ArticleCMAJ open
Emergency department utilization and hospital admissions for ambulatory care sensitive conditions among people seeking a primary care provider during the COVID-19 pandemic.
Open access · diamondAbstract read
In one paragraph
Article in CMAJ open. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
3.1field-weighted citation impact, top 9% of its field
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
6 citing papers in PubMed, 7 citations in OpenAlex.
- Unplanned Emergency Department Visits Within 90 Days of Breast Reduction Surgery: A Retrospective Cohort Study.Plastic surgery (Oakville, Ont.) · 2026Article
- Understanding the experience of clinicians and non-clinical staff in Integrated Virtual Care, a hybrid primary care program in rural Ontario, Canada: a qualitative study.BMC health services research · 2025Article
- Article
- Who Dies Alone? Demographics, Underlying Diseases, and Healthcare Utilization Patterns of Lonely Death Individuals in Korea.Journal of preventive medicine and public health = Yebang Uihakhoe chi · 2025Article
- Reasons for 90-day emergency department visits after primary knee arthroplasty.Canadian journal of surgery. Journal canadien de chirurgieArticle
- Evaluating Patient Experience with Integrated Virtual Care (IVC), a Hybrid Primary Care Model in Rural Ontario, Canada: A Cross-Sectional Survey.Journal of primary care & community healthArticle
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
14 authors at 2 institutions in 2 countries.
Emily Gard MarshallDepartment of Family Medicine Primary Care Research Unit (Marshall, Stock, Buote, Moritz), Dalhousie University; Nova Scotia Health (Marshall, MacKenzie, McDougall, Mooney); Department of Community Health and Epidemiology (Marshall, Stock, MacKenzie, McDougall), Dalhousie University; Maritime Strategy for Patient-Oriented Research Support for People and Patient-Oriented Research and Trials (SPOR SUPPORT) Unit (Marshall, Andrew, MacKenzie); Division of Geriatric Medicine (Andrew), Department of Medicine, Dalhousie University, Halifax, NS; Department of Community Health Sciences (Breton, Cossette), Université de Sherbrooke, Sherbrooke, Que.; Departments of Family Medicine and Public Health Sciences (Green), Queen's University; ICES Queen's (Green), Kingston, Ont.; College of Pharmacy (Isenor), Dalhousie University, Halifax, NS; Department of Family Medicine (Mathews), Schulich School of Medicine & Dentistry, Western University, London Ont.; School of Nursing (Martin-Misener), Dalhousie University, Halifax, NS emily.marshall@dal.ca.
David StockDepartment of Family Medicine Primary Care Research Unit (Marshall, Stock, Buote, Moritz), Dalhousie University; Nova Scotia Health (Marshall, MacKenzie, McDougall, Mooney); Department of Community Health and Epidemiology (Marshall, Stock, MacKenzie, McDougall), Dalhousie University; Maritime Strategy for Patient-Oriented Research Support for People and Patient-Oriented Research and Trials (SPOR SUPPORT) Unit (Marshall, Andrew, MacKenzie); Division of Geriatric Medicine (Andrew), Department of Medicine, Dalhousie University, Halifax, NS; Department of Community Health Sciences (Breton, Cossette), Université de Sherbrooke, Sherbrooke, Que.; Departments of Family Medicine and Public Health Sciences (Green), Queen's University; ICES Queen's (Green), Kingston, Ont.; College of Pharmacy (Isenor), Dalhousie University, Halifax, NS; Department of Family Medicine (Mathews), Schulich School of Medicine & Dentistry, Western University, London Ont.; School of Nursing (Martin-Misener), Dalhousie University, Halifax, NS.
Richard BuoteDepartment of Family Medicine Primary Care Research Unit (Marshall, Stock, Buote, Moritz), Dalhousie University; Nova Scotia Health (Marshall, MacKenzie, McDougall, Mooney); Department of Community Health and Epidemiology (Marshall, Stock, MacKenzie, McDougall), Dalhousie University; Maritime Strategy for Patient-Oriented Research Support for People and Patient-Oriented Research and Trials (SPOR SUPPORT) Unit (Marshall, Andrew, MacKenzie); Division of Geriatric Medicine (Andrew), Department of Medicine, Dalhousie University, Halifax, NS; Department of Community Health Sciences (Breton, Cossette), Université de Sherbrooke, Sherbrooke, Que.; Departments of Family Medicine and Public Health Sciences (Green), Queen's University; ICES Queen's (Green), Kingston, Ont.; College of Pharmacy (Isenor), Dalhousie University, Halifax, NS; Department of Family Medicine (Mathews), Schulich School of Medicine & Dentistry, Western University, London Ont.; School of Nursing (Martin-Misener), Dalhousie University, Halifax, NS.
