Close to 1 in 5 Canadians do not have a regular health care provider.Reference1 And even those who do have such a provider may not be able to access care when they need it.Reference2

High-quality primary health care is a cornerstone of Canada’s health system, and improving access to this care is a priority of governments across Canada.Reference1

Canadians who need primary health care but do not have timely access often seek care at emergency departments. There, they may face long wait times, and they do not get the benefits of being able to see their own regular health care provider who specializes in family medicine.Reference3

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I had severe stomach problems and didn’t have a family doctor. I went to the ER and knew there were other people there who had more intense emergencies, but I didn’t have another option. It was a full waiting room, late at night. It seems like there aren't enough doctors, or even allied health care professionals. We often go through our family doctors for everything, for any kind of referral, even to get a blood test requisition. — Melanie De Sousa, Patient Partner

Canadians would prefer not to go to the ED if they can receive care elsewhere.Reference4 Reference5 And many describe their most recent emergency department visit as one that could have been managed by their regular care provider.Reference2

Why do patients go to the ED for conditions that could be managed in primary care? There can be a variety of reasons. Here are a few examples:

• Patients don’t have a regular health care provider, or their regular health care provider is not available soon enough or at a time that works for them.
• The ED is the closest, or only, place for a patient to seek care. (This is often true in rural and remote areas.)
• Patients feel that if they go elsewhere, they can’t get the same service quality and access speed that they can get in the ED. Or the ED may be the place patients know best and/or feel safest.
• A patient’s condition has worsened — possibly due to poor access to quality primary care — to a status that necessitates an ED visit.

Having to seek primary care in the ED also has implications for the health care system. The emergency department is not an ideal place for patients to receive primary health care, and using it for primary care may lead to system inefficiencies.Reference3

Getting the right care in the right place at the right time is a challenge both for patients and for the governments that are responsible for funding and setting up appropriate health system infrastructure.

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Debates about ED overcrowding often pit patients on stretchers against ambulatory patients, suggesting that only the former truly matter. However, ambulatory patients account for more than 60% of ED visits in Canada. The waiting times and lack of access to care they experience are unacceptable. A significant number of these patients should actually be seen in primary care clinics. Measurement is the first step toward real structural change. This change is more necessary than ever for the sustainability of our EDs and for the quality of care provided to the population. — Dr. Simon Berthelot, Emergency Physician, Associate Professor and Researcher, Département de médecine de famille et de médecine d’urgence, Université Laval

Our data shows that over 1 in 7 visits to emergency departments across Canada were for conditions that could potentially have been managed in primary care. Calculated for 6 provinces and territories,Footnote i this represents about 1.2 million visits to the ED each year. 

This data includes 173 conditions or reasons for such visits. The most common are antibiotic prescriptions, colds, sore throats, ear infections and prescription refills. 

Our data cannot be used at the individual level to understand appropriateness of care. But viewed in aggregate, this proportion reflects an opportunity to better address Canadians’ unmet needs for primary care in their communities. 

The data in this report reflects an indirect system-level measure of access to primary care. These indicators evaluate broad patterns of emergency department use. They can provide health system decision-makers and planners with information to improve systems to better meet patient needs. They also add to the limited information we already have for monitoring access to primary care at the regional level. 

This data cannot speak to individual patient scenarios or to appropriateness of an ED visit. The conditions listed for consideration in the indicator can, in most cases, be managed in primary care — but some situations may be best served in the ED.

Still, at a population level, these indicators are valuable for understanding the impacts of primary care access on the broader health system. Refer to to explore the data further and to compare indicator results across geographies and time frames.

While 15% of all emergency department visits across Canada were for conditions that could potentially be managed in primary care, this percentage varies across the country. The figure above shows how this differs by province/territory of patient residence, adjusted by age and sex. 

The percentage also varies within provinces. Refer to to explore results at a regional level.

Due to data differences, results from Quebec and British Columbia are underestimated and not comparable with results for other jurisdictions. 

This is mainly because data from these provinces excludes most patients who left the ED without being seen by a clinician or who left it against medical advice. And this is a sizable proportion of overall emergency department visits: 12% in Quebec, 6% in British Columbia and 8% in other provinces and territories. 

Patients who leave an ED without being seen by a clinician tend to be different from those who stay on to do so. Data suggests they have lower levels of urgency based on their triage level. They are also more likely to have had a condition that could be managed in primary care. 

Additionally, data from British Columbia is incomplete. The coverage is largely limited to urban areas, where EDs are generally relied on less for primary care needs.

Data from Quebec and British Columbia can be compared across regions and over time within each province. But due to the differences listed above, data on this topic from Quebec and British Columbia cannot be compared with data from other jurisdictions across Canada. 

• Better access to primary care key to improving health of Canadians
• CIHI’s information on health workforce
• CIHI: Connected Care

If you have any questions or would like to learn more, please send us an email.

hsp@cihi.ca