176: Access to Primary Care for Children with and without Asthma in Montreal: A Randomized Telephone Audit Study

Primary health care is an essential component of the health care system and has been shown to improve health outcomes (such as decreased urgent health care use) in patients with chronic conditions. Asthma is the most prevalent chronic illness in children and contributes major costs to the system with emergency room visits and hospital admissions. The federal and provincial governments had recognized the value of primary care and over a decade ago had invested millions of dollars in primary care reforms to improve quality and access for the population. Reforms introduced new models of care, such as Family Medicine Groups (FMG) and Integrated Network clinics in Quebec, as well as financial incentives for physicians to take on patients with chronic conditions but there is no evidence that these structures or incentives have been successful in prioritizing children with conditions such as asthma. Very little data exist on access to primary health care for children in Canada. It is thus pertinent to explore whether children with asthma are being prioritized in terms of access to primary care. To determine the patient acceptance rates into primary care practices in Montreal for a child without asthma compared to a healthy child. We conducted a randomized telephone audit study between July 24–October 10, 2014 in which primary care clinics in Montreal were randomized to two script scenarios. One scenario consisted of a caller posing as a mother of a four-year-old son with asthma, and the second was a mother of a healthy four-year-old son. In both cases, the caller was looking for a primary care physician for the child. We collected baseline data on the clinics, including health and social services region, clinic type (pediatrics, FMG, FMG-integrated network, non-FMG clinics). We conducted descriptive statistics (proportions) and χ2 tests to determine difference between the acceptance rates of two scenarios. Of the 257 clinics included, 30 (11.7%) were willing to accept a child. There was no significant difference between acceptance rates for a child with or without asthma (13.3% vs. 10.2%, respectively). Of the 227 clinics that would not accept the child, 45 (18.5%) said they did not accept children at all. Pediatric compared to other clinic types were more likely to accept new patients (P=0.005). Access to primary care in Montreal is poor. The majority (88.3%) of primary care clinics are not accepting children altogether. Children with asthma are not being prioritized in terms of access to primary care. Given the importance of primary care in children, especially those with chronic disease, policy-makers should re-examine current structures and incentives to address problems in primary care access.

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