RT Journal Article
SR Electronic
T1 Emergency department utilization and hospital admissions for ambulatory care sensitive conditions among people seeking a primary care provider during the COVID-19 pandemic
JF CMAJ Open
JO CMAJ
FD Canadian Medical Association
SP E527
OP E536
DO 10.9778/cmajo.20220128
VO 11
IS 3
A1 Marshall, Emily Gard
A1 Stock, David
A1 Buote, Richard
A1 Andrew, Melissa K.
A1 Breton, Mylaine
A1 Cossette, Benoit
A1 Green, Michael E.
A1 Isenor, Jennifer E.
A1 Mathews, Maria
A1 MacKenzie, Adrian
A1 Martin-Misener, Ruth
A1 McDougall, Beth
A1 Mooney, Melanie
A1 Moritz, Lauren R.
YR 2023
UL http://www.cmajopen.ca/content/11/3/E527.abstract
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.