Jessie Weaver, MD, CCFP; Christa Kozanczyn, MD, CCFP; Anwar Parbtani PhD, MD, CCFP

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1 Jessie Weaver, MD, CCFP; Christa Kozanczyn, MD, CCFP; Anwar Parbtani PhD, MD, CCFP Family Medicine Teaching Unit, Royal Victoria Regional Health Centre, Barrie and DFCM, University of Toronto

2 DISCLOSURES: This study or investigators did not receive funding or other support from commercial/ industrial agencies. There was no real or perceived conflict of interest. ACKNOWLEDGEMENTS: RVH Research Ethics Board for advise and approval of this study. Dr. Monica Wolnik, Director of the Huronia UCC, Barrie and all physicians and staff at the HUCC, Barrie

3 As per Statistics Canada, 4.4 million (15.3%) Canadians did not have a primary care provider (PCP) in % of this population used walk-in clinics and 12.8% used hospital emergency departments (ED) for their ailments. There is an implication that not having a PCP is the main reason for the walk-in clinic and ED overuse, but many studies have refuted this assumption.

4 While numerous studies are available, assessing the determinants and patterns of Walk-in Clinic and Emergency Department use, studies determining the use of specific Urgent Care Clinics are rare. Such studies would help us to better organize our clinics/practices, and would help with an appropriate utilization of resources to better serve our communities.

5 To examine patients reasons for accessing care from an urgent care clinic (UCC) vs their own PCP. To examine whether the UCC was actually utilized as an URGENT care centre vs as any other walk-in clinic. To examine whether having a PCP or not was a factor for the use of the UCC. For patient with a PCP; to determine whether access to the PCP was a determinant of the UCC use.

6 Design: A prospective, cross sectional survey (a ten questionnaire survey Setting: A mid-size Ontario city, with 80+ PCP, one UCC, four regular walk-in clinics, and a hospital based emergency department. Patients: Patients over the age of 18 years attending the urgent-care clinic between January and March, Target: 300 completed surveys.

7 Note: Only 11% of the patients used the Urgent Care Clinic for specific medical reason requiring urgent attention; the rest used it as any other Walk-in Clinic. Reason for Choosing the UCC 14% Proximity Good service Hours/Wait times 11% 36% 39%

8 PERCEIVED ACUITY REASONS FOR VISITS 100% 90% 80% 70% 60% 50% 40% 30% 20% Acuity 1-3 Acuity 4-6 Acuity 7-10 ENT Resp Other 6% 16% 13% 10% Injury Pain/Joint GI 32% 23% 10% 0%

9 Sixty three percent of patients (n=184) had a PCP (a family physicians or a NP). However, only 37% (p<0.001) called their PCP prior to the visit. Of those who did not call their PCP: 47% assumed unavailability 27% assumed that they would not get a timely appointment.

10 Of the 37% of patients with PCP, who did call their PCP: 14% were told to seek help at a walkin clinic or the Urgent Care Clinic. 26% got an appointment, which they considered to be too remote.

11 61% of patients who could not get an appointment with PCP cited the following reasons: Busy Line (15%) Physician Away (27%) No Opening (19%)

12 Interestingly, assumptions of physicians unavailability and remote appointments were not far from reality ( p=0.1; p=0.9 respectively). Thus inaccessibility of the PCP was not only a perception, but a reality!

13 By James Chapman PUBLISHED: 22:02 GMT, 20 May 2013 (U.K.) The GPs who don't even know your name..: Health minister to launch attack on failings of inaccessible family doctors Jeremy Hunt will use speech to condemn scandal of out-of-hours services.

14 By James Chapman; PUBLISHED: 22:02 GMT, 20 May 2013 In a major speech, the Health Secretary will condemn the scandal of out-of-hours services where you speak to a doctor who doesn t know you from Adam..he will insist family doctors must once again take ultimate responsibility for round-the-clock care.

15 Correct the misperception that walk-in clinic or UCC use means bad medicine! Educate patients about the real acuity of their ailments. Implement the Advance Booking models Utilize partners in health care provision (Nurse Practitioners, Physician Assistants) to cope with the immediate access requests.

16 The Urgent Care Clinic was being used as any other walk-in clinic by a large majority of users (89%). For patients who had a PCP, major determinants for the clinic use were: perceived and real unavailability of their PCP. Inability to obtain timely appointments.

17 Another key determinant for the UCC use seemed to be the perceived high acuity/urgency of the medical condition. TeleHealth was rarely approached (a grossly underused service in Ontario).