Abstract
BackgroundUnattached patients do not have a regular primary care provider. Initiatives are being developed to increase attachment rates across Canada. Most existing attention paid to patient unattachment has focused on quantifying the problem and health system costs. Our purpose is to qualitatively identify the implications of chronically ill patients’ experiences of unattachment for health policy and planning to provide policy-relevant insights for Canadian attachment initiatives.MethodsThree focus groups were conducted with marginalized chronically ill individuals residing in a mid-sized city in British Columbia who are unattached to a family doctor. We use the term marginalized as a descriptor to acknowledge that by virtue of their low socio-economic status and lack of attachment the participants are marginalized in Canada’s health care system Focus groups were structured as an open conversation organized around a series of probing questions. They were digitally recorded and transcribed verbatim. Thematic analysis was employed.ResultsTwenty-six individuals participated in the focus groups. The most common chronic illnesses reported were active drug addiction or recovery (and their associated symptoms), depression, arthritis, and hepatitis C. Participants identified life transitions as being the root cause for not having a family doctor. There was a strong sense that unsuccessful attempts to get a family doctor reflected that they were undesirable patients. Participants wanted to experience having a trusting relationship with a regular family doctor as they believed it would encourage greater honesty and transparency. One of the main health concerns regarding lack of access to a regular family doctor is that participants lacked access to preventative care. Participants were also concerned about having a discontinuous medical record due to unattachment.ConclusionsParticipants perceived that there are many benefits to be had by having attachment to a regular family doctor and that experiencing unattachment challenged their health and access to health care. We encourage more research to be done on the lived experience of unattachment in order to provide on-the-ground insights that policy-makers require in order to develop responsive, patient-centred supports and programs.
Highlights
Unattached patients do not have a regular primary care provider
Most existing attention paid to unattachment has focused on quantifying the problem and health system costs [1,12,25,38,39]. To address this knowledge gap, in the present article we examine the experiences of unattached patients in a low socio-economic status neighbourhood of a mid-sized British Columbia (BC) city who are managing chronic illnesses in order to provide policy-relevant qualitative insights
We ran focus groups [41,42] with chronically ill individuals residing in a low socio-economic status neighbourhood of a mid-sized BC city who self-identified as being unattached to a family doctor
Summary
Unattached patients do not have a regular primary care provider. Initiatives are being developed to increase attachment rates across Canada. A number of regional and provincial/territorial health administration bodies have created initiatives in the form of policies and programs designed to increase the numbers of practicing family doctors [15] These initiatives exist typically at regional and provincial/territorial levels because while the Canadian public health care system is partially funded federally, it is administered on a provincial or territorial basis [16]. The program encourages family doctors to take new high-needs patients into their practice, including chronically ill individuals and seniors [17,19]. Initiatives such as this one have been implemented across the country [20,21,22]
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