Long commutes to primary care link to missed cancer screenings and more ER use
More than one in ten Ontarians enrolled with a family physician live over 30 kilometres from their doctor—a distance that, according to a recent population-based study, is linked to lower continuity of care, increased emergency department use, and reduced uptake of recommended cancer screening.
The study, conducted in Ontario and published in CMAJ, found that patients living farther than 30 kilometres from their family physician had 43 percent higher odds of making nonurgent emergency department visits.
They also had 28 percent higher odds of not seeing any family physician in the previous two years.
In addition, these patients were less likely to be screened for colon, breast, and cervical cancers.
For example, the odds of missing colon cancer screening were 17 percent higher for those living at greater distances, while the odds were 24 percent and 17 percent higher for missing breast and cervical cancer screenings, respectively, compared to those living closer to their physician1.
The research highlights the critical role of proximity in primary care delivery.
According to the study, effective primary care not only improves patient and provider experience but also reduces costs and advances population health.
However, the ongoing shortage of primary care providers in Canada—exacerbated by the COVID-19 pandemic—has left about 6.5 million Canadians without a regular family physician or nurse practitioner, as reported by the Canadian Institute for Health Information2.
Distance to care is a significant determinant of health care utilization.
The study’s authors note that as distance increases, so does the likelihood of patients foregoing primary care visits and relying instead on walk-in clinics or emergency departments.
This trend disrupts continuity of care, which has been shown to reduce hospitalizations and improve health outcomes.
According to the study, mean continuity of care scores dropped from nearly 70 percent for those living within 10 kilometres of their physician to just over 42 percent for those living more than 200 kilometres away1.
The findings underscore the importance of health system reforms that prioritize access to primary care close to home. The authors suggest that offering primary care within 30 kilometres of a patient’s residence should be a minimum standard to improve access, continuity, and preventive care uptake.
