Longer distance between family physicians and patients can be potential barrier to receiving care

Living farther than 30 km from a family physician can negatively affect access to health care, found a new Ontario study published in CMAJ (Canadian Medical Association Journal) https://www.cmaj.ca/lookup/doi/10.1503/cmaj.250265.

Over the last 10 years, access to primary care has declined in Canada, and this decline accelerated with the COVID-19 pandemic. Even after moving, many patients reported continuing with their family physicians, despite travelling longer distances to reach them.

"Distance to health care services is an important determinant of health and can be classified as a factor of health care utilization, with increased distance a potential barrier to receiving care," writes Dr. Archna Gupta, a scientist at Upstream Lab and a family physician at St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, with coauthors.

To understand the impact of distance between family physicians and their patients on health care usage and quality of care, researchers undertook a large study based on data as of Mar. 31, 2023. The study of almost 10 million patients in Ontario, Canada's largest province, found that 13% of patients lived more than 30 km from their family physician. These patients were more likely to visit the emergency department for nonurgent reasons and had fewer visits with a family physician in the previous two years. They were also more likely to be male, to be under 65 years of age, to live in a low-income neighborhood, and to be newcomers to Ontario.

Our research shows that people use the emergency room not just because they don't have a family doctor or can't get an appointment. It's also because their family doctor might be too far away to reach easily. The distance makes it harder for many Ontarians to get the care they need when they need it most."

Dr. Archna Gupta, scientist at Upstream Lab and family physician at St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario

Patients who lived more than 150 km from their family physician had the highest odds of an emergency department visit for nonurgent reasons and were less likely to visit their physician. As well, the farther patients lived from their primary care physician, the less likely they were to undergo preventive screening for colorectal, breast, or cervical cancer.

The authors hope this study will aid policy-makers with health care planning.

"Incorporating distance to a family physician can provide policy-makers with a more nuanced understanding of unmet primary care demand. Our findings suggest that reforms should prioritize offering primary care a minimum of 30 km from a patient's home," conclude the authors.