• Christine Salahub, Peter C Austin, Li Bai, Simon Berthelot, R Sacha Bhatia, Cherryl Bird, Laura Desveaux, Tara Kiran, Aisha Lofters, Danielle Martin, Kerry McBrien, Rita K McCracken, J Michael Paterson, Bahram Rahman, Jennifer Shuldiner, Mina Tadrous, Niels Thakkar, Noah M Ivers, and Lauren Lapointe-Shaw.
• Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada (Salahub).
• Ann Fam Med. 2024 Nov 1; 22 (6): 483491483-491.

PurposePrimary care access is a key health system metric, but little research has compared models to provide primary care access when one's regular physician is not available. We compared health system use after a visit with a patient's own family physician group (ie, within-group physician who was not the patient's primary physician) vs a visit with a walk-in clinic physician who was not part of the patient's family physician group.MethodsWe conducted a population-based, retrospective cohort study using administrative data from Ontario, Canada, including all individuals formally enrolled with a family physician, from April 1, 2019 to March 31, 2020. We compared those visiting within-group physicians to those visiting walk-in clinic physicians using propensity score matching to account for differences in patient characteristics. The primary outcome was any emergency department visit within 7 days of the initial visit.ResultsMatched patients who visited a within-group physician (N = 506,033) were 10% less likely to visit an emergency department in the 7 days after the initial visit compared to patients who saw a walk-in clinic physician (N = 506,033; 20,117 [4.0%] vs 22,320 [4.4%]; risk difference [RD] 0.4%; 95% CI 0.4-0.5; relative risk [RR] 0.90; 95% CI, 0.89-0.92). Restricting to visits occurring on weekends, the observed association was stronger (7,964 [3.7%] vs 10,055 [4.7%]; RD 1.0%; 95% CI 0.9-1.1; RR 0.79; 95% CI, 0.77-0.82). Those accessing after-hours within-group physician visits were more likely to have ≥1 additional virtual or in-person within-group physician visit within 7 days (virtual RR 1.86, in-person RR 1.87).ConclusionsCompared to visiting a walk-in clinic physician, seeing a within-group physician after hours might decrease downstream emergency department visits. This finding could be explained by better continuity of care and can inform primary care service models and the policies that support them.© 2024 Annals of Family Medicine, Inc.

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