Key Messages
A limited literature search was conducted to identify interventions to improve access to primary health care in Canada.
Identified programs included components such as better scheduling, incentives for family doctors to work after-hours or provide more cancer screening, encouraging doctors to see the same patient throughout the course of their care, and involving other types of care providers or aides in accessing care.
Context
Primary care is the first point of contact for a patient’s health and well-being.1 This care is mainly provided by family physicians and other general health practitioners, who diagnosis and treat illness.2 Challenges of primary health care include inadequate continuity of care, poor health promotion, poor access in remote and rural areas, low access in urban areas that do not have after-hours options, and strenuous working conditions of health care providers.2
The purpose of this report is to provide a list and summary of program level and community-based primary care interventions that aim to improve access to primary care in Canada.
Research Question
What health system–level models and practices exist in Canada that can improve access to primary care (particularly in rural and remote settings)?
Methods
This report is not a systematic review and does not involve critical appraisal or include a summary of study findings. Rather, it presents an annotated list of citations and summary of the key components of programs and community-based interventions related improving access to primary care in Canada. This report is not intended to provide recommendations for or against a particular intervention.
Literature Search Methods
A limited literature search was conducted by an information specialist on key resources including MEDLINE and Embase through the Ovid platform, CINAHL through EBSCOHost, the Cochrane Database of Systematic Reviews, the International HTA Database, the websites of Canadian health technology agencies, as well as a focused internet search. The search strategy comprised both controlled vocabulary, such as the National Library of Medicine’s MeSH (Medical Subject Headings), and keywords. The main search concepts were primary care and access, models, or practices. Retrieval was limited to publications from or mentioning Canada or Canadian regions and cities. The search was completed on May 24, 2022, and limited to English-language documents published since January 1, 2012.
Selection Criteria and Summary Methods
One reviewer screened literature search results (titles and abstracts) and full texts of potentially relevant publications according to the inclusion criteria presented in Table 1. Primary studies and systematic reviews of primary studies were considered for inclusion if they presented results for interventions implemented in Canada to increase access to primary health care.
Exclusion Criteria
Articles were excluded if they did not meet the selection criteria outlined in Table 1, they were duplicate publications, or were published before 2017. Studies were also excluded if they did not mention an intervention or change in care, were descriptive, did not report results for Canada specifically, were not focused on increasing access, were about consultations with specialists, or included logic analysis. Additional references of potential interest that did not meet the inclusion criteria are provided in Appendix 1.
Overall Summary
This report identified 34 articles that reported on interventions conducted in Canada to improve access to primary care. Interventions were conducted in several provinces and territories in Canada including Alberta, 12 British Columbia, 30, 22 New Brunswick,15 Newfoundland and Labrador,18 Northwest Territories,22 Nova Scotia, 6,10,20 Ontario, 7,13,14,17,19,23-25,32,35 Quebec, 3-5,8,11,16,27,29,33,34 and Saskatchewan.26,28 Five studies9,15,21,22,36 were conducted across multiple jurisdictions in Canada and 1 study31 did not specify region within Canada. No studies were conducted in Yukon, Nunavut, or Prince Edward Island
For those articles about interventions for specific populations, these populations included:
young families
pregnant people
pediatric patients
people described as “vulnerable”
immigrants, refugees, or asylum seekers
farmers
Indigenous peoples
populations experiencing poverty, homelessness, or trauma
people living with diabetes
older adults
people living in rural areas
transgender and gender-nonconforming people
people with income in the lowest quintile
people with severe and persistent mental illness
people with a chronic disease
people who did not finish high school
people experiencing addictions
people discharged from hospitals
people with limited access to primary care.
Practices identified included:
advanced access models
open-access scheduling
incentives for rostering patients and offering after-hours care
providing equity-oriented care
including nurse practitioners or physician assistants in care
better tracking and maintenance of patient appointment schedules
centralized waiting lists and prioritization
offering navigation help for patients to attend appointments
provider networks
digital tools and virtual care
serving high-risk or underserved populations
rural clinics.
Annotated Reference List
Thirty-four articles3-36 were included in the current report; qualitative studies are summarized briefly in Table 2; reviews, including scoping, rapid, systematic, and realist, are reported in Table 3; longitudinal studies are summarized in Table 4; and other study types are summarized in Table 5. Further details can be found by consulting the individual article citations.
Annotated Reference List Details — Qualitative Studies.
Annotated Reference List — Reviews.
Annotated Reference List — Longitudinal Studies.
Annotated Reference List — Other Study Types.
References
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Appendix 1. References of Potential Interest
Note that this appendix has not been copy-edited.
Potentially Relevant, Results Not Specified for Canada
LeBlanc
M, Petrie
S, Paskaran
S, Carson
DB, Peters
PA. Patient and provider perspectives on eHealth interventions in Canada and Australia: a scoping review. Rural Remote Health.
2020;20(3):5754.
[
PubMed: 32949485]
Potentially Relevant Protocols Published in 2020 and Later
Côté
N, Chouinard
R, Freeman
A, et al.
Implementation of a new clinical and organisational practice to improve access to primary care services: a protocol for an effectiveness-implementation hybrid study. BMJ Open.
2022;12(4):e059792.
[
PMC free article: PMC9020307] [
PubMed: 35440462]
Gaboury
I, Breton
M, Perreault
K, et al.
Interprofessional advanced access - a quality improvement protocol for expanding access to primary care services. BMC Health Serv Res.
2021;21(1):812.
[
PMC free article: PMC8361639] [
PubMed: 34388996]
Kazevman
G, Mercado
M, Hulme
J, Somers
A. Prescribing phones to address health equity needs in the COVID-19 era: the PHONE-CONNECT Program. J Med Internet Res.
2021;23(4):e23914.
[
PMC free article: PMC8025912] [
PubMed: 33760753]
Maillet
L, Champagne
G, Dery
J, et al.
Implementation of an intersectoral outreach and community nursing care intervention with refugees in Quebec: a protocol study. J Adv Nurs.
2021;77(11):4586-4597.
[
PubMed: 34423471]
Marshall
EG, Breton
M, Cossette
B, et al.
Problems in Coordinating and Accessing Primary Care for Attached and Unattached Patients Exacerbated During the COVID-19 Pandemic Year (the PUPPY Study): protocol for a longitudinal mixed methods study. JMIR Res Protoc.
2021;10(10):e29984.
[
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PubMed: 34559672]
Breton
M, Maillet
L, Duhoux
A, et al.
Evaluation of the implementation and associated effects of advanced access in university family medicine groups: a study protocol. BMC Fam Pract.
2020;21(1):41.
[
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PubMed: 32085728]
Ziegler
E, Valaitis
R, Carter
N, Risdon
C, Yost
J. Exploring the implementation and delivery of primary care services for transgender individuals in Ontario: case study protocol. Prim Health Care Res Dev.
2020;21:e14.
[
PMC free article: PMC7264858] [
PubMed: 32434629]
Potentially Relevant Article Without Enough Information
Lapointe
J, Badr
J, Motulsky
A. Usage of digital tools to access primary care in Quebec: an environmental scan. Stud Health Technol Inform. 2021;281:689-693.
[
PubMed: 34042664]
Cite As: Improving Access to Primary Care. (CADTH Environmental Scan). Ottawa: CADTH; 2022 Jun.
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