Melissa K AndrewDepartment of Family Medicine Primary Care Research Unit (Marshall, Stock, Buote, Moritz), Dalhousie University; Nova Scotia Health (Marshall, MacKenzie, McDougall, Mooney); Department of Community Health and Epidemiology (Marshall, Stock, MacKenzie, McDougall), Dalhousie University; Maritime Strategy for Patient-Oriented Research Support for People and Patient-Oriented Research and Trials (SPOR SUPPORT) Unit (Marshall, Andrew, MacKenzie); Division of Geriatric Medicine (Andrew), Department of Medicine, Dalhousie University, Halifax, NS; Department of Community Health Sciences (Breton, Cossette), Université de Sherbrooke, Sherbrooke, Que.; Departments of Family Medicine and Public Health Sciences (Green), Queen's University; ICES Queen's (Green), Kingston, Ont.; College of Pharmacy (Isenor), Dalhousie University, Halifax, NS; Department of Family Medicine (Mathews), Schulich School of Medicine & Dentistry, Western University, London Ont.; School of Nursing (Martin-Misener), Dalhousie University, Halifax, NS.
Mylaine BretonDepartment of Family Medicine Primary Care Research Unit (Marshall, Stock, Buote, Moritz), Dalhousie University; Nova Scotia Health (Marshall, MacKenzie, McDougall, Mooney); Department of Community Health and Epidemiology (Marshall, Stock, MacKenzie, McDougall), Dalhousie University; Maritime Strategy for Patient-Oriented Research Support for People and Patient-Oriented Research and Trials (SPOR SUPPORT) Unit (Marshall, Andrew, MacKenzie); Division of Geriatric Medicine (Andrew), Department of Medicine, Dalhousie University, Halifax, NS; Department of Community Health Sciences (Breton, Cossette), Université de Sherbrooke, Sherbrooke, Que.; Departments of Family Medicine and Public Health Sciences (Green), Queen's University; ICES Queen's (Green), Kingston, Ont.; College of Pharmacy (Isenor), Dalhousie University, Halifax, NS; Department of Family Medicine (Mathews), Schulich School of Medicine & Dentistry, Western University, London Ont.; School of Nursing (Martin-Misener), Dalhousie University, Halifax, NS.
Benoit CossetteDepartment of Family Medicine Primary Care Research Unit (Marshall, Stock, Buote, Moritz), Dalhousie University; Nova Scotia Health (Marshall, MacKenzie, McDougall, Mooney); Department of Community Health and Epidemiology (Marshall, Stock, MacKenzie, McDougall), Dalhousie University; Maritime Strategy for Patient-Oriented Research Support for People and Patient-Oriented Research and Trials (SPOR SUPPORT) Unit (Marshall, Andrew, MacKenzie); Division of Geriatric Medicine (Andrew), Department of Medicine, Dalhousie University, Halifax, NS; Department of Community Health Sciences (Breton, Cossette), Université de Sherbrooke, Sherbrooke, Que.; Departments of Family Medicine and Public Health Sciences (Green), Queen's University; ICES Queen's (Green), Kingston, Ont.; College of Pharmacy (Isenor), Dalhousie University, Halifax, NS; Department of Family Medicine (Mathews), Schulich School of Medicine & Dentistry, Western University, London Ont.; School of Nursing (Martin-Misener), Dalhousie University, Halifax, NS.
Michael E GreenDepartment of Family Medicine Primary Care Research Unit (Marshall, Stock, Buote, Moritz), Dalhousie University; Nova Scotia Health (Marshall, MacKenzie, McDougall, Mooney); Department of Community Health and Epidemiology (Marshall, Stock, MacKenzie, McDougall), Dalhousie University; Maritime Strategy for Patient-Oriented Research Support for People and Patient-Oriented Research and Trials (SPOR SUPPORT) Unit (Marshall, Andrew, MacKenzie); Division of Geriatric Medicine (Andrew), Department of Medicine, Dalhousie University, Halifax, NS; Department of Community Health Sciences (Breton, Cossette), Université de Sherbrooke, Sherbrooke, Que.; Departments of Family Medicine and Public Health Sciences (Green), Queen's University; ICES Queen's (Green), Kingston, Ont.; College of Pharmacy (Isenor), Dalhousie University, Halifax, NS; Department of Family Medicine (Mathews), Schulich School of Medicine & Dentistry, Western University, London Ont.; School of Nursing (Martin-Misener), Dalhousie University, Halifax, NS.
