PT  - JOURNAL ARTICLE
AU  - Marshall, Emily Gard
AU  - Stock, David
AU  - Buote, Richard
AU  - Andrew, Melissa K.
AU  - Breton, Mylaine
AU  - Cossette, Benoit
AU  - Green, Michael E.
AU  - Isenor, Jennifer E.
AU  - Mathews, Maria
AU  - MacKenzie, Adrian
AU  - Martin-Misener, Ruth
AU  - McDougall, Beth
AU  - Mooney, Melanie
AU  - Moritz, Lauren R.
TI  - Emergency department utilization and hospital admissions for ambulatory care sensitive conditions among people seeking a primary care provider during the COVID-19 pandemic
AID  - 10.9778/cmajo.20220128
DP  - 2023 May 01
TA  - CMAJ Open
PG  - E527--E536
VI  - 11
IP  - 3
4099  - http://www.cmajopen.ca/content/11/3/E527.short
4100  - http://www.cmajopen.ca/content/11/3/E527.full
SO  - CMAJ2023 May 01; 11
AB  - Background: Primary care attachment improves health care access and health outcomes, but many Canadians are unattached, seeking a provider via provincial wait-lists. This Nova Scotia–wide cohort study compares emergency department utilization and hospital admission associated with insufficient primary care management among patients on and off a provincial primary care wait-list, before and during the first waves of the COVID-19 pandemic.Methods: We linked wait-list and Nova Scotian administrative health data to describe people on and off wait-list, by quarter, between Jan. 1, 2017, and Dec. 24, 2020. We quantified emergency department utilization and ambulatory care sensitive condition (ACSC) hospital admission rates by wait-list status from physician claims and hospital admission data. We compared relative differences during the COVID-19 first and second waves with the previous year.Results: During the study period, 100 867 people in Nova Scotia (10.1% of the provincial population) were on the wait-list. Those on the wait-list had higher emergency department utilization and ACSC hospital admission. Emergency department utilization was higher overall for individuals aged 65 years and older, and females; lowest during the first 2 COVID-19 waves; and differed more by wait-list status for those younger than 65 years. Emergency department contacts and ACSC hospital admissions decreased during the COVID-19 pandemic relative to the previous year, and for emergency department utilization, this difference was more pronounced for those on the wait-list.Interpretation: People in Nova Scotia seeking primary care attachment via the provincial wait-list use hospital-based services more frequently than those not on the wait-list. Although both groups have had lower utilization during COVID-19, existing challenges to primary care access for those actively seeking a provider were further exacerbated during the initial waves of the pandemic. The degree to which forgone services produces downstream health burden remains in question.