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Connecting the Dots for Patients – Family Doctors’ Views on Coordinating Patient Care in Ontario’s Health System

A Report from Health Quality Ontario
Released June 1, 2016

Health Quality Ontario released a report June 1 examining the results of the Commonwealth Fund International Health Policy Survey of Primary Care Doctors in the Ontario context. The survey was given to family doctors in Australia, Canada, France, Germany, Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States. Only family doctors were surveyed so the results do not include the views of other primary care providers such as nurses, nurse practitioners, and others on the care team.

Family doctors in Ontario are primarily working in group based practices, including community clinics and community health centres. Only 24% of family physicians operate in private solo practices and only 5% operate out of a different setting, such a hospital-based practice.

Summary of Survey Results

Among family doctors in Ontario who have patients receiving home care services, only 29% report that they or someone in their practice routinely communicate with their patient’s home care provider regarding the needs and services of their patients. Internationally, Canada scored the worst on this measure with a national average of 32%. France, at 36%, was the only other country reporting rates of less than 50%.

Canada and Ontario both fair better on the percentage of family doctors who say they or other personnel in their practice frequently coordinate care with social services or other community providers. Ontario doctors report coordinating this care 53% of the time, slightly higher than the Canadian average of 50%. The Canadian average rests halfway between the French low of 35% and the British high of 65%.

Only 36% of doctors in Ontario report that it is easy or very easy to coordinate their patients’ care with social services and other community providers. Doctors in most other countries also report low ease in this area, with Switzerland as the only country with over 50% of doctors saying this process is easy or very easy.

The percentage of family doctors who say they always or often receive a report back from specialists with all relevant health information was 90% in Ontario, exceeding the overall Canadian response of 85% and scoring highly on international comparisons which range from 56% to 96%. The percentage of Ontario family doctors who say they always or often receive information that is timely and available when needed after their patient has been seen by a specialist was 71%. This percentage far exceeds the number reported in Quebec, which was only 37%, and falls in the higher range internationally. These figures are important to the role of the family doctor as the common point of contact between specialists.

A quarter of Ontario family doctors report that tests or procedures had to be repeated for their patients during the past month because the results were unavailable. While Ontario doctors report less repeat tests compared to other jurisdictions, these repeated tests are inefficient, are inconvenient for patients, increase costs, and are avoidable. Health Quality Ontario reports that doctors are more likely to need to repeat tests when a patient has the tests done at a stand-alone lab, a hospital, or a walk-in clinic.

At hospital discharge, a report is prepared by the doctors in the hospitals summarizing the patient’s hospital stay and recommendations for follow-up. The percentage of family doctors who say they always or often receive notification when their patient is discharged from the hospital is 71% in Ontario, the highest in Canada. The international range for this measure is quite large, spanning from 35% to 97%, with Canada sitting at 65%.

Half of Ontario family doctors or other personnel in their practice frequently coordinate follow-up care with hospitals upon discharge. This figure rests between the Canadian low of 37% in Quebec and the high of 65% in New Brunswick.

Implications for Ontario’s Health Care System

Disconnected health care systems are difficult for patients, caregivers, families, and health care providers. In order for patients to receive the best care, information needs to flow quickly from one provider to another and from one place of care to another. This is especially important for patients with multiple chronic conditions and who are receiving care from multiple specialists. Rough transitions between settings of care can have significant impacts on the physical and emotional well-being of patients and poor care coordination can contribute to many negative and costly health outcomes such as unnecessary hospital admissions and emergency room visits, medical errors, and repeated tests.

The report from Health Quality Ontario provides several examples of good care coordination, including an example of a practice in east Toronto who have a dedicated community and home care manager and a nurse-practitioner led clinic in Oshawa that organizes care meetings at least once a year and up to every three months with patients and their care team. These examples are exceptional as Health Quality Ontario reports that doctors point to insufficient capacity to coordinate care, including a lack of resources, time, and infrastructure.

Several initiatives are underway to increase coordination between parts of the health system. These include hospital discharge protocols and electronic medical records. On June 2, the Ontario government tabled the Patients First Act, legislation that will dissolve the Community Care Access Centres (CCACs) and transfer their responsibilities for home and community care to the Local Health Integration Networks (LHINs). Once the bill is passed, the LHINs will also be responsible for resourcing primary care. With one administrative body responsible for many types of care, some people are hopeful that coordination between these types of care will increase.

Full Report
Health Quality Ontario