Meeting the primary care needs of communities where they are: mobile primary care clinics, test and try evaluation, Nova Scotia Canada

BACKGROUND: Primary care is crucial for reducing health disparities and enhancing population health. The COVID-19 pandemic exacerbated long-standing challenges for Canada in maintaining robust primary care; however, it also presented opportunities for health system transformation. One such transformation was the rapid implementation of Mobile Primary Care Clinics (MPCCs) in the Atlantic Canadian province of Nova Scotia to enhance healthcare accessibility and alleviate pressure on emergency departments (EDs). This evaluation aimed to assess the impact, implementation, and partner experiences of MPCCs as another point of primary care access for Nova Scotians. METHODS: The evaluation involved a mixed-methods approach (September 2022-October 2023) guided by implementation outcomes of effectiveness, efficiency, acceptability, and feasibility. Data sources included clinic utilization and cost records, administrative data, patient and provider surveys, and a questionnaire from the implementation team. A scenario-based economic analysis with probabilistic sensitivity analysis (PSA) was performed from a third-party payer perspective. ED diversion estimates were derived by combining survey-reported counterfactual care-seeking behaviour with observed ED utilization within 72 h of an MPCC visit, identified through linkage to provincial administrative data. RESULTS: Across 157 clinic days, 13,019 visits were recorded. The most common presentations were respiratory or dermatological complaints and prescription renewals. Among 1,888 patient survey respondents, 23.7% would have sought ED care, and 7.2% would have gone untreated had an MPCC not been available. ED utilization within 72 h of an MPCC visit occurred in 13.7% of visits. The mean cost per visit was CAD $103 for general primary care clinics and $236 for upper respiratory infection clinics. Scenario-based estimates of potential fiscal offsets from survey-reported ED diversions were $1.95 million (95% CI $0.77-$3.64 million). Surveyed patients (97%) and providers (99%) rated the clinics favorably, citing timely access and interdisciplinary teamwork. Implementation enablers included adequate staffing, clear roles and strong interagency partnerships; key barriers were limited EMR integration and inconsistent public awareness. CONCLUSIONS: Preliminary findings show MPCCs have made a positive impact by enabling access to primary care in multiple communities across the province. Estimates of ED diversion-related fiscal offsets are illustrative and should be validated with linked administrative data. As operational planning and integration with primary care continue, ongoing work should address continuity of care, efficiency, equity, and sustainability.