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Canadians happy with primary health care, study says

The largest survey on primary health care ever conducted in Canada found that most people have high praise for their family doctor, and a staggering 92 per cent would recommend their physician to a relative or friend.

Canadians - except those living in Nunavut - have excellent access to primary health care: 85 per cent of people aged 12 and older have a regular doctor, and two thirds have been seeing the same doctor for five years or more, according to the Canadian Institute for Health Information (CIHI) study, released yesterday.

"I feel darn good that 92 per cent of Canadians would recommend their family doctor to a friend. That is the litmus test," said Sharon Johnston, a family physician and University of Ottawa professor.

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Very few Canadians complained about not having a family doctor - despite the oft-repeated grievance about a shortage of physicians in some parts of the country.

The report is being released just as the Canadian health-care system is coming under increased scrutiny south of the border. President Barack Obama is attempting to reform the U.S. system with a $1-trillion initiative that would bring health care to 47 million Americans who lack coverage. His opponents have complained about the spiralling cost of his proposed overhaul, and pointed to alleged shortcomings in Canada's health-care system.

However, the CIHI report identifies only one area for improvement in primary health care, which otherwise receives high marks for its accessibility and quality.

The report found small gaps in the management of the 40 per cent of Canadians who have chronic health conditions, including diabetes, heart disease, arthritis, emphysema and cancer.

Forty per cent of those with chronic illnesses reported they have no long-term treatment plan. Fewer than one quarter of these patients receive written instructions from their family doctor about how to manage their disease. Though this is not a clinical requirement, it is increasingly recognized as an important part of care.

The study also found that while most of these patients get the clinically recommended annual checks for blood pressure, blood sugar, weight and cholesterol, a small number said they do not.

This gap in care may lead to unnecessary hospitalizations and emergency-ward visits as people's diseases progress more rapidly than they need to.

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"There are a lot of positive findings in this study," noted Greg Webster, CIHI's director of primary health-care information. "But gaps in primary health-care access, continuity and quality can lead to poorer health for patients and increased demand for hospital-based services."

Studies show that a treatment plan, including written instructions about medications, diet and exercise, may help patients manage a chronic disease, he added.

The study is based on 11,000 respondents to a 2008 household-based survey and excludes those living on first nations reserves. It is important to note that it is based on patients' memories, which aren't always 100 per cent accurate.

Primary-care physicians deal with everything from chronic disease to mental health, maternity and child care, end-of-life care and common ailments such as flu.

The study found that 95 per cent of Canadians with chronic health conditions had a regular place of care, either a family doctor, or community health centre.

Two thirds of Canadians said their doctor allows them enough time to discuss their fears and concerns about their health.

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More than 54 per cent of those surveyed required ongoing medical care within the past year. Of those, only 13 per cent experienced difficulties getting an appointment or contacting a doctor. Most were able to see a doctor within seven days.

Of the patients with diabetes, heart disease, high blood pressure or history of stroke, 25 per cent said they didn't have their weight checked on an annual basis. One fifth said their cholesterol or blood sugar wasn't monitored, while 8 per cent reported not having their blood pressure measured.

"Even a small gap translates into complications," noted Mr. Webster. "We also have an aging population so a lot of people are affected by chronic disease." Diabetics, for example, have an elevated risk of developing heart and kidney disease, so monitoring their condition is key.

The concept of patient self-management is relatively new, say experts, and will take time to be fully implemented. Not all doctors feel comfortable raising lifestyle changes the day they diagnose a patient with diabetes or heart disease. And not all patients are prepared to check their blood sugar level, or change their diet and start exercising.

"Supporting patients to manage their own health is a paradigm shift. It requires a change in training and in the patient-doctor understanding," said Dr. Johnston. "We are working at it slowly."

Studies show that involving patients in their own care can save the system money, and lead to better outcomes. People with chronic obstructive pulmonary disease who are taught how to manage their illness have fewer hospital admissions, for example. Counselling patients about risky behaviours, including smoking cessation, can also stop premature death and illness.

Dr. Johnston said she was heartened by the study's many optimistic findings, including the relatively short wait times. Eighty-five per cent of adults requiring immediate care for a minor problem were seen within a day.

This is the first national study of its kind to analyze patients' expectations of primary care. It found that Canadians identified continuity, co-ordination, patient-centred care, satisfaction, outcomes and interpersonal communication as important features of the primary health-care system.

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