Walk-in clinics in Quebec, Canada: patients and doctors do not agree on appropriateness of visits

Walk-in clinics aim to be highly accessible facilities, in particular for urgent primary care cases. A perceived increase of walk-in clinic visits in Canada could put this accessibility at risk. We aimed to study the appropriateness of walk-in clinic visits in Qubec, Canada. We performed a cross-sectional pilot study in Montral and surrounding areas, Qubec, in 2012, in which both patients and either family physicians or family medicine residents completed a questionnaire about the walk-in clinic visit, including the rating of appropriateness on a three-level scale and patients motives. Patients and doctors surveys were matched for their corresponding visits and next analysed for their agreement on appropriateness of visits by kappa statistic. Influence of modifying factors on appropriateness ratings was analysed by Pearsons chi-square testing. A total of 142 visits were included. Physicians judged more than half of the visits as appropriate, whereas most patients scored their visits urgency as low or medium. Agreement between both scores by kappa statistics was low (0.05) and non-significant. Visits were rated less appropriate in evenings, in teaching hospitals and by less-experienced doctors (mainly working in teaching hospitals). Common motives for visiting the walk-in clinics included worries about symptoms getting worse, persistence of symptoms and not being able to get regular appointments. In our study, doctors rated most visits to walk-in clinics as appropriate, whereas most patients rated the same visits urgency as medium or low. Doctors in Qubec appear to judge patient factors like worries and logistics as legitimate reasons for attending these facilities.