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Primary care among newborns at a Canadian urban center: an observational study
Sloane Jaye Freeman1,2, Rosane Nisenbaum3,4, Thivia Jegathesan5
1Women and Children's Health Program, St. Michael's Hospital, Unity Health Toronto, 61 Queen Street E, 2nd Floor Pediatric CLinic, Toronto, ON, M4c 2T2, Canada. Sloane.freeman@unityhealth.to.
Insights
A significant portion of newborns in Canada lack access to primary care, highlighting a critical gap in healthcare for infants. This study reveals 30.6% of newborns at a Toronto hospital did not have a primary care provider, underscoring the ongoing healthcare crisis.
Area of Science:
- Pediatrics
- Public Health
- Healthcare Access
Background:
- Canada faces a primary healthcare crisis characterized by physician shortages and long wait times.
- A notable percentage of Canadian children (8.1%) lack a regular healthcare provider.
- Primary care access for newborns remains understudied.
Purpose of the Study:
- To determine the prevalence of newborns without primary care access.
- To evaluate the association between lack of newborn primary care and sociodemographic factors.
- To investigate primary care access in newborns at a large Canadian urban hospital.
Main Methods:
- Cross-sectional survey of caregivers of newborns delivered within one week at a Toronto hospital.
- Logistic regression analysis to assess associations between newborn PCP access and caregiver sociodemographics.
- Calculation of unadjusted and adjusted odds ratios (ORs) and 95% confidence intervals (CIs).
Main Results:
- 30.6% of newborns (202 out of 659) lacked a primary care provider (PCP).
- Newborns without a PCP were associated with caregivers lacking a PCP (adjusted OR 6.18), not owning a home (adjusted OR 1.68), and being born outside Canada (adjusted OR 1.69).
- Other associated factors included lower income and non-English first language.
Conclusions:
- A substantial proportion of newborns (30.6%) at a major urban Canadian hospital lack primary care.
- Addressing newborn primary care access is crucial given Canada's healthcare challenges.
- Future research will link survey data to provincial records to examine emergency department visits and hospital admissions.
Background:
Canada is facing a primary healthcare crisis with physician shortages and long wait times. Across Canada, 8.1% of children lack a regular healthcare provider. However, little is understood about primary care access among newborns. The objective of this study was to determine the prevalence of newborns without primary care, and to evaluate the association between lack of primary care and sociodemographic factors at a large Canadian urban hospital.
Methods:
This was a cross-sectional survey of caregivers of newborns who delivered within one week on the post-partum ward at a large urban hospital in Toronto, Ontario, Canada. To determine the association between lack of a primary care provider (PCP) among newborns and caregivers' sociodemographic characteristics, a logistic regression model estimated unadjusted and adjusted odds ratios (OR)s and 95% confidence intervals (CI).
Results:
There were 656 caregivers and 659 newborns. Of these, 202 did not have access to a PCP with a prevalence of 30.6% (95% CI 27.2% - 34.3%). In the unadjusted analyses, not having a PCP for newborns was associated with caregivers not having a PCP for themselves (OR 7.59, 95% CI 5.06-11.39), not owning a home (OR 2.86, 95% CI 1.88-4.35), being born outside of Canada (OR 2.62, 95% CI 1.74-3.96), income <$75,000 (OR 2.30, 95% CI 1.47-3.61), and first language not English (OR 1.66, 95% CI 1.18-2.32). Similarly, in the adjusted analyses, not having a PCP for newborns was associated with caregivers not having a PCP for themselves (adjusted OR 6.18, 95% CI 4.04-9.46), not owning a home (adjusted OR 1.68, 95% CI 1.04-2.71), and being born outside of Canada (adjusted OR 1.69 95% CI 1.05-2.71).
Conclusio:
This study found that 30.6% of newborns at a large urban Canadian hospital did not have primary care. Given the primary care crisis in Canada, it is essential to understand the lack of access to primary care among newborns. Next steps will be to link survey data to provincial datasets to determine the association between lack of primary care and emergency department visits and hospital admissions within the first year of life.
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