Distance to primary care and its association with health care use and quality of care in Ontario: a cross-sectional study

Abstract

Background: In Canada, patients who move may choose to stay on their original family physician’s roster, creating long distances to seek primary care. We sought to explore how distance to primary care affected health care use and quality of care. Methods: We conducted a population-based study in Ontario, Canada, including urban and suburban patients enrolled with a family physician as of Mar. 31, 2023. The primary exposure was patients’ travel distance to their physician. Outcomes included emergency department visits, primary care visits, continuity of care, and cancer screening rates. Results: We included 9967955 patients. Of these, 1 261 112 (12.7%) patients lived farther than 30 km from their family physician. These patients had greater odds of having nonurgent emergency department visits in the past year (odds ratio [OR] 1.43, 95% confidence interval [CI] 1.42 to 1.44); having no visits with any family physician in the previous 2 years (OR 1.28, 95% CI 1.27 to 1.28); and not having had screening for colon cancer (OR 1.17, 95% CI 1.16 to 1.18), breast cancer (OR 1.24, 95% CI 1.23 to 1.25), and cervical cancer (OR 1.17, 95% CI 1.16 to 1.18). Interpretation: Among Ontario patients living in urban or suburban areas and rostered to a family physician within a patient enrolment model, more than 10% of patients resided farther than 30 km from their family physician. Proximity to primary care was associated with higher use of primary care, reduced emergency department use, and increased uptake of recommended cancer screening, underscoring the importance of reforms that enhance access to care close to home.