Determining the adequacy of health care in Canada
Published Tuesday November 3rd, 2009
Chronic diseases are far and away the most prevalent causes of ill health in Canadians.
Nearly half of Canadian adults have at least one of seven chronic conditions - namely, arthritis, cancer, emphysema or chronic obstructive pulmonary disease, diabetes, heart disease, high blood pressure and mood disorders, excluding depression.
The Canadian Institute for Health Information has just issued a study on the access to care of those with chronic diseases.
The point of the study is to determine the adequacy of care across Canada.
For some, treatments have resulted in chronic conditions following from acute disease.
Some survive a heart attack, only to find that they now have congestive heart failure.
Other chronic conditions may result from lifestyle choices that are less than healthy. Smoking, for example, may lead to developing chronic obstructive pulmonary disease.
The consumption of high levels of sugar, may lead to diabetes. It's a bit ironic that we are progressing in the treatment of acute diseases, only to find that often a chronic disease is the result.
A number of chronic diseases occur as a result of ageing. Some arthritis and various dementias are examples.
Largely, there is now a need to manage a chronic disease.
Such management is the responsibility of the primary care level.
This level of care is the patient's first point of contact with the health system.
Family doctors' offices, walk-in clinics, and community health centres are the usual points of contact.
Ninety-one per cent of Canadians reported having access to one of these primary health providers.
Seventy-eight per cent choose a doctor's office, and 17 per cent went to a clinic or health centre.
Self-management of one or more chronic diseases is critical, along with disease prevention and good health promotion.
The gaps found in primary health care indicate that more can be done in helping patients manage their conditions.
The study found that 40 per cent of those with at least one of the seven common chronic conditions reported not having made a treatment plan with their provider within the last 12 months.
Fewer than one in four were provided with a written list of instructions to manage their disease.
In addition, 40 per cent of patients with three or more chronic conditions reported they were rarely or never counselled in the last 12 months on what to do to improve their health.
Such gaps lead to deterioration in the health of those with chronic diseases, which leads to more expensive hospitalizations.
Primary health care teams are those made up of professionals from different disciplines who work together to provide integrated care.
The survey indicates that 27 per cent of patients had a nurse involved in their care.
Sixteen per cent said their regular place of care had other health professionals available.
The results of this study are reasonably encouraging.
The high percentage of those who have primary care providers was impressive in a time when there still seems to be some shortage of family doctors.
Making use of primary health care centres is relatively recent.
Supporting patients in self-management, and establishing a co-operative relationship with a provider can save the system money in the long-term, and lead to better results.
Responders to the survey said they had short waiting times to see their provider.
Eighty-five per cent of adults requiring immediate care of a minor problem were seen within a day.
Of the 54 per cent who needed ongoing medical care within the past year, only 13 per cent of these had difficulties getting an appointment.
Most were able to see a doctor within seven days.
The use of primary care teams - although still small as a percentage of providers - is also an encouraging development.
This particular form of primary care requires changes in training, and in the patient-doctor relationship.
Jo-Ann Fellows is a writer with an interest in health care. She lives in Fredericton. Her column appears every other Tuesday. Send comments to letters@dailygleaner.com.
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