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In search of attachment: a qualitative study of chronically ill women transitioning between family physicians in rural Ontario, Canada

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Randall, Ellen, Crooks, Valorie A, Goldsmith, Laurie J·2012·BMC Family Practice
DOI 10.1186/1471-2296-13-125PMC PMC3548744
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Abstract

BACKGROUND: Most Canadians receive basic health services from a family physician and these physicians are particularly critical in the management of chronic disease. Canada, however, has an endemic shortage of family physicians. Physician shortages and turnover are particularly acute in rural regions, leaving their residents at risk of needing to transition between family physicians. The knowledge base about how patients manage transitioning in a climate of scarcity remains nascent. The purpose of this study is to explore the experience of transitioning for chronically ill, rurally situated Canadian women to provide insight into if and how the system supports transitioning patients and to identify opportunities for enhancing that support. METHODS: Chronically ill women managing rheumatic diseases residing in two rural counties in the province of Ontario were recruited to participate in face-to-face, semi-structured interviews. Interview transcripts were analysed thematically to identify emergent themes associated with the transitioning experience. RESULTS: Seventeen women participated in this study. Ten had experienced transitioning and four with long-standing family physicians anticipated doing so soon. The remaining three expressed concerns about transitioning. Thematic analysis revealed the presence of a transitioning trajectory with three phases. The detachment phase focused on activities related to the termination of a physician-patient relationship, including haphazard notification tactics and the absence of referrals to replacement physicians. For those unable to immediately find a new doctor, there was a phase of unattachment during which patients had to improvise ways to receive care from alternative providers or walk-in clinics. The final phase, attachment, was characterized by acceptance into the practice of a new family physician. CONCLUSIONS: Participants often found transitioning challenging, largely due to perceived gaps in support from the health care system. Barriers to a smooth transition included inadequate notification procedures, lack of formal assistance finding new physicians, and unsatisfactory experiences seeking care during unattachment. The participants' accounts reveal opportunities for a stronger system presence during transition and a need for further research into alternative models of primary care delivery.

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  • Patients without a regular primary care provider often experience access barriers, lower continuity of care, less comprehensive care, a lack of care coordination, more unmet needs, and often rely on walk-in clinics and emergency departments.

    “Conversely, patients without a regular primary care provider often experience access barriers, lower continuity of care, less comprehensive care, a lack of care coordination, more unmet needs, and often rely on walk-in clinics and emergency departments, where care can be suboptimal, particularly for patients with complex needs [2, 7, 18–21].”

    From Improved access to and continuity of primary care after attachment to a family physician: longitudinal cohort study on centralized waiting lists for unattached patients in Quebec, Canada (2022) · cites this paper as [20]

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  • Patients without a regular provider often avoid health care, have unmet needs, face difficulties accessing preventive care, and accumulate health problems.

    “Patients without a regular provider often avoid health care, have unmet needs, face difficulties accessing preventive care, and accumulate health problems [2, 7, 18–20, 73].”

    From Improved access to and continuity of primary care after attachment to a family physician: longitudinal cohort study on centralized waiting lists for unattached patients in Quebec, Canada (2022) · cites this paper as [20]

    The Results (Unattachment phase; page unavailable) describe one woman delaying chronic-disease care until her symptoms became acute. The Discussion (Implications for service delivery; page unavailable) reports an association between being without a regular physician and a preventive-care deficit. These passages do not establish that patients generally avoid care, have unmet needs, or accumulate health problems; the Discussion (Gaps in system support; page unavailable) says most participants found interim care. (LLM, conf=0.84)

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Research works printed but not linked: 2

  1. Arthritis and Related Conditions in Ontario. Chapter 4. Primary and Specialist Care http://www.acreu.ca/pdf/ICES_atlas-ch4.pdf
  2. 2010–2011 Year in Review http://www.arthritis.ca/local/files/pdf documents/About TAS/2011 English Annual Report Web_1.pdf

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Authors
Randall, E., Crooks, V. A., & Goldsmith, L. J.
Affiliations
Simon Fraser University (CA)
Corresponding author
Randall, Ellen
ORCID
Venue
BMC Family Practice
Publisher
Springer Science and Business Media LLC
Published
2012-12
Volume
13
Issue
1
Pages
125-125
ISSN
1471-2296 (ISSN-L)
DOI
10.1186/1471-2296-13-125
PMC
PMC3548744
OpenAlex
W2117163899
Cited by
18
References
46
Citations by year
2026: 2 · 2025: 1 · 2023: 2 · 2022: 7 · 2021: 2 · 2018: 1 · 2017: 1 · 2015: 1 · 2014: 1
FWCI
1.14
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Family Practice (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Summit (Simon Fraser University) (submittedVersion, cc-by)
Funders
  • Canadian Health Services Research Foundation
  • Public Health Agency of Canada
  • Public Health Agency
  • Canadian Institutes of Health Research
  • Institute of Population and Public Health
Topics
  • Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
  • Social Sciences › Business, Management and Accounting › Organizational Behavior and Human Resource Management › Healthcare Systems and Technology
  • Health Sciences › Health Professions › Speech and Hearing › Adolescent and Pediatric Healthcare
Keywords
family physician shortage, chronic disease management, rheumatic diseases, women's health, rural primary care, physician-patient relationship, health system support, rural Ontario
MeSH terms
Adult, Aged, Aged, 80 and over, Attitude to Health, Chronic Disease, Continuity of Patient Care, Family Practice, Female, Humans, Middle Aged, Object Attachment, Ontario, Physician-Patient Relations, Referral and Consultation, Rheumatic Diseases, Rural Population, Qualitative Research, Patient Handoff

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