Access to primary care is important in Canada. Approximately 2.3 million Ontarians lack access to a regular source of public funding through the Ontario Health Insurance Plan (OHIP). Ontario’s primary care has shifted to patient enrolment models, with 75% of the population assigned to family physicians. Geographic distance poses challenges, as many patients have links to distant providers, which impact access to care. Limited data on the effects of distance from family physicians on healthcare utilization and results exist in Canada.
This study aimed to assess the link between family physicians and healthcare utilization and quality of care among Ontario residents enrolled in a patient enrolment model. This study evaluated whether greater travel distance was associated with variation in emergency department (ED) use, continuity of care, primary care visits, and preventive cancer screening rates.
This population-based cross-sectional study used linked administrative health data from Ontario, Canada, collected on March 31, 2023. It included suburban and urban patients (Rurality Index for Ontario score 0-39) formally enrolled with a family physician under a patient enrolment model. Patients who were virtually rostered and not formally enrolled, were seen primarily at community health centers, or who had missing demographic data, were excluded.
Data were collected from the ICES Primary Care Population (PCPOP) database, which included all Ontario residents eligible for OHIP and was linked to many other databases to provide information on demographics, postal codes, physician location, and health service use. The primary exposure was the distance between the patient’s residence and their family physician. It is calculated using straight-line distance between postal codes and categorised into ranges (≤10 km, 11 to 30 km, 31 to 50 km, etc.). A 10% random sample was used to validate straight-line distance against driving distance and time, which showed high correlations (r = 0.91-0.93).
Primary outcomes included measures of healthcare utilization (ED visits, nonurgent ED visits, and primary care visits) and quality of care (continuity of care with a rostered physician or group and cancer screening rates for breast, colorectal, and cervical cancer). Statistical analyses were conducted using descriptive statistics, χ² tests for trend, and weighted regression to evaluate links across distance categories. Sensitivity analyses were conducted by using distance cut-offs of 30 km and 50 km.
9,967,955 patients were included in the main analysis. 1,261,112 (12.7%) lived more than 30 km from their family physician. Patients who lived far from this location were more likely to be male, younger than 65 years, newcomers to Ontario, and living in lower-income neighbourhoods.
More distance was linked with high ED use. The odds of an ED visit were highest among patients living 151-200 km away (odds ratio [OR] 1.30, p < 0.001). Nonurgent ED visits were more common in those living away from care. The proportion of patients with no primary care visits increased with distance.
Continuity of care decreased with distance from 69.6% for patients within 10 km to 42.2% for those more than 200 km away for visits to the rostering group. It decreases from 63.7% to 38.0% (p < 0.001) for visits to their own physicians. Rates of colorectal, breast, and cervical cancer screening decreased as the distance increased.
Patients living far away had higher odds of ED use and nonattendance at primary care and lower odds of going to recommended cancer screening by using a 30 km threshold. Sensitivity analyses using a 50 km cutoff and driving measures produced consistent results.
This large population-based study demonstrated that a greater distance from a family physician is associated with poorer access to primary care and lower quality of primary care in Ontario. Approximately 10% of urban and suburban patients lived more than 30 km from a physician, leading to less continuous and preventive care and greater reliance on the ED. These finding underscores the importance of geographic proximity to primary care providers and recommend health system reforms to ensure availability within 30 km of their homes, thereby increasing care continuity and reducing unnecessary ED use.
Reference: Gupta A, Kiran T, Pablo LA, et al. Distance to primary care and its association with health care use and quality of care in Ontario: a cross-sectional study. CMAJ. 2025;197(37):E1214–E1223. doi:10.1503/cmaj.250265
