Understanding disparities in primary care patient experience

This article was submitted to Canadian Family Physician on January 22, 2019 and accepted for publication on May 6, 2019 following peer review. The version of record will be published in Canadian Family Physician and available at https://www.cfp.ca/Objective: To understand disparities in primary care patient experience Design: We conducted a serial cross-sectional study to understand disparities in patient experience at two time points (2014 and 2016). We explored disparities related to age, gender, neighbourhood income, and self-rated health using three analytic approaches: 1) stratification, 2) logistic regression, and 3) relative comparison across multiple demographic variables. Setting: A multi-site Family Health Team in Toronto, Canada Participants: Patients in the family medicine practice who completed email surveys in 2014 (N=1171, 19% response rate) and 2016 (N=1823, 15% response rate). Outcome measures: Patient-reported access (timely access when sick; access after-hours) and patient-centredness (opportunity to ask questions; involvement in care decisions; enough time with provider). Results: Performance for all measures improved between 2014 and 2016, with the greatest absolute improvement seen in access after-hours (61% in 2014; 75% in 2016). Patients residing in low income neighbourhoods reported worse patient experience than those in high income neighbourhoods as did patients with poor versus excellent self-rated health, even after adjustment for other variables. For example, in 2016, 60% of patients residing in low income neighbourhoods reported timely access when sick versus 70% in high income neighbourhoods (aOR 0.67, 95% CI 0.47 to 095); 60% of patients with poor/fair self-rated health reported timely access when sick versus 72% with excellent self-rated health (aOR 0.54 95% CI 0.35 to 0.84). Comparing across demographic groups, patients with excellent and poor/fair self-rated health reported the best and worst experience, respectively, for all measures. In 2016, the average disparity between subgroups was largest for access after-hours. Conclusion: In our setting, patient experience was worse for patients in lower income neighbourhoods and those with poor self-rated health. Access after-hours demonstrated the greatest overall absolute improvement but also greatest widening of disparities