Sweeping review takes pulse of primary care in Ontario
Colon cancer test rates, diabetic complications among major concerns
More than 40 per cent of Ontarians are overdue for colon cancer testing, according to the most comprehensive report on primary care ever undertaken in the province.
The report, from Health Quality Ontario, also shows too many diabetics are suffering from serious complications and too many hospital patients are discharged with inadequate followup.
The document, released today, sheds light on the significant variations in the quality of primary care across Ontario.
“Where you live matters, as do factors such as your income, the language you speak, and whether you are new to Canada,” it says.
Primary care refers to a patient’s first point of contact in the health system. Providers include family doctors and increasingly other professionals such as nurse practitioners and registered nurses.
Among their duties: screen for disease; help manage chronic conditions; provide vaccinations, assessments and diagnoses; and co-ordinate care from other providers such as specialists.
The report measures the performance of the sector based on access, provision of specific services and co-ordination with the rest of the health system. Measurements are given for 14 distinct geographic areas of the province.
On colorectal cancer screening, the average Ontarian between the ages of 50 and 74 should be tested. While 41.5 per cent of that population was overdue for screening in 2013, that’s a little better than three years earlier when 46.2 per cent were screened. Northern Ontarians are the most likely to be overdue.
While most Ontarians have a primary care provider, only 44.3 per cent are able to see the provider within 24 hours if sick. Ontario ranks last in a comparison of 10 countries in this area.
Those living outside urban areas have the biggest problems with access. Only 28.4 per cent of Ontarians living in some northern regions and 34.6 per cent in rural areas can get an appointment within a day if sick.
Some 77.9 per cent of patients receive a call back from their primary care provider’s office within the same day, but if the main language spoken at home is not English or French, that number drops to 67.6 per cent.
The report shows that 4.1 per cent of diabetics suffered complications such as amputations in 2013, down from 6 per cent eight years earlier. Ontarians with lower incomes and those living in rural areas are most likely to experience complications.
The co-ordination of care between hospitals and primary care is also spotty. Overall, fewer than a third of Ontarians see a primary care doctor within the recommended seven days,
This report provides a baseline for measuring primary care indicators and Health Quality Ontario plans to follow up annually.
“Primary care is the gateway to the health system. Unfortunately, that gate doesn’t open equally for everybody,” said Health Quality Ontario president Dr. Joshua Tepper.
In an effort to improve the sector, HQO is making available to primary care doctors annual reports informing them how their practices compare to others.
Meantime, a new study from the Institute for Clinical Evaluative Sciences reveals that screening for cancers, diabetes and heart disease remains low despite efforts by the province to increase numbers. Ontario and Canadian health guidelines recommend that all people be tested at determined ages for cervical, breast and colon cancers, as well as for elevation of cholesterol and glucose, states the study published in the journal CMAJ Open.
It urges that the screening rates be increased to 65 per cent during the next decade.