Emergency department utilization and hospitalizations for ambulatory care sensitive conditions among unattached people actively seeking a primary care provider during the COVID-19 pandemic: a retrospective cohort study

ABSTRACT Background Primary care (PC) attachment improves healthcare access and prevention and management of chronic conditions. Yet, growing proportions of Canadians are unattached, signing-up on provincial waitlists. Understanding variations in healthcare utilization during COVID-19, and among potentially vulnerable unattached patients, is needed. This study compares emergency department (ED) utilization and hospitalization among those on and off a provincial PC waitlist, during the first two waves of COVID-19. Methods Waitlist and administrative health data were linked to describe persons ever/never on the waitlist between January 1, 2017, and December 24, 2020. ED utilization and ambulatory care sensitive conditions (ACSC) hospitalization rates by current waitlist status were quantified from physician claims and hospitalization data. Relative differences during COVID-19 first and second waves were compared with the previous year. Results During the study period, 100,867 Nova Scotians (10.1%) were on the waitlist. Those on the waitlist had higher ED utilization and ACSC hospitalizations. ED utilization was higher overall for individuals ≥65 years and females; lowest during first two COVID-19 waves; and differed more by waitlist status for those <65 years. ED contacts and ACSC hospitalizations decreased during COVID-19 relative to the previous year, and for ED utilization this difference was more pronounced for those on the waitlist. Interpretation Nova Scotians seeking PC attachment utilize hospital-based services more frequently than those not on the waitlist. Both groups had lower utilization during the COVID-19 pandemic than the year before. The degree to which forgone services produces downstream health burden remains to be seen.