Thread by @DrRitaMc

The #FamilyDoctorShortage
Can we fix it with more walk-in clinics?

A 🧵 about access hours
for (episodic) primary care in BC
based on our recent pre-print paper

#Cdnhealth #primarycare #bcpoli #tweetorial
@ircoopy @LindsayKHedden @UBCISU @sarah_fletch

medrxiv.org/content/10.110…

1⃣ What's the difference
between seeing a family doctor at a walk-in clinic
versus
a "regular" family doctor's office?

There are two typical kinds of "relationships" people have with a family doctor - EPISODIC + LONGITUDINAL #Cdnhealth #primarycare

A LONGITUDINAL relationship
with a doctor, NP, clinic,
ie you get to know each other

Research has shown that LONGITUDINAL primary care
improves the health of a community +
reduces overall costs of the system.

🪄Magic, right? #Cdnhealth #primarycare
pubmed.ncbi.nlm.nih.gov/16202000/

versus... EPISODIC - where you see someone once, for a specific problem - like at a WALK-IN CLINIC #Cdnhealth #primarycare

We don't have much research
to tell us how
episodic (walk-in/urgent) care
impacts patient health or health system costs
But there are some signals
that it is not as effective
as LONGITUDINAL CARE. #bcpoli #primarycare

In the 1980's
walk-in clinics were introduced across 🇨🇦
In BC, the first one was Care Point, Inc.
that billed itself as
providing care after hours
"to attract customers away from hospital emergency wards and general practitioners"
#bcpoli #primarycare
⤵️
proquest.com/canadiannews/d…

As of June 2021
BC had 243 walk-in clinic's
providing EPISODIC care
which is ~20% of the
total ~1240 BC family medicine clinics
that have at least 2 doctors working there.
#bcpoli #primarycare
(ref: another recent paper) @jmirpub formative.jmir.org/2022/6/e34141/

🤯Plus BC started adding a new type of clinic,
URGENT & PRIMARY CARE CLINIC's (UPCC)
in fact, they added them so fast
we repeated data collection during our study period! #Cdnhealth #primarycare
⤵️
healthlinkbc.ca/health-service…

We used patient-facing
publicly available information
to total up the
number of service hours
available in a week (Table 1)
and compared
after hours availability
btwn walk-ins & UPCC's #Cdnhealth #primarycare

We found that
26.7% of walk-ins
kept to "regular business hours"
versus 96% of UPCC's were open "after hours" (Table 2) #Cdnhealth #primarycare

We also compared
the number of clinics and service hours
per 100,000 people,
between the
5 different geographical "health authorities" in BC
(Figure 1)
#Cdnhealth #primarycare

So what do we think these findings mean?
especially in light of the
#FamilyDoctorShortage in BC?
Well...

#1, BC has >13,000 service h/week of
EPISODIC care, and more UPCC's are still being added. #bcpoli #primarycare

#2, Walk-in clinics are
most often adjacent to or part of
a LONGITUDINAL family practice +
are open fewer after hours
It's possible they are being used
by people otherwise
unattached to LONGITUDINAL CARE
rather than as a convenience. #Cdnhealth #primarycare

🤓Interesting side project
we compared the
"practice standards"
for walk-in clinics all across Canada...
and they vary #Cdnhealth #primarycare
(see the comparison here ⤵️)
medrxiv.org/content/10.110…

#3 there's regional variation
in the availability of EPISODIC care service hours
and we don't know if this means
that there is a "shortage"
or if this reflective of
how health care organization
varies in urban v. rural areas #bcpoli #primarycare

‼️LIMITATIONS‼️
we used publicly available data
about service hours and
did not tie it to MD billing nor patient outcome data
Future work, including those links,
could help tell us more about
the real impacts of EPISODIC care
#Cdnhealth #primarycare

The #FamilyDoctorShortage
(aka the widespread access to primary care problem)
is a 🇨🇦mega problem
we need to measure and evaluate
all solutions and policies
to make sure they are
INCREASING ACCESS
equitably, to high quality primary care
#Cdnhealth #primarycare

🙄
So, we (still) don't really know
how changes to EPISODIC care access
affects LONGITUDINAL access
nor patient outcomes
nor system costs
BUT, this initial work may help set up a framework to answer those key questions!
#bcpoli #primarycare

Thanks to all the authors!
#MaryAMcCracken @ircoopy, #MicheeAnaHamilton @JanKlimas #CameronLindsay @sarah_fletch @drpriceless @LindsayKHedden @UBCISU @UBCFamPractice @UBCmedicine @SFU_FHS

A note about "pre-prints"
we've since submitted this paper to a peer-reviewed journal
a pre-print lets us share these findings sooner
and
GATHER FEEDBACK
from a wide audience
please add any thoughts in the comments section on @medrxivpreprint medrxiv.org/content/10.110…