Lauren Lapointe-Shaw, Tara Kiran, Christine Salahub, Peter C Austin, Simon Berthelot, Laura Desveaux, Aisha Lofters, Malcolm Maclure, Danielle Martin, Kerry A McBrien, Rita K McCracken, Bahram Rahman, Susan E Schultz, Jennifer Shuldiner, Mina Tadrous, Cherryl Bird, J Michael Paterson, R Sacha Bhatia, Niels A Thakkar, Yingbo Na, Noah M Ivers
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We compared the sociodemographic characteristics and health care utilization patterns of patients attending 1 of 72 walk-in clinics with those of the general Ontario population. We examined the subset of patients who were enrolled with a family physician and compared walk-in clinic visits to family physician visits.</p><p><strong>Results: </strong>Our study found that 562 781 patients made 1 148 151 visits to the included walk-in clinics. Most (70%) patients who attended a walk-in clinic had an enrolling family physician. Walk-in clinic patients were younger (mean age 36 yr v. 41 yr, standardized mean difference [SMD] 0.24), yet had greater health care utilization (moderate and high use group 74% v. 65%, SMD 0.20) than the general Ontario population. Among enrolled Ontarians, walk-in patients had more comorbidities (moderate and high count 50% v. 45%, SMD 0.10), lived farther from their enrolling physician (median 8 km v. 6 km, SMD 0.21) and saw their enrolling physician less in the previous year (any visit 67% v. 80%, SMD 0.30). Walk-in encounters happened more often after hours (16% v. 9%, SMD 0.20) and on weekends (18% v. 5%, SMD 0.45). Walk-in clinics were more often within 3 km of patients' homes than enrolling physicians' offices (0 to < 3 km: 32% v. 22%, SMD 0.21).</p><p><strong>Interpretation: </strong>Our findings suggest that proximity of walk-in clinics and after-hours access may be contributing to walk-in clinic use among patients enrolled with a family physician. 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引用次数: 2
摘要
背景:免预约诊所在北美很常见，旨在提供急性发作性护理而无需预约。我们试图描述一个在加拿大安大略省的免预约门诊患者的样本，这是一个具有高水平初级保健依恋的环境。方法:我们使用2019年的卫生行政数据进行了横断面研究。我们比较了在72家免预约诊所中1家就诊的患者的社会人口学特征和医疗保健利用模式与安大略省普通人口的情况。我们检查了与家庭医生登记的患者子集，并比较了上门就诊和家庭医生就诊。结果:我们的研究发现，562 781例患者到包括免预约诊所就诊1 148 151次。大多数(70%)到免预约诊所就诊的患者有一名注册家庭医生。步入式诊所的患者更年轻(平均年龄36岁vs 41岁，标准化平均差[SMD] 0.24)，但与安大略省一般人群相比，他们有更高的医疗保健利用率(中度和高度使用组74% vs 65%， SMD 0.20)。在入组的安大略人中，免预约患者有更多的合共病(中重度患者占50% vs 45%， SMD为0.10)，离入组医生更远(中位数为8公里vs 6公里，SMD为0.21)，前一年见入组医生的次数更少(任何就诊次数为67% vs 80%， SMD为0.30)。下班后(16% vs . 9%， SMD 0.20)和周末(18% vs . 5%， SMD 0.45)的偶遇更频繁。步入式诊所往往在患者家3公里内比注册医生办公室(0至< 3公里:32% vs 22%， SMD 0.21)。解释:我们的研究结果表明，免预约诊所的邻近和下班后的访问可能有助于免预约诊所在家庭医生登记的患者中使用。这些发现对制定政策以改善免预约诊所和纵向初级保健的整合具有启示意义。
Walk-in clinic patient characteristics and utilization patterns in Ontario, Canada: a cross-sectional study.
Background: Walk-in clinics are common in North America and are designed to provide acute episodic care without an appointment. We sought to describe a sample of walk-in clinic patients in Ontario, Canada, which is a setting with high levels of primary care attachment.
Methods: We performed a cross-sectional study using health administrative data from 2019. We compared the sociodemographic characteristics and health care utilization patterns of patients attending 1 of 72 walk-in clinics with those of the general Ontario population. We examined the subset of patients who were enrolled with a family physician and compared walk-in clinic visits to family physician visits.
Results: Our study found that 562 781 patients made 1 148 151 visits to the included walk-in clinics. Most (70%) patients who attended a walk-in clinic had an enrolling family physician. Walk-in clinic patients were younger (mean age 36 yr v. 41 yr, standardized mean difference [SMD] 0.24), yet had greater health care utilization (moderate and high use group 74% v. 65%, SMD 0.20) than the general Ontario population. Among enrolled Ontarians, walk-in patients had more comorbidities (moderate and high count 50% v. 45%, SMD 0.10), lived farther from their enrolling physician (median 8 km v. 6 km, SMD 0.21) and saw their enrolling physician less in the previous year (any visit 67% v. 80%, SMD 0.30). Walk-in encounters happened more often after hours (16% v. 9%, SMD 0.20) and on weekends (18% v. 5%, SMD 0.45). Walk-in clinics were more often within 3 km of patients' homes than enrolling physicians' offices (0 to < 3 km: 32% v. 22%, SMD 0.21).
Interpretation: Our findings suggest that proximity of walk-in clinics and after-hours access may be contributing to walk-in clinic use among patients enrolled with a family physician. These findings have implications for policy development to improve the integration of walk-in clinics and longitudinal primary care.
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