Abstract
BackgroundAccess to primary healthcare is an important social determinant of health and having a regular general practitioner (GP) has been shown to improve access. In Canada, socio-economically disadvantaged patients are more likely to be unattached (i.e. not have a regular GP). In the province of Quebec, where over 30% of the population is unattached, centralized waiting lists were implemented to help patients find a GP. Our objectives were to examine the association between social and material deprivation and 1) likelihood of attachment, and 2) wait time for attachment to a GP through centralized waiting lists.MethodsA cross-sectional study was conducted in five local health networks in Quebec, Canada, using clinical administrative data of patients attached to a GP between June 2013 and May 2015 (n = 24, 958 patients) and patients remaining on the waiting list as of May 2015 (n = 49, 901), using clinical administrative data. Social and material area deprivation indexes were used as proxies for patients’ socio-economic status. Multiple regressions were carried out to assess the association between deprivation indexes and 1) likelihood of attachment to a GP and 2) wait time for attachment. Analyses controlled for sex, age, local health network and variables related to health needs.ResultsPatients from materially medium, disadvantaged and very disadvantaged areas were underrepresented on the centralized waiting lists, while patients from socially disadvantaged and very disadvantaged areas were overrepresented. Patients from very materially advantaged and advantaged areas were less likely to be attached to a GP than patients from very disadvantaged areas. With the exception of patients from socially disadvantaged areas, all other categories of social deprivation were more likely to be attached to a GP compared to patients from very disadvantaged areas. We found a pro-rich gradient in wait time for attachment to a GP, with patients from more materially advantaged areas waiting less than those from disadvantaged areas.ConclusionOur findings suggest that there are socio-economic inequities in attachment to a GP through centralized waiting lists. Policy makers should take these findings into consideration to adjust centralized waiting list processes to avoid further exacerbation of health inequities.
Highlights
Access to primary healthcare is an important social determinant of health and having a regular general practitioner (GP) has been shown to improve access
Average wait time for patients attached to a GP was 284 days (s.d. 350) and 458 days (s.d. 359) for patients waiting for attachment (p < 0.0001)
Compared to the distribution of deprivation indexes at the provincial level, we found that patients from the most materially advantaged areas represented 30.6% of patients on the waiting lists while patients from the most materially disadvantaged areas represented a mere 11.65%, with a pro-rich gradient in proportions of patients on the waiting lists
Summary
Access to primary healthcare is an important social determinant of health and having a regular general practitioner (GP) has been shown to improve access. In Canada GPs are key to accessing PHC as they are often the first point of contact to the healthcare system [13, 14], 15% of the population does not have a regular GP [14] - a large proportion compared to seven other OECD countries [15]. One of the main explanations for this large proportion of unattached patients is that GPs are required to dedicate a part of their time to regionally determined particular medical activities (activités médicales particulières) such as practicing in the emergency department or in long-term care facilities [17]. GPs in Quebec have fewer hours available to care for attached patients [17]
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