The use of centralized waiting lists for attachment to family physicians in Quebec, Canada: predictive factors and association with non-urgent emergency department use

BACKGROUND: In Quebec, Canada, more than a quarter of residents are unattached to a family physician (FP). To streamline attachment requests, centralized waiting lists (CWLs) were implemented in the province. However, FPs can still opt for non-CWL attachment, which may contribute to disparities in access to primary care. The objective of this study was to identify predictive factors for the mode of attachment (CWL vs. non-CWL) and to examine its association with the number of non-urgent emergency department (ED) visits. METHODS: This population-based retrospective cohort study (N = 1,417,838) examined adult patients attached to a FP between April 2017 and June 2021 in Quebec, Canada, using administrative data from the Régie de l’assurance maladie du Québec and the Ministry of Health and Social Services. Random forests were used to assess the relative importance of sociodemographic and health factors in predicting the mode of attachment. An adjusted negative binomial model was fitted to estimate the incidence rate ratio (IRR) of non-urgent ED visits, a proxy for unmet access to primary care, in the year following attachment to a FP. RESULTS: Key predictive factors identified include the fiscal year of attachment, age, rurality, and prior healthcare utilization. FPs who attached patients outside the CWLs did so more often in urban areas (+ 3% in metropolitan areas), and non-CWL-attached patients were slightly younger (− 3.4 years) and had generally lower healthcare needs compared with CWL-attached patients. Compared to those attached to a FP through a non-CWL approach, those attached through a CWL had a 4.7% lower incidence rate of ED visits in the year following attachment (IRR = 0.952; 95% CI: 0.946–0.960). CONCLUSION: These findings underscore the potential benefits of fostering greater participation in the CWLs among FPs and patients to promote equity in access to FPs.