PLOS ONE Medicine&Health

Designed for simplicity, used for complexity: The systemic pressures shaping walk-in clinic practices and outcomes

by Braeden A. Terpou, Lauren Lapointe-Shaw, Ruoxi Wang, Danielle Martin, Mina Tadrous, Sacha Bhatia, Jennifer Shuldiner, Simon Berthelot, Niels Thakkar, Kerry McBrien, Bahram Rahman, Aisha Lofters, J. Michael Paterson, Rita McCracken, Christine Salahub, Tara Kiran, Noah M Ivers, Laura Desveaux

Walk-in clinics (WICs), appreciated for their accessibility and convenience, have become an increasingly popular healthcare option in Ontario for patients with and without primary care enrolment. Despite their utility, WICs face criticism for delivering lower-quality care compared to comprehensive, enrolment-based primary care models. Critics argue that WICs contribute to system inefficiencies and encourage practice patterns misaligned with population health goals. This study explored physician perspectives on two key outcomes often associated with low-quality care in WICs: repeat primary care visits and potentially inappropriate antibiotic prescribing. Using a qualitative descriptive approach, semi-structured interviews were conducted with Ontario-based family physicians (N = 19) who had experience practicing in both WICs and enrolment-based primary care. The findings highlight systemic challenges, including limited access to enrolment-based primary care and increasing healthcare demands, which have pushed WICs beyond their intended role. This misalignment has created tensions between their structure and purpose, resulting in visits that participants described as more transactional than those in primary care. These constraints—rooted in a lack of informational and relational continuity—often limited participants’ ability to provide in-depth engagement or follow-up care. Repeat visits were frequently linked to efforts to ensure continuity for complex or chronic conditions. Similarly, participants acknowledged the reality of potentially inappropriate antibiotic prescribing, attributing it to the high patient volume, desire to satisfy patient expectations, and a tendency to “err on the side of caution” when the nature of the illness is in question. The findings underscore how health system pressures and well-intended policies, such as Ontario’s primary care access bonus, can produce unintended consequences, including inequities in access and difficulties with care coordination across settings. Addressing these challenges requires reforms to better integrate WICs with the primary care system, alongside tailored training to support physician decision-making in episodic care contexts.

PLOS ONE Medicine&Health

Impact of vitamin C on the reduction of opioid consumption for acute musculoskeletal pain: A double-blind randomized control pilot study

by Raoul Daoust, Jean Paquet, David Williamson, Vérilibe Huard, Caroline Arbour, Jeffrey J. Perry, Marcel Émond, Simon Berthelot, Patrick Archambault, Dominique Rouleau, Judy Morris, Alexis Cournoyer

Introduction

Recent evidence has shown that vitamin C has analgesic and opioid sparing properties in immediate postoperative context. However, this has never been studied for acute musculoskeletal (MSK) emergency department (ED) injuries. The aim of this pilot study is to evaluate the feasibility of conducting a randomized placebo-controlled study to determine the opioid sparing and analgesic effect of vitamin C compared to placebo, in acute MSK injured ED patients.

Methods

A double-blind randomized controlled trial (RCT) distributed in two arms, stratified for fractures, was performed in a tertiary care center, one group receiving 1 g of vitamin C twice a day for 14 days and another receiving placebo. Participants were ≥18 years of age, treated in ED for MSK injuries present for ≤2 weeks, and discharged with a standardized opioid prescription of 20 morphine 5 mg tablets (M5T) and, at the clinician discretion, 28 tablets of naproxen 500 mg. Participants completed a 14-day paper diary and were contacted by phone at 14 days, to document their analgesic use, vitamin C consumption, and pain intensity.

Results

Overall, 137 patients were screened; 44(32%) were excluded, 38(40.9%) refused, leaving 55(59.1%) participants, with a consent rate of 9.2/month. Mean age was 53 years (SD = 16) and 55% were men. Fourteen (25%) participants were lost to follow-up and 33(83%) patients complied with treatment. For per-protocol analysis, the median (IQR) M5T consumed was 6.5 (3.3–19.5) for the vitamin C and 9.0 (1.5–16.0) for placebo group. The median (IQR) naproxen 500 mg tablets consumed was 0 (0–9.8) for the vitamin C group and 20 (0–27) for the placebo arm.

Conclusion

This pilot study supports the feasibility of a larger RCT on the opioid sparing and analgesic properties of vitamin C for acute MSK injured ED patients. Strategies to reduce the refusal and lost to follow-up rates are discussed.

Trial registration number

NCT05555576, ClinicalTrials.Gov PRS.