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Patients not attached to new primary care practices receive lower quality care, research suggests

Toronto, November 14, 2016

By Kelly O'Brien

Tara Kiran
Tara Kiran

One in six patients in Ontario does not belong to an organized primary care practice, new research suggests. These patients receive lower quality care and are more likely to be poor, urban and new immigrants, the study says.

The Ontario government has invested millions of dollars in reforming the primary care system to improve access and quality of care. Fifteen years ago, most doctors practiced alone and were paid by the visit (fee-for-service). Now, most doctors are part of groups where they formally enroll patients, provide after-hours care, and get some lump-sum payment per year for looking after their enrolled patients (capitation). Joining these new groups was voluntary for doctors and their patients.

When reforms are voluntary, there is a risk the most vulnerable in society will be left behind, said Dr. Tara Kiran, a family physician at St. Michael’s Hospital, an adjunct scientist at the Institute for Clinical Evaluative Sciences and lead author of the study.

In the study, published today in Annals of Family Medicine, Dr. Kiran and colleagues analyzed Ontario data from 2001 to 2011. They found that patients who didn’t belong to these new primary care practices were more likely to reside in an urban area, live in a low-income neighbourhood and have immigrated to Canada in the last 10 years.

The study also found that patients left out of new primary care practices were less likely than those who were included to be screened for cervical, breast, and colorectal cancer (52 per cent vs. 66 per cent, 58 per cent vs. 73 per cent and 44 per cent vs. 62 per cent, respectively), and were less likely to receive recommended tests for diabetes (25 per cent vs. 34 per cent ).

In 2011, 2, 376, 248 (18 per cent of) Ontarians did not belong to these new primary care practices.

“Some of these people that have been left behind are seeing traditional fee-for-service doctors,” said Dr. Kiran. “But others might not want a regular primary care doctor or perhaps couldn’t find one and are getting care from walk-in clinics.”

Dr. Kiran said that patients left behind from these new groups had poorer quality of care even before reforms were introduced and the gaps in quality of care seem to have widened over time.

The report follows the Ontario government’s introduction of the Patients First Act, a goal of which is to improve access to primary care. Dr. Kiran said there are lessons to be learned from what worked and what didn’t during the last round of reforms.

She said that new reforms need to specifically reach out to more vulnerable groups of patients to connect them with a primary care provider.

“We need to educate new Canadians about what good primary care looks like and how they can access it,” said Dr. Kiran.

Dr. Kiran said health care leaders should also be reaching out to doctors who still practice alone and finding ways to support them and their patients.

“To improve care for all Ontarians, there needs to be specific strategies to reach out to both patients and physicians who are not currently part of an organized primary care practice,” she said.


This paper is an example of how St. Michael's Hospital is making Ontario Healthier, Wealthier, Smarter.

About St. Michael's Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael's Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.

About ICES

The Institute for Clinical Evaluative Sciences is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of health care issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting health care needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. For the latest ICES news, follow us on Twitter: @ICESOntario

Media contacts

For more information, please contact:

Kelly O'Brien
Communications Advisor - Media, St. Michael's Hospital
416-864-5047
obrienkel@smh.ca

Deborah Creatura
Media Advisor, ICES
(o) 416-480-4780 or (c) 647-406-5996
deborah.creatura@ices.on.ca