What do you mean I can't have a doctor? This is Canada! - The myriad of consequences for unattached patients: health outcomes, mistrust, and strategic efforts to self-manage health and gain access to primary care

Abstract Access and attachment to primary healthcare (PHC) is foundational to stronger healthcare systems and healthier populations yet has declined over time. We explore consequences of unattachment employing a realist-informed qualitative study with unattached patients in Nova Scotia, Canada. Semi-structured interviews with nine participants were conducted. The framework method was used to structure analysis, guided by Donabedian’s model of assessing healthcare access and quality. Five key findings noted: participants used creative strategies to attempt to gain attachment to a PHC provider; and to address their health needs in the absence of a regular PHC provider; participants experienced negative feelings about themselves and the healthcare system; stress related to the added work of being unattached, and health consequences from lost care. These findings may underestimate unattachment consequences for further at-risk populations not represented in the data. Consequences of unattachment could be mitigated by interventions, such as enhanced centralized waitlists promoting attachment.