ArticleBMC primary care2025
Assessing the impact of attachment to primary care and unattachment duration on healthcare utilization and cost in Ontario, Canada: a population-based retrospective cohort study using health administrative data.
Article in BMC primary care, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
What it found
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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.
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Who cites it
5 citing papers in PubMed.
- An Equity-Driven Analysis of the Implications of Attachment and Attachment Readiness Within Primary Care Healthcare Systems in Canada.Healthcare (Basel, Switzerland) · 2026Article
- Primary Care Attachment and Long-Term Mortality in Burn Survivors: A Population-Based Cohort Study.Journal of burn care & research : official publication of the American Burn Association · 2026Article
- Differences in Preventive Care Uptake in Attached and Unattached Rural-Living Residents.Health promotion practice · 2026Article
- Primary care unattachment: impact on mortality, hospitalizations and costs.Health affairs scholar · 2026Article
- Trends in access to primary care among Canadian older adults before, during, and following the COVID-19 public health emergency.Scientific reports · 2025Article
Corrections and comments
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundInsufficient access to primary care remains a major public health issue in Ontario, Canada, particularly for unattached residents (i.e., those who are not formally enrolled with a primary care provider, usually a family physician or occasionally a nurse practitioner). This study evaluates healthcare utilization and costs among unattached individuals, focusing on the impact of unattachment duration.
methodsWe conducted a population-based retrospective cohort study using health administrative data, comparing provincially insured residents who maintained a consistent attachment status over the 12-month period (April 1, 2021, to March 31, 2022) to those who were unattached. We employed multivariable regression analyses to examine the associations between attachment status, duration of unattachment, demographic and patient health characteristics, and healthcare utilization and costs.
resultsProlonged periods of unattachment to primary care were significantly associated with increased healthcare costs, particularly in populations with a higher burden of comorbidities. In the context of healthcare costs, attached residents with low comorbidities had a median cost of $287, increasing to $3,711 (cost ratio: 12.93, CI: 12.86-13.01, p < 0.0001) for those with high comorbidities. Unattached individuals with low comorbidities had a median cost of $238 (cost ratio: 0.83, CI: 0.82-0.83, p < 0.0001), rising to $7,106 (cost ratio: 24.76, CI: 24.27-25.26, p < 0.0001) for high comorbidities, and up to $8,177 (cost ratio: 28.49, CI: 26.61-30.49, p < 0.0001) for long-term unattached with high comorbidities.
conclusionsOur findings underscore the substantial impact of long-term unattachment on both individual patients and the healthcare system, with higher levels of chronic disease further exacerbating these effects. These results are crucial for shaping programs and policies to maximize their impact on reducing emergency department visits, hospitalizations, and overall healthcare costs.
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