Evaluating Novel Approaches That Engage and Support Vulnerable Patient Groups to Equitably Access Primary Care

There is a serious crisis of people gaining access to primary care in Canada. It is estimated that 1 in 5 Canadians do not have a primary care provider. The challenge of access to primary care is exacerbated in populations that are made vulnerable such as newcomers, racialized individuals and low-income individuals.

In an effort to solve the access to primary care crisis, governments have announced billions in new funding, however, without planning and the engagement of patients made vulnerable by social and economic policies, these investments may actually widen inequities in access. Two key problems face policymakers: How to ensure investments reach and engage patients who are made vulnerable? How to adapt quickly, rather than implement a policy and wait years to decades before it is evaluated? Adaptive Platform Trials (APTs) are an ideal design to compare multiple approaches and to allow for new approaches to be added as they emerge.

APTs study multiple interventions in a single area in a perpetual manner, with new interventions allowed to enter or leave the platform over time based on a decision algorithm. APTs use a master protocol to establish standard operating procedures, including interim analyses to determine whether enrollment in interventions can be stopped early for statistical efficiencies (sequential designs). By using an APT design, researchers can respond swiftly to dynamic changes in policies and funding and continually refine strategies to ensure they remain effective and cost-effective.

The ENGAGE study will conduct a pilot cluster randomized control trial (cRCT) in two intervention and two comparison sub-regions in Toronto. Unattached adults (18+) made vulnerable who are seeking a primary care provider within the boundaries of the sub-regions of the study will be eligible to participate.

In the intervention sub-regions, posters bearing contact information for the study team will be displayed in public spaces including but not limited to bus stops and community notice boards. The study team will engage with primary care providers in the sub-regions to create a list of those accepting new patients, their general criteria for doing so and whether there are any exceptional circumstances under which they will accept new patients.

Persons made vulnerable who are unattached to primary care will contact the study team directly using the contact information from the posters. Primary care connectors will attempt to connect the unattached persons made vulnerable with a local primary care provider that can best serve them, based on the information gathered to create the list of practices accepting new patients. Because of this information, connectors may be able to more quickly direct those made vulnerable to primary care than they would be able to on their own. However, connectors will not guarantee that a connection to a local primary care provider will be made.

Posters will also be displayed in the the comparison sub-regions and persons made vulnerable who are seeking a primary care provider will contact the study team, similar to in the intervention sub-regions. Connectors will verbally inform participants of the existing resources for finding a primary care provider or services such as through Health Care Connect.

Connectors will follow-up with participants in both intervention and comparison sub-regions to to ascertain whether they were able to get access to a provider using the information that was shared with them. Access to a provider will be assessed as an appointment date or if the participant has been rostered with the provider.

Inclusion criteria

• Unattached adults (18+) made vulnerable who are seeking a primary care provider within the boundaries created by the Toronto Region Primary Care Workforce Planning Toolkit.

Exclusion criteria

• Patients under 18 years old.
• Patients above 18 years who have not been made vulnerable and are already registered and/or attached to a primary care organization within the boundaries created by the Toronto Region Primary Care Workforce Planning Toolkit.