Time to Finding a Regular Primary Care Provider for Unattached Patients at the Primary Care Diabetes Support Program in London, Ontario, Canada.

Abstract

Objective: The Primary Care Diabetes Support Program (PCDSP) at St. Joseph's Health Care in London, Ontario, focuses on managing diabetes in high-risk adults (e.g. those who are socially and medically complex) and works to attach patients to a regular primary care provider. We describe the characteristics of the unattached patient population enrolled in the PCDSP and identify the time to and predictors of attachment (i.e. finding a regular provider).

Methods: We conducted a retrospective cohort study using electronic medical record data of patients enrolled in the PCDSP between April 1, 2011, and March 31, 2018 and followed patients for 5 years. We used descriptive statistics to assess characteristics of patients and time-to-event analyses to assess time to attachment.

Results: Among a final cohort of 726 patients with 5-year follow-up data, 401 individuals (55.2%) became attached. The estimated median time to attachment was 998 days (95% confidence interval [CI]: 748-1,248). Individuals who were both socially and medically complex (hazard ratio=1.44; 95% CI: 1.01-2.06) and joined the PCDSP in fiscal 2012 (hazard ratio=1.40; 95% CI: 1.01-1.95) were more likely to be attached compared with those who were non-complex and joined the program in fiscal 2011, respectively.

Conclusions: The PCDSP prioritises high-risk patients, particularly those who are both medically and socially complex, to attach them to a regular primary care provider. Our findings may relate to the social support workers in the program who play a crucial role in documenting social risk indicators, prioritising high-risk patients, and advocating for their attachment to primary care.