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The number of patients in Ontario, Canada, who do not have a family physician increased by more than 20% during the first 2 years of the pandemic, according to recent data.
A cross-sectional study revealed that more than 2.2 million patients in Ontario were without a family physician, a figure that had increased from 1.8 million in March 2020. The study results were made available to the public and the Ontario government but have not been published in a peer-reviewed journal.
Investigators used Ontario Health Insurance Plan administrative data and billing codes to identify patients who consult physicians who provide longitudinal primary care services, what to do for rash from bactrim study author Kamila Premji, MD, an assistant professor of family medicine at the University of Ottawa, Ontario, told Medscape Medical News. Premji also is a PhD candidate in family medicine at Western University in London, Ontario.
“It sounds alarming, because it’s a large number — 400,000 more — but it’s also not surprising because of the retirement data that we had produced,” said Premji. She led a previous study that found that as of 2019, 1.7 million Ontarians were consulting a family doctor who was aged 65 years or older. The increase in the number of patients without a family physician was foreseeable, said Premji.
About 1.5% of family physicians permanently close shop in Ontario each year, but that percentage doubled to 3% during the pandemic, said Premji. The results of this study will be supplied to Ontario’s health ministry to help develop policy to ensure that patients in Ontario find family physicians or primary care providers, she added.
The data suggest that the healthcare system in Ontario is under pressure, said Mekalai Kumanan, MD, president of the Ontario College of Family Physicians and family physician in Cambridge, Ontario, who commented on the findings for Medscape.
Dr Mekalai Kumanan
“We know the system overall is under significant strain, and we are facing a significant shortage of family physicians across the province,” said Kumanan. “But I think we certainly are seeing that as our population is aging, patients are presenting with more complex medical issues, so each appointment often requires more time from us as family physicians.
“What we need to really be thinking about when we are looking at solutions is how we can overall increase the capacity in our primary care system, so that we can make sure every patient is connected to a family physician and is able to get care.”
Kumanan suggested that a possible solution would be to implement team-based care. Under this arrangement, the family physician is one of several healthcare professionals in a healthcare team and can direct patients to other members of the team.
“The idea behind team-based care is that the patient can access the right care from the right person at the right time,” said Kumanan. For a patient with diabetes, for example, the right person may be a certified diabetes educator.
Similarly, an elderly patient at risk of falling should be directed to an occupational therapist who can conduct an assessment and help reduce this risk. He or she also could be directed to a pharmacist for a medication review.
Telemedicine models, in which patients may see a nurse or nurse practitioner in person while a family physician is available remotely if needed, may assist in making sure Ontarians secure primary care, said Premji.
The scarcity of primary care professionals is having ripple effects in the healthcare system, according to Kumanan. “The trends are concerning, in terms of patients who don’t have family physicians and are left to their own to find ways to access care,” she said. “That is why we can see increased hospital emergency department usage where that patient may not otherwise require the emergency room. Because they do not have a family physician, that may be the only option for them to access care in their community.”
The study indicates that low-income Ontarians are more strongly affected by the lack of family physicians. This outcome is unsettling, said Kumanan. “One of the most concerning trends that we are seeing, in particular with the Toronto data, is that those individuals living with the lowest income are more likely to not have a family physician,” she said. “More than 120,000 people with the lowest income do not have a family physician in Toronto.”
Too Much Paperwork
A significant factor contributing to patients’ difficulty in finding a family physician is that family physicians are devoting too much time to administrative duties, said Premji. Family physicians spend about 19 hours per week on paperwork, according to a Canadian Medical Association survey.
Easing physicians’ administrative burden would be a step in the right direction, said Kumanan. “Nineteen hours is more than 2 clinical days,” she said. “Much of that work does not require physicians to do it. We can find solutions to address that administrative burden to reduce the amount of paperwork that we are faced with, so that we can then spend more time with our patients.”
Premji and Kumanan have disclosed no relevant financial relationships.
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