Access to a Usual Source of Care and Healthcare Utilization among Canadian Adults with Cardiovascular-Related Conditions: Implications for Chest Pain Care Pathways
Uwanmwende Omenai
Department of Psychiatry, Federal Neuropsychiatric Hospital Benin, Benin City, Edo State, Nigeria.
Onize Ekome
Department of Mental Health, Braxia Health, Mississauga, Ontario, Canada.
Goitom Abraha
Department of Family Medicine, Obafemi Awolowo University, Ile-Ife, Oyo State, Nigeria.
Akinyele Oladimeji
Department of Internal Medicine, University of New Mexico Hospital, New Mexico, United States.
Sarah Waseem
General Medicine, Dow University of Health Sciences, Karachi, Pakistan.
Emmanuella E. Ogelebor
General Medicine, Kwame Nkrumah University of Science and Technology, Accra, Ghana.
Adaeze E. Uzozie
General Medicine, University of Nigeria Teaching Hospital, Enugu, Enugu State, Nigeria.
Okelue E. Okobi *
Department of Family Medicine, Larkin Community Hospital, Palm Springs Campus, Miami, FL, USA.
Peace Oghenerukevwe Emudianughe
General Medicine, Zaporizhzhia State Medical University, Zaporizhzhia, Zaporizhia Oblast, Ukraine.
Nyengifuro A. Tamunokuro
Department of General Medicine, College of Health Sciences, University of Port Harcourt, Port Harcourt, Rivers State, Nigeria.
Azeberoje Osueni
Department of Critical Care, Onvida Health, Yuma Medical Center, Yuma, Arizona, USA.
*Author to whom correspondence should be addressed.
Abstract
Background: Emergency department visits for chest pain are common and require effective transitions to outpatient care to support patient management and reduce repeat healthcare use. Evidence on how outpatient follow-up relates to subsequent utilisation remains limited in population-based settings.
Objective: This study examined the association between access to a usual source of care and healthcare utilisation, including hospitalisation and frequent emergency department use, among Canadian adults with cardiovascular-related conditions.
Methods: A cross-sectional study was conducted using data from the Canadian Community Health Survey (2015-2016), a nationally representative survey of Canadian adults. Adults aged 18 years or older (n = 25,763; weighted N = 6,561,930) with at least one emergency department visit in the past 12 months were included. The outcomes were hospitalisation in the past 12 months and frequent emergency department use, whereas the primary exposure was access to a usual source of care. Multivariable logistic regression models were fitted using survey weights and bootstrap methods to account for the complex sampling design, adjusting for age, sex, education level, body mass index classification, hypertension, diabetes, heart disease, and self-perceived health. Model assumptions and survey design adjustments were considered in all analyses. This study is reported in accordance with the STROBE guidelines for cross-sectional studies.
Results: Most participants reported having a usual source of care, representing 5,956,749 (91%) individuals compared with 605,181 (9%) without usual care. After adjustment, access to a usual source of care was not associated with hospitalisation in the past 12 months (aOR = 1.01, 95% CI: 0.83-1.22, p = 0.951) or frequent emergency department use within the same 12-month period (aOR = 0.93, 95% CI: 0.78-1.10, p = 0.375). Higher healthcare utilisation was associated with older age (≥65 years), female sex, cardiovascular conditions including hypertension, diabetes, and heart disease, and poorer self-perceived health, as demonstrated by adjusted odds ratios (aORs) from multivariable logistic regression models.
Conclusion: Access to a usual source of care, used as a proxy for outpatient care access and continuity, was not associated with hospitalisation or frequent emergency department use. Clinical factors and self-perceived health were more strongly associated with healthcare utilisation.
Keywords: Usual source of care, healthcare utilisation, emergency department use, cardiovascular conditions, chest pain care pathways, outpatient care access, continuity of care, hospitalisation, Canadian Community Health Survey, population-based survey.