Jennifer E IsenorDepartment of Family Medicine Primary Care Research Unit (Marshall, Stock, Buote, Moritz), Dalhousie University; Nova Scotia Health (Marshall, MacKenzie, McDougall, Mooney); Department of Community Health and Epidemiology (Marshall, Stock, MacKenzie, McDougall), Dalhousie University; Maritime Strategy for Patient-Oriented Research Support for People and Patient-Oriented Research and Trials (SPOR SUPPORT) Unit (Marshall, Andrew, MacKenzie); Division of Geriatric Medicine (Andrew), Department of Medicine, Dalhousie University, Halifax, NS; Department of Community Health Sciences (Breton, Cossette), Université de Sherbrooke, Sherbrooke, Que.; Departments of Family Medicine and Public Health Sciences (Green), Queen's University; ICES Queen's (Green), Kingston, Ont.; College of Pharmacy (Isenor), Dalhousie University, Halifax, NS; Department of Family Medicine (Mathews), Schulich School of Medicine & Dentistry, Western University, London Ont.; School of Nursing (Martin-Misener), Dalhousie University, Halifax, NS.
Maria MathewsDepartment of Family Medicine Primary Care Research Unit (Marshall, Stock, Buote, Moritz), Dalhousie University; Nova Scotia Health (Marshall, MacKenzie, McDougall, Mooney); Department of Community Health and Epidemiology (Marshall, Stock, MacKenzie, McDougall), Dalhousie University; Maritime Strategy for Patient-Oriented Research Support for People and Patient-Oriented Research and Trials (SPOR SUPPORT) Unit (Marshall, Andrew, MacKenzie); Division of Geriatric Medicine (Andrew), Department of Medicine, Dalhousie University, Halifax, NS; Department of Community Health Sciences (Breton, Cossette), Université de Sherbrooke, Sherbrooke, Que.; Departments of Family Medicine and Public Health Sciences (Green), Queen's University; ICES Queen's (Green), Kingston, Ont.; College of Pharmacy (Isenor), Dalhousie University, Halifax, NS; Department of Family Medicine (Mathews), Schulich School of Medicine & Dentistry, Western University, London Ont.; School of Nursing (Martin-Misener), Dalhousie University, Halifax, NS.
Adrian MacKenzieDepartment of Family Medicine Primary Care Research Unit (Marshall, Stock, Buote, Moritz), Dalhousie University; Nova Scotia Health (Marshall, MacKenzie, McDougall, Mooney); Department of Community Health and Epidemiology (Marshall, Stock, MacKenzie, McDougall), Dalhousie University; Maritime Strategy for Patient-Oriented Research Support for People and Patient-Oriented Research and Trials (SPOR SUPPORT) Unit (Marshall, Andrew, MacKenzie); Division of Geriatric Medicine (Andrew), Department of Medicine, Dalhousie University, Halifax, NS; Department of Community Health Sciences (Breton, Cossette), Université de Sherbrooke, Sherbrooke, Que.; Departments of Family Medicine and Public Health Sciences (Green), Queen's University; ICES Queen's (Green), Kingston, Ont.; College of Pharmacy (Isenor), Dalhousie University, Halifax, NS; Department of Family Medicine (Mathews), Schulich School of Medicine & Dentistry, Western University, London Ont.; School of Nursing (Martin-Misener), Dalhousie University, Halifax, NS.
Ruth Martin-MisenerDepartment of Family Medicine Primary Care Research Unit (Marshall, Stock, Buote, Moritz), Dalhousie University; Nova Scotia Health (Marshall, MacKenzie, McDougall, Mooney); Department of Community Health and Epidemiology (Marshall, Stock, MacKenzie, McDougall), Dalhousie University; Maritime Strategy for Patient-Oriented Research Support for People and Patient-Oriented Research and Trials (SPOR SUPPORT) Unit (Marshall, Andrew, MacKenzie); Division of Geriatric Medicine (Andrew), Department of Medicine, Dalhousie University, Halifax, NS; Department of Community Health Sciences (Breton, Cossette), Université de Sherbrooke, Sherbrooke, Que.; Departments of Family Medicine and Public Health Sciences (Green), Queen's University; ICES Queen's (Green), Kingston, Ont.; College of Pharmacy (Isenor), Dalhousie University, Halifax, NS; Department of Family Medicine (Mathews), Schulich School of Medicine & Dentistry, Western University, London Ont.; School of Nursing (Martin-Misener), Dalhousie University, Halifax, NS.
