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Dr. Joshua Tepper

Exploring Common Barriers to Care Coordination

Health Quality Ontario’s latest report reviews responses from a recent Commonwealth Fund survey of family doctors across Canada and the world and shows areas where Ontario’s care services can improve.

Proper care coordination is an important element of patient-centered care, and a role that often falls to primary care.

Yet care coordination in Ontario isn't delivered as uniformly or consistently as it could be.

Our report, Connecting the Dots for Patients, explores how the health system can work together to enhance transitions for better quality care.

It’s a topic that couldn’t be timelier as increasing numbers of patients with complex care conditions will soon come to rely on our health system, and larger teams spread across multiple settings will soon be required to provide care. As these changes occur, we must ensure that gaps in care coordination and communication don't grow with them.

Our report shows that less than a third (29%) of family doctors in Ontario say they, or members of their team, routinely communicate with their patients’ case manager or home care provider about their patients’ needs and services to be provided. To put that number into perspective: More than twice as many family doctors in Saskatchewan (62%) say they regularly communicate with home care.

This means that compared to the rest of Canada’s provinces – and many other countries in the world – Ontario reports one of the lowest percentages of family doctors communicating with home care and community services.

Connecting the Dots for Patients explores the complex issues involved in care coordination and other system-related barriers using data from the 2015 Commonwealth Fund International Health Policy Survey of Primary Care Doctors. The survey combined and analyzed the responses of thousands of family doctors from across Canada and 10 other counties, including Australia, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom and the United States.

Compared to Ontario, the survey shows that more family doctors in many other countries around the word report regularly communicating with home care. For example, in Norway as many as 63% of family doctors report routinely communicating with home care and 56% of family doctors report the same in the Netherlands.

As a family doctor, I understand first-hand many of the difficulties that primary care providers may experience in coordinating care.

For example, one of my patients – a man in his 50s with multiple chronic conditions – interacts with more than eight doctors and several other health care providers. He is on 15 different medications, almost none of which I’ve initially prescribed, and has a steady stream of investigations at centres across the city. Yet, I am often his first call when he has issue.

In this instance, providing care takes a lot of time and effort and requires many different people. Still, it’s not a given that every family doctor has the time or team to support patients with these type of needs. While there have been significant efforts made by many primary care providers and health care professionals to ensure good care coordination, there is more work to be done. Support needs to be available regardless of geography or model of primary care practice.

The report also looks at ease of communication between providers and finds that just 36% of family doctors in Ontario say it is “easy” or “very easy” to coordinate their patients’ care with social services or other community services when needed. Meanwhile, that percentage climbs in other areas of the world, with more than twice as many family doctors in Switzerland (74%), more than half of Saskatchewan family doctors (55%) and 45% of Nova Scotian family doctors all reporting the same.  

That said, there are areas that show positive results when it comes to Ontario’s family doctors coordinating care with hospitals and specialists. With respect to hospital discharge notifications, 71% of family doctors report “always” or “often” receiving a notification with their patient is discharged. That’s one of the highest rates in Canada, in comparison with Quebec (52%), Manitoba (58%), Saskatchewan (61%) and Alberta (63%).

And 90% of family doctors in Ontario say they’ve received a report from specialists involved with their patients’ care, which is similar with other provinces in Canada (except Quebec, where it’s 66%) and better than other countries, included Sweden (56%), the United States (76%), Germany (82%), Australia (83%) and the United Kingdom (84%).

Lastly, only a handful of family doctors in Ontario (25%) report that tests or procedures for their patients had to be repeated during the past month, because results were unavailable. This number is better by comparison to many family doctors in provinces across Canada and other countries, including the UK, where 48% of family doctors report repeat tests being required.

Moving away from the data, I appreciate how our report is enriched by stories from primary care providers. We hear from nurse practitioner Stephanie Skopyk, who discusses integrating primary care and social services at her clinic in Oshawa. Dr. Thuy-Nga (Tia) Pham reflects on the benefit of having a dedicated case manager from her clinic in East Toronto. While Dr. Harry O‘Halloran speaks candidly about the challenges of obtaining information for patients outside of the local systems and its impact on patient outcomes from his Collingwood practice.

These stories give us important insights into the different obstacles many primary care providers may face in their day-to-day practice. While the report itself doesn’t pinpoint the specific barriers to care, it does show us where there is room for improvement. Two examples to address these areas include Health Quality Ontario’s strategic plan, Better Has No Limit, which recognizes the need to focus on enhancing transitions between different types or settings of care in order to address such gaps; and the Ministry of Health and Long-Term Care’s discussion paper, Patients First, which also identifies areas where primary care can become more patient-centred.

It is my hope that you will read our report and share it with your networks. It takes dedicated effort on behalf of everyone in the system to improve the way we coordinate and communicate care. It needs to be easier to do the right thing for patients.

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