Attaching Patients In Primary Care Through Centralized Waiting Lists: Seven Canadian Provinces Compared

Canada has the lowest rate of attachment to primary care providers among OECD countries, which makes access and continuity of care problematic. To address this important issue, seven Canadian provinces have implemented centralized waiting lists (CWLs) for unattached patients in primary care. Introduced at different times, no two provinces' CWLs are exactly alike. The main goal of these CWLs is to reduce the number of unattached patients. In some provinces, CWLs also serve to monitor primary care activity or prioritize vulnerable patients. Societal pressure and broader primary care reform influenced the implementation of the CWLs in each province. Monitoring, in terms of data collected and purpose, differs between provinces. The interprovincial comparison enables identification of strengths, weaknesses, opportunities and threats during implementation and at each step of the CWLs: registration, patient assessment and attachment. Common issues with CWLs across provinces include the importance of monitoring to facilitate implementation, the need for specific measures to ensure access for vulnerable and complex patients, and the shortage of primary care providers. Le taux d'inscription a un professionnel de la sante en premiere ligne au Canada est le plus bas parmi les pays de l'OCDE, ce qui souleve un important probleme d'accessibilite et de continuite aux soins de premiere ligne. Pour repondre a cette preoccupation, sept provinces canadiennes ont mis en place des listes d'attente centralisees (LAC) pour les patients non-affilies a un professionnel de la sante en premiere ligne. Les LAC ont ete implantees a differents moments, et different beaucoup d'une province a l'autre. Le principal objectif des LAC est de diminuer le nombre de patients non-affilies, mais dans certaines provinces elles peuvent egalement servir a surveiller les activites de la premiere ligne ou a prioriser les patients vulnerables. La pression sociale et d'importantes reformes des soins de premiere ligne ont influence l'implantation des LAC. Le monitorage, en termes de donnees collectees et d'utilisation, differe d'une province a l'autre. La comparaison interprovinciale permet l'identification des forces, faiblesses, opportunites et menaces a l'implantation et a chaque etape de la LAC : l'enregistrement, l'evaluation du patient et l'affiliation. L'importance de la surveillance afin de faciliter l'implantation, le besoin d'interventions specifiques pour garantir l'acces pour les patients vulnerables et complexes et le manque de prestataire de soins de premiere ligne sont quelques exemples des problematiques des LAC communes a toutes les provinces.