The immigrant effect: factors impacting use of primary and emergency department care – a Canadian population cross-sectional study

AbstractObjectiveIn 2011, Canada had a foreign-born population of approximately 6,775,800. They represented 20.6% of the total population. Immigrants possess characteristics that reduce the use of primary care. This is thought to be, in part, due to a lower education level, employment, and better health status. Our objective was to assess whether, in an immigrant population without a primary care physician, similar socioeconomic factors would also reduce the likelihood of using the emergency department compared to a non-immigrant population without primary care.MethodsData regarding individuals ≥ 12 years of age from the Canadian Community Health Survey from 2007 to 2008 were analysed (n=134,073; response rate 93%). Our study population comprised 15,554 individuals identified without a primary care physician who had a regular place for medical care. The primary outcome was emergency department as a regular care access point. Socioeconomic variables included employment, health status, and education. Covariates included chronic health conditions, mobility, gender, age, and mental health. Weighted logistic regression models were constructed to evaluate the importance of individual risk factors.ResultsThe sample of 15,554 (immigrants n=1,767) consisted of 57.3% male and 42.7% female respondents from across Canada. Immigrants were less likely than Canadian-born respondents to use the emergency department as a regular access point for health care (odds ratio=0.48 [95% CI 0.40 – 0.57]). Adjusting for health, education, or employment had no effect on this reduced tendency (odds ratio=0.47 [95% CI 0.38 – 0.58]).ConclusionIn a Canadian population without a primary care physician, immigrants are less likely to use the emergency department as a primary access point for care than Canadian-born respondents. However, this effect is independent of previously reported social and economic factors that impact use of primary care. Immigration status is an important but complex component of racial and ethnic disparity in the use of health care in Canada.

Download Full-text

LO078: The immigrant effect: a barrier to accessing primary and emergency department care - a Canadian population cross-sectional study

CJEM ◽

10.1017/cem.2016.115 ◽

2016 ◽

Vol 18 (S1) ◽

pp. S57-S57

Author(s):

R. Ohle ◽

H. Bleeker ◽

J.J. Perry

Keyword(s):

Primary Care ◽

Emergency Department ◽

Primary Care Physician ◽

Odds Ratio ◽

Care Physician ◽

Model Parameters ◽

Emergency Department Care ◽

Canadian Population ◽

Study Population ◽

Immigrant Effect

Introduction: In 2011, Canada had a foreign-born population of about 6,775,800 people. They represented 20.6% of the total population, the highest proportion among the G8 countries. Immigrants encounter significant barriers to accessing primary healthcare. This is thought to be due to lower education level, employment status and the healthy immigrant effect. Our objective was to assess in an immigrant population without a primary care physician, would similar socioeconomic barriers also prevent access to the emergency department. Methods: Data regarding individuals’ ≥12 years of age from the Canadian Community Health Survey, 2007 to 2008 were analyzed (N=134,073, response rate 93%). Our study population comprised 15,554 individuals identified without a primary care physician who used emergency department care. Socioeconomic variables included employment, health status, and education. Covariates included chronic health conditions, mobility, gender, age, and mental health. Prevalence estimates and confidence intervals for each variable were calculated. Weighted logistic regression models were constructed to evaluate the importance of individual risk factors and their interactions after adjustment for relevant covariates. Model parameters were estimated by the method of maximum likelihood. The Wald statistic was employed to test the significance of individual variables or interaction terms in relation to ED choice. Results: Our study population included 1,767 immigrants and 13,787 Canadian born respondents from across Canada without a primary care physician (57.3% male). Immigrants were less likely to use the emergency department then Canadian born respondents (Odds Ratio 0.4759 (95%CI 0.396-0.572). Adjusting for health, education or employment had no effect on this reduced access (Odds Ratio 0.468 (95%CI 0.378-0.579). Conclusion: In a Canadian population without a primary care physician, immigrants access the emergency department less then Canadian born respondents. However this effect is independent of previously reported social and economic barriers. Immigration status is an important but complex component of racial and ethnic disparity in access to care. Specific policy and system development targeting this at risk population are required to allow for equal access to healthcare.

Download Full-text

Factors associated with choosing the emergency department as the primary access point to health care: a Canadian population cross-sectional study

CJEM ◽

10.1017/cem.2016.350 ◽

2016 ◽

Vol 19 (04) ◽

pp. 271-276

Author(s):

Robert Ohle ◽

Michelle Ohle ◽

Jeffrey J. Perry

Keyword(s):

