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From the Departments of Family Medicine and of Clinical Epidemiology and Biostatistics (Hutchison) and the Centre for Health Economics and Policy Analysis (Hutchison, Torrance-Rynard), McMaster University, Hamilton, Ont.; the Department of Community and Family Medicine, Duke University, Durham, NC (Østbye); the Department of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ont. (Barnsley, Vayda); the Departments of Family Medicine (Stewart, Harris), of Epidemiology and Biostatistics (Campbell, Harris), of Obstetrics and Gynaecology (Campbell) and of Paediatrics (Campbell), Faculty of Medicine, and the Centre for Studies in Family Medicine (Stewart, Harris, Tyrrell), The University of Western Ontario, London, Ont.; the Division of Community Health, Memorial University of Newfoundland, St. John's, Nfld. (Mathews); and The Lawson Research Institute, London, Ont. (Campbell). Members of the Ontario Walk-In Clinic Study Research Team are listed at the end of the article.Members of the Ontario Walk-In Clinic Study Research Team: Principal Investigators: Jan Barnsley, A. Paul Williams, University of Toronto, Toronto, Ont. Coinvestigators: Alan Campbell, David Davis, Allan Detsky, Philip Ellison, Lutchmie Narine, Eugene Vayda, University of Toronto, Toronto, Ont.; Brian Hutchison, Janusz Kaczorowski, Gina Ogilvie, McMaster University, Hamilton, Ont.; and Judith Belle Brown, Karen Campbell, Stewart Harris, Truls Østbye (now with Department of Community and Family Medicine, Duke University, Durham, NC), Moira Stewart, Evelyn Vingilis, The University of Western Ontario, London, Ont.
Correspondence to: Dr. Brian G. Hutchison, Centre for Health Economics and Policy Analysis, Health Sciences Centre, Room 3H1D, McMaster University, Hamilton ON L8N 3Z5; fax 905 546-5211; hutchb{at}fhs.mcmaster.ca.
Background: Although walk-in clinics are an increasingly common feature of Ontario's health care system, the quality of care they provide is the subject of continuing debate. In this study we examined differences in patient satisfaction and quality of care for common acute conditions in walk-in clinics, family practices and emergency departments.
Methods: For this prospective cohort study, we recruited 12 walk-in clinics, 16 family practices and 13 emergency departments from 11 geographic areas in greater Toronto, Hamilton-Burlington and London, Ont. An expert review panel selected and established quality-of-care criteria for 8 common acute conditions. Patients who sought initial care for 1 of the 8 conditions were recruited by an on-site data collector. We used a questionnaire to assess the satisfaction of 433 patients with patient-centred communication, the physician's attitude and any delay in the waiting room during the study visit. Abstractors reviewed 600 charts for the study patients to assess whether the quality-of-care criteria had been met. A quality score for each case was computed as the percentage of applicable criteria that were met. Mean quality scores for the 3 settings were computed, with adjustment for potentially confounding variables (sex, age, city and diagnosis).
Results: After adjustment for 12 patient characteristics, walk-in clinic patients were significantly more satisfied than emergency department patients on all 3 satisfaction scales. Family practice patients were more satisfied than walk-in clinic patients on all 3 satisfaction scales, but the difference was statistically significant only for satisfaction with waiting time. Adjusted mean quality-of-care scores were 73.1% for emergency departments, 69.9% for walk-in clinics and 64.1% for family practices. The scores for walk-in clinics and emergency departments were significantly higher than that for family practices.
Interpretation: Satisfaction with waiting time was highest among family practice patients. Both family practices and walk-in clinics were perceived more positively than emergency departments on all 3 dimensions of satisfaction. Overall quality-of-care scores were higher in walk-in clinics and emergency departments than in family practices.
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