Emergency department utilization and hospital admissions for ambulatory care sensitive conditions among people seeking a primary care provider during the COVID-19 pandemic.

Background: Primary care attachment improves health care access and health outcomes, but many Canadians are unattached, seeking a provider via provincial wait-lists. This Nova Scotia-wide cohort study compares emergency department utilization and hospital admission associated with insufficient primary care management among patients on and off a provincial primary care wait-list, before and during the first waves of the COVID-19 pandemic.
Methods: We linked wait-list and Nova Scotian administrative health data to describe people on and off wait-list, by quarter, between Jan. 1, 2017, and Dec. 24, 2020. We quantified emergency department utilization and ambulatory care sensitive condition (ACSC) hospital admission rates by wait-list status from physician claims and hospital admission data. We compared relative differences during the COVID-19 first and second waves with the previous year.
Results: During the study period, 100 867 people in Nova Scotia (10.1% of the provincial population) were on the wait-list. Those on the wait-list had higher emergency department utilization and ACSC hospital admission. Emergency department utilization was higher overall for individuals aged 65 years and older, and females; lowest during the first 2 COVID-19 waves; and differed more by wait-list status for those younger than 65 years. Emergency department contacts and ACSC hospital admissions decreased during the COVID-19 pandemic relative to the previous year, and for emergency department utilization, this difference was more pronounced for those on the wait-list.
Interpretation: People in Nova Scotia seeking primary care attachment via the provincial wait-list use hospital-based services more frequently than those not on the wait-list. Although both groups have had lower utilization during COVID-19, existing challenges to primary care access for those actively seeking a provider were further exacerbated during the initial waves of the pandemic. The degree to which forgone services produces downstream health burden remains in question.
Competing Interests: Competing interests: Michael Green reports receiving support from the Canadian Institutes of Health Research (CIHR) for project grant funding; from the Brian Hennen Chair in Family Medicine for research team and work; and from the Ontario Ministry of Health for the INSPIRE-PHC research team through grant funding. Dr. Green also receives research grant funding from Ontario Health, and has received honoraria as an external reviewer from the University of Toronto and University of Western Ontario. Dr. Green participates on the Advisory Board of the Child and Youth Diabetes Strategy of the Lawson Foundation (a not-for-profit foundation) and is a board member and chair of the Grants and Fellowships Committee of AMS Healthcare Inc. and a board member and officer (President-Elect) of the College of Family Physicians of Canada. Dr. Green is also a geographically full-time faculty member of Queen’s University. Ruth Martin-Misener is coinvestigator on a contract funded by the Canadian Council of Nurse Regulators and International Council of Nurses and is principal or coinvestigator on other research grants from CIHR, the Nova Scotia Health Authority, Nova Scotia Research Foundation, SIGMA, Dalhousie Pharmacy Endowment Fund, Faculty of Health, Canadian Nurses Foundation, College of Registered Nurses of Newfoundland & Labrador Research, Faculty of Nursing Research Grant, Memorial University, Dalhousie University Nursing Research Fund, Canadian Nurses Association and the New Brunswick Health Research Fund. Dr. Martin-Misener holds an unpaid position as codirector of the Canadian Centre for Advanced Practice Nursing Research at McMaster University. No other competing interests were declared.
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