Timeliness, continuity or travel time: results of a choice-based analysis exploring public preferences for access to primary care in Canada

Access and continuity are two pillars of primary care that are often in tension. While both are important to patients, it is unclear which they prioritize. This study examines public preferences for timeliness, continuity, and travel time to primary care in Canada using a discrete choice experiment. The experiment was embedded in a national online survey of adults in Canada. Respondents were randomly assigned to one of four clinical scenarios (worsening depression, new sore throat, new sexually transmitted infection, or worsening diabetes) and completed a discrete choice experiment selecting between two hypothetical primary care options. Each option varied in timeliness (same/next day, 2–7 days, 1 week–1 month), continuity (regular provider, unknown provider with or without access to records), and travel time (≤ 10 min, 10–30 min, > 30 min). We estimated marginal means (MM) to assess attribute preferences and conducted stratified analyses by socio-demographic characteristics. Responses were weighted to be demographically representative of the Canadian population. We analyzed data from 9276 survey respondents. All three primary care attributes significantly impacted decision-making, with timeliness and continuity being more important for decision-making than travel time. For example, for depression, 75% of participants (95% CI 73%-77%) opted for healthcare options that offered the quickest appointment, 66% (95% CI 64%-68%) opted for care with their regular clinician, and 56% (95% CI 54%-58%) favored the shortest travel time less than 10 min. Including the third level of each care attribute in a healthcare option significantly reduced the likelihood of selecting that option. Preferences did not vary substantially by socio-demographic characteristics. Both attributes of access and continuity were consistently prioritized by respondents, with preferences remaining stable across respondent characteristics. Our findings highlight the need for care models that offer timely access with familiar clinicians, or alternatives that maintain informational continuity.