1 Canadian Institute for Health Information

Disparities in Primary Health Care Experiences Among Canadians With Ambulatory Care Sensitive Conditions Released March 6,

Analysis in Brief Outline Health and economic burden of ambulatory care sensitive conditions (ACSCs) in Canada Prevalence estimates on primary health care experiences (access to, use of and appropriateness of care) for those with ACSCs, according to –Sex, adjusted household income, rural or urban residence and presence of multiple chronic conditions to assess whether systemic differences exist in primary health care A brief overview of initiatives and programs to strengthen primary heath care in Canada 3

Methods and Definitions 2008 Canadian Survey of Experiences With Primary Health Care is used to report on primary health care experiences –Accessibility, utilization, clinical management and support for self-management of chronic conditions The results are based on the population age 18 and older, living in private dwellings and reporting having been diagnosed with an ACSC (n = 4,138) ACSCs are medical conditions that can be managed with adequate primary health care on an outpatient basis, such as –Asthma, chronic obstructive pulmonary disease, diabetes, high blood pressure, certain heart diseases 4

Health Burden of ACSCs ACSCs cause considerable illness, hospitalization and death among Canadians and result in a high use of health care services According to the Canadian Survey of Experiences With Primary Health Care (2008), approximately 7.9 million, or one in three, adults (31%) were living with a diagnosed ACSC –30% of individuals with an ACSC reported having been diagnosed with three or more chronic conditions that included at least one ACSC The burden of ACSCs is not shared equally among all population groups, with low-income individuals and those living in rural areas particularly affected 5

Primary Health Care Experiences Most adults with ACSCs reported overall satisfaction with their primary health care provider –Most had a place to go when they were sick or needed health advice (96%) and had a regular medical doctor (94%) –Most (87% to 89%) had no difficulties obtaining needed routine/ongoing care or health information/advice in the previous 12 months –Majority reported positive experiences interacting with their providers (56% to 70%) or receiving coordinated care from other doctors and places when needed (74%) 6

Primary Health Care Experiences Gaps in care remain for some Canadians with diagnosed ACSCs –One in five (21%) reported not contacting a family physician in the previous 12 months –One in eight (12%) reported that their last visit to an emergency department was for a condition that they perceived as being treatable by their primary health care provider –Many were not receiving recommended tests to monitor their chronic conditions (49%), appropriate management of their medications (40% to 42%) or support to self-manage their chronic conditions Lower-income individuals and females experienced particular challenges with primary health care 7

Disparities in Primary Health Care by Income 8 Source Canadian Survey of Experiences With Primary Health Care, 2008, Canadian Institute for Health Information, Health Council of Canada and Statistics Canada. Low-income individuals reported being high users of primary health care and of using emergency departments for conditions that they perceived as being treatable by their primary health care provider. However, they were less likely to report that their primary health care physician routinely involved them in clinical decisions or helped them make a treatment plan, compared with high-income individuals. Low-income individuals reported being high users of primary health care and of using emergency departments for conditions that they perceived as being treatable by their primary health care provider. However, they were less likely to report that their primary health care physician routinely involved them in clinical decisions or helped them make a treatment plan, compared with high-income individuals. Percentage

Disparities in Primary Health Care by Sex 9 Source Canadian Survey of Experiences With Primary Health Care, 2008, Canadian Institute for Health Information, Health Council of Canada and Statistics Canada. Females were less likely than males to report receiving all four recommended tests for chronic disease monitoring or to have medication side effects explained. Females were also more likely than males to report not receiving the tools to self-manage their conditions. Females were less likely than males to report receiving all four recommended tests for chronic disease monitoring or to have medication side effects explained. Females were also more likely than males to report not receiving the tools to self-manage their conditions. Percentage Primary Health Care Physician Generally Did Not or Almost Never

Disparities in Primary Health Care by Residence 10 Rural residents were more likely than urban residents to report that their last visit to an emergency department was for a condition that they perceived as being treatable by their primary health care provider. Percentage Source Canadian Survey of Experiences With Primary Health Care, 2008, Canadian Institute for Health Information, Health Council of Canada and Statistics Canada.

Those in Higher Need Received Higher Level of Primary Health Care 11 Source Canadian Survey of Experiences With Primary Health Care, 2008, Canadian Institute for Health Information, Health Council of Canada and Statistics Canada. Individuals with three or more chronic conditions reported being high users of primary health care and of using emergency departments for conditions that they perceived as being treatable by their primary health care provider. They were also more likely to report more positive experiences in the clinical management of their conditions and receiving support to independently manage their chronic conditions than those with a single ACSC. Individuals with three or more chronic conditions reported being high users of primary health care and of using emergency departments for conditions that they perceived as being treatable by their primary health care provider. They were also more likely to report more positive experiences in the clinical management of their conditions and receiving support to independently manage their chronic conditions than those with a single ACSC. Percentage

Strengthening Primary Health Care in Canada A number of strategies and models have been introduced to strengthen primary health care in Canada and internationally, which could influence health disparities. These focus on –The quality of patient–clinician interactions –Care delivery and records management –Supporting patients to self-manage their chronic conditions as a means of supplementing health care services –Improving individuals’ sense of control over their condition A number of initiatives are under way to specifically address disparities in access to primary health care for vulnerable groups –Some rural and northern areas are reorienting service delivery, employing nurse-led clinics to deliver primary health care in underserviced areas –In some areas, programs are being implemented to provide low-income populations with subsidies for prescription drugs, food supplements and transportation options to medical appointments 12

Conclusion This Analysis in Brief highlights that there is room for improvement in providing more equitable access to and use of primary health care, clinical management of chronic conditions and support for patients to self-manage their conditions Further research is needed to more fully understand and address these factors and to further explore the impact of primary health care initiatives on disadvantaged populations Addressing the gaps in care highlighted in this report could lead to more appropriate care and to a more efficient health care system 13

Peer Reviewers Dr. Rick Glazier, MD, University of Western Ontario, and MPH, Johns Hopkins University School of Public Health Dr. Michel Grignon, PhD, Director, Centre for Health Economics and Policy Analysis, and Associate Professor, McMaster University 14

About us... 15

About the Canadian Institute for Health Information (CIHI) CIHI established in 1994 as independent, not-for-profit corporation CIHI’s vision: To help improve Canada’s health system and the well-being of Canadians by being a leading source of unbiased, credible and comparable information that will enable health leaders to make better-informed decisions CIHI’s mandate: To lead the development and maintenance of comprehensive and integrated health information that enables sound health policy and effective health system management CIHI’s data holdings: 27 databases of health information Range of stakeholders in health system and beyond –Government organizations (such as Health Canada and Statistics Canada), ministries of health, regional health authorities, non- government organizations, private-sector organizations, professional associations, health facilities 16

About the Canadian Population Health Initiative (CPHI) CPHI is a branch within CIHI CPHI’s mission: To support policy-makers and health system managers in Canada in their efforts to improve population health and reduce health inequalities through research and analysis, evidence synthesis and performance measurement Work is guided by the CPHI Council, including representatives from government organizations, regional health authorities and research and academic institutes 17

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