Chronically Ill Canadians' Experiences of Being Unattached To a Family Doctor: A Qualitative Study of Marginalized Patients in British Columbia

Background: Unattached patients do not have a regular primary care provider. Initiatives are being developed toincrease attachment rates across Canada. Most existing attention paid to patient unattachment has focused onquantifying the problem and health system costs. Our purpose is to qualitatively identify the implications ofchronically ill patients’ experiences of unattachment for health policy and planning to provide policy-relevantinsights for Canadian attachment initiatives.Methods: Three focus groups were conducted with marginalized chronically ill individuals residing in a mid-sized city inBritish Columbia who are unattached to a family doctor. We use the term marginalized as a descriptor to acknowledgethat by virtue of their low socio-economic status and lack of attachment the participants are marginalized in Canada’shealth care system Focus groups were structured as an open conversation organized around a series of probingquestions. They were digitally recorded and transcribed verbatim. Thematic analysis was employed.Results: Twenty-six individuals participated in the focus groups. The most common chronic illnesses reported were activedrug addiction or recovery (and their associated symptoms), depression, arthritis, and hepatitis C. Participants identifiedlife transitions as being the root cause for not having a family doctor. There was a strong sense that unsuccessfulattempts to get a family doctor reflected that they were undesirable patients. Participants wanted to experience having atrusting relationship with a regular family doctor as they believed it would encourage greater honesty and transparency.One of the main health concerns regarding lack of access to a regular family doctor is that participants lacked access topreventative care. Participants were also concerned about having a discontinuous medical record due to unattachment.Conclusions: Participants perceived that there are many benefits to be had by having attachment to a regular familydoctor and that experiencing unattachment challenged their health and access to health care. We encourage moreresearch to be done on the lived experience of unattachment in order to provide on-the-ground insights thatpolicy-makers require in order to develop responsive, patient-centred supports and programs.