Abstract
OBJECTIVES: To determine whether socio-economic status (SES) and presence of a chronic condition are associated with the response a prospective patient receives when seeking a family physician (FP).
METHODS: Scripted telephone calls (indicating higher or lower SES and presence or absence of a chronic condition) were made to all 327 FP offices in Nova Scotia (NS) requesting an appointment. The main outcome measures were the responses to callers seeking a FP: being accepted for an appointment or being offered further assistance if not accepted (e.g., walk-in clinic, alternative provider, and telehealth), as well as the callers’ perception of the experience as positive, negative, or neutral.
RESULTS: Only 9.9% of offices accepted callers as new patients. There were no statistically significant differences by SES or chronic condition in the proportion of calls resulting in an appointment. Callers indicating high SES were more likely to be provided further assistance than those with low SES (p = 0.06), and callers indicating a chronic condition reported a better overall experience than those without (p = 0.03).
CONCLUSION: First contact accessibility for prospective new patients was low across NS. Lower SES was associated with fewer offers of additional assistance than higher SES. This is particularly troubling since those with lower SES may need additional support as they may have less access to resources and networks that could provide support. This study signals the need to improve general and equitable accessibility to primary care providers.
Key words: Primary health care, general practice, chronic disease, social class, access to health care, health equity
Résumé
OBJECTIFS: Déterminer si le statut socioéconomique (SSE) et la présence d’un état chronique sont associés à la réponse reçue par un patient éventuel qui cherche un médecin de famille (MF).
MÉTHODE: Des appels téléphoniques scriptés (mentionnant un SSE élevé ou faible et la présence ou l’absence d’un état chronique) ont été placés auprès des 327 cabinets de MF de la Nouvelle-Écosse pour demander un rendez-vous. Les principaux indicateurs de résultat étaient les réponses données aux personnes ayant appelé pour demander un MF: l’offre d’un rendez-vous, l’offre d’assistance supplémentaire si un rendez-vous n’était pas disponible (p. ex. service de consultation sans rendez-vous, autre dispensateur, ligne télésanté) et la perception de l’expérience (positive, négative ou neutre) par la personne ayant appelé.
RÉSULTATS: Seulement 9,9 % des cabinets ont dit accepter de nouveaux patients. Il n’y a eu aucun écart significatif selon le SSE ou l’état chronique dans la proportion d’appels ayant donné lieu à un rendez-vous. Les personnes ayant appelé en mentionnant un SSE élevé ont été plus susceptibles de se faire offrir de l’assistance supplémentaire que celles ayant mentionné un faible SSE (p = 0,06), et les personnes ayant appelé en mentionnant un état chronique ont dit avoir eu une meilleure expérience dans l’ensemble que celles n’ayant pas mentionné d’état chronique (p = 0,03).
CONCLUSION: L’accessibilité au premier contact pour les nouveaux patients éventuels était faible partout en Nouvelle-Écosse. Le faible SSE était associé à un moins grand nombre d’offres d’assistance supplémentaire que le SSE élevé. C’est particulièrement troublant, car les personnes de faible SSE peuvent avoir besoin d’aide supplémentaire; en effet, elles peuvent avoir moins accès aux ressources et aux réseaux susceptibles de les appuyer. L’étude indique qu’il est nécessaire d’améliorer l’accessibilité en général et l’équité d’accès aux dispensateurs de soins primaires.
Mots clés: soins de santé primaires, médecine générale, maladie chronique, classe sociale, accès aux soins de santé, équité en santé
Footnotes
Acknowledgements: The authors thank the study participants, whose participation made this study possible.
Conflict of Interest: None to declare.
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