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Not having a primary care doctor is putting Ontario children at risk: study


Children in some parts of Ontario are receiving sub optimal care because they don’t have access to a family doctor. New research done at the Institute for Clinical Evaluative Sciences (ICES) shows that children who live in areas with few primary care physicians are twice as likely to visit the Emergency Department (ED) as children who live in areas with adequate numbers of primary care physicians.

“Universal health insurance does not guarantee that all children are treated equally. Important differences in primary and ED care use and preventable admissions related to local physician supply exist. Physician distribution is a critical issue to address in policies to improve access to primary care,” says Astrid Guttmann, principal investigator of the study and ICES scientist.

The population-based, cross-sectional study of all Ontario children aged 0 to 17 years-old from 2003 to 2005 found:

  • There are rural areas in Ontario with inadequate numbers of primary care physicians.
  • Approximately eight per cent of children in Ontario live in areas with very low numbers of primary care physicians (>3000 children/physician). Children who live in areas with few primary care physicians (family physicians or primary care pediatricians)
  •  visit Emergency Departments up to twice as much, and are hospitalized more, than children who live in areas with adequate numbers of primary care physicians.
  • Children living in areas with few primary care physicians are less likely to receive recommended primary care visits and are more likely to not have a primary care provider, or to have trouble accessing their physician.

“The findings suggest that primary care reform needs to continue to address the issue of improving access to timely care in order to optimize the health of Canadian children,” says Guttmann,who is also a staff physician at the Hospital for Sick Children.

Author affiliations: ICES (A. Guttmann, K. Lam, T. A. Stukel); Division of Pediatric Medicine, SickKids (A. Guttmann); Dept. of Pediatrics (A. Guttmann, K. Lam); Dept.of Pediatrics Health Policy, Management, and Evaluation, Faculty of Medicine, UofT (A. Guttmann, T. A. Stukel); Dartmouth Institute for Health Policy and Clinical Practice (S. A. Shipman, D. C. Goodman); Dept. of Pediatrics, Dartmouth Medical School (S. A. Shipman, D. C. Goodman).

The study “Primary physician supply and children’s healthcare use and outcomes: findings from a universal-access system,” is in the May 24, 2010 issue of Pediatrics.

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.



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