Characterizing and Improving Access to Primary Care for Unattached Patients: Insights from the Primary Care Diabetes Support Program

Background: The Primary Care Diabetes Support Program (PCDSP) at St. Joseph’s Health Care in London, Ontario, is an innovative program that focuses on managing diabetes in high-risk groups (e.g., socially and medically complex). The program also works to attach patients without a primary care provider (PCP) to a regular PCP. We described the characteristics of the unattached patient population at the PCDSP and identified time to attachment. Methods: We used an observational retrospective cohort design and electronic medical record data of patients enrolled at the PCDSP between April 1, 2011, and March 31, 2018. We used descriptive statistics to assess characteristics of unattached patients and time-to-event analyses to assess time to attachment within 5 years. Results: Of 6,863 PCDSP patients, 1,183 were identified as unattached (17.2%). Among a final cohort of 728 patients, 402 individuals (55.2%) became attached. The median time to attachment was 998 days (95%CI: 748 to 1245 days). Individuals who were both socially and medically complex (HR = 1.47 [95% CI 1.02 to 2.11]), aged 65 or older (HR = 1.33 [95% CI 1.08 to 1.63]), and had family history of diabetes (HR = 1.43 [95% CI 1.09 to 1.88]), were more likely to be attached compared to those who were non-complex, younger than 65, or had no family history of diabetes, respectively. Conclusions: The PCDSP prioritizes high-risk patients to find a regular PCP. Particularly, patients who were both medically and socially complex had greater likelihood of attachment to a PCP through the PCDSP.