Attaching Patients in Primary Care Through Centralized Waiting Lists

Seven Canadian Provinces Compared

  • Mylaine Breton Université de Sherbrooke
  • Mélanie Ann Smithman Université de Sherbrooke
  • Audrey Vandesrasier Université de Sherbrooke
  • Sara Kreindler University of Manitoba
  • Martin Sasseville Université de Sherbrooke
  • Jason Sutherland University of British Columbia
  • Michael Green Queen's University
  • Jalila Jbilou Université de Moncton
  • Jay Shaw University of Toronto
  • Emily Gard Marshall Dalhousie University
  • Valorie A. Crooks Simon Fraser University
  • Astrid Brousselle University of Victoria
  • Damien Contandriopoulos University of Victoria
  • Sabrina T. Wong University of British Columbia
Keywords: comparative study, primary health care, primary care provider, health services accessibility, unattached patients, waiting lists, registries, physicians

Abstract

Canada has the lowest rate of attachment to primary care providers among OECD countries, which makes access and continuity of care problematic. To address this important issue, seven Canadian provinces have implemented centralized waiting lists (CWLs) for unattached patients in primary care. Introduced at different times, no two provinces' CWLs are exactly alike. The main goal of these CWLs is to reduce the number of unattached patients. In some provinces, CWLs also serve to monitor primary care activity or prioritize vulnerable patients. Societal pressure and broader primary care reform influenced the implementation of the CWLs in each province. Monitoring, in terms of data collected and purpose, differs between provinces. The interprovincial comparison enables identification of strengths, weaknesses, opportunities and threats during implementation and at each step of the CWLs: registration, patient assessment and attachment. Common issues with CWLs across provinces include the importance of monitoring to facilitate implementation, the need for specific measures to ensure access for vulnerable and complex patients, and the shortage of primary care providers.

Le taux d'inscription à un professionnel de la santé en première ligne au Canada est le plus bas parmi les pays de l'OCDE, ce qui soulève un important problème d'accessibilité et de continuité aux soins de première ligne. Pour répondre à cette préoccupation, sept provinces canadiennes ont mis en place des listes d'attente centralisées (LAC) pour les patients non-affiliés à un professionnel de la santé en première ligne. Les LAC ont été implantées à différents moments, et diffèrent beaucoup d'une province à l'autre. Le principal objectif des LAC est de diminuer le nombre de patients non-affiliés, mais dans certaines provinces elles peuvent également servir à surveiller les activités de la première ligne ou à prioriser les patients vulnérables. La pression sociale et d'importantes réformes des soins de première ligne ont influencé l'implantation des LAC. Le monitorage, en termes de données collectées et d'utilisation, diffère d'une province à l'autre. La comparaison interprovinciale permet l'identification des forces, faiblesses, opportunités et menaces à l'implantation et à chaque étape de la LAC : l'enregistrement, l'évaluation du patient et l'affiliation. L'importance de la surveillance afin de faciliter l'implantation, le besoin d'interventions spécifiques pour garantir l'accès pour les patients vulnérables et complexes et le manque de prestataire de soins de première ligne sont quelques exemples des problématiques des LAC communes à toutes les provinces.

Author Biographies

Mylaine Breton, Université de Sherbrooke

Mylaine Breton, PhD, Associate Professor, Department of Community Health Sciences, Université de Sherbrooke, Chairwoman, Canadian Research Chair in Clinical Governance on Primary Health Care, Longueuil, QC, Canada

Mélanie Ann Smithman, Université de Sherbrooke

Mélanie Ann Smithman, MSc, Doctoral Student, Université de Sherbrooke, Longueuil, QC, Canada

Audrey Vandesrasier, Université de Sherbrooke

Audrey Vandesrasier, Research professional, Centre de recherche Charles-Le Moyne - Saguenay–Lac-Saint-Jean sur les innovations en santé – Université de Sherbrooke, Longueuil, QC, Canada

Sara Kreindler, University of Manitoba

Sara Kreindler, PhD, Assistant Professor, Department of Community Health Sciences, University of Manitoba, Manitoba Research Chair in Health System Innovation and Community Health Sciences, Winnipeg, MB, Canada

Jason Sutherland, University of British Columbia

Jason Sutherland, PhD, Associate Professor, Centre for Health Services and Policy Research, University of British Columbia, Scholar, Michael Smith Foundation for Health Research, Vancouver, BC, Canada

Michael Green, Queen's University

Michael Green, MD, Associate Professor, Departments of Family Medicine and Public Health Sciences, Queen's University, CTAQ Chair in Applied Health Economics/Health Policy, Director, Centre for Health Services and Policy Research, Associate Director, Centre for Studies in Primary Care, Adjunct Scientist, Institute for Clinical Evaluative Sciences, Kingston, ON, Canada

Jalila Jbilou, Université de Moncton

Jalila Jbilou, MD, PhD, Professor and Researcher, Centre de formation médicale du Nouveau-Brunswick and École de psychologie, Université de Moncton, Moncton, NB, Canada

Jay Shaw, University of Toronto

Jay Shaw, PhD, Scientist, Institute for Health System Solutions and Virtual Care, Women's College Research Institute, Women's College Hospital, Assistant Professor, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada

Emily Gard Marshall, Dalhousie University

Emily Gard Marshall, PhD, Associate Professor, Department of Family Medicine, Dalhousie University, Halifax, NS, Canada

Valorie A. Crooks, Simon Fraser University

Valorie A. Crooks, PhD, Professor, Department of Geography, Simon Fraser University, Scholar, Michael Smith Foundation for Health Research, Canada Research Chair in Health Service Geographies, Burnaby, BC, Canada

Astrid Brousselle, University of Victoria

Astrid Brousselle, PhD, Director and Professor, School of Public Administration, University of Victoria, Victoria, BC, Canada

Damien Contandriopoulos, University of Victoria

Damien Contandriopoulos, PhD, Professor, School of Nursing, University of Victoria, Chairman, Research Chair Policies, Knowledge and Health (Pocosa/Politiques, Connaissances, Santé), Victoria, BC, Canada

Sabrina T. Wong, University of British Columbia

Sabrina T. Wong, PhD, Professor, School of Nursing and Centre for Health Services and Policy Research, University of British Columbia, Co-Director, BC Primary Care Sentinel Surveillance Network, Vancouver, BC, Canada

Published
2019-03-11
Section
Comparative Health Reform Analyses