More than one in five Canadian adults lack access to primary health care, confirms a new study published by the Canadian Medical Association Journal, which also highlights significant regional disparities in this area.

This would therefore mean that approximately 6.5 million Canadians do not have access to a family doctor or nurse practitioner they can consult on a regular basis.

The situation is even worse in Quebec and the Atlantic region, where an estimated one in three adults lacks access to basic care, even taking into account the diverse demographic characteristics of survey respondents – a situation that the study’s author, Dr. Tara Kiran of the University of Toronto, considers “unacceptable.”

“We saw huge disparities (between provinces),” said Dr Kiran. “I find it remarkable that in a country where we are supposed to have universal access to health care (…) that one in three people do not have access to basic care. I don’t know what else to say… It breaks my heart that people are left behind and have no one to turn to.”

The study conducted by Dr. Kiran and her colleagues spanned 18 months, during which they analyzed responses to an online questionnaire from approximately 9,300 Canadians across the country; 73% of the questionnaires were completed in English and 27% in French.

In contrast to residents of Quebec and the Atlantic, where only 69% of participants reported that they were in this situation, 87% of Ontario residents responded that they had regular access to basic care.

“In our survey, the largest differences in access to primary care were regional, with nearly one in three people reporting not having a primary care doctor in Quebec and the Atlantic region, a 70% lower likelihood than in Ontario, even after accounting for population differences between (respondents),” we can read in the CMAJ.

Men, people under 65 years of age and participants with “poor or fair” health were most disadvantaged in this regard.

And even Canadians who have access to frontline health care don’t necessarily have access to it when they need it. Across Canada, only a third of survey respondents said they were able to get an urgent appointment within 48 hours. All others had to wait at least three days, and 7.5% of respondents never got an appointment.

In Quebec, 36.6% of participants reported being able to get an appointment within 48 hours, compared to just 23.9% in the Atlantic.

When asked about the health services that were most important to them, survey respondents said they wanted access to a provider “who knows me as an individual and takes into account all the factors that affect my health.”

“I can attest to that from my own practice as a primary care physician,” said Dr. Kiran. When you get to know someone over time, you understand their values, their family, the community they live in, and that allows you to better tailor the care that person provides to their specific needs.”

Nine out of 10 participants said they would be happy to receive help from another member of their GP team (i.e. they would not necessarily want to see their usual doctor). Yet only 15% of participants reported that their GP worked with other healthcare professionals within the same clinic.

“People have been very open to different ways of doing things,” Dr. Kiran noted. If necessary, they are willing to not always see the same doctor, but are willing to go to a clinic where the doctor has access to their records. But there is no match between this openness of people to do things differently and what the system offers them.

People are willing to receive care “in different ways,” she added, “as long as that care is relationship-based.”

In Quebec and Ontario, survey respondents were most likely to be able to speak to a pharmacist, social worker or nutritionist, for example.

Ultimately, Dr Kiran reminded us, we know that health systems where access to primary care is good also have “greater equity” and lower costs.

“The results of our survey show that our primary health system is in crisis,” she concluded. It is damaging the health of our population and leading to higher costs. It is important to take an interest in this if we want an egalitarian society and an efficient system.”

Jean-Benoit Legault, The Canadian Press