Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article


Master of Science


Epidemiology and Biostatistics


Ali, Shehzad

2nd Supervisor



The most common measures used by patients in which quality of care is judged would be satisfaction and wait times for care. Despite their relevance to gauging performance of health care services, they have not been widely studied in the context of primary care. A gap in the literature exists in studies assessing the relationship between patient satisfaction and wait times for primary care services in relation to social and health determinants. The objective of this thesis was to assess the association of individual level social and health determinants with patient satisfaction and wait times in primary care in adult Canadians. This dissertation is comprised of three studies; two systematic reviews and one cross sectional analysis of pooled data from the 2015/2016 and 2019 cycles of the Canadian Community Health Survey (CCHS). We found that the common determinants influencing both outcomes were health status, comorbidities, and socioeconomic status based on the 2 systematic reviews conducted. The cross-sectional analysis corroborated these findings, as those with worse self-reported health status (OR 0.62, 95% CI; 0.54-0.70) andthose with multiple chronic conditions (multimorbidity) (OR 0.81, 95% CI; 0.73-0.90) were found to have significantly lower odds of reporting satisfactory experiences. Those with excellent self-reported health status (OR 1.10, 95% CI;1.01- 1.19) and those classified as having a multimorbidity (OR 1.17, 95% CI; 1.03, 1.33) were also found to be at significantly higher odds of waiting 1 month or more for primary care. It is recommended that future studies investigate causal pathways between social and health determinants on patient satisfaction alongside wait times for care.

Summary for Lay Audience

Patient satisfaction and wait times for subsequent healthcare services go hand in hand with influencing patients’ experience with care and their perception of the competency of the healthcare system and health care providers. Poor health service-related elements may not only let vulnerable patients slip through the cracks but deter future patients from seeking care based on unsatisfactory experiences. One way policy makers may support uptake of primary care among at-risk populations with low health service utilization is to identify potential social and health determinants that predispose patients to unsatisfactory interaction with physicians as well as longer wait times. Knowledge of relevant social and health determinants influencing patient satisfaction and wait times to care will allow policy makers to better tailor effective public health interventions at the health care system, community, or Indvidual/family level. Examples of such public health initiatives could be implementing open access appointment booking, community outreach by primary care providers, or a push for more patient centered care.

The Canada Health Act is federal legislation that ensures that medically necessary services are covered by provincial insurance plans such that “ability to pay” is not a determinant of receiving care. However, this creates an imbalance in demand and supply for health services, as there is no price to counteract increasing demand from the public. With limited physicians and healthcare resources at the supply end, wait times become a non-monetary cost to “ration” healthcare services amongst Canadians. Despite the widespread availability of primary care services in Canada, patients' individual experiences with care vary greatly, in no small part to the primary care wait times. Individuals of certain ethno-racial groups, gender orientations, and marginalized sociodemographic groups too often fall through the cracks of Canada’s primary healthcare system. This results in them being less likely to adhere to care, access healthcare themselves, and respond to public health initiatives. Therefore, this integrated thesis focusses on identifying social and health determinants that exacerbate their wait times for primary care and deteriorate their satisfaction with said care.

Two systematic reviews of the current body of literature and a cross sectional analysis of a national sample of adult Canadians found that those with in adverse health conditions and those at lower socioeconomic standing were more prone to a lower quality of perceived care than others. Future studies should address the limitations in utilizing the CCHS datasets, such as scarcity of information collected in indigenous communities regarding income and the lack of questions inquiring specifically about primary care patient experience.

Creative Commons License

Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.

Available for download on Saturday, August 29, 2026