Patterns of patient experience with primary care access in Australia, Canada, New Zealand and Switzerland: A comparative study

Abstract

Objective Access to primary care (PC) is vital, but complex to define and compare between settings. We aimed to generate a typology of patients’ access patterns across countries using a novel inductive approach. Design Cross-sectional surveys. Setting Australia, Canada, New Zealand and Switzerland between 2012 and 2014 as part of the QUALICO-PC project. Participants Data were collected from 1306 general practices and 10 000+ patients, with nine patients per practice. Intervention(s) None. Main Outcome Measure(s) Typology of access. Results Three axes were retained, explaining 23% of the total variance: (i) ‘temporal and geographical access’; (ii) ‘frequency of access and unmet healthcare needs’; and (iii) ‘affordability and frequency of access’. Based on the three axes, we identified four clusters of patients: (i) patients reporting overall good access to PC; (ii) frequent users with unmet healthcare needs; (iii) under-users with financial barriers; and (iv) users with poor time/geographical access. Better access to PC was experienced in Switzerland and New Zealand, while worst access was reported in Canada, where most of the time and geographical barriers were reported. Most financial barriers were observed in Australia and New Zealand. Frequent users with some level of unmet healthcare needs are prevalent in all four countries. Conclusions Four main groups of patients with different patterns of access were identified: (i) good access; (ii) geographical and time barriers; (iii) financial barriers; and (iv) frequent users with unmet healthcare needs. Differences in access between the four countries are substantial.