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Canada Gets Poor Marks in International Health Survey of Doctors

Posted on: Thursday, 2 November 2006, 18:01 CST

By BETH GORHAM

WASHINGTON (CP) - Canada lags far behind other countries except the United States in an international study of effective primary health care for patients released Thursday by the Commonwealth Fund.

The survey of more than 6,000 doctors in seven countries gave Canada poor marks on several aspects of patient care, including wait times for tests, use of electronic medical records, doctors available after hours, multi-discipline teams to treat chronic illness and financial incentives for improving quality of care.

The survey suggested Canada has a long way to go on many fronts to catch up with the other countries, which included the United Kingdom, Netherlands, New Zealand, Australia and Germany.

For instance, only 47 per cent of Canadian doctors have arrangements for after-hours care so people can avoid going to an emergency room, compared with 95 per cent in the Netherlands. Only the United States is lower than Canada at 40 per cent.

Other findings include:

-Fifty-one per cent of Canadian physicians report patients face long waits for diagnostic tests, compared with six per cent in Australia.

-Canada's doctors wait longest for full hospital discharge reports or don't get them at all.

-Only 23 per cent use electronic medical records, the lowest percentage and far behind 98 per cent in the Netherlands.

Most doctors don't use computers to prescribe medications, access test results and hospital records, receive alerts about potential problems with drug doses or interactions or know when patients are overdue for essential care.

-Thirty-two per cent routinely work with multi-discipline teams and non-physicians to treat chronic illnesses, compared with 81 per cent in the United Kingdom.

-Forty-one per cent report getting government financial incentives to improve care, compared with 95 per cent in the U.K.

-Canada had the lowest rate of doctors giving plans for home care to patients with chronic diseases.

-Only 27 per cent of doctors set formal targets for clinical performance, compared with 70 per cent in Germany and the U.K. Few collect information on patient satisfaction or clinical outcomes.

A Canadian official acknowledged the country needs to do a lot better in a number of areas, especially wait times and ensuring that doctors have information technology.

"While we are certainly not celebrating the results," said Frank Fedyk, acting assistant deputy health minister, "we are happy to note that they confirm what we already know, areas where we are, in fact, already taking action.

"We recognize that primary care health renewal involves fundamental changes in the organization and delivery of health services and not simply more of the status quo," he told a news conference held by the private, non-partisan research group.

In particular, he said, there's a growing consensus in Canada about the need for team-based, comprehensive care. Such family health networks are treating about half of Ontarians now but have been slow to spread through the rest of the country.

Ottawa and the provinces agreed in 2003 to a target of providing 50 per cent of Canadians with round-the-clock access to a doctor outside a hospital by 2011.

And provinces are negotiating with doctors on varying incentives to spend more time with patients, said Fedyk.

"It's still early days so more evaluation will need to be done."

A federal-provincial health accord signed two years ago worth C$41.3 billion channelled more money into reducing wait times in five specific areas - cancer care, heart operations cataract removal, hip and knee replacement and diagnostic imaging.

The Canadian Medical Association said earlier this month it's now looking at whether there's a huge backlog for other surgeries.

Since 2001, Canada has invested more than C$1 billion in initiatives for accelerating information technology, said Fedyk, but most of the money is going to hospitals first.

CMA president Colin McMillan said many doctors can't afford the investment on their own and aren't getting paid to become involved in a multi-purpose practice.

"The new generation will be much more responsive and adaptive," he predicted.

Michael McBane at the Canadian Health Coalition said he wasn't surprised by the study results, charging that some doctors are driving up waiting times by protecting their turf and aren't held accountable to the public, resulting in misappropriation of scarce resources.

"There's a lot of inappropriate referrals to specialists. We're not using physicians properly. They don't spend enough time with patients to do the prevention work."

That's not going to change, he said, unless Ottawa stands up to the profession and forces change on how they operate.

"It's not acceptable for the prime minister to shirk responsibility for leadership in health care," said McBane.

Source: Canadian Press

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