An Equity-driven Analysis of the Implications of Attachment and Attachment Readiness within Primary Care Healthcare Systems in Canada

Background: The persistent challenge of not having a physician or nurse practitioner for ongoing care for millions of residents imposes a burden on the health economy in Canada and demands a shift in focus from mere system registry to the value-based concept of attachment readiness. With a hypothesis that true attachment is a function of attachment readiness, a relational process shaped by the intersection of patients’ preparation, providers’ capacity, and systemic support, this study aims to investigate challenges of attachment creating barriers to meaningful healthcare relationships. Methods: This sequential mixed-methods study was designed to integrate a comprehensive scoping review of academic librarian-guided databases, search engines, grey literature, and snowballing, followed by 360-degree qualitative interviews with experts, service providers, and clients. Qualitative data was analyzed by thematic coding to answer the research questions. Results: Attachment is a function of a multitude of factors from patients and physicians, ‘attachment readiness’ is a multilevel, process-oriented condition shaped by patient preparedness, provider capacity, and system design more than a single episodic event or individual attribute. Facilitators such as team-based care, patient navigation, culturally responsive outreach, and structured onboarding reinforce readiness as a system-enabled condition. However, persistent system-level barriers delay attachment among motivated patients (readiness decay), leading to frustration, disengagement, and reduced trust. Findings further suggest that attachment is constrained not only by physician supply but also by time-sensitive readiness conditions. Conclusions: This study suggests that attachment to primary care is one leg of a three-legged stool, upheld and sustained by the two others- equity and access. To facilitate true attachment and to move beyond fragmented care and reliance on high-cost emergency departments, Canadian healthcare policy must consider attachment readiness through standardizing onboarding (Implementing uniform digital intake processes to reduce repetitive data entry and administrative friction), equity lens for prioritizing vulnerability (Refining centralized waitlist algorithms to account for clinical urgency and social determinants of health), and supporting provider capacity (Providing financial and administrative incentives that recognize the labour involved in establishing new longitudinal relationships for patients with complex needs).