Trends in attachment to family physicians among assisted living residents in Ontario, Canada: a home-level repeated cross-sectional study

Objectives — To describe trends in family physician (FP) attachment among assisted living (AL) residents and examine AL home-level characteristics associated with attachment and primary care visits.

Design — Repeated cross-sectional study.

Setting and participants — Licensed AL homes were linked to population-level health administrative data in Ontario, Canada, from January 1, 2013, to December 31, 2023.

Methods — Our primary outcome was the proportion of AL residents with an attached FP, operationalized at the home level. Secondary outcomes included the type of FP practice model and frequency of primary care visits. Home-level exposures included AL home size, services offered, rurality, colocation with a nursing home, and area-level marginalization. We used autoregressive integrated moving average models to forecast the proportion of residents rostered, binomial regression with generalized estimating equations (GEEs) to model the proportion of attached residents, and Poisson regression with GEEs to model the number of primary care visits.

Results — From 2013 to 2023, the proportion of AL residents attached to FPs remained stable (∼82%). Attachment was lower in homes with on-site medical services and those located in marginalized areas. AL homes in rural communities, smaller homes, and those providing medical services had higher visit rates, whereas FP attachment and homes with pharmacist services were associated with fewer visits.

Conclusions and implications — Despite ongoing challenges with primary care access in the community, trends in FP attachment of AL residents have remained unchanged. Facilitating FP access and incentivizing on-site care in AL homes may improve access to primary care among this population.