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New Report: Quality in Primary Care

Health Quality Ontario releases new report that reveals not everyone in Ontario is receiving the same level of primary health care.

Getting the best primary care in Ontario may depend on where you live or who you are.

That’s because not everyone can access same-day or next-day care when they are ill, or receive a timely call back after phoning their primary care provider. Some Ontarians feel more involved than others in decisions related to their care. And screening tests for certain conditions aren’t occurring at the same rate across the province. These findings and others are presented in Health Quality Ontario’s recently released report, Quality in Primary Care.

This report captures many of the challenges I’ve seen within the primary care sector from my perspective as a family doctor where my clinical practice has taken me to many different parts of Ontario. From my time in northern Ontario in the earlier part of my career to my current work with homeless individuals and first-generation immigrants in Toronto, I have seen similar frustrations, shared both by providers and patients.

There is a need to think differently about how the primary care sector offers its services in addressing inequities - and this need spans many geographies and communities.

Everyone expects care to be equitable, whether we live in low-income neighbourhoods, rural communities or northern areas, and regardless of the languages we speak.

But our report shows that’s not always the case right now.

While most people in Ontario (94%) say they have a family doctor, some are able to see their primary care provider easier and faster than others.

The gap appears most noticeably when we compare same-day or next-day access for people who are in urban settings to those in rural or northern communities: Just 28% of people in the North West region and 35% of people in all rural areas are able to see their primary care provider on the same day or next day. Meanwhile, that number climbs to 46% for people in urban settings.

Another significant disparity is seen if you speak a language other than English or French at home. Patient-centered, safe care relies on effective communication. Yet our report shows non-English speakers are less likely to get a timely response from your primary care provider when you call their office. In fact, 68% of non-English speakers reported speaking to someone or getting a call back compared to 79% of English speakers. Similarly, 78% of new immigrants to Ontario, compared to 88% of Ontarians born in Canada, say their primary care provider always or often involves them in decisions related to their care.

We also saw inconsistencies in the quality of evidence-based care Ontarians in low-income groups receive. Many are overdue for some forms of screening: 50% of people aged 50-74 living in the lowest-income urban neighbourhoods haven’t received colorectal cancer screening. For the highest-income neighbourhoods, the number drops to 35%.

This report is not intended to point fingers or suggest blame on anyone’s part. Rather, this report should stimulate new and important conversations. It should emphasize the need to include equity as a lens in our quality improvement work. Equity is one of six dimensions of health care quality and should be front of mind as we continue to monitor performance in primary care.

There’s quote that seems fitting, it’s one often attributed to Ghandi. “The greatness of a nation can be judged by the way it treats its weakest members.” Novelist Pearl Buck said it similarly: “The test of a civilization is the way that it cares for its helpless members.” While I don’t agree with using terms like “weak” or “helpless” to describe people, I do appreciate both sentiments and believe our health system should be attuned to all members in our community and province.

We know that primary care forms the foundation upon which a healthy health system is built; but, it is weakened by inequities across the health system. To better understand these and other aspects of our primary care system I encourage you to read the report.

I hope this report starts an important discussion. Please read it and share it and tell us your thoughts on Twitter @HQOntario or directly to me at @DrJoshuaTepper. Data from the indicators we reported on will be updated regularly as part of our ongoing work to monitor and report on primary care. Please visit our website for more details.

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