A Comparative Analysis of Centralized Waiting Lists for Unattached and Complex Patients Implemented in Six Canadian Provinces

BC, MB, ON, QB, NS, NB, PEI: Mylaine Breton, Michael Green, Jalila Jbilou, Sara Kreindler, Jason Sutherland, Valorie Crooks, Damien Contandriopoulos, Mélanie Ann Smithman, Astrid Brousselle, Jay Shaw, Emily Marshall, Sabrina Wong

Please describe your research project and how it contributes to improving primary care.

The main objective of this study was to compare the different models of centralized waiting lists (CWL) for unattached patients implemented in six provinces of Canada to each other and to available scientific knowledge to make recommendations on ways to improve their design in an effort to increase attachment of patients to a primary care provider. We used a logic analysis approach developed in three steps:

  1. Build logic models that describe each province’s CWL through interviews with key stakeholders in each province;
  2. Develop a conceptual framework, separate from the provincially informed logic models, that identifies key characteristics of CWLs for unattached patients and factors influencing their implementation through a literature review and interviews with experts;
  3. Compare the logic models to the conceptual framework to make recommendations to improve CWLs in different provinces during a pan Canadian face-to-face exchange with decision-makers, clinicians and researchers.

We published a protocol paper in BMC Health Services Research in 2017 and the main results in Healthcare Policy in 2018. Logic models of each province’s intervention were built after a grey literature review. We conducted 42 semi-structured interviews and performed a validation process with key stakeholders. Our analysis showed variability and common features in the design of CWLs, such as same main objective to attach patients to a primary care provider; implementation as a province-wide program (with the exception of BC); management at a regional level; voluntary participation for providers (except in two provinces where it was mandatory for providers to attach CWL patients); similar registration processes; some forms of prioritization of patients, either using simple criteria or assessing for vulnerability (except in New Brunswick).

Despite differences in design, CWLs face common issues and challenges regarding provider capacity to address the demand for attachment, barriers to the attachment of more vulnerable and complex patients, and non-standardized approaches to evaluating their effectiveness.

What are the key messages from this project to share with stakeholder groups (i.e. clinicians, policy makers, patients)?

This project originally started with six provinces but was so compelling to Nova Scotia decision makers that they joined. As of September 2019, BC now joins the rest of Canada in having a provincially funded CWL, and adopts a model of managing the wait list similar to what was done in two different divisions of family practice. This was significant because we were able to provide the BC Ministry of Health with evidence to inform their decision-making and because we could draw on learnings from across Canada. This project has also led to a new CIHR funded grant, led by Emily Marshall, to examine the effect of CWLs across seven provinces.