Centralized Waiting Lists for Unattached Patients in Primary Care: Learning from an Intervention Implemented in Seven Canadian Provinces

INTRODUCTION: Centralized waiting lists (CWLs) are one solution to reduce the problematic number of patients without a regular primary care provider. This article describes different models of CWLs for unattached patients implemented in seven Canadian provinces and identifies common issues in the implementation of these CWLs. METHODS: Logic models of each province's intervention were built after a grey literature review, 42 semi-structured interviews and a validation process with key stakeholders were performed. RESULTS: Our analysis across provinces showed variability and common features in the design of CWLs such as same main objective to attach patients to a primary care provider; implementation as a province-wide program with the exception of British Columbia; management at a regional level in most provinces; voluntary participation for providers except in two provinces where it was mandatory for providers to attach CWL patients; fairly similar registration process across the provinces; some forms of prioritization of patients either using simple criteria or assessing for vulnerability was performed in most provinces except New Brunswick. CONCLUSION: Despite their differences in design, CWLs implemented in seven Canadian provinces face common issues and challenges regarding provider capacity to address the demand for attachment, barriers to the attachment of more vulnerable and complex patients as well as non-standardized approaches to evaluating their effectiveness. Sharing experiences across provinces as CWLs were being implemented would have fostered learning and could have helped avoid facing similar challenges.