Disadvantaged populations have poorer health status, but similar primary and specialist care

Despite wide variations in health needs and preventive healthcare, people who have low socioeconomic status (SES), report unmet health needs, live in rural areas, and are immigrants or members of visible minorities all have similar levels of primary and specialist care. This key finding, and many others regarding primary care services for specific patient populations, were released today in the second installment of the ICES Primary Care Atlas.

“Up until now, there has been little analysis or discussion in Ontario regarding the state of primary care for specific patient groups. With the current policy focus on expanding and improving primary care, examining health service delivery for certain population groups and people with specific conditions can help to determine priorities for more targeted service provision,” said report co-author and ICES senior scientist Dr. Rick Glazier.

The second installment of the ICES Primary Care Atlas describes how primary care services were provided to patients with congestive heart failure, cancer, respiratory diseases, and mental health problems between 1992/93 and 2002/03. It also examines the care provided to disadvantaged populations for 2000/01. The report was conducted prior to the introduction of new primary care reform initiatives in Ontario, such as Family Health Teams.

OVERVIEW OF REPORT FINDING

Physician Care for Hospitalized Patients with Newly Diagnosed Heart Failure

• Mortality rates for patients cared for by a general practitioner/family physician (GP/FP) during their hospital admission were higher than for patients who were cared for by specialists. Patients cared for by a GP/FP with specialist consultation had lower hospital readmission rates than those without a specialist consultation.
• Patients cared for by a GP/FP during their hospital admission were slightly less likely to receive some recommended heart failure medications relative to those cared for by specialists.
• Across Local Health Integration Networks (LHINs), there were large variations in the type of physician that provided care to newly diagnosed heart failure patients who were admitted to hospital.

Physician Care of Cancer Patients

• During the initial diagnosis of cancer, post-treatment (follow-up), and palliative care periods, patients with lung, colorectal, breast, and prostate cancer have more contact with their GP/FPs than with any cancer specialist or other type of physician.
• GP/FPs play a key role throughout the continuum of cancer care, including the work-up and diagnosis of cancer patients, support during the active treatment of cancer, and in patients’ follow-up and palliative care.
• The proportion of care provided by GP/FPs to cancer patients ranged from 47% in the Hamilton Niagara Haldimand Brant LHIN to 59% in the South East LHIN.

Primary Care for Respiratory Diseases

• Primary care visits for respiratory diseases, such as pneumonia, asthma and chronic obstructive pulmonary disease (COPD), show clear seasonal outbreaks, with annual peaks in the occurrence of new cases from winter to spring, which coincides with the seasonal nature of influenza and other viral infections.
• Nearly all patients with respiratory diseases visit a primary care physician for treatment, with less than one per cent visiting only an emergency department (ED).
• Rates of health service utilization for respiratory diseases are high throughout the life cycle, but are especially high in the very young and very old.

Primary Mental Healthcare in Ontario

• In 2001/02, five per cent of Ontarians suffered from major depression in the previous twelve months, although only half reported contact with health professionals for mental healthcare.
• Among those who sought mental healthcare, including those with depression, the most commonly contacted provider was a GP/FP.
• Of those who reported contact with a GP/FP, more than two-thirds had two or more contacts with the same GP/FP and the majority was satisfied with their care.

Primary Care in Disadvantaged Populations

• People with low SES and those with unmet health needs have the poorest health status. There are large disparities in preventive care across populations, with low SES groups, immigrants, and members of visible minorities having the lowest rate of service use.
• Despite wide variations in health needs and preventive healthcare, the number of primary care and specialist visits was similar across all groups, as was continuity of primary care.
• The use of EDs was higher among those with low SES and among those with unmet health needs, but lower among immigrants and visible minorities. People in rural communities also used EDs more frequently, but were less sick when they did visit an ED.

“It is clear from our findings that primary care providers play a major role in caring for and in educating their patients with these common chronic conditions,” said Dr. Liisa Jaakkimainen, Atlas co-editor and ICES scientist.

“As such, there is a need for system changes to promote more organized and collaborative care between primary care providers and specialists in areas such as heart failure and cancer care. Consistent updated diagnostic and treatment decision aids and guidelines are also needed to support primary care providers. The current healthcare system appears to be unresponsive to the needs of disadvantaged populations, indicating that special efforts need to be made to ensure that they receive the care they need. In addition, policy makers need to ensure that there will be sufficient numbers of GP/FPs to provide the necessary care for these patient populations into the future.”

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