Transcript Access to Primary Care

Quality of care
Patient-centred primary and specialist care
Medication reviews
Chronic condition management
and disease prevention
1
Most older Canadians have a positive experience
with their regular doctor
When older Canadians needed care or
treatment, their regular doctor always or often
Canada
CMWF average
Knew important information about their
medical history
87%
87%
Spent enough time with them
82%
86%
Encouraged them to ask questions
70%
66%
Compared with the CMWF average
Above average
Same as average
Below average
2
Patient-centred care from specialists
is also relatively good in Canada
When specialists provided care or treatment,
they always or often
Canada
CMWF average
Told patients about treatment choices
72%
72%
Involved patients as much as they wanted
to be in decisions about treatment or care
79%
77%
Compared with the CMWF average
Above average
Same as average
Below average
3
However, continuity of care between regular
doctors and specialists can be improved
In the past 2 years, was there a time when
Canada
CMWF average
A specialist did not have basic information or test
results from the patient’s regular doctor about the
reason for the visit
13%
9%
A patient’s regular doctor did not seem informed
and up to date about the specialist care received
25%
18%
Compared with the CMWF average
Above average
Same as average
Below average
4
How do the provinces compare?
B.C.
Alta.
Sask. Man.
Ont.
Que.
N.B.
N.S.
P.E.I.
N.L.
Can.
CMWF Avg.
Regular doctor always or often
Knew important information
about patients’ medical history
88% 86% 89% 84% 86% 89% 87% 85% 87% 84% 87%
87%
Spent enough time
with patients
81% 80% 80% 79% 81% 87% 80% 85% 80% 78% 82%
86%
Encouraged patients to
ask questions
72% 70% 64% 65% 68% 76% 68% 66% 72% 62% 70%
66%
Told patients about
treatment choices
74% 74% 75% 78% 77% 58% 73% 76% 80% 77% 72%
72%
Involved patients as much as
they wanted to be in decisions
81% 79% 83% 76% 80% 76% 81% 85% 88% 79% 79%
77%
Specialists always or often
Compared with the CMWF average
Above average
Same as average
Below average
5
How do the provinces compare?
Continuity of care between primary doctors and specialists was comparable to the
international average in most Canadian provinces.
Specialist did not have basic
medical information from
primary doctor
Primary doctor did not seem
informed or up to date about
care from specialist
B.C.
Alta.
Sask.
8%
8%
8%
Man.
Ont.
Que.
N.B.
N.S.
P.E.I.
N.L.
Can.
CMWF Avg.
11% 10% 26% 13%
6%
4%
9%
13%
9%
16% 18% 18% 18% 18% 46% 22% 10% 13% 10% 25%
18%
Compared with the CMWF average
Above average
Same as average
Below average
6
Medication reviews are common for
older Canadians
80%
said a health care professional reviewed their medications in the
past 12 months.
How does Canada compare (2014)?
United States
New Zealand
CANADA
80%*
Germany
In Canada, seniors use an average
of 7.2 prescription drugs in a year.
Australia
United Kingdom
Switzerland
CMWF AVERAGE
70%
Netherlands
Norway
France
Sweden
Source
Canadian Institute for Health Information. Drug Use
Among Seniors on Public Drug Programs in Canada,
2012: Revised October 2014. Ottawa, ON: CIHI; 2014.
7
Canadians are more likely to have discussions
about medication use
In the past 12 months, has a health care professional
Explained potential side effects
CANADA
United Kingdom
New Zealand
United States
Australia
Germany
CMWF AVERAGE
France
Netherlands
Switzerland
Norway
Sweden
Provided a written list of all medications
74%*
59%
Sweden
United Kingdom
CANADA
New Zealand
Netherlands
United States
Australia
CMWF AVERAGE
Germany
Norway
Switzerland
France
67%*
57%
8
Patient safety incidents related to medication
use are common in Canada
Proportion of seniors on public
drug programs taking a potentially
inappropriate (Beers list) drug, 2012
Almost 140,000 hospitalizations
for adverse drug reactions among
seniors between 2006–2007
and 2010–2011
Source
Canadian Institute for Health Information. Adverse Drug
Reaction–Related Hospitalizations Among Seniors, 2006 to 2011.
Ottawa, ON: CIHI; 2013.
39%
Source
Canadian Institute for Health Information. Drug Use Among Seniors
on Public Drug Programs in Canada, 2012: Revised October 2014.
Ottawa, ON: CIHI; 2014.
9
How do the provinces compare?
Across provinces, medication management among older patients was equal to or better
than that in other countries, on average.
In the past 12 months, has a health care professional
B.C.
Alta.
Sask.
Man.
Ont.
Que.
N.B.
N.S.
P.E.I.
N.L.
Can.
CMWF Avg.
