Canada’s primary care quality lags other nations

OTTAWA – A survey of primary care in 10 industrialized countries shows Canada at the low end of the pack when it comes to many measurements of quality. In particular, the Commonwealth Fund’s survey found only 53% of Canadian doctors reporting that patients who request a same-day or next-day appointment can get one. That puts Canada in ninth place in this category – with Switzerland at the top (85%) and Sweden at the bottom (42%).

Moreover, Canadian primary care doctors are considerably less likely than doctors in other countries to routinely review surveys on patient satisfaction and patient experiences (17% versus 47%), or to compare their performance with that of other primary care practices (17% versus 37%).

These and more insights come from How Canada Compares: Results From The Commonwealth Fund 2015 International Health Policy Survey of Primary Care Physicians. The study was released in January by the Canadian Institute for Health Information (CIHI) in partnership with the Canadian Institutes of Health Research, and with co-funding from Canada Health Infoway.

“Primary care is the hub of patients’ healthcare experiences. If it isn’t strong and working efficiently, patients won’t get the best possible care,” said Commonwealth Fund President David Blumenthal, M.D (pictured). “Taking steps to encourage doctors, nurses, and social service providers to work together in teams, making it easier for patients to get care on nights and weekends, and facilitating better communication between providers are essential to creating better primary care.”

The Commonwealth Fund survey polled primary care doctors in 10 countries on topics such as access to care, coordination of patient care, organization of practice, use of information technology and performance measurement.

The survey also found the following:

• Only 48% of Canadian doctors have an arrangement in their practice where patients can see a doctor or nurse if needed when the practice is closed (after hours) without going to the hospital emergency department. This is second lowest in the 10-country cohort, higher only than the United States.
• The Netherlands was highest in this category, at 94%, while the group average was 75%.
• 40% of Canadian primary care doctors thought their patients often experienced difficulty getting specialized diagnostic tests (e.g., CT imaging, mammogram, MRI). That was second worst in the group, with only New Zealand reporting a higher figure (54%).
• Wait times to see a specialist were rated worst in Canada, as 70% of Canadian primary care doctors thought their patients often experienced long wait times to see a specialist. That compared with 9% in Switzerland and an average of 45% among the 10 countries.
• When it comes to coordination of primary care and home care, Canada scored 8th on the list of countries. Physicians were asked if their practices routinely communicate with a case manager or home care provider about a patient’s needs when a patient is receiving home care services.
• Canada also ranked 8th out of 10 nations when asked if they are routinely advised of a relevant change in the condition or health status of their patients who are receiving home care services.
• The survey looked at how physicians are using their EMRs to support quality of care.
• Canada scored 7th among the 10 countries whose physicians routinely use a computerized system for at least 2 of the following:
• Electronic alert or prompt about a potential problem with drug dose or drug interaction
• Reminder notices for patients when it is time for regular preventive or follow-up care
• Alert or prompt to provide patients with test results
• Reminder for guideline-based interventions and/or screening tests.

The countries surveyed included:

Canada
United States
United Kingdom
Germany
Switzerland
Sweden
New Zealand
Netherlands
Australia
Norway

Based in the United States, The Commonwealth Fund is a private foundation that aims to promote a high-performing healthcare system that achieves better access, improved quality and greater efficiency, particularly for society’s most vulnerable populations.

The Commonwealth Fund 2015 International Health Policy Survey of Primary Care Physicians received core funding from The Commonwealth Fund and co-funding from the following organizations for an expanded Canadian sample within Canada: the Canadian Institute for Health Information; the Canadian Institutes of Health Research; Canada Health Infoway; the Commissaire à la santé et au bien-être du Québec; and Health Quality Ontario.