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An overview of the types of physicians treating acute cardiac conditions in Canada

Tu K, Gong Y, Austin PC, Jaakkimainen L, Tu JV; Canadian Cardiovascular Outcomes Research Team. Can J Cardiol. 2004; 20(3):282-91.

Background — As the issue of physician supply and distribution increases in intensity in Canada, the scope of practice of different types of physicians becomes increasingly important.

Objective — To determine the type of physician treating hospitalized patients with acute cardiac conditions in the provinces and health regions in Canada.

Methods — Data from the Canadian Institute for Health Information Discharge Abstract Database for all available provinces and the Maintenance et Exploitation des Données pour l'Etude de la Clientèle Hospitalière for Quebec were used to determine the most responsible physician treating patients hospitalized for congestive heart failure and acute myocardial infarction from fiscal years 1997/1998 to 1999/2000. For patients whose most responsible physician was a general practitioner/family doctor, the proportion receiving a consult from a specialist (cardiologist or general internist) was calculated. The type of physician most responsible for treating the acute cardiac conditions with respect to age, sex and urban versus rural hospital was also examined.

Results — For approximately 50% of patients in Canada, and in 84% (99 of 118) of the health regions across Canada for which data were available, a general practitioner/family physician was the most responsible physician for patients admitted with congestive heart failure. On a national average, a specialist was the most responsible physician for treating acute myocardial infarction for 65% of patients and in 50% (57 of 115) of the health regions for which data were available. Younger patients, men and people living in urban areas were more likely to be cared for by specialists for both congestive heart failure (age, P<0.0001; sex, P<0.0001; area of admission, P<0.0001) and acute myocardial infarction (age, P<0.0001; sex, P<0.0001; area of admission, P<0.0001).

Conclusions — The results of this study show that general practitioners/family physicians take a leading role in the treatment of hospitalized congestive heart failure patients, whereas cardiologists or internists are more often responsible for treating acute myocardial infarction in Canada. This distribution has important implications for cardiac educational strategies and may aid in the determination of health human resource policies.