Experiences of Canadians without a primary care clinician

Context Primary care is the bedrock of an effective healthcare system. More than one-in-five people in Canada have no access to primary care yet little is known about their experiences and preferences.

Objective To characterize the healthcare-seeking behaviours and preferences for system reform of Canadians without a primary care clinician.

Study Design and Analysis National bilingual online survey distributed in Fall 2022.

Setting Canada.

Population Studied Adults 18 years and over in Canada.

Outcome Measures Sociodemographic characteristics of people without a family physician or nurse practitioner (primary care clinician), related healthcare seeking behaviours, importance of primary care attributes, and preferences towards reorganizing primary care.

Results 22.0% of respondents reported not having a primary care clinician. This was significantly more likely for those who identified as: men, younger than 65, residents of British Columbia, Quebec, or Atlantic Canada, French-speakers, college- or trade school-educated, making $30,000-$69,999, or having poor or fair health. 83.1% of respondents without a primary care clinician said they were looking for one. Men and those without private health benefits were significantly less likely to be looking. Significantly more respondents without a primary care clinician, versus those with a clinician, reported visiting a walk-in clinic in the last year (71.7% vs. 41.2%) and they were significantly less likely to be satisfied (40.5% vs. 55.3%). Respondents without a primary care clinician were more open to a variety of system reforms or ways of delivering care that would expand team- and neighbourhood-based care.

Conclusion Canadians without a primary care clinician differ from their attached peers by sociodemographic characteristics, walk-in clinic utilization patterns, and preferences for system reform. Their experiences should be considered when designing primary care reforms.