Designed for simplicity, used for complexity: The systemic pressures shaping walk-in clinic practices and outcomes

Area of Science:

• Health Services Research
• Primary Care Medicine
• Qualitative Health Research

Background:

• Walk-in clinics (WICs) are increasingly utilized in Ontario, offering accessibility but facing criticism for potentially lower quality care compared to enrolment-based models.
• Concerns exist regarding WICs contributing to system inefficiencies and misaligned practice patterns.
• This study investigates physician views on repeat primary care visits and antibiotic prescribing in WICs.

Purpose of the Study:

• To explore family physicians' perspectives on factors contributing to repeat primary care visits and potentially inappropriate antibiotic prescribing in Ontario's walk-in clinics.
• To understand how systemic challenges and policy influences affect care delivery in episodic care settings.

Main Methods:

• Qualitative descriptive study utilizing semi-structured interviews.
• Conducted with 19 family physicians in Ontario experienced in both WICs and enrolment-based primary care.

Main Results:

• Physicians reported WICs are often used beyond their intended role due to limited primary care access, leading to transactional visits lacking continuity.
• Repeat visits are common for managing complex or chronic conditions, highlighting continuity gaps.
• Potentially inappropriate antibiotic prescribing is linked to high patient volume, patient expectations, and diagnostic uncertainty.

Conclusions:

• Systemic pressures and policies can create unintended consequences, including access inequities and care coordination difficulties.
• Reforms are needed to better integrate WICs into the primary care system.
• Targeted training for physicians on decision-making in episodic care is recommended.