Abstract
Objective
Approximately 4.3 million Canadians are without a primary care physician,
of which 13% choose the emergency department (ED) as their regular access point
to health care. We sought to identify factors associated with preferential ED
use over other health services. We hypothesized that socioeconomic barriers
(i.e., employment, health status, education) to primary care would also prevent
access to ED alternatives.
Methods
Data from the Canadian Community Health Survey, 2007 to 2008, were
analysed (N=134,073; response rate 93.5%). Our study
population comprised 14,091 individuals identified without a primary care
physician. Socioeconomic variables included employment, health, and education.
Covariates included chronic health conditions, immigrant status, gender, age,
and mental health. Prevalence estimates and 95% confidence intervals (CIs) for
each variable were calculated. Weighted logistic regression models were
constructed to evaluate the importance of individual risk factors and their
interactions after adjustment for relevant covariates.
Results
The sample comprised 57.2% males from across Canada. Employment (OR 0.73
[95% CI: 0.59-0.90]), good health (OR 0.73 [95% CI 0.57-0.88]), and
post-secondary education (OR 0.68 [95% CI 0.53-0.88]) reduced respondents use
of the ED. The reduced odds of ED use were independent of chronic conditions,
mental health, gender, poor mobility, province, and age.
Conclusions
Low socioeconomic status dictates preferential ED use in those without a
primary care physician. Specific policy and system development targeting this
at-risk population are indicated to alter ED use patterns in this
population.
Physician, Practice, and Patient Characteristics Related to Primary Care Physician Physical and Mental Health: Results from the Physician Worklife Study