What we’re doing: Primary care is the first point of contact and primary point of continuing care for patients within a health care system. In Canada, primary care is typically delivered by general practitioners or family physicians but can also be delivered, for example, by pediatricians, nurse practitioners, or a team of health care professionals. Primary care plays an especially important role in disease prevention, health promotion, care coordination and management of acute and chronic illnesses and injuries. Health systems with strong primary care systems have been shown to have better health outcomes, lower costs, and fewer health disparities. We are using a range of data and methods to explore how primary care is delivered in Ontario, the quality of primary care, and the equity of care and related outcomes.

Why we’re doing it:  In recent years, Ontario introduced a number of changes to the way family doctors are compensated and organized to deliver care to patients. Prior to 2002, the vast majority of family doctors were paid by the visit (fee-for-service) and most worked in independent offices. Now, seventy-five percent of family physicians in Ontario are part of a ‘medical home’ model. These new ‘medical home’ models generally include:

  • Patient enrollment, where a patient and doctor sign a document formalizing their relationship.
  • A group of physicians working together.
  • Access to after-hours care.
  • At least some portion of physician payment provided per patient (capitation) rather than per service (fee-for-service).
  • A range of incentives for physicians related to chronic disease management.
  • In some cases, access to other health professionals such as nurses, social workers, nurse practitioners, pharmacists, and dietitians (this model is called the Family Health Team).

We are exploring the impacts of these changes, with a particular focus on patients living on low incomes, and patients who are new immigrants.

How we’re doing it: We are using different combinations of data such as health care records, Citizenship and Immigration Canada records and Census records.

What we’re asking:

We have a range of studies underway. Here are some we’ve completed, and others that are in progress.

Q: Is quality of care different for patients attached to medical homes vs. patients who are accessing different types of primary care such as walk-in clinics or fee-for-service family physicians?

A: Yes. Patients attached to medical homes are more likely to receive appropriate diabetes screening, and to receive screening for cervical, breast and colorectal cancer. But one in six Ontario residents still does not belong to a medical home. In particular, patients who are living on low incomes and/or who are new immigrants are less likely to be attached to a medical home. Read a plain language discussion of the findings here, and full text of the paper here. You can also explore a presentation here.

Q: Is quality of care different for patients in different types of medical homes?

A: To some degree. There are minimal differences when it comes to rates of cancer screening. Patients enrolled with Family Health Teams, however, were more likely to receive recommended testing for diabetes. Read full text of the paper here. You can also explore a presentation here.

Q: What kinds of patients are accessing inter-professional Family Health Teams?

A: In 2012, we found that new immigrants, people living in cities, and people who are sicker are less likely to access Family Health Teams. We recently explore the reasons for this inequity, and some solutions, here.

Q: Has the introduction of medical homes and expansion of after-hours care decreased emergency room visits in Ontario?

A: We are currently exploring this question and will have analysis available soon.

How are we sharing our results?

We are sharing our results directly with the Ministry of Health, and various Local Health Integration Networks. We will also be creating plain language materials for patients, outlining what to look for in a medical home.

For more information, contact: Dr. Tara Kiran at kirant@smh.ca