Primary care among newborns at a Canadian urban center: an observational study

BACKGROUND: Canada is facing a primary healthcare crisis with physician shortages and long wait times. Across Canada, 8.1% of children lack a regular healthcare provider. However, little is understood about primary care access among newborns. The objective of this study was to determine the prevalence of newborns without primary care, and to evaluate the association between lack of primary care and sociodemographic factors at a large Canadian urban hospital. METHODS: This was a cross-sectional survey of caregivers of newborns who delivered within one week on the post-partum ward at a large urban hospital in Toronto, Ontario, Canada. To determine the association between lack of a primary care provider (PCP) among newborns and caregivers' sociodemographic characteristics, a logistic regression model estimated unadjusted and adjusted odds ratios (OR)s and 95% confidence intervals (CI). RESULTS: There were 656 caregivers and 659 newborns. Of these, 202 did not have access to a PCP with a prevalence of 30.6% (95% CI 27.2% - 34.3%). In the unadjusted analyses, not having a PCP for newborns was associated with caregivers not having a PCP for themselves (OR 7.59, 95% CI 5.06-11.39), not owning a home (OR 2.86, 95% CI 1.88-4.35), being born outside of Canada (OR 2.62, 95% CI 1.74-3.96), income <$75,000 (OR 2.30, 95% CI 1.47-3.61), and first language not English (OR 1.66, 95% CI 1.18-2.32). Similarly, in the adjusted analyses, not having a PCP for newborns was associated with caregivers not having a PCP for themselves (adjusted OR 6.18, 95% CI 4.04-9.46), not owning a home (adjusted OR 1.68, 95% CI 1.04-2.71), and being born outside of Canada (adjusted OR 1.69 95% CI 1.05-2.71). CONCLUSIO: This study found that 30.6% of newborns at a large urban Canadian hospital did not have primary care. Given the primary care crisis in Canada, it is essential to understand the lack of access to primary care among newborns. Next steps will be to link survey data to provincial datasets to determine the association between lack of primary care and emergency department visits and hospital admissions within the first year of life.