Disparities in Primary Health Care Experiences Among Canadians With Ambulatory Care Sensitive Conditions. Published by the Canadian Institute for Health Information. 2011.
This report examines primary care treatment access and care for ambulatory care sensitive conditions, which are defined as conditions that can be managed on an outpatient basis. Examples of these conditions include: asthma, diabetes, chronic obstructive pulmonary disease, some heart diseases, and high blood pressure. One in three Canadian adults lives with an ambulatory care sensitive condition, placing substantial demand on health care system resources. Increasing the effectiveness of primary care can help prevent further health complications and hospitalizations for these conditions, and improve cost-effectiveness of the health care system.
Descriptive analysis and multiple logistic regression analysis of data collected from the 2008 Canadian Survey of Experiences with Primary Health Care revealed disparities in primary health services for sex, geographic location, household income, and health factors.
Low income individuals were both more likely to use primary health care services, and to visit the emergency room for a condition they perceived to be effectively manageable through primary health care. They also reported reduced access to after-hours care. As well, these individuals were less likely to report being involved by their physician in the decisions for managing their care and developing a treatment plan.
Women were less likely than men to receive medical advice for managing their condition and prescription drug side effects, and were less likely to report receiving the four recommended tests for monitoring disease within the previous year.
Individuals from rural areas and individuals with three or more chronic conditions (including at least one ambulatory care sensitive condition) were both more likely to report visiting an emergency room for a condition perceived to be treatable by their primary health care provider. However, people with multiple chronic conditions were also more likely to report being involved in treatment decisions, receiving the four recommended tests for monitoring chronic disease, and the necessary support to manage their health independently.
The cost savings of improving access to primary health care for ambulatory care sensitive conditions, and reducing the number of hospitalization and emergency room visits is significant. Estimated average costs suggest $34 million in savings for every 10% reduction in hospitalizations.
Models for improving primary health care include: supporting patients in managing their conditions, and implementing electronic record keeping to improve health information. Initiatives that are implemented or being developed in Canada include: communication technologies that allow rural Canadians to connect to medical professionals more easily, nurse-led clinics in areas with lower levels of primary care service, and methods to decrease financial barriers to health care treatment in low-income populations.
The authors recommended exploring further options to address disparities in primary health care services, and monitoring programs aimed at addressing health care inequalities to determine their effectiveness.
As stated by the authors, one of the main limitations of the study is that it does not measure the quality of primary health care received, or whether the care was even related to the ambulatory sensitive condition. Therefore, they cannot establish a link between primary care for ambulatory sensitive conditions and adverse health outcomes.
Another problem with using data collected from a survey is that the data is self-reported; thus, the results may be skewed due to misinterpretation of the questions or poor recall. This may vary between demographics if there is a disparity in communication skills, potentially resulting in inaccuracies for some but not others.
The sample size of 4,138 was estimated as equating to 7.9 million Canadians. Given that the population of Canada is over 34 million, this calls into question whether the sample size was large enough to provide representative results for the entire country.
One aspect of the study that strengthened the findings was that the survey results were compared to data from electronic records of health care providers (CIHIs Primary Health Care Voluntary Reporting System) for individuals with multiple chronic conditions, and were found to be consistent.
Despite the limitations of the study, this research provides insight into the experiences of individuals from various demographics with primary health care. The information can be used to develop effective programs and services aimed at improving quality and access of primary health care to vulnerable groups, which may help to reduce adverse health outcomes and provide considerable cost savings to the health care system. Reviewed by Elise Broughton