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ICES report presents in-depth look at primary care across the life-cycle


A new report from the Institute for Clinical Evaluative Sciences (ICES) released today provides Ontarians with the most comprehensive picture, to date, on the state of primary care health services throughout major life stages. The first installment of the ICES Primary Care Atlas presents current trends in primary care for women during pregnancy, labour and childbirth; care of children; care provided to adults; and, patterns in preventive healthcare.

“The delivery of primary care services in Ontario has been in transition over the past decade. We are moving from an era where primary care services were delivered by physicians – either solo or in group practices – to one with a vision of more integrated and interdisciplinary care,” said report co-author and ICES scientist Dr. Liisa Jaakkimainen.

“The information contained in this ICES Atlas will be beneficial to ensuring that ongoing initiatives aimed at expanding or improving primary care service delivery are successful in bringing the best care in the most appropriate manner possible to the people of Ontario.”

This report is the first in a series which will make up the full Primary Care Atlas. The other installments, due out later this summer, will describe how primary care services are provided to specific patient groups: those with cancer, respiratory diseases, congestive heart failure, and mental health problems, as well as disadvantaged populations. Each installment examines primary care services between 1992/93 and 2002/03, prior to the introduction of new primary care reform initiatives in Ontario, such as Family Health Teams.


Primary Care during Pregnancy, Labour and Childbirth

  • Fewer women are receiving prenatal care exclusively from general practitioners/family physicians (GP/FPs). The majority of deliveries are performed by obstetricians and this trend is increasing. Midwives are providing more prenatal and intrapartum (the period covering labour and birth) services, although the number of births attended by this group of care providers was proportionally small over the study period.
  • Fewer teenage girls are having children; there are more mothers aged 35 and older; and, a greater number of multiple births. As well, the proportion of caesarean births is increasing substantially.

Primary Care for Children

  • There has been a decrease in the average number of primary care visits made by children to either GP/FPs and/or pediatricians. In addition, the proportion of children having no primary care visits has increased over time.
  • There was a three-fold variation in the average number of visits made to pediatricians by children in Ontario.
  • While the majority of pediatric care is provided by GP/FPs, pediatricians are providing an increasing amount of primary care to children in Ontario.

Ambulatory Physician Care for Adults

  • In 2002/03, over 80% of women and 64% of men aged 20 to 39 had at least one office-based visit with a GP/FP. Among those aged 40 to 64, about 90% of women and 76% of men had a GP/FP office visit.
  • The proportion of adults between 20 and 39 years of age having no Ontario Health Insurance Plan (OHIP) physician visit billings increased over time from 11% to 15% in women and from 27% to 33% in men.
  • This proportion has decreased in older adults from 8% to 5% in women and from 9% to 6% in men. For both adult women and men, the proportion seeing both GP/FPs and other consultant specialists increased with age, along with increases in the number of annual visits per person.

Primary and Secondary Prevention

  • Indicators of primary prevention are suboptimal. For example, fewer than half of all Ontarians aged 12 and up reported a Body Mass Index (BMI) considered to be within a healthy range in the 2000/01 Canadian Community Health Survey. As well, self-reported levels of physical activity and vaccination were low, and the rate of tobacco use is still a cause for concern (18% of women and 20% of men indicated they were daily smokers).
  • In 2000/01, a large percentage of adult women reported having received preventive primary care, such as a pap smear, a clinical breast exam and/or a mammogram.

“New models for primary care reform need to consider and address the trends shown in our report,” said Dr. Jaakkimainen.

“This might include more formal arrangements for shared care or formal affiliations between obstetricians, family physicians, midwives, and other care providers for pregnant women. Pediatricians should also be included in primary care initiatives since they may also provide primary care to many children in Ontario. The reasons behind the growing number of children who never visit a physician for primary care need to be further explored. Reforms for adult primary care will need to anticipate the increase in the proportion of older adults requiring care and adults living with a variety of different chronic ailments.

“Finally, new models of care delivery need to recognize the important role that primary care providers have in counseling patients on risk factor modification, and need to ensure that public policy initiatives support health promotion and disease prevention.”

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.


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


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