Electronic Thesis and Dissertation Repository

Thesis Format

Monograph

Degree

Master of Science

Program

Epidemiology and Biostatistics

Supervisor

Mathews, Maria

2nd Supervisor

Hedden, Lindsay

Affiliation

Simon Fraser University

Co-Supervisor

Abstract

Background: The Primary Care Diabetes Support Program (PCDSP) at St. Joseph’s Health Care in London, Ontario, is an innovative program that focuses on managing diabetes in high-risk groups (e.g., socially and medically complex). The program also works to attach patients without a primary care provider (PCP) to a regular PCP. We described the characteristics of the unattached patient population at the PCDSP and identified time to attachment.

Methods: We used an observational retrospective cohort design and electronic medical record data of patients enrolled at the PCDSP between April 1, 2011, and March 31, 2018. We used descriptive statistics to assess characteristics of unattached patients and time-to-event analyses to assess time to attachment within 5 years.

Results: Of 6,863 PCDSP patients, 1,183 were identified as unattached (17.2%). Among a final cohort of 728 patients, 402 individuals (55.2%) became attached. The median time to attachment was 998 days (95%CI: 748 to 1245 days). Individuals who were both socially and medically complex (HR = 1.47 [95% CI 1.02 to 2.11]), aged 65 or older (HR = 1.33 [95% CI 1.08 to 1.63]), and had family history of diabetes (HR = 1.43 [95% CI 1.09 to 1.88]), were more likely to be attached compared to those who were non-complex, younger than 65, or had no family history of diabetes, respectively.

Conclusions: The PCDSP prioritizes high-risk patients to find a regular PCP. Particularly, patients who were both medically and socially complex had greater likelihood of attachment to a PCP through the PCDSP.

Summary for Lay Audience

The Primary Care Diabetes Support Program (PCDSP) at St. Joseph’s Health Care in London, Ontario, helps manage diabetes in high-risk individuals and assists those without a regular primary care provider to find one. This study examined the characteristics of patients at the PCDSP without a primary care provider (i.e. unattached) and how long it took them to become attached to a primary care provider.

We used data from PCDSP patients between April 2011 and March 2018. We found that out of 6,863 patients, 1,183 (17.2%) were unattached. We created a cohort of 728 patients with five years of data. Of that cohort, more than half (55.2%) became attached to a primary care provider, with a median time to attachment of approximately 3 years.

Patients who were both socially and medically complex, older than 65, or had a family history of diabetes were more likely to become attached compared to those who were non-complex, younger than 65, or had no family history of diabetes, respectively. These findings highlight that the PCDSP is effective in helping high-risk patients become attached to a regular primary care provider, especially those with complex medical and social needs.

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Available for download on Wednesday, October 01, 2025

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