Ontario patients lack immediate access to family doctors when sick: report

Theglobeandmail.com
Nov. 10, 2015
By Elizabeth Church

Less than half of Ontario residents can get an appointment with their family doctor or other primary care provider within 48 hours when they are sick, and close to a quarter can’t get their call returned the same day, says a new study that measures access levels across the province.

The new numbers, released Tuesday, come at a time when the province’s Health Minister is vowing to improve access. While the new figures bolster the case for reform, they are likely to increase the already strained relations between the province and its doctors, who are locked in a months-long dispute over fees that has prompted physicians to launch a Charter challenge.

Joshua Tepper, the chief executive officer of Health Quality Ontario, the provincial agency that prepared the report, and a family doctor himself, said the findings provide a “flag” for problem areas. They show that issues of access go beyond having a primary care provider, he said, and that they vary depending on location and demographics.

“In Canada, where primary care is the gateway to the rest of the system, it is important that it be robust,” Dr. Tepper said. “We should know how it is performing.”

The new report finds that while 94 per cent of Ontario residents say they have a primary care provider, 44 per cent say they can’t get a same-day or next-day appointment when they are sick. Only 77 per cent say they can reach someone in the office when they call or receive a return call the same day.

The report did not provide targets. But it did note that the availability of same-day or next-day appointments puts Ontario in the last spot when compared with a group of 10 other countries with similar social and economic status.

Access also varies depending on where in the province someone lives. Those in the North are less likely to have a primary care provider, such as a family doctor or nurse practitioner, as are those living in the central core of Toronto. About 85 per cent of immigrants who have been in Canada for less than 10 years have a primary care provider - almost 10 per cent lower than the general population.

Dr. Tepper said the report is the first effort to publicly monitor the performance of primary care in the 14 health regions of the province, in the same way that hospitals and long-term care homes have been evaluated through numbers such as wait times.

The release of the benchmark study comes days after Health Minister Eric Hoskins told a hospital conference in Toronto that primary care should be organized “around the needs of patients” and promised to “significantly improve same-day or next-day access to care.”

A report on primary care reform prepared for the province by an expert panel, released last month, recommended that patients be organized into groups based on geography, much like students in school districts, in order to ensure access. The report, which was released without comment by the province, said patients would still be free to go outside their area to choose their own doctor, but health professionals in a given region would be responsible for ensuring all residents had access to primary care, including after-hours and on weekends.

Dr. Tepper, who was a member of that expert panel, said it is a coincidence that the provincial agency he heads has also chosen now to look at access to primary care, describing it as an “area of opportunity” that was identified by the agency’s board.

The study looks at other measures, such as the rate of follow-up by primary care doctors within seven days of discharge from hospital, hospital readmission rates within 30 days of discharge and colorectal cancer screening rates.

The measures will be monitored for changes each year, and individual doctors can ask to access their own data confidentially to see how they compare with provincial and local averages, Dr. Tepper said.