Immigrants, low-income earners less likely to receive optimal health care

Yorkregion.com
Nov. 19, 2015
By Chris Traber

Ontarians are less likely to receive optimal primary care if they are immigrants, live in a low-income neighbourhood or live in a rural, remote or northern area of the province, according to the new Health Quality Ontario report.

Research has established that quality primary care is integral for overall population health and forms the base on which a first-rate health system is built, reports Quality in Primary Care: Setting a foundation for monitoring and reporting in Ontario.

Primary care providers, such as family doctors and nurse practitioners, assess and diagnose patients, support early detection of health problems, promote healthy behaviours, provide counselling, and help co-ordinate a patient's journey through the health system.

"Primary care is a crucial component of our health system and, right now, who you are and where you live matter when it comes to receiving high-quality primary care in Ontario," Health Quality Ontario president and CEO Dr. Joshua Tepper said. "The inequity in care underscores the importance of monitoring performance and working toward a strategy that will improve primary care for all Ontarians."

The report measured primary care performance using indicators, such as whether Ontarians are able to get a timely response when they call their primary care provider, whether they feel they are involved in decisions about their own care and treatment and whether they are receiving screening tests for certain conditions. The indicators were selected in partnership with an advisory committee of primary care experts and patients and their data will be updated every year.

Among the key findings:

• Many of the nearly 30 per cent of Ontarians who are immigrants may not have the same access as non-immigrants to quality primary care
  
  
• 86 per cent of immigrants living in Canada for less than 10 years have a primary care provider they see regularly compared to 94 per cent of Ontarians born in Canada.
  
  
• 78 per cent of immigrants in Canada less than 10 years and 82 per cent of immigrants in Canada 10 years or more say their primary care provider always or often involves them in decisions about their care and treatment. Among Ontarians born in Canada, 88 per cent say they are involved.
  
  
• 50 per cent of people aged 50 to 74 living in the lowest-income urban neighbourhoods are overdue for colorectal cancer screening, compared to 35 per cent in the highest-income neighbourhoods.
  
  
• 15 per cent of recently hospitalized people in the lowest-income neighbourhoods are back in hospital within 30 days, compared to 12 per cent of people in the highest-income neighbourhoods.
  
  
• Many Ontarians can't get same or next-day access to their primary care provider when they are sick, especially those living in rural, northern or remote areas.
  
  
• While 94 per cent of Ontarians aged 16 or older say they have a primary care provider, only 44 per cent of Ontarians report having access to same-day or next-day appointments with their primary care provider when they are ill.
  
  
• 28 per cent of residents living in the area covered by Ontario's North West Local Health Integration Network are able to see their primary care provider on the same or next day when sick. The North West network includes roughly the western half of the province north of Lake Superior.
  
  
• In rural areas, 35 per cent of people are able to see their primary care provider on the same or next day when sick, compared to 46 per cent in urban settings.
  
  
• After being hospitalized for conditions such as lung disease or heart problems, 22 per cent of patients in the North East network had a follow-up visit with a primary care doctor within seven days of discharge, compared to 38 per cent in the Central West network just northwest of Toronto.
  
  
• Although there has been improvement in screening for colorectal cancer overall, more people in northern regions of Ontario are overdue for colorectal cancer screening than in the rest of the province. In the North West network, 46 per cent of people aged 50 to 74 are overdue for screening, compared to 37 per cent in North Simcoe Muskoka.

Physicians from each of York Region’s three hospitals agree that primary care is a crucial component of our health care system.

“We work collaboratively with our primary care physicians to ensure our Family Health Team has reserved appointments for same day access, as well as urgent care clinics that run in the evenings and on Saturdays,” Southlake Regional Health Centre department of family and community medicine chief Dr. Paul Cantarutti said.

Southlake is a community-affiliated teaching site for the University of Toronto, where family medicine residents are trained, he said.

“This gives us an increased ability to accept many patients from our community, including new Canadians, who might otherwise have difficulty obtaining access to primary care,” Cantarutti said. “Our department has also recently been an active participant with the Central Local Health Integration Network to develop strategies to improve quality measures across our entire region.”

Mackenzie Health provides excellent patient care for residents across Southwest York Region and beyond, chief of family practice Dr. Jack Moussadji said, adding the catchment is a growing and diverse community.

“Keeping up with the demand for health care services in a growing area is challenging, but we are fortunate to have a large number of primary care providers in the community, of which 134 are credentialed at Mackenzie Health,” he said.

As the lead organization for the Southwest York Region Health Link, Mackenzie Health is fostering collaboration with 20 community partners across the continuum of care to help make it easier for people who rely on the system the most, such as seniors and people with complex conditions, to access health care in our region, Moussadji explained.

Markham Stouffville Hospital and its Health for All Family Health Team has put a focus on global health, family medicine chief  Dr. Alan A. Monavvari said. The hospital’s global health mandate has been able to reduce some of the disparities faced by newcomers.

“Part of our mandate as a family medicine teaching unit is to train future health care providers to be culturally sensitive in their practice,” he said.

On findings pertaining to same or next-day appointments, Monavvari noted that as health care providers, “We need to think outside of the box and make accessing health care services in a timely manner easier for our patients.” The hospital has tried to improve access by having after-hours availability to increase same or next-day access.

Primary care providers who use electronic medical records with reminder systems do much better with colon cancer screening numbers, he added

“I commend HQO for putting this report together,” he said. “The more we look at data and outcomes, the better health care will become.”