Living Far From a Family Doctor Impairs Access to Care – Medscape

Report on the Impact of Geographic Proximity to Primary Care on Health Outcomes and Sustainable Development Goals

Introduction and Context

A recent population-based analysis in Ontario, Canada, involving nearly 10 million patients, examined the relationship between travel distance to primary care physicians and healthcare utilization. The study’s findings provide critical insights into healthcare accessibility, directly informing progress toward United Nations Sustainable Development Goals (SDGs), particularly SDG 3 (Good Health and Well-being) and SDG 10 (Reduced Inequalities). The research is timely, coinciding with Ontario’s legislative efforts to establish universal access to primary care, a key component of achieving Universal Health Coverage (Target 3.8).

Key Findings on Healthcare Access and Utilization

The analysis revealed a significant correlation between increased distance from a primary care physician and negative health outcomes. This demonstrates a critical barrier to achieving SDG 3, which aims to ensure healthy lives and promote well-being for all at all ages.

• Increased Emergency Department Use: Patients living more than 30 km from their physician had a 1.43 odds ratio of having non-urgent emergency department visits, indicating a reliance on acute care systems instead of preventative primary care.
• Decreased Primary Care Engagement: Distant patients had a 1.28 odds ratio of having no visits with any family physician in the previous two years, undermining continuity of care essential for managing health effectively.
• Reduced Cancer Screening: Uptake of recommended cancer screenings was lower among patients living farther away, with odds ratios of 1.17 for colon cancer, 1.24 for breast cancer, and 1.17 for cervical cancer. This directly impacts SDG Target 3.4, which seeks to reduce premature mortality from non-communicable diseases through prevention.

Demographic Disparities and SDG 10: Reduced Inequalities

The study highlights that the burden of distance disproportionately affects specific populations, underscoring the challenge of SDG 10 (Reduced Inequalities). The cohort of patients living farther from their primary care provider was more likely to be:

1. Male
2. Younger than 65 years
3. Residents of low-income neighborhoods
4. Newcomers to Ontario

These findings illustrate how geographic barriers can compound existing socio-economic inequalities, preventing equal access to essential health services and hindering progress toward ensuring equal opportunity for all.

Policy Implications and Future Strategies

The report’s conclusions support policy initiatives aimed at improving the geographic distribution of healthcare services. The concept of developing “primary care districts,” similar to school districts, was proposed as a potential solution. Such a strategy would align with multiple SDGs:

• SDG 3 (Good Health and Well-being): By ensuring convenient and inclusive access to primary care teams.
• SDG 11 (Sustainable Cities and Communities): By integrating healthcare infrastructure planning into community development to create more inclusive and resilient communities.

However, expert commentary noted the need to balance geographic accessibility with patient choice and the established trust in a patient-physician relationship. A successful strategy for achieving Universal Health Coverage must therefore consider both systemic planning for proximity and the preservation of patient autonomy and continuity of care.

Analysis of Sustainable Development Goals (SDGs) in the Article

SDG 3: Good Health and Well-being

This goal is central to the article, which focuses on ensuring healthy lives and promoting well-being by examining access to primary healthcare services.

1. Target 3.4: Reduce premature mortality from non-communicable diseases (NCDs) through prevention and treatment.

   • Explanation: The article highlights that patients living far from their primary care physicians had lower rates of screening for colon, breast, and cervical cancer. Cancer is a major NCD, and screening is a critical prevention and early detection strategy. Reduced screening uptake, as shown in the study (ORs of 1.17 for colon and cervical, 1.24 for breast), directly undermines efforts to reduce mortality from these diseases.
   • Indicators:
     • Rates of screening for colon, breast, and cervical cancer.

2. Target 3.8: Achieve universal health coverage (UHC), including access to quality essential health-care services.

   • Explanation: The entire article revolves around barriers to accessing essential primary care services, a cornerstone of UHC. The study demonstrates that even patients who are officially “enrolled with a family physician” face significant access challenges due to distance. This leads to increased use of emergency departments for non-urgent care and fewer primary care visits, indicating a gap in effective health coverage. The mention of Ontario’s “Primary Care Act,” which aims to provide care for “everyone who lives in the province,” directly aligns with the ambition of UHC.
   • Indicators:
     • Rate of non-urgent emergency department visits.
     • Number of primary care visits per person over a defined period (e.g., 2 years).
     • Geographic distance between a patient and their primary care provider.

SDG 10: Reduced Inequalities

The article addresses this goal by identifying specific population groups that are disproportionately affected by poor access to healthcare, highlighting inequalities within the province of Ontario.

1. Target 10.2: Empower and promote the social, economic and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion or economic or other status.

   • Explanation: The study found that patients living farther from their doctors were more likely to “live in low-income neighborhoods” and to be “newcomers to Ontario.” This demonstrates that geographic barriers to healthcare are not evenly distributed and disproportionately affect vulnerable and marginalized groups, leading to their exclusion from convenient and effective primary care.
   • Indicators:
     • Disparities in healthcare access (e.g., travel distance) based on neighborhood income level.
     • Disparities in healthcare access for newcomers/immigrants compared to the general population.

SDG 11: Sustainable Cities and Communities

This goal is relevant through its focus on ensuring access to basic services for all inhabitants, with healthcare being a fundamental service.

1. Target 11.1: By 2030, ensure access for all to adequate, safe and affordable housing and basic services.

   • Explanation: The article’s emphasis on “geographics” and the physical distance to healthcare facilities connects directly to urban and regional planning. The proposal to develop “primary care districts,” similar to school districts, is a strategy to improve the spatial distribution of basic health services, making communities more inclusive and sustainable by ensuring residents can conveniently access the care they need.
   • Indicators:
     • Average travel distance to the nearest primary care facility within a community or district.

SDGs, Targets, and Indicators Summary

Source: medscape.com