1. Access to After-hours Primary Care in Ontario __________________________
Dr. Glen E. Randall
Dr. Michelle Howard
McMaster University
Ontario, Canada
Presented at:
1st International Conference on Healthcare Transformation: Primary Care
May 10, 2008
Singapore

2. Access to After-hours Primary Care in Ontario
Acknowledgments ________________________________________________________
Research funded by the Ontario Ministry of Health and Long Term Care
NOTE:
The view expresses in this presentation are the views of this author and do not necessarily reflect those of the Ontario Ministry of Health and Long Term Care.
Please do not cite information contained in this presentation without the prior written consent of the authors.
May 10, 2008
Access to After-hours Primary Care in Ontario

3. Background ________________________________________________________
Ontario’s health care system
Public funding / private provision
On-going efforts by the government to implement primary care reform initiatives
Access to after hours care
Funding models (13 main models now)
In 2001, 59% of family physicians in Ontario reported providing some form of after-hours care for their patients
May 10, 2008
Access to After-hours Primary Care in Ontario

4. Access to After-hours Primary Care in Ontario
Research Objectives ________________________________________________________
To describe the options for after-hours care offered by family physicians’ offices
To determine whether physician characteristics, geographic region, or type of physician practice are associated with after-hours care options
May 10, 2008
Access to After-hours Primary Care in Ontario

5. Methodology ________________________________________________________
Cross-sectional telephone survey
1680 randomly selected family practice physicians from the Canadian Medical Directory
Stratified by 14 health regions (LHINs – Local Health Integration Networks)
Contacted:
8-10:30 pm Monday through Friday
9-12:00 pm Saturday
Data collected October 2007 to February 2008
Recorded specific instructions provided to patients for accessing after-hours care
Univariate analysis and logistic regression conducted
May 10, 2008
Access to After-hours Primary Care in Ontario

6. Results ________________________________________________________
1,680 physicians telephoned
578 (34%) ineligible
161 – incorrect telephone number
395 – non-family practice setting (e.g. other specialty or hospital)
22 – declined to provide information
Ineligible numbers were distributed evenly across the province
1102 included in the study
May 10, 2008
Access to After-hours Primary Care in Ontario

7. Access to After-hours Primary Care in Ontario
Results – Funding Models ________________________________________________________
Funding Model
family practices
negation
Family Health Group
534 (48.5%) no
Family Health Network
226 (20.5%)
yes
Family Health Organization
65 (5.9%)
Rural and Northern Physician Group
22 (2.0%)
Group Health Cooperative
8 (0.7%)
Other Special Reform Arrangements
36 (3.3%)
Non-Reform Models
211 (19.1%)
May 10, 2008
Access to After-hours Primary Care in Ontario

8. Results ________________________________________________________
Patient instructions:
58.6% use emergency services (hospital emergency department or call “911”)
14.7% only gave this advice
45.0% call THAS nurse-staffed telephone health advisory service for rostered patients (access to on-call physician)
8.0% direct number for on-call physician
6.9% Tele-Health Ontario
8.2% some other option (e.g. after-hours clinic)
13.9% provided no instructions
May 10, 2008
Access to After-hours Primary Care in Ontario

9. Access to After-hours Primary Care in Ontario
% (n) of Physician offices in row giving each instruction in their message
Telephone health advisory service
P value
After-hours clinic
Walk-in clinic
Certified in family medicine
Yes (n=565)
No (n=537)
48.7 (275)
41.1 (221)
0.01
28.5 (161)
27.2 (146)
0.63
5.3 (30)
8.6 (46)
0.03
Hospital appointment
Yes (n=639)
No (n=463)
47.3 (302)
41.9 (194)
0.08
29.3 (187)
25.9 (120)
0.22
6.6 (42)
7.9 (34)
0.62
Year of medical school graduation
Before 1970 (n=129)
(n=291)
(n=350)
1990 and later (n=332)
39.5 (51)
40.9 (119)
52.9 (185)
42.5 (141)
0.28
28.7 (37)
27.5 (80)
26.0 (91)
29.8 (99)
0.71
9.3 (12)
8.2 (24)
6.3 (22)
5.4 (18)
0.35
Medical school in Canada
Yes (n=889)
No (n=213)
46.9 (417)
37.1 (79)
28.6 (254)
24.9 (53)
6.4 (57)
8.9 (19)
0.19
University appointment
Yes (n=99)
No (n=1003)
51.5 (51)
44.4 (445)
0.17
27.3 (27)
27.9 (280)
0.89
4.0 (4)
7.2 (72)
0.24
Gender
Female (n=385)
Male (n=717)
46.8 (180)
44.1 (316)
0.39
29.6 (114)
26.9 (193)
0.34
7.3 (28)
6.7 (48)
0.72
May 10, 2008
Access to After-hours Primary Care in Ontario

10. Not in reformed model (n=211)
Instructions given in telephone message for physicians in reformed model and physicians not in a reformed model ________________________________________________________
In reformed model (n=891)
Not in reformed model (n=211)
P value
Telephone health advisory service (THAS)
52.5 (468)
13.3 (28)
<0.001
Tele-health Ontario
5.8 (52)
10.0 (21)
0.03
Emergency department, urgent care centre or 911
59.9 (534)
53.1 (112)
0.07
Walk-in clinic
7.2 (64)
5.7 (12)
0.44
Do not use walk-in clinic
1.3 (12)
0.5 (1)
0.29
After-hours clinic
32.0 (285)
10.4 (22)
On-call physician
7.0 (62)
12.3 (26)
0.01
Other number- not mentioning any of above
12.6 (26)
Only emergency dept/urgent care/911.
12.6 (112)
23.7 (50)
None of the above
11.1 (99)
25.6 (54)
May 10, 2008
Access to After-hours Primary Care in Ontario

11. Discussion ________________________________________________________
14.7% of practices limited instructions to emergency services
12% in a reform model
23% on other practices
13.9% of practices do not provide any instructions
11% in a reform model
25% in other practices
27.7% provided no after-hours care
23.7% in reform practice
44.5% in other practices
May 10, 2008
Access to After-hours Primary Care in Ontario

12. Conclusions ________________________________________________________
No significant relationship between physician characteristics and availability of after-hours care
Physicians in a reform model were
More likely to offer after-hours clinic, use THAS and use Tele-health
Less likely to provide no service or to suggest emergency services
72.3% of family physicians in Ontario reported providing some form of after-hours care for their patients
Up from 59% in 2001
Despite improvement, this suggests the need for:
Greater use of reform models
Research to determine reasons for the lack of uptake of THAS and Tele-health services by those practices in a reform model.
May 10, 2008
Access to After-hours Primary Care in Ontario

13. Access to After-hours Primary Care in Ontario
Thank You!
Questions?
May 10, 2008
Access to After-hours Primary Care in Ontario