Canadians’ access to primary care is worse than previously thought, according to results of the first phase of the OurCare project, one of the largest ever nation-wide surveys on primary health care. Of the nearly 9,300 survey respondents, only 77 per cent reported having a family doctor or nurse practitioner. Pre-pandemic estimates had put this number closer to 85 per cent.
Survey data have been compiled into an interactive online dashboard. The survey results mark the end of the first of three phases of the OurCare project, which aims to find the gaps and possible solutions to some of the biggest issues in primary care in Canada. The project was conceived in June 2021 as a collaboration between Tara Kiran, a family doctor and scientist with MAP Centre for Urban Health Solutions, and colleague Peter MacLeod with MASS LBP. Plans were finalized with buy-in from provincial and national health-care partners, stakeholders and the public through the Canadian Medical Association’s group, Patient Voice.
Questions covered topics ranging from timeliness and proximity to care, relationships with caregivers and willingness to receive care from a health team.
“[The survey] provides really important perspectives from the public that can help to shape the reforms that we know must come,” says Kiran. “We know that primary care is something that needs to change.”
Timely access to care was highlighted as a key issue. Walk-in clinics were used by nearly half of respondents in the past year, with one-third citing walk-in clinics as the only places they could get care.
The survey confirmed that certain demographics have even less access to primary care support. Young adults, immigrants, lower income groups and racialized people were all even less likely to have a family doctor. But access by region was the most prominent determinant of connection with a family doctor. Only 69 to 71 per cent of respondents in B.C., Quebec and the Atlantic provinces had access to a family doctor, compared with 86 and 82 per cent in Ontario and the Prairies, including Manitoba, Saskatchewan and Alberta, respectively.
More than 9,200 people completed the survey, which ran from September to October last year. The responses were then weighted to reflect Canadian demographics based on recent census data.
Kiran says that Canadians are open to doing things differently if it means they and their neighbours will ultimately receive better access to care; About 90 per cent said they would be comfortable getting support from another health team member if their doctor recommended it.
“Relationships are important – even more important than timely access to care.”
She says she was heartened to see what respondents highlighted as one of their top priorities. “Patients want to be viewed as a complete person by their health-care providers,” says Kiran. “Relationships are important – even more important than timely access to care. We know that relationships are really at the heart of good primary care, and now all of the evidence actually lines up to say that.”
Some health-care reforms, however, don’t sit well with the public. “We asked how willing you would be to use virtual-care services if the company that ran the service was receiving payments or was owned by a pharmaceutical company.” The response: 70 per cent answered “not very willing” or “not willing at all” to receive care if that was the case.
Canadians also are leery of virtual-care services selling their data; 84 per cent said they would not use virtual care if the company sells data about their health, even if identifying information were removed. “I think it just speaks to the importance of people knowing clearly how their data will be used upfront before they decide to use that service,” Kiran says.
The next step of the OurCare project involves a more in-depth review of Ontario’s primary care. A group of 36 volunteers from outside the medical community and who are representative of the demographic distributions of the province have been chosen to take part in sessions to learn the details of the primary care system.
The group has already begun meeting to cover topics such as different primary-care models, health systems, equity and access. “I think this is going to challenge experts and really help us continue to talk about the values that underlie the future primary-care system,” says Kiran. The panelists will spend more than 30 hours learning about primary care from different experts and perspectives.
After the group has been primed with all the information, it will meet in-person in February to discuss possible solutions. “This is a really exciting step that I think is going to help us go deeper than we could with the survey.” On Feb. 12, the group will present its final recommendations. Matthew Anderson, CEO of Ontario Health, is among the health-system leaders who will attend.
The third and final phase of the project will assemble local community round tables made up of volunteers from marginalized backgrounds who will focus on the unique needs of underserved communities. The local community round tables are expected to meet in the spring.