regular primary care provider is essential to having access to high-quality care and other health care services. Attachment also promotes health equity and confidence in the public health care system and has broader system-level, social, and policy implications.

Objectif: Comprendre comment le fait de ne pas avoir de professionnel de soins primaires régulier influe sur les points de vue des patients sur les soins primaires, sur leur capacité à répondre à leurs besoins en soins de santé, et sur leur confiance dans le système de santé.

Type d’étude: Une étude qualitative descriptive à l’aide d’entrevues semistructurées.

Contexte: Les provinces canadiennes de la Nouvelle-Écosse, de l’Ontario et du Québec.

Participants: Des patients âgés de 18 ans et plus qui n’avaient pas de médecin régulier, ou qui avaient été rattachés à un médecin durant l’année suivant l’entrevue et qui résidaient dans la province où ils avaient été interviewés.

Méthodes: Quarante et une entrevues ont été effectuées, durant lesquelles on demandait aux patients de décrire comment ils étaient devenus orphelins, leur quête pour trouver un nouveau professionnel de soins primaires, leurs perceptions et leurs expériences relatives à la liste d’attente centralisée dans leur province, leurs expériences relatives à la recherche de soins en tant qu’orphelins, de même que les répercussions du fait d’être orphelins sur leur santé et leurs perceptions du système de santé. Les entrevues ont été transcrites et analysées à l’aide d’une approche thématique.

Principales constatations: Deux principaux thèmes se sont dégagés des entrevues avec des patients orphelins ou récemment rattachés à un professionnel : les besoins non comblés des patients orphelins et les répercussions du fait d’être orphelins. Selon les patients, parmi les avantages d’être rattachés à un professionnel de la santé figuraient l’accès aux soins, les relations longitudinales avec des professionnels, la connaissance des antécédents médicaux, les suivis de surveillance et la coordination des soins. Le fait d’être orphelin était associé à des effets négatifs sur la santé mentale, à des issues défavorables en santé, à une baisse de la confiance dans le système de santé et à de plus grandes iniquités préexistantes en matière de santé.

Conclusion: Le rattachement à un professionnel des soins primaires régulier est essentiel pour avoir accès à des soins de grande qualité et à d’autres services de soins de santé. Ce rattachement favorise aussi l’équité en santé et la confiance dans le système de santé public, et il a des implications plus vastes sur les plans systémique, social et stratégique.

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Cited by

Attributes of family physician encounters valued by older adults: a systematic review.
Correia RH, Dash D, Pasat Z, Strum RP, Aryal K, Kabir H, Potter M, Swayze E, Beaudoin P, Ward P, Siu HY. Correia RH, et al. BMC Prim Care. 2025 Mar 28;26(1):87. doi: 10.1186/s12875-025-02794-1. BMC Prim Care. 2025. PMID: 40155879 Free PMC article.

References

1. Primary care needs OurCare: the final report of the largest pan-Canadian conversation about the future of primary care. Toronto, ON: MAP Centre for Urban Health Solutions; 2024. Available from: https://issuu.com/dfcm/docs/primary_care_needs_ourcare_the_final_report_.... Accessed 2024 May 15.
1. Kiran T, Green M, Breton M, Lavergne R, Kovacina N, Brown-Shreves D, et al. . Results from the OurCare survey: public perspectives on primary care in Canada. Ann Fam Med 2023;21(Suppl 3):5232.
1. Hay C, Pacey M, Bains N, Ardal S.. Understanding the unattached population in Ontario: evidence from the Primary Care Access Survey (PCAS). Healthc Policy 2010;6(3):33-47. - PMC - PubMed
1. Islam MK, Kellett P.. Provincial variations in not having a regular medical doctor and having unmet healthcare needs among Canadians. Int J Health Plann Manage 2022;37(4):2090-105. Epub 2022 Mar 4. - PubMed
1. Crooks VA, Agarwal G, Harrison A.. Chronically ill Canadians’ experiences of being unattached to a family doctor: a qualitative study of marginalized patients in British Columbia. BMC Fam Pract 2012;13:69. - PMC - PubMed

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[1] Primary care needs OurCare: the final report of the largest pan-Canadian conversation about the future of primary care. Toronto, ON: MAP Centre for Urban Health Solutions; 2024. Available from: https://issuu.com/dfcm/docs/primary_care_needs_ourcare_the_final_report_.... Accessed 2024 May 15.

[2] Primary care needs OurCare: the final report of the largest pan-Canadian conversation about the future of primary care. Toronto, ON: MAP Centre for Urban Health Solutions; 2024. Available from: https://issuu.com/dfcm/docs/primary_care_needs_ourcare_the_final_report_.... Accessed 2024 May 15.

[3] Kiran T, Green M, Breton M, Lavergne R, Kovacina N, Brown-Shreves D, et al. . Results from the OurCare survey: public perspectives on primary care in Canada. Ann Fam Med 2023;21(Suppl 3):5232.

[4] Kiran T, Green M, Breton M, Lavergne R, Kovacina N, Brown-Shreves D, et al. . Results from the OurCare survey: public perspectives on primary care in Canada. Ann Fam Med 2023;21(Suppl 3):5232.

[5] Hay C, Pacey M, Bains N, Ardal S.. Understanding the unattached population in Ontario: evidence from the Primary Care Access Survey (PCAS). Healthc Policy 2010;6(3):33-47. - PMC - PubMed

[6] Hay C, Pacey M, Bains N, Ardal S.. Understanding the unattached population in Ontario: evidence from the Primary Care Access Survey (PCAS). Healthc Policy 2010;6(3):33-47. - PMC - PubMed

[7] Islam MK, Kellett P.. Provincial variations in not having a regular medical doctor and having unmet healthcare needs among Canadians. Int J Health Plann Manage 2022;37(4):2090-105. Epub 2022 Mar 4. - PubMed

[8] Islam MK, Kellett P.. Provincial variations in not having a regular medical doctor and having unmet healthcare needs among Canadians. Int J Health Plann Manage 2022;37(4):2090-105. Epub 2022 Mar 4. - PubMed

[9] Crooks VA, Agarwal G, Harrison A.. Chronically ill Canadians’ experiences of being unattached to a family doctor: a qualitative study of marginalized patients in British Columbia. BMC Fam Pract 2012;13:69. - PMC - PubMed

[10] Crooks VA, Agarwal G, Harrison A.. Chronically ill Canadians’ experiences of being unattached to a family doctor: a qualitative study of marginalized patients in British Columbia. BMC Fam Pract 2012;13:69. - PMC - PubMed

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Care-seeking experiences of unattached patients in the Canadian health care system: Qualitative study

Affiliations

Care-seeking experiences of unattached patients in the Canadian health care system: Qualitative study

Authors

Affiliations

Abstract
in English, French

Similar articles

Cited by

References

MeSH terms

LinkOut - more resources

Full Text Sources

Abstract in English, French

Similar articles

Cited by

References

MeSH terms

LinkOut - more resources

Full Text Sources

Abstract
in English, French