Where should patients seek treatment when their primary physician is not available?

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Despite the well-established significance of access to primary care as a key health system metric, there’s relatively little research comparing models to provide primary care access when a patient’s regular physician is unavailable. A population-based, retrospective cohort study of administrative data from Ontario, Canada, which was recently published in the Annals of Family Medicine, determined that, compared to visiting a walk-in clinic physician, patients seeing a within-group physician after hours—that is, a physician also belonging to a patient’s own family physician group, though not their primary physician—were less likely to visit an emergency department (ED) within one week of the initial visit. Researchers attribute this finding to better continuity of care, though they stress that further research is required.

“We found that, compared to having a visit with a walk-in clinic physician, having an after-hours visit with a physician who belongs to one’s own enrolling group was associated with a small decrease in the risk of an ED visit in the following week,” the authors of the research article wrote. “More research is needed to understand the underlying reasons for our observation, particularly the role that informational or management continuity might play in mitigating health system use.”

The Canadian study included all Ontario residents who were formally enrolled with a family physician from April 2019 through March 2020, and had visited at least one time during that span. Researchers compared those visiting within-group physicians to those visiting walk-in clinic physicians, considering individual patient characteristics. The primary outcome of the study was whether the patients then logged an ED visit within seven days of the initial visit.

Patients who visited within-group physicians were determined to be 10% less likely to visit an ED in the following week compared to patients who saw a walk-in clinic physician.

Notably, the decreased incidence of 7-day ED visits following an encounter with a within-group physician was driven by individuals who lived in large urban areas and children/adolescents. According to the study, those who lived in rural areas, even if they had seen within-group physicians, had an increased likelihood of an ED visit in the week following their visit.

“The mechanism behind our present findings is uncertain—fewer ED visits could be the result of more appropriate care, greater access to one’s own primary care clinic or improved patient satisfaction owing to greater informational or management continuity,” the researchers explained in the article. “In addition to timely access and continuity, patients’ trust and physicians’ confidence in the advice, treatment or follow-up plan could also be contributing factors.”

The researchers emphasized the importance of additional studies into this area of research. Again, it should be noted that this is a study of Canadian health care, so results may vary if the same research were to be conducted in the United States.

“In primary care practice and systems, there is an ongoing tension between timely access and care continuity,” the researchers concluded. “Relationship continuity is associated with better health outcomes and decreased health care utilization and costs and is valued by patients… In this context, timely care within a group is likely a second-best alternative to timely care with one’s own clinician. Findings from the present study support this approach.”