Abstract
Background: Improving primary care access requires a place-based understanding of social determinants of health (SDOH). However, health and SDOH data are often siloed, making it difficult to plan, implement, and monitor strategies that enhance health equity across communities.
Approach: To increase cross-sector collaboration in addressing health inequities, we developed a collaborative data hub that integrates place-based, equity-oriented data on health outcomes and social determinants of health (SDOH). This hub enables intersectoral partners to share and analyze locally relevant data to identify and address disparities across Ottawa’s neighbourhoods. In one application of this hub, we focused on addressing the primary care attachment crisis in Ottawa, a city with a population of one million residents and approximately 900 practicing family doctors. We collaborated with partners to examine primary care attachment rates among residents eligible for publicly funded healthcare. Data sources included: i) 2022 primary care attachment rates from the Ottawa Community Health Profiles Partnership, ii) 2024 registry data from the College of Physicians and Surgeons of Ontario, and iii) neighbourhood-level data from Statistics Canada’s 2021 Census, curated by the Ottawa Neighbourhood Study (ONS) (https://www.neighbourhoodstudy.ca/). Using ONS’s community-defined boundaries and datasets, we mapped sociodemographic factors (age, race/ethnicity, income, and SES) against primary care attachment rates across neighbourhoods. Our outcome measures included: i) the proportion of residents unattached to primary care, and ii) the ratio of family doctors-to-residents.
Results: Among Ottawa's residents, 15.6% (n=165,362) were unattached to primary care, but rates of unattachment varied significantly across neighbourhoods, from 7.4% to 27.7%. We observed strong correlations between unattachment rates and various sociodemographic factors, with greater unattachment in neighbourhoods with greater proportions of residents living on a low income (coefficient of determination (R2) = 0.75), young adults aged 20-34 years (R2 = 0.66), living alone (R2 = 0.55), unemployed (R2 = 0.51), or racialized (R2 = 0.32). There was a clear gradient in the unattachment rates by neighbourhood socioeconomic status (SES) (11.7% in most advantaged quintile vs 22.1% in least advantaged quintile). Ottawa was served by 928 family doctors overall, yielding an overall ratio of 0.91 family doctors per 1,000 residents. Despite lower attachment rates, disadvantaged neighbourhoods (socioeconomic quintiles 4 and 5) had significantly higher family doctor-to-resident ratios (1.3 family doctors per 1,000 resident) compared to advantaged neighbourhoods (SES quintiles 1 and 2) (0.6 family doctors per 1,000 resident)
Implications: Our findings demonstrate the influence of socioeconomic factors on primary care attachment and show the power of neighbourhood-level data and geospatial techniques in primary care research. They also highlight the need for targeted interventions to improve equitable healthcare access within communities. In response to our data, we are now collaborating with our local health and service delivery partners to identify individuals in priority populations who would most benefit from primary care attachment. To date, we have successfully connected 200 patients with family doctors in their neighbourhoods.