Transcript Canadian Institute for Health Information

Canadian Institute for Health Information
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Disparities in Primary Health
Care Experiences Among
Canadians With Ambulatory
Care Sensitive Conditions
Released March 6, 2012
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Analysis in Brief Outline
• Health and economic burden of ambulatory care
sensitive conditions (ACSCs) in Canada
• Prevalence estimates on primary health care
experiences (access to, use of and appropriateness
of care) for those with ACSCs, according to
– Sex, adjusted household income, rural or urban residence
and presence of multiple chronic conditions to assess
whether systemic differences exist in primary health care
• A brief overview of initiatives and programs
to strengthen primary heath care in Canada
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Methods and Definitions
• 2008 Canadian Survey of Experiences With Primary Health
Care is used to report on primary health care experiences
– Accessibility, utilization, clinical management and support for
self-management of chronic conditions
• The results are based on the population age 18 and older,
living in private dwellings and reporting having been
diagnosed with an ACSC (n = 4,138)
• ACSCs are medical conditions that can be managed
with adequate primary health care on an outpatient basis,
such as
– Asthma, chronic obstructive pulmonary disease, diabetes,
high blood pressure, certain heart diseases
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Health Burden of ACSCs
• ACSCs cause considerable illness, hospitalization and
death among Canadians and result in a high use of
health care services
• According to the Canadian Survey of Experiences With
Primary Health Care (2008), approximately 7.9 million, or one
in three, adults (31%) were living with a diagnosed ACSC
– 30% of individuals with an ACSC reported having been
diagnosed with three or more chronic conditions that included
at least one ACSC
• The burden of ACSCs is not shared equally among all
population groups, with low-income individuals and those
living in rural areas particularly affected
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Primary Health Care Experiences
• Most adults with ACSCs reported overall satisfaction
with their primary health care provider
– Most had a place to go when they were sick or needed
health advice (96%) and had a regular medical doctor (94%)
– Most (87% to 89%) had no difficulties obtaining needed
routine/ongoing care or health information/advice in the
previous 12 months
– Majority reported positive experiences interacting with their
providers (56% to 70%) or receiving coordinated care from
other doctors and places when needed (74%)
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Primary Health Care Experiences
• Gaps in care remain for some Canadians with
diagnosed ACSCs
– One in five (21%) reported not contacting a family physician in
the previous 12 months
– One in eight (12%) reported that their last visit to an emergency
department was for a condition that they perceived as being
treatable by their primary health care provider
– Many were not receiving recommended tests to monitor
their chronic conditions (49%), appropriate management of
their medications (40% to 42%) or support to self-manage their
chronic conditions
• Lower-income individuals and females experienced
particular challenges with primary health care
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Disparities in Primary Health Care by Income
Low-income individuals reported being high users of primary health care and of using emergency
departments for conditions that they perceived as being treatable by their primary health care provider.
However , they were less likely to report that their primary health care physician routinely involved them
in clinical decisions or helped them make a treatment plan, compared with high-income individuals.
Percentage
90
78.1
80
70
60.3
60
71.0
65.8
46.7
50
54.2
40
30
19.1
20
10
3.4
6.2
10.1
0
High Use (Average ED Visit for Perceived
Number of Contacts)
PHC-Treatable
(Days)
Condition
No After-Hours
Access
High Income
Involved in Clinical
Decisions
Generally Does Not
Receive Help With
Treatment Plan
Low Income
Source
Canadian Survey of Experiences With Primary Health Care, 2008, Canadian Institute for Health Information, Health Council of Canada and Statistics Canada.
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Disparities in Primary Health Care by Sex
Females were less likely than males to report receiving all four recommended tests for chronic disease
monitoring or to have medication side effects explained.
Females were also more likely than males to report not receiving the tools to self-manage their conditions.
Percentage
80
70
60
50
40
30
20
10
0
64.6
55.8
66.7
56.1
45.9
42.1
48.9
56.2
74.6
63.5
40.5
29.3
Received
Recommended
Tests for Disease
Side-Effects of
Medications
Discussed Goals
Helped to Make
Treatment Plan
Written List of
Things to Improve
Health
Take Care of
Themselves
Primary Health Care Physician Generally Did Not or Almost Never
Males
Females
Source
NeverCanada.
or Almost
Not
Generally
CareforPhysician
Health
Canadian Survey of Experiences With Primary Health Care,Primary
2008, Canadian
Institute
Health Information,
Health Did
Council
of Canada
and Statistics
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Disparities in Primary Health Care by Residence
Rural residents were more likely than urban residents to report that their last visit to an emergency
department was for a condition that they perceived as being treatable by their primary health care provider.