Beth McDougallDepartment of Family Medicine Primary Care Research Unit (Marshall, Stock, Buote, Moritz), Dalhousie University; Nova Scotia Health (Marshall, MacKenzie, McDougall, Mooney); Department of Community Health and Epidemiology (Marshall, Stock, MacKenzie, McDougall), Dalhousie University; Maritime Strategy for Patient-Oriented Research Support for People and Patient-Oriented Research and Trials (SPOR SUPPORT) Unit (Marshall, Andrew, MacKenzie); Division of Geriatric Medicine (Andrew), Department of Medicine, Dalhousie University, Halifax, NS; Department of Community Health Sciences (Breton, Cossette), Université de Sherbrooke, Sherbrooke, Que.; Departments of Family Medicine and Public Health Sciences (Green), Queen's University; ICES Queen's (Green), Kingston, Ont.; College of Pharmacy (Isenor), Dalhousie University, Halifax, NS; Department of Family Medicine (Mathews), Schulich School of Medicine & Dentistry, Western University, London Ont.; School of Nursing (Martin-Misener), Dalhousie University, Halifax, NS.
Melanie MooneyDepartment of Family Medicine Primary Care Research Unit (Marshall, Stock, Buote, Moritz), Dalhousie University; Nova Scotia Health (Marshall, MacKenzie, McDougall, Mooney); Department of Community Health and Epidemiology (Marshall, Stock, MacKenzie, McDougall), Dalhousie University; Maritime Strategy for Patient-Oriented Research Support for People and Patient-Oriented Research and Trials (SPOR SUPPORT) Unit (Marshall, Andrew, MacKenzie); Division of Geriatric Medicine (Andrew), Department of Medicine, Dalhousie University, Halifax, NS; Department of Community Health Sciences (Breton, Cossette), Université de Sherbrooke, Sherbrooke, Que.; Departments of Family Medicine and Public Health Sciences (Green), Queen's University; ICES Queen's (Green), Kingston, Ont.; College of Pharmacy (Isenor), Dalhousie University, Halifax, NS; Department of Family Medicine (Mathews), Schulich School of Medicine & Dentistry, Western University, London Ont.; School of Nursing (Martin-Misener), Dalhousie University, Halifax, NS.
Lauren R MoritzDepartment of Family Medicine Primary Care Research Unit (Marshall, Stock, Buote, Moritz), Dalhousie University; Nova Scotia Health (Marshall, MacKenzie, McDougall, Mooney); Department of Community Health and Epidemiology (Marshall, Stock, MacKenzie, McDougall), Dalhousie University; Maritime Strategy for Patient-Oriented Research Support for People and Patient-Oriented Research and Trials (SPOR SUPPORT) Unit (Marshall, Andrew, MacKenzie); Division of Geriatric Medicine (Andrew), Department of Medicine, Dalhousie University, Halifax, NS; Department of Community Health Sciences (Breton, Cossette), Université de Sherbrooke, Sherbrooke, Que.; Departments of Family Medicine and Public Health Sciences (Green), Queen's University; ICES Queen's (Green), Kingston, Ont.; College of Pharmacy (Isenor), Dalhousie University, Halifax, NS; Department of Family Medicine (Mathews), Schulich School of Medicine & Dentistry, Western University, London Ont.; School of Nursing (Martin-Misener), Dalhousie University, Halifax, NS.
Marshall Medical Center · USWestern University · CA
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundPrimary care attachment improves health care access and health outcomes, but many Canadians are unattached, seeking a provider via provincial wait-lists. This Nova Scotia-wide cohort study compares emergency department utilization and hospital admission associated with insufficient primary care management among patients on and off a provincial primary care wait-list, before and during the first waves of the COVID-19 pandemic.
methodsWe linked wait-list and Nova Scotian administrative health data to describe people on and off wait-list, by quarter, between Jan. 1, 2017, and Dec. 24, 2020. We quantified emergency department utilization and ambulatory care sensitive condition (ACSC) hospital admission rates by wait-list status from physician claims and hospital admission data. We compared relative differences during the COVID-19 first and second waves with the previous year.
resultsDuring the study period, 100 867 people in Nova Scotia (10.1% of the provincial population) were on the wait-list. Those on the wait-list had higher emergency department utilization and ACSC hospital admission. Emergency department utilization was higher overall for individuals aged 65 years and older, and females; lowest during the first 2 COVID-19 waves; and differed more by wait-list status for those younger than 65 years. Emergency department contacts and ACSC hospital admissions decreased during the COVID-19 pandemic relative to the previous year, and for emergency department utilization, this difference was more pronounced for those on the wait-list.
interpretationPeople in Nova Scotia seeking primary care attachment via the provincial wait-list use hospital-based services more frequently than those not on the wait-list. Although both groups have had lower utilization during COVID-19, existing challenges to primary care access for those actively seeking a provider were further exacerbated during the initial waves of the pandemic. The degree to which forgone services produces downstream health burden remains in question.
Indexed as
COVID-19PandemicsAmbulatory Care Sensitive ConditionsCohort StudiesEmergency Service, HospitalFemaleHospitalsHumansNova ScotiaPrimary Health Care
Identifiers
What OpenQuestion holds
Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390
Registered trials
None linked
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.