Contextual Factors Shaping Patients’ Experiences of Access to Primary Care: Insights from Quebec

Background: In Quebec, Canada, the main model of primary care (PC) clinics is the family medicine group (FMG), which serves 65% of the population. However, despite these patients being formally attached to a PC provider, challenges in timely access remain. Few studies have examined how contextual factors such as clinic size and rurality influence patient experiences of access. This study aimed to assess associations between clinic-level contextual factors and patient-reported experiences of access to PC.

 

Approach: A cross-sectional study was conducted with 122,397 patients from 104 FMGs across Quebec who responded to an online survey between September 2022 and June 2023. Patients with a valid email address were invited to complete a 52-item questionnaire assessing patients’ experiences of access to care in their clinics as well as individual socio-economic and clinical characteristics. Contextual factors included clinic size and the clinic’s geographical location.

 

Clinic size was categorized into three groups based on attachment targets: small (6,000 to 14,999 patients), medium (15,000 to 23,999) and large (24,000 or more). Geographical location (rural/urban) was determined by the postal code of the clinic. Patient experiences were measured using two outcomes: 1) perceived difficulty obtaining an appointment with their PC provider (family physician or nurse practitioner) and 2) perceived unmet healthcare needs. Multilevel logistic regressions were conducted adjusting for individual and organizational factors.

 

Results: In total, 29% and 35% of patients were attached to small and medium clinics, respectively, while 36% were attached to large clinics.

 

Most patients were from clinics located in urban areas (85%). Clinic size was associated with both outcomes. Compared to patients in small clinics, those attached to PC providers in medium-sized clinics were less likely to report difficulties obtaining appointments and unmet healthcare needs. In contrast, the clinic’s geographical location was not associated with patients’ perceived experiences of access to care.

Implications: Findings highlight that contextual factors, particularly clinic size, influence patients’ experiences of access to care. Interestingly, geographic location did not significantly impact patient experiences. For international delegates, these results emphasize that strategies targeting clinic size and related processes may be more effective than location-based strategies for improving experiences of access. Future studies are needed to better understand the organizational structure and processes that could account for the results in order to inform policy reforms and strengthen equitable access to primary care.