Mental Health ◽

Primary Care ◽

Health Care ◽

Emergency Department ◽

Primary Care Physician ◽

Low Socioeconomic Status ◽

Access Point ◽

Care Physician ◽

Individual Risk ◽

Factors Associated

Abstract Objective Approximately 4.3 million Canadians are without a primary care physician, of which 13% choose the emergency department (ED) as their regular access point to health care. We sought to identify factors associated with preferential ED use over other health services. We hypothesized that socioeconomic barriers (i.e., employment, health status, education) to primary care would also prevent access to ED alternatives. Methods Data from the Canadian Community Health Survey, 2007 to 2008, were analysed (N=134,073; response rate 93.5%). Our study population comprised 14,091 individuals identified without a primary care physician. Socioeconomic variables included employment, health, and education. Covariates included chronic health conditions, immigrant status, gender, age, and mental health. Prevalence estimates and 95% confidence intervals (CIs) for each variable were calculated. Weighted logistic regression models were constructed to evaluate the importance of individual risk factors and their interactions after adjustment for relevant covariates. Results The sample comprised 57.2% males from across Canada. Employment (OR 0.73 [95% CI: 0.59-0.90]), good health (OR 0.73 [95% CI 0.57-0.88]), and post-secondary education (OR 0.68 [95% CI 0.53-0.88]) reduced respondents use of the ED. The reduced odds of ED use were independent of chronic conditions, mental health, gender, poor mobility, province, and age. Conclusions Low socioeconomic status dictates preferential ED use in those without a primary care physician. Specific policy and system development targeting this at-risk population are indicated to alter ED use patterns in this population.

Download Full-text

The Influence of Having an Assigned Medicaid Primary Care Physician on Utilization of Otitis Media–related Services

PEDIATRICS ◽

10.1542/peds.104.s6.1192 ◽

1999 ◽

Vol 104 (Supplement_6) ◽

pp. 1192-1197

Author(s):

Stephen Berman ◽

Jessica Bondy ◽

Dennis Lezotte ◽

Barbara Stone ◽

Patricia J. Byrns

Keyword(s):

Primary Care ◽

Emergency Department ◽

Retrospective Study ◽

Primary Care Physician ◽

Otitis Media ◽

Odds Ratio ◽

Care Physician ◽

Administrative Database ◽

Related Services ◽

Utilization Patterns

Objective. This study documents the influence of having an assigned Medicaid primary care physician (PCP) on the utilization of otitis media–related services. Design/Methods. This is a retrospective study using the 1991 Colorado Medicaid administrative database that followed 28 844 children <13 years who had at least 1 visit for otitis media. Results. Children continuously enrolled in Medicaid throughout the entire year were >4 times (odds ratio: 4.2 and 4.89, respectively) as likely to always or sometimes have a PCP compared with children who were discontinuously enrolled. The likelihood of ever using the emergency department for an otitis media–related visit was increased by 26% and 50%, respectively, when a child sometimes or never had a PCP compared with always having a PCP. The likelihood of ever filling an antibiotic for otitis media was reduced by 23% and 34%, respectively, when a child sometimes or never had a PCP compared with always having a PCP. The likelihood of ever having otitis media–related surgery was not affected by PCP status, but young children, 13 to 18 months of age, had higher referral rates when they had an assigned PCP. Conclusions. These findings suggest that having an assigned Medicaid PCP influences the utilization patterns of some otitis media–related medical services.

Download Full-text

Primary care physician and health care system characteristics influence the likelihood of referral to specialists

PsycEXTRA Dataset ◽

10.1037/e556172006-023 ◽

2006 ◽

Keyword(s):

Primary Care ◽

Health Care ◽

Primary Care Physician ◽

Health Care System ◽

Care Physician ◽

System Characteristics ◽

Care System

Download Full-text

Likelihood of Normal ABI Increases With Physiologic Testing Referrals From Rural Primary Care Physicians

Journal for Vascular Ultrasound ◽

10.1177/1544316719870070 ◽

2019 ◽

Vol 43 (3) ◽

pp. 123-127

Author(s):

Robert P. Scissons ◽

Abraham Ettaher ◽

Sophia Afridi

Keyword(s):

Primary Care ◽

Health Care ◽

Primary Care Physician ◽

Primary Care Physicians ◽

Bypass Graft ◽

Ankle Brachial Index ◽

Care Physician ◽

Health Care Facilities ◽

Rural Primary Care ◽

And Gender

Disparities in diagnostic capabilities have been noted between rural and urban health care facilities. We believe the clinical evaluation of peripheral arterial disease (PAD) by rural physicians may be similarly affected. Patients referred for arterial physiologic testing in an urban and rural regional health care network for a consecutive 7-month period were reviewed. Patients were classified into 3 groups based on referring physician specialty: (1) vascular surgeon or vascular medicine specialist (Vasc), (2) urban primary care physician (Urban), and (3) rural primary care physician (Rural). Normal patients were defined by a posterior tibial (PT) or dorsalis pedis (DP) ankle-brachial index (ABI) of ⩾0.90, bilaterally. Abnormal patients had both PT and DP ABI <0.90 in one or both extremities. Group comparisons were made for normal and abnormal patients, age (⩾65 years old), and gender. Patients with history of amputations, angioplasty, bypass graft, stent, calcification (PT or DP ABI ⩾1.30), and previous physiologic testing outside the designated period of analysis were considered a separate subclassification and analyzed separately. Emergency room referrals, inpatients, and patients with incomplete examination data were excluded from the analysis. A total of 430 patient exams were evaluated. Group-Rural had significantly greater numbers of normal ABI patients compared with Group-Urban ( P = .0028) and Group-Vasc ( P = .0000). No significant differences were noted between all groups for age and gender. Substantial disparities were noted in normal and abnormal ABI patients between rural health care physicians and their urban primary care and vascular specialist counterparts. Significantly greater numbers of normal ABI referrals by rural primary care physicians may warrant enhanced PAD diagnosis education or telemedicine alternatives.

Download Full-text