Area deprivation and attachment to a general practitioner through centralized waiting lists: a cross-sectional study in Quebec, Canada
Abstract Background Access to primary healthcare is an important social determinant of health and having a regular general practitioner (GP) has been shown to improve access. In Canada, socio-economically disadvantaged patients are more likely to be unattached (i.e. not have a regular GP). In the pr...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2018-12-01
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| Series: | International Journal for Equity in Health |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12939-018-0887-9 |
| _version_ | 1819168883656884224 |
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| author | Mélanie Ann Smithman Astrid Brousselle Nassera Touati Antoine Boivin Kareen Nour Carl-Ardy Dubois Christine Loignon Djamal Berbiche Mylaine Breton |
| author_facet | Mélanie Ann Smithman Astrid Brousselle Nassera Touati Antoine Boivin Kareen Nour Carl-Ardy Dubois Christine Loignon Djamal Berbiche Mylaine Breton |
| author_sort | Mélanie Ann Smithman |
| collection | DOAJ |
| description | Abstract Background Access to primary healthcare is an important social determinant of health and having a regular general practitioner (GP) has been shown to improve access. In Canada, socio-economically disadvantaged patients are more likely to be unattached (i.e. not have a regular GP). In the province of Quebec, where over 30% of the population is unattached, centralized waiting lists were implemented to help patients find a GP. Our objectives were to examine the association between social and material deprivation and 1) likelihood of attachment, and 2) wait time for attachment to a GP through centralized waiting lists. Methods A cross-sectional study was conducted in five local health networks in Quebec, Canada, using clinical administrative data of patients attached to a GP between June 2013 and May 2015 (n = 24, 958 patients) and patients remaining on the waiting list as of May 2015 (n = 49, 901), using clinical administrative data. Social and material area deprivation indexes were used as proxies for patients’ socio-economic status. Multiple regressions were carried out to assess the association between deprivation indexes and 1) likelihood of attachment to a GP and 2) wait time for attachment. Analyses controlled for sex, age, local health network and variables related to health needs. Results Patients from materially medium, disadvantaged and very disadvantaged areas were underrepresented on the centralized waiting lists, while patients from socially disadvantaged and very disadvantaged areas were overrepresented. Patients from very materially advantaged and advantaged areas were less likely to be attached to a GP than patients from very disadvantaged areas. With the exception of patients from socially disadvantaged areas, all other categories of social deprivation were more likely to be attached to a GP compared to patients from very disadvantaged areas. We found a pro-rich gradient in wait time for attachment to a GP, with patients from more materially advantaged areas waiting less than those from disadvantaged areas. Conclusion Our findings suggest that there are socio-economic inequities in attachment to a GP through centralized waiting lists. Policy makers should take these findings into consideration to adjust centralized waiting list processes to avoid further exacerbation of health inequities. |
| first_indexed | 2024-12-22T19:10:41Z |
| format | Article |
| id | doaj.art-191b899762144f45bb5b14c913cb938f |
| institution | Directory Open Access Journal |
| issn | 1475-9276 |
| language | English |
| last_indexed | 2024-12-22T19:10:41Z |
| publishDate | 2018-12-01 |
| publisher | BMC |
| record_format | Article |
| series | International Journal for Equity in Health |
| spelling | doaj.art-191b899762144f45bb5b14c913cb938f2022-12-21T18:15:40ZengBMCInternational Journal for Equity in Health1475-92762018-12-0117111610.1186/s12939-018-0887-9Area deprivation and attachment to a general practitioner through centralized waiting lists: a cross-sectional study in Quebec, CanadaMélanie Ann Smithman0Astrid Brousselle1Nassera Touati2Antoine Boivin3Kareen Nour4Carl-Ardy Dubois5Christine Loignon6Djamal Berbiche7Mylaine Breton8Centre de recherche Charles-Le Moyne - Saguenay Lac-St-Jean sur les innovations en santé, Université de SherbrookeSchool of Public Administration, University of VictoriaCentre de recherche sur la gouvernance, École nationale d’administration publiqueCentre de recherche du Centre Hospitalier de l’Université de Montréal, Université de MontréalDirection de