Queen’s University team leads primary care research in Ontario

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A group of researchers linked to Queen’s University are helping to inform provincial health care policy with the data they collect.

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Inspire-PHC, a government-funded group of researchers at Ontario universities, led by a team from Queen’s, has been collecting, organizing and sharing data about Ontario’s health care system for 15 years.

On Wednesday, researchers presented 2022 Primary Health Care Data Reportinformation gathered from the province’s 54 Ontario Health Teams – reorganized regions replacing the province’s former Local Health Integration Network (LHIN) system – to hundreds of primary care providers across the province during a daytime webinar.

This is the first presentation of data from Ontario Health Teams since 2020.

These data point to a health care system that is becoming less accessible, according to Eliot Frymire, research director at Queen’s University Center for Health Services and Policy Research and project leader of Inspire-PHC.

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“We’re trying to see who has and who doesn’t have an attachment or a primary care physician,” Frymire told the Whig-Standard. “It’s getting worse. There are more and more people who don’t have access to primary care.

In March 2022, more than 2.2 million Ontario residents, or 14.7%, were without a source of primary care, compared to 1,778,022 or 12.2% in 2020.

In the Frontenac, Lennox and Addington Health Teams region, that number increased from 8.5% to 9.3% from 2020 to 2022, and is likely higher today because the methodology behind the network of attribution for Ontario Health Teams is not fully up to date.

“Newborn babies, or anyone who moves into the province without having an OHIP card, they wouldn’t be caught,” Frymire explained. “We lack data on this. But the bottom line is that the rate of single people, those without access to primary care, has increased and continues to increase, and it is increasing in all categories.

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Different health organizations and governing bodies in Ontario are reporting different numbers of unregistered patients, many of which are much higher than the numbers presented by Inspire-PHC, but it comes down to something called “virtual registration”, a category of patients that are not technically attached. to a family doctor, but continue to access them for care on a fairly regular basis.

“We consider this a normal, regular supplier that they go to,” Frymire explained.

“Virtually enrolled” patients – not to be confused with people who see doctors through online access – represent about 10% of patients in the Frontenac, Lennox and Addington area, or more than 12,000 people.

Other lone patient measurement methodologies do not differentiate between virtually enrolled patients and lone patients and aggregate these numbers. However, the Ministry of Health and Ontario Health both use Inspire-PHC data in their analysis of people not connected to a family doctor.

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“We’ve been working on it for 10 or 12 years,” Frymire said. “There are papers that have validated this approach and it has been accepted as a strong approach in the scientific literature.”

The Inspire-PHC report breaks down detailed demographics, patient characteristics, primary care indicators and health care utilization for every registered patient in the province.

This includes looking more closely at who is or is not committed to primary care, age, gender, income, ethnic diversity, marginalization, comorbidity, chronic conditions, frailty, mental health diagnoses, emergency room visits and more.

These numbers are all available province-wide or broken down by Ontario Health Team region.

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The report also breaks down geographically those who have access to team-based primary care, those who do not, and those who do not have access to primary care.

Team-based primary care, in family health clinics and community health centres, varies across the province. It is well implemented in the Kingston area, where more than 50% of primary care patients receive team-based care.

“Kingston is very lucky to have a lot of patients in team care, where you have a series of care providers around a doctor, like (occupational therapist), (physiotherapist), pharmacist, social worker ,” Frymire said.

A worrying rising trend in the province is the number of children without a primary health care provider.

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“We’ve seen a huge increase in the number of pediatric patients who are not accessing care, across Ontario,” Frymire said.

From 2020 to 2022, the number of children in Ontario without regular primary care has increased from 215,901 (7.4%) to 359,769 (12.9%).

“I think everyone would agree that children should have access to a primary care provider,” Frymire said. “We just don’t see that, and the number of children who don’t have access to it is growing.”

Frymire said the data continues to highlight gaps in access to primary care across income brackets, showing that those who “can least afford not to have access to it” are struggling the most. access primary care.

“There’s a bit of a ‘reverse law of care’ here, which means that sometimes the healthiest or wealthiest Ontarians have better access to care than people who really need it,” Frymire explained.

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The Reverse Care Act was an idea published by Julian Tudor Hard over 50 years ago, demonstrating the reverse relationship between healthcare, those who have the most access to it and those who need it the most.

“This is not a phenomenon specific to health care,” Frymire said. “We see it in a lot of different things, but we certainly see it in health care, that people are most able to contribute resources so that health care delivery has better access.”

Those with higher incomes have better circumstances for accessing primary care, including owning a car, being able to miss work on weekdays for appointments, having access to sick leave for elective surgeries , etc.

“If you look by income quintile, you’ll always see a direct relationship between income quintile and percentage attachment to a primary care provider,” he said. “The lowest income quintile still has the lowest access to primary care, and the highest quintile, the top 20% earners, has the best access to care.

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“It’s not specific to Kingston; it’s Ontario and all of Canada.

Data collected and curated by Inspire-PHC is used by Ontario Health, the Ministry of Health and other agencies to inform policy development and change. Changes need to take place to better provide people with the care they need because the trend is in the opposite direction, Frymire said.

“Generally, we are in a crisis situation all over the province,” he said. “This province is doing better than most other provinces in ensuring that most people have a primary care provider. But there are still many, many people without a primary care provider. »

To see the 2022 Primary Health Care Data Report and other detailed data, visit www.inspire-phc.org.

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