Public experiences and perspectives of primary care in Canada: results from a cross-sectional survey
Tara Kiran, Maryam Daneshvarfard, Ri Wang, Alexander Beyer, Jasmin Kay, Mylaine Breton, Danielle Brown-Shreves, Amanda Condon, Michael Green, Lindsay Hedden, Alan Katz, Maggie Keresteci, Neb Kovacina, M Ruth Lavergne, Aïsha Lofters, Danielle Martin, Goldis Mitra, Sarah Newbery, Katherine Stringer, Peter MacLeod, Clifton van der Linden
Abstract
<h3>Background:</h3> Through medicare, residents in Canada are entitled to medically necessary physician services without paying out of pocket, but still many people struggle to access primary care. We conducted a survey to explore people’s experience with and priorities for primary care. <h3>Methods:</h3> We conducted an online, bilingual survey of adults in Canada in fall 2022. We distributed an anonymous link through diverse channels and a closed link to 122 053 people via a national public opinion firm. We weighted completed responses to mirror Canada’s population and adjusted for sociodemographic characteristics using regression models. <h3>Results:</h3> We analyzed 9279 completed surveys (5.9% response rate via closed link). More than one-fifth of respondents (21.8%) reported having no primary care clinician, and among those who did, 34.5% reported getting a same or next-day appointment for urgent issues. Of respondents, 89.4% expressed comfort seeing another team member if their doctor recommended it, but only 35.9%, 9.5%, and 12.4% reported that their practice had a nurse, social worker, or pharmacist, respectively. The primary care attribute that mattered most was having a clinician who “knows me as a person and considers all the factors that affect my health.” After we adjusted for respondent characteristics, people in Quebec, the Atlantic region, and British Columbia had lower odds of reporting a primary care clinician than people in Ontario (adjusted odds ratio 0.30, 0.33, and 0.39, respectively; <i>p</i> < 0.001). We also observed large provincial variations in timely access, interprofessional care, and walk-in clinic use. <h3>Interpretation:</h3> More than 1 in 5 respondents did not have access to primary care, with large variation by province. Reforms should strive to expand access to relationship-based, longitudinal care in a team setting.