1 in 7 ER visits in Canada are for conditions that could have been managed in primary care: report

Lack of access to family doctors and other primary care providers leaves many Canadians with no option than to go to the emergency department for care, new data suggests.

About one in seven visits to the emergency department in Canada are for conditions that could have been managed by a family doctor or other primary care provider like a nurse practitioner or pediatrician and roughly half of those visits could have been managed virtually, according to the Canadian Institute for Health Information (CIHI).

Thursday's report focuses on primary and virtual care access through the lens of visits to emergency departments between April 2023 and March 2024.

The institute previously reported over five million Canadian adults say they don't have a family health provider, and even those who do say they experience major challenges getting access to timely care.

Now, CIHI developed a new indicator to gauge how hard it is to access care: emergency department visits for conditions that could potentially be managed in primary care.

Sunita Karmakar-Hore, CIHI's manager of health system performance reporting in Toronto, said people who report that they don't have access to a doctor at a walk-in clinic or their own family doctor have slightly more visits to the emergency department for primary care conditions during weekdays.

"What's surprising is that even for people that report that they do have access to a primary care doctor, the percentage of visits for conditions that could be managed in primary care is still high," said Karmakar-Hore. "It's about 13 per cent, and those visits are happening on the weekends."

Emergency visits even higher for kids

Those emergency visits are happening the most for little kids.

Among children aged two to nine, 26 per cent of emergency department visits were for types of conditions that could be managed potentially in primary care, such as for antibiotic prescriptions, colds, sore throats, ear infections and prescription refills. The rate was markedly higher than for other age groups, CIHI said.

"This is telling us that parents of young children are really struggling to get care when they need it," she said.

"If you're lucky enough to have a family doctor, but ... you can't get in for a week or two, parents can't really wait that long. They're worried."

Conditions can escalate quickly in younger age groups, Karmakar-Hore said, and parents are often forced to turn to the emergency department for their children.

The report covers fiscal years 2022-24, and includes data from Prince Edward Island, Nova Scotia, Ontario, Saskatchewan, Alberta and Yukon.

The new indicators aim to drive improvement efforts in access to primary and virtual care.

ERs struggling

Dr. Fraser Mackay, an emergency physician in Saint John and chair of the rural remote and small urban section of the Canadian Association of Emergency Physicians, wasn't involved in CIHI's report. He welcomes the new data.

"We've seen these problems coming, the human health resource crunch, the lack of emergency physicians, the lack of family physicians, the way the money has been distributed and the way there has been no accountability for how health-care money has been spent and especially it is not been data-driven," Mackay said. "The work is frustrating, but the reports and the data that's coming out are not."

While a doctor told CBC that most patients in their emergency department need true emergency care, a new report flags how many people use the ER for problems that could be handled by a family doctor. (David Lipnowski/The Canadian Press)

Overall, Mackay said it's important to recognize that the challenges in emergency medicine and in primary care overlap.

"You cannot point the finger at one or the other."

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All emergency departments are currently struggling to balance pressures, said Dr. Kyle Vojdani, chief and medical director of the emergency department at Toronto's Michael Garron Hospital. Vojdani was not involved in the report and said the burden on the emergency department from people who don't have a family doctor is not a major factor in overcrowding.

"Patients presenting to our ED are largely patients that need true emergency care," Vojdani said. "I'm not going to say that it isn't a component of the pressures that we experience, but certainly it isn't the driving pressure."

But in rural locations where about 20 per cent of Canadians live, Mackay said that's where about 10 per cent of physicians live and work. The result? Any problems in health-care access across the country are "magnified" in rural communities.

The authors of the CIHI report said rural and remote areas have more than twice the proportion of emergency visits for conditions that could be managed in primary care, 24 per cent, compared with urban areas at 11 per cent.

Tearful call to premier

Cassidy Allison-Rea lives in Fergus, Ont., a town 100 kilometres west of Toronto, where she's been looking for a family doctor for years. About five months ago, Allison-Rea said the search became more urgent because she's pregnant. In desperation, she called Ontario Premier Doug Ford and Sylvia Jones, the province's health minister.

"When I spoke with Doug Ford, I was ... sobbing on the phone about it," she recalled. "It is stressful to have to navigate the health-care system completely on your own."

Allison-Rea has an obstetrician. But last week, she had terrible ear pain, which is outside the scope of what OBGYNs treat. She went to the emergency department in Fergus, waited four hours and was told the issue was just wax. But the pain kept escalating and turned out to be an ear infection.

"You feel, like, guilty for using these resources that are really meant for emergencies," Allison-Rea said. "But you have no other choice."

In rural or remote areas, Karmakar-Hore said a person's primary care clinician may also be the emergency department physician, so the ED may be where people regularly access their primary care.

"These indicators are not meant to blame individuals or deter them from going to the ED," she said.

Karmakar-Hore's physician-backed advice for Canadians like Allison-Rea: "If the ED is the only place to go, that's where you should go."