Patients who rely on walk-in clinics for primary care less likely to have had annual exam or flu shot

Ontarians who rely on walk-in or after hours clinics for the majority of their primary care are less likely to have had either an annual exam or a flu shot. This is one of many important findings from the final installment of the ICES Atlas: Primary Care in Ontario – the largest and most detailed analysis of primary care services ever conducted in the province.

“Although primary care is by far the biggest component of the healthcare system in Ontario, our report marks the first time it has been studied in this depth,” said Dr. Liisa Jaakkimainen, Atlas co-editor and ICES scientist. “We hope that the results of this report will serve as an important tool to inform policy as the province enters a new era of more integrated and interdisciplinary care.”

Today’s release of the third and final installment of the Atlas examines the supply of physicians providing primary care, their practice locations, workloads, services provided, and patient characteristics, as well as the factors which influence preventive, chronic and acute disease management in primary care. Key findings include:

• Approximately 140,000 people make a general practitioner/family physician (GP/FP) office visit each day in Ontario. This is equivalent to about four annual visits for each Ontarian under 65 years of age, and seven annual visits for those aged 65 years and older. The average person in Ontario will make several hundred visits to a GP/FP in their lifetime.
• Despite Ontario’s growing and aging population, there was no change in the overall number of visits to GP/FPs between 1992/93 and 2002/03.
• In 2003/04, approximately 30% of Ontario GP/FPs were purely in solo practice, with no formal group affiliations.
• Just under 60% of women between 20 and 39 years of age received at least one Pap test (which can screen for cervical cancer) in the two-year period, between 2000/01 and 2002/03.
• Between 2002/03 and 2003/04, only 17% of Ontarians between 50 and 69 years of age underwent colorectal cancer screening.
• Just over 70% of children had at least five vaccinations by age two (representing the minimum number needed to be up-to-date with the funded routine vaccination schedule).
• The proportion of adults having high continuity of care (more than 75% of office-based primary care with one GP/FP) was just under 40%. Approximately 14% saw a GP/FP but had less than three visits in a two-year period, and 16% did not visit a GP/FP at all.

Earlier installments of the Atlas examined current trends in primary care for women during pregnancy, labour and childbirth; the care of children and adults; patterns in preventive healthcare; as well as how primary care services were provided to those with cancer, respiratory diseases, congestive heart failure, mental health problems, and to disadvantaged populations. Highlights of these results included:

The proportion of children and young adults in Ontario who did not see any primary care provider during a given year increased over the study time period of 1992/93 to 2003/04.

GP/FP practice has become almost exclusively office-based, with a dramatic decrease in the proportion of GP/FPs involved in obstetrical care.

The amount of obstetrical primary care provided by midwives has increased and the amount of primary care provided by specialists such as obstetricians and pediatricians is growing.

Improvements are needed in the provision of preventive care and in the management of some chronic diseases such as congestive heart failure.

“The information presented in this ICES Atlas reinforces the fact that primary care physicians provide substantially more direct services than any other healthcare provider, and they are also indirectly involved in a large proportion of other services,” said Dr. Jaakkimainen. “Moreover, this frontline care is being provided in an environment which is in continual transition and becoming increasingly complex.

“Because of the central role of GP/FPs, policy makers need to consider how any changes to the primary care system will affect both the lives of Ontarians and the overall healthcare system. As such, our research indicates that essential areas of focus should include: creating stronger incentives to attract students to primary care medicine; ensuring that the current system does not penalize physicians for sharing patient care; and, identifying and addressing populations, whether by geographic region or by socioeconomic group, who do not have equal access to services.”

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.

FOR FURTHER INFORMATION, PLEASE CONTACT:

• Julie Dowdie
• Media Relations Officer, ICES
• (416) 480-4780 or cell (416) 432-8143