santé publique, Centre intégré de santé et des services sociaux - Montérégie-CentreFaculty of Nursing, Université de Montréal, 2375, chemin de la Côte Ste-Catherine, Office 5103Centre de recherche Charles-Le Moyne - Saguenay Lac-St-Jean sur les innovations en santé, Université de SherbrookeCentre de recherche Charles-Le Moyne - Saguenay Lac-St-Jean sur les innovations en santé, Université de SherbrookeCentre de recherche Charles-Le Moyne - Saguenay Lac-St-Jean sur les innovations en santé, Université de SherbrookeAbstract Background Access to primary healthcare is an important social determinant of health and having a regular general practitioner (GP) has been shown to improve access. In Canada, socio-economically disadvantaged patients are more likely to be unattached (i.e. not have a regular GP). In the province of Quebec, where over 30% of the population is unattached, centralized waiting lists were implemented to help patients find a GP. Our objectives were to examine the association between social and material deprivation and 1) likelihood of attachment, and 2) wait time for attachment to a GP through centralized waiting lists. Methods A cross-sectional study was conducted in five local health networks in Quebec, Canada, using clinical administrative data of patients attached to a GP between June 2013 and May 2015 (n = 24, 958 patients) and patients remaining on the waiting list as of May 2015 (n = 49, 901), using clinical administrative data. Social and material area deprivation indexes were used as proxies for patients’ socio-economic status. Multiple regressions were carried out to assess the association between deprivation indexes and 1) likelihood of attachment to a GP and 2) wait time for attachment. Analyses controlled for sex, age, local health network and variables related to health needs. Results Patients from materially medium, disadvantaged and very disadvantaged areas were underrepresented on the centralized waiting lists, while patients from socially disadvantaged and very disadvantaged areas were overrepresented. Patients from very materially advantaged and advantaged areas were less likely to be attached to a GP than patients from very disadvantaged areas. With the exception of patients from socially disadvantaged areas, all other categories of social deprivation were more likely to be attached to a GP compared to patients from very disadvantaged areas. We found a pro-rich gradient in wait time for attachment to a GP, with patients from more materially advantaged areas waiting less than those from disadvantaged areas. Conclusion Our findings suggest that there are socio-economic inequities in attachment to a GP through centralized waiting lists. Policy makers should take these findings into consideration to adjust centralized waiting list processes to avoid further exacerbation of health inequities.http://link.springer.com/article/10.1186/s12939-018-0887-9Physicians, familyPhysicians, primary carePrimary health careHealth services accessibilitySocioeconomic factorsHealthy equity |
| spellingShingle | Mélanie Ann Smithman Astrid Brousselle Nassera Touati Antoine Boivin Kareen Nour Carl-Ardy Dubois Christine Loignon Djamal Berbiche Mylaine Breton Area deprivation and attachment to a general practitioner through centralized waiting lists: a cross-sectional study in Quebec, Canada International Journal for Equity in Health Physicians, family Physicians, primary care Primary health care Health services accessibility Socioeconomic factors Healthy equity |
| title | Area deprivation and attachment to a general practitioner through centralized waiting lists: a cross-sectional study in Quebec, Canada |
| title_full | Area deprivation and attachment to a general practitioner through centralized waiting lists: a cross-sectional study in Quebec, Canada |
| title_fullStr | Area deprivation and attachment to a general practitioner through centralized waiting lists: a cross-sectional study in Quebec, Canada |
| title_full_unstemmed | Area deprivation and attachment to a general practitioner through centralized waiting lists: a cross-sectional study in Quebec, Canada |
| title_short | Area deprivation and attachment to a general practitioner through centralized waiting lists: a cross-sectional study in Quebec, Canada |
| title_sort | area deprivation and attachment to a general practitioner through centralized waiting lists a cross sectional study in quebec canada |
| topic | Physicians, family Physicians, primary care Primary health care Health services accessibility Socioeconomic factors Healthy equity |
| url | http://link.springer.com/article/10.1186/s12939-018-0887-9 |
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