Research Program Manager, Early Career Research and Bioethics Graduate Student Unity Health Toronto Toronto, Ontario, Canada
Background: Approximately 25% of Canadians living in urban communities do not have a primary care provider. Although several studies have described challenges with primary care access among adults in North America, little has been reported on access to primary care for newborns. Objective: Our objective is to examine the association between lack of access to primary care among Ontario newborns and Emergency Department (ED) visits and/or hospital admissions within one year after birth, adjusting for parent sociodemographic characteristics. Design/Methods: This is a prospective cohort study of newborns born between June 2023 and June 2024. Phase I: We administered the Primary Care Access for Newborns (PCAN) survey to parents of newborns at an urban academic hospital shortly after delivery. The PCAN survey asks whether parents have a primary care doctor for their newborn. Family-level sociodemographic data were also collected. The prevalence of newborns without a primary care provider was estimated with 95% confidence interval, and sociodemographic characteristics were summarized using descriptive statistics. Phase II: Data will be sent to ICES for linkage to determine the number of ED visits and/or hospital admissions up to one year after birth. Bivariate associations will be determined using the t-test or Wilcoxon rank-sum tests for continuous variables, and the chi-square or Fisher’s exact tests for categorical variables. A multivariable logistic regression model, adjusting for sociodemographic factors, will estimate the odds ratio and 95% confidence interval for the association between lack of access to primary care and ED visits and/ or hospital admissions. Results: Our initial data showed that 32 of 122 newborns or 26% (95% CI 19%-35%) do not have access to a primary care provider before hospital discharge from birth. In terms of parent sociodemographic data (n=120 participants), 44% indicated that English was not their first language, 17% had a family annual income of <$75,000, 65% were born outside of Canada, 63% did not own housing, and 79% had a primary care doctor for themselves.
Conclusion(s): Our current data show that the prevalence of newborns lacking a primary care provider is similar to that of adults. Evaluating how this impacts newborn health care utilization will fill knowledge gaps that are critical for laying the foundation for future population health-intervention research focused on primary care access among urban newborns.