Reviewed all
medications
77% 78% 78% 75% 83% 83% 75% 66% 77% 65% 80%
70%
Explained potential
side effects
72% 72% 72% 67% 76% 76% 67% 70% 68% 62% 74%
59%
Given a written list
of all medications
59% 58% 58% 51% 67% 80% 66% 62% 57% 54% 67%
57%
Compared with the CMWF average
Above average
Same as average
Below average
10
Care to help manage chronic conditions
is above average in Canada
78%
of older Canadians had at least 1 chronic condition*
(CMWF average 71%).
Older people with chronic conditions who
Canada
CMWF average
Had discussions about main goals or priorities
with their health providers
60%
55%
Received clear instructions about symptoms
to watch for
60%
56%
Compared with the CMWF average
Above average
Same as average
Below average
* Chronic conditions include hypertension or high blood pressure; heart disease, including heart attack; diabetes;
asthma or chronic lung disease such as chronic bronchitis, emphysema or chronic obstructive pulmonary disease;
depression, anxiety or other mental health problems; cancer; and joint pain or arthritis.
11
However, there is room to improve
across countries
People with chronic conditions who received
a written plan for self-management from their
health provider
Canada
CMWF average
37%
35%
Compared with the CMWF average
Above average
Same as average
21%
Routinely
Occasionally
58%
Below average
21% of family physicians routinely
gave their patients with chronic
conditions written instructions for
self-management.
Source
The Commonwealth Fund, 2012 Commonwealth
Fund International Survey of Primary Care Doctors.
12
Hospitalizations for chronic conditions are declining
in Canada but vary widely across the country
Ambulatory care sensitive conditions (ACSCs) are chronic conditions that—when treated
effectively in community settings—should not, in most cases, lead to hospitalization.
ACSC hospitalization rates (per 100,000)
Canadian rates
435
417
319
289
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
258
428 419
425
296
267 275
319
289
B.C. Alta. Sask. Man. Ont. Que. N.B. N.S. P.E.I. N.L. Can.
Compared with the Canadian average
Above average
Same as average
Below average
Source
Canadian Institute for Health Information. Your Health System. http://yourhealthsystem.cihi.ca/. Accessed November 27, 2014.
13
How do the provinces compare?
In most provinces, management of chronic conditions was similar to the international
average experience.
In the past 12 months, has a health professional
B.C.
Alta.
Sask.
Man.
Ont.
Que.
N.B.
N.S.
P.E.I.
N.L.
Can.
CMWF Avg.
Discussed with patients their
main goals or priorities in
caring for this condition
59% 59% 61% 57% 61% 61% 56% 60% 61% 58% 60%
55%
Given patients clear
instructions about symptoms
to watch for and when to seek
further care or treatment
56% 57% 60% 60% 58% 68% 62% 58% 62% 58% 60%
56%
Given patients a written plan
to help them manage their
own care
42% 32% 36% 34% 35% 38% 35% 41% 42% 39% 37%
35%
Compared with the CMWF average
Above average
Same as average
Below average
14
Discussions about healthy life habits are more
frequent in Canada
But they happened less often in 2014 than they used to.
During the past 2 years, has a health professional discussed
61%
57%
50%
54%
51%*
55%*
48%
43%
37%
35%
25%
2010
2014
A healthy diet and healthy eating
2010
2014
Exercise or physical activity
Canada
2010
23%
2014
Things in life that worry patients
or cause stress
CMWF Average
Source
The Commonwealth Fund, 2010 Commonwealth Fund International Health Policy Survey.
15
Canada leads in smoking cessation discussions
78%
of older Canadians who smoked said a health professional talked
to them about the health risks of smoking or using tobacco and
ways to quit.
How does Canada compare (2014)?
CANADA
United States
New Zealand
France
United Kingdom
CMWF AVERAGE
Sweden
Switzerland
Norway
Germany
Netherlands
Australia
78%*
17% of older Canadians smoked,
higher than the CMWF average.
63%
Lung cancer mortality rates were
among the highest in the world for
Canadian women at 46 deaths
per 100,000 population.
Source
OECD Health Statistics 2014.
16
How do the provinces compare?
During the past 2 years, has a health professional discussed
B.C.
Alta. Sask. Man. Ont. Que. N.B.
N.S.
P.E.I.
N.L.
Can.
CMWF Avg.
A healthy diet and healthy eating
54% 52% 49% 47% 52% 48% 48% 52% 52% 47% 51%
43%
Exercise or physical activity
60% 55% 52% 51% 55% 55% 49% 54% 55% 51% 55%
48%
Things in life that worry patients
or cause stress
27% 23% 25% 24% 26% 20% 22% 32% 22% 24% 25%
23%
Health risks of smoking or using
tobacco and ways to quit
92% 75% 66% 84% 79% 71% 72% 72% 60% 59% 78%
63%
Compared with the CMWF average
Above average
Same as average
Below average
17