Rahman Bahram, Costa Andrew P, Gayowsky Anastasia, Rahim Ahmad, Kiran Tara, Ivers Noah, Price David, Jones Aaron, Lapointe-Shaw Lauren
Physician and Provider Services Division (Rahman), Ministry of Health, Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (Rahman, Costa, Gayowsky, Rahim, Jones), McMaster University; ICES McMaster (Costa, Gayowsky, Jones); Centre for Health Economics and Policy Analysis (Costa), and Department of Medicine (Costa), McMaster University; The Research Institute of St. Joe's Hamilton (Costa), St. Joseph's Healthcare Hamilton; Centre for Integrated Care (Costa), St. Joseph's Health System, Hamilton, Ont.; Schlegel Research Institute for Aging (Costa), Waterloo, Ont.; ICES Central (Kiran, Ivers, Lapointe-Shaw); Institute of Health Policy, Management and Evaluation (Kiran, Ivers, Lapointe-Shaw), and Department of Family and Community Medicine (Kiran, Ivers), University of Toronto; Department of Family and Community Medicine (Kiran), St. Michaels's Hospital; MAP Centre for Urban Health Solutions (Kiran), St. Michaels's Hospital; Women's College Institute for Health System Solutions and Virtual Care (Ivers, Lapointe-Shaw), Women's College Hospital, Toronto, Ont.; McMaster Family Health Team (Price), Hamilton, Ont.; Division of General Internal Medicine and Geriatrics (Lapointe-Shaw), University Health Network and Sinai Health System; Department of Medicine (Lapointe-Shaw), University of Toronto, Toronto, Ont.
CMAJ Open. 2023 Sep 26;11(5):E847-E858. doi: 10.9778/cmajo.20220231. Print 2023 Sep-Oct.
Challenges in timely access to one's usual primary care physician and the ongoing use of walk-in clinics have been major health policy issues in Ontario for over a decade. We sought to determine the association between patient-reported timely access to their usual primary care physician or clinic and their use of walk-in clinics.
We conducted a cross-sectional study of Ontario residents who had a primary care physician by linking population-based administrative data to Ontario's Health Care Experience Survey, collected between 2013 and 2020. We described sociodemographic characteristics and health care use for users of walk-in clinics and nonusers. We measured the adjusted association between self-reported same-day or next-day access and after-hours access to usual primary care physicians or clinics and the use of walk-in clinics in the previous 12 months.
Of the 60 935 total responses from people who had a primary care physician, 16 166 (weighted 28.6%, unweighted 26.5%) reported visiting a walk-in clinic in the previous 12 months. Compared with nonusers, those who used walk-in clinics were predominantly younger, lived in large and medium-sized urban areas and reported a tight, very tight or poor financial situation. Respondents who reported poor same-day or next-day access to their primary care physician or clinic were more likely to report having attended a walk-in clinic in the previous 12 months than those with better access (adjusted odds ratio [OR] 1.23, 95% confidence interval [Cl] 1.13-1.34). Those who reported being unaware that their primary care physician offered after-hours care had a higher likelihood of going to a walk-in clinic (adjusted OR 1.14, 95% Cl 1.07-1.21).
In this population-based health survey, patient-reported use of walk-in clinics was associated with a reported lack of access to same-day or next-day care and unawareness of after-hours care by respondents' usual primary care physicians. These findings could inform policies to improve access to primary care, while preserving care continuity.
在安大略省，能否及时看自己的常规初级保健医生以及随诊诊所的持续使用情况，在过去十多年里一直是重大的卫生政策问题。我们试图确定患者报告的及时看自己常规初级保健医生或诊所的情况与他们使用随诊诊所之间的关联。
我们通过将基于人群的行政数据与2013年至2020年期间收集的安大略省医疗保健体验调查相链接，对有初级保健医生的安大略省居民进行了一项横断面研究。我们描述了随诊诊所使用者和非使用者的社会人口学特征及医疗保健使用情况。我们测量了自我报告的当日或次日看诊以及非工作时间看常规初级保健医生或诊所与过去12个月内使用随诊诊所之间的校正关联。
在有初级保健医生的60935份总回复中，16166人（加权28.6%，未加权26.5%）报告在过去12个月内去过随诊诊所。与非使用者相比，使用随诊诊所的人主要更年轻，居住在大中型城市地区，且报告财务状况紧张、非常紧张或不佳。报告当日或次日难以看自己初级保健医生或诊所的受访者，比看诊较方便的受访者更有可能报告在过去12个月内去过随诊诊所（校正比值比[OR]1.23，95%置信区间[Cl]1.13 - 1.34）。那些报告不知道自己的初级保健医生提供非工作时间护理的人去随诊诊所的可能性更高（校正OR 1.14，95% Cl 1.07 - 1.21）。
在这项基于人群的健康调查中，患者报告使用随诊诊所与报告的无法当日或次日看诊以及受访者的常规初级保健医生未提供非工作时间护理的情况有关。这些发现可为改善初级保健可及性的政策提供参考，同时保持护理连续性。
