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Thursday, January 24, 2013

Why should we care?

Dr. Alan Katz, Research Director, Department of Family Medicine, University of Manitoba

Why should we care what family doctors think about primary care delivery in Canada?
For at least two reasons. First, the future of our single payer healthcare system depends on a highly efficient primary care system. Because of this, provincial governments have started investing heavily in improving our primary care system. Second, because much of the change needs to happen in the offices of primary care providers where family doctors play a key leadership role. So this survey serves two purposes. It tells us what has changed over the last six years and it tells us what family doctors think about the system. There appears to be good news (e.g., increased use of electronic medical records) and bad news (e.g., poor access to care on short notice, inadequate use of regular clinical performance reviews) in the results of the survey. There are also results that are difficult to interpret (Are the docs with EMRs using them to full capacity? Why do so few physicians report the availability of incentives for home visits?).

Our healthcare system is complex. There are many ways of studying what happens in healthcare. In addition to excellent surveys like the 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians, we need to use other methods to study the system so that we know more than just what doctors think and say.

Canadian researchers are world leaders in the use of administrative claims data to study both the healthcare system and the health of the population. This research uses the routinely collected information that is used to run the system like physician payment claims to provincial governments, hospital discharge information and drug prescriptions filled by pharmacies, to look at the system from a different perspective.

Our research at the Manitoba Centre for Health Policy using many linkable administrative claims databases has looked at some of these same questions. Our answers are not based on the responses of a small group of physicians but include all contacts with the healthcare system for all residents of Manitoba (there are a few rare exceptions). For example, our work has shown that many family doctors do not use their EMRs to their full capacity!

One of the most concerning things about the results of this survey is the poor co-ordination of care between hospital care and primary care. Our work suggests that this may be due to patients seeing more than one primary care physician. Patients are often referred to specialists by a different physician to the one they usually see. We cannot tell why this is the case but it raises questions: Did the patient see the different primary care physician because they were unhappy with the care of their own doctor? Did the referral result because the new physician did not know the patient’s medical history well enough? Would a more formal process of patient registration with a primary care practice (such as has been introduced in Ontario) improve care co-ordination? What do you think?

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