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

• Published in: CMAJ open 2023-05, Vol.11 (3), p.E527-E536
• Main Authors: Marshall, Emily Gard, Stock, David, Buote, Richard, Andrew, Melissa K, Breton, Mylaine, Cossette, Benoit, Green, Michael E, Isenor, Jennifer E, Mathews, Maria, MacKenzie, Adrian, Martin-Misener, Ruth, McDougall, Beth, Mooney, Melanie, Moritz, Lauren R
• Format: Article
• Language: English
• Subjects: Ambulatory Care Sensitive Conditions; Cohort Studies; COVID-19 - epidemiology; Emergency Service, Hospital; Female; Hospitals; Humans; Nova Scotia - epidemiology; Pandemics; Primary Health Care
• ISSN: 2291-0026; 2291-0026
• DOI: 10.9778/cmajo.20220128

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. 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. 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. 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.