Continuity of Care, Immigrant Status, and Emergency Department Use among Seniors in Canada

This study examines the relationship between continuity of care with a family doctor and the usual place of care for minor health problems among Canadian seniors, with a focus on differences between immigrants and the native-born. Data come from the Canadian Health Survey on Seniors (n = 40,848). The outcome identifies respondents' usual source of immediate care for minor problems: a doctor's office, hospital outpatient/community clinic/walk-in clinic, emergency department (ED), or another location. Multinomial logistic regression models estimate associations between continuity of care-measured as duration of attachment to a family doctor-and place of care, with and without interaction terms between continuity and immigrant status, adjusting for demographic, socioeconomic, health, and access-related factors. Seniors attached to a regular family doctor for more than 2 years are significantly less likely to rely on the ED as their usual source of care (OR = 0.89, P < 0.05). Immigrants are also less likely than native-born seniors to use the ED (OR = 0.69, P < 0.001). However, interaction models show that immigrants with short-term attachment (less than 1 year) have higher odds of ED use than native-born seniors with similar attachment (OR = 2.33, P = 0.031). Poor self-rated health, lower income, and access barriers are associated with greater ED reliance. These findings highlight the importance of sustained primary care relationships, particularly for newly attached and immigrant seniors, to reduce avoidable ED use and promote equitable access to community-based care in Canada.