Access to primary care is important to patients, AFHTO members and MOHLTC. Based on international comparator reports, Canada and Ontario have performed badly on this measure with no improvement in performance over the past 5 years or more. However, these international healthcare rating reports consistently focus on “ability to get an appointment on the same or next day” as a reflection of access to primary care. There is considerable evidence and input from patients and providers that this might not be the only or best way to measure access.
Arguments against using “same/next day” as a meaningful measure of access
The % of people who are able to get an appointment within the same or next day when they need it (the so-called same/next day indicator) may not truly reflect what is important to patients and providers in terms of access to primary care. Some of the evidence to this effect is as follows:- For all five iterations of D2D to date, about 80% of patients report having a “reasonable wait” for an appointment with about 53% being able to get an appointment on the same or next day. Reasonable access clearly includes appointments NOT on the same or next day.
- The increase in low acuity ER visits for patients whose wait times for primary care are high does not happen until after 3 days and plateaus at 7 days. ER use is widely seen by patients as being medically necessary and only moderately related to ability to access their usual source of Primary Health Care.[i]
- Of the 11 key performance targets identified by patients (through Patients Canada), the only reference to “same day” service is about getting phone calls returned. Other aspects of access that are explicitly mentioned are access to EMR for appointment booking and review of results and access to non-Emergency-Department after-hours care.
Alternative approach to measuring access
Given the political traction of the “same/next day” indicator as a measure of access, especially in light of international comparisons, it is inevitable that the indicator will continue to be of interest to MOHLTC and LHINs. It may also be important to some (although clearly not all) patients and providers. To address this, AFHTO is advocating for a more balanced, meaningful approach to measuring access that includes:- Combining it with “reasonable wait” to continually highlight the difference between the two ways of understanding access.
- Adding other measures of access of interest to patients such as phone responsiveness and electronic solutions to allow patients to book appointments online and view their EMR.
- Considering a more comprehensive, relationship-based measure of quality such as that embodied by the D2D Quality Roll-Up indicator to monitor primary care system performance.