Time to finding a regular primary care provider for unattached patients at the Primary Care Diabetes Support Program...

The Primary Care Diabetes Support Program (PCDSP) at St. Joseph's Health Care in London, Ontario, focuses on managing diabetes in high-risk adults (e.g., socially and medically complex) and works to attach patients to a regular primary care provider. We described the characteristics of the unattached patient population at the PCDSP and identified time to and predictors of attachment (i.e., finding a regular provider).

We conducted a retrospective cohort study using electronic medical record data of patients enrolled at the PCDSP between April 1, 2011, and March 31, 2018 and followed patients for 5 years. We used descriptive statistics to assess characteristics of patients and time-to-event analyses to assess time to attachment.

Among a final cohort of 726 patients with 5-year follow-up data, 401 individuals (55.2%) became attached. The estimated median time to attachment was 998 days (95%Confidence Interval [CI] 748-1248). Individuals who were both socially and medically complex (Hazard Ratio [HR]=1.44; 95% CI 1.01 to 2.06) and joined the PCDSP in fiscal 2012 (HR=1.40; 95%CI 1.01-1.95), were more likely to be attached compared to those who were non-complex and joined the program in fiscal 2011, respectively.

The PCDSP prioritizes high-risk patients, particularly those who are both medically and socially complex, to attach them with a regular primary care provider. Our findings may relate to the social-support workers in the program who play a crucial role in documenting social risk indicators, prioritizing high-risk patients, and advocating for their attachment to primary care.