Percentage
80
69.3
70
58.3
60
50
40
30
23.0
20
10
4.3
3.4
8.8
0
High Use
(Average Number of Contacts)
(Days)
ED Visit for Perceived
PHC-Treatable Condition
Urban
No After-Hours Access
Rural
Source
Canadian Survey of Experiences With Primary Health Care, 2008, Canadian Institute for Health Information, Health Council of Canada and Statistics Canada.
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Those in Higher Need Received Higher Level
of Primary Health Care
Individuals with three or more chronic conditions reported being high users of primary health care and
of using emergency departments for conditions that they perceived as being treatable by their primary
health care provider.
They were also more likely to report more positive experiences in the clinical management of their conditions
and receiving support to independently manage their chronic conditions than those with a single ACSC.
Percentage
80
70
60
50
40
30
20
10
0
74.3
57.8
45.1
2.6
6.5
8.0
63.3
62.3
52.9
49.6
37.7
16.2
High Use (Average
ED Visit for
Received
Number of Contacts) Perceived PHCRecommended
(Days)
Treatable Condition Tests for Disease
Single ACSC
Involved in Clinical Generally Did Not Generally Did Not
Decisions
Receive Help With Receive a Written
Treatment Plan List of Things to Do
to Improve Health
Three or More Chronic Conditions
Source
Canadian Survey of Experiences With Primary Health Care, 2008, Canadian Institute for Health Information, Health Council of Canada and Statistics Canada.
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Strengthening Primary Health Care
in Canada
•
A number of strategies and models have been introduced to strengthen
primary health care in Canada and internationally, which could
influence health disparities. These focus on
– The quality of patient–clinician interactions
– Care delivery and records management
– Supporting patients to self-manage their chronic conditions as a means
of supplementing health care services
– Improving individuals’ sense of control over their condition
•
A number of initiatives are under way to specifically address disparities
in access to primary health care for vulnerable groups
– Some rural and northern areas are reorienting service delivery, employing
nurse-led clinics to deliver primary health care in underserviced areas
– In some areas, programs are being implemented to provide low-income
populations with subsidies for prescription drugs, food supplements and
transportation options to medical appointments
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Conclusion
• This Analysis in Brief highlights that there is room
for improvement in providing more equitable
access to and use of primary health care, clinical
management of chronic conditions and support
for patients to self-manage their conditions
• Further research is needed to more fully understand
and address these factors and to further explore
the impact of primary health care initiatives on
disadvantaged populations
• Addressing the gaps in care highlighted in this report
could lead to more appropriate care and to a more
efficient health care system
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Peer Reviewers
• Dr. Rick Glazier, MD, University of Western Ontario,
and MPH, Johns Hopkins University School of
Public Health
• Dr. Michel Grignon, PhD, Director, Centre for
Health Economics and Policy Analysis, and
Associate Professor, McMaster University
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About us . . .
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About the Canadian Institute for Health
Information (CIHI)
• CIHI established in 1994 as independent, not-for-profit corporation
• CIHI’s vision: To help improve Canada’s health system and the
well-being of Canadians by being a leading source of unbiased,
credible and comparable information that will enable health leaders
to make better-informed decisions
• CIHI’s mandate: To lead the development and maintenance of
comprehensive and integrated health information that enables
sound health policy and effective health system management
• CIHI’s data holdings: 27 databases of health information
• Range of stakeholders in health system and beyond
– Government organizations (such as Health Canada and Statistics
Canada), ministries of health, regional health authorities, nongovernment organizations, private-sector organizations, professional
associations, health facilities
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About the Canadian Population Health
Initiative (CPHI)
• CPHI is a branch within CIHI
• CPHI’s mission: To support policy-makers and health
system managers in Canada in their efforts to improve
population health and reduce health inequalities
through research and analysis, evidence synthesis
and performance measurement
• Work is guided by the CPHI Council, including
representatives from government organizations,
regional health authorities and research and
academic institutes
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Contact Us
• CIHI: www.cihi.ca
• CPHI: [email protected]
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Thank You
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