In response to a number of policy initiatives, the number of unattached patients in Ontario dropped from 8. The College of Family Physicians of Canada [ 1 ] shows that only Given the acknowledged shortage of family physicians in all jurisdictions, this research asks the question: Do people with disabilities have particular difficulty finding a family physician? The goals of this study were to answer the following questions:. What is the average wait time for patients with disabilities to be linked with a primary care physician compared to other patients?
Are patients with disabilities more challenging to link to primary care practices than patients without disabilities? What are the issues facing Care Connectors when referring people with disabilities to primary care physicians? The study used a mixed qualitative and quantitative approach to assess the ease or difficulty of linking some of the most complex and resource-intensive patients to family physicians. We used a retrospective review of records of the Health Care Connect program, to assess the experience of Ontarians who have a disability seeking a primary care provider.
The study also involved qualitative interviews with Health Care Connect staff about the processes, challenges and outcomes of their work with disabled or chronically ill patients. The sample for the quantitative portion of this study included , patients registered with the Health Care Connect program between February and June This designation was used by Health Care Connect to identify patients in most urgent need of care.
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The intake protocol was administered by clerical admissions staff, using a standardized set of questions. At school or work? In other activities, such as transportation or leisure time activities? It should be noted that this is a self-report identification.
They are registered nurses hired by each region, to liaise between prospective patients and family physicians. There are 33 Care Connectors employed across the province. We contacted Care Connectors directly and invited them to participate in the study.
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The sample for the study included 23 of the 33 Health Care Connectors across the province, representing 12 of 14 regions. The obstacle to participation in the remaining two regions was a highly bureaucratic process of approval that exceeded the timelines for the interview process. Given the HCC staff are a small group, it was a condition of the programmatic ethics review that identifying information regarding the interviewees not be provided. Descriptive statistics were provided to the research team in aggregate form tables on registration and referral patterns by region.
The qualitative portion of the study involved semi-structured telephone interviews with the Care Connectors, lasting between 10 and 30 min. Care Connectors were asked about their experiences with physicians and patients with disabilities compared to non-disabled patients. Questions were developed in collaboration with the lead Care Connector to ensure high quality interviews.
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Interview questions are found below. Interviews were conducted by two research assistants. Interview contents were audiotaped, transcribed and analyzed using N-Vivo. How often do you encounter patients with disabilities looking for a family doctor? What kinds of disabilities and chronic conditions do you tend to see among your patients looking for FPs? What are disabled patients typically looking for in a family physician? What are their restrictions?
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What are their priorities? What are the barriers that you encounter when trying to link patients with disabilities with family doctors? Are these barriers different from those faced by patients who do not have disabilities? Probe for: doctor-, patient-, and system-level barriers. How successful do you feel HCC has been in connecting complex-vulnerable patients with family doctors?
What about patients with disabilities in particular?
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How do you feel the program could be improved to be more successful in linking disabled patients with doctors? Over the period studied February —June ; 16 months , Table 1 shows that , people registered with HCC seeking a family doctor, of whom 29, Almost two-thirds Looking at the four main regions of the province, there are notable differences between regions. The Central region is a large metropolitan area, including Toronto and several other major urban and suburban areas.
Although participation in the program is relatively low given the very large population base, the referral rate for disabled registrants By contrast, the North, characterized as rural and remote, had the lowest referral rates for both disabled The Eastern and Western regions are a mixture of moderate-sized urban and rural communities. The final column shows that the overall odds of being successfully linked with a family physician are slightly better for disabled registrants in the program than for non-disabled.
The only region in which this is not the case is the North. Success rates in linking non-disabled and disabled registrants with family physicians by region. Eastern region includes: Central East, Southeast, Champlain.
Western region includes: Erie-St. Clair, South West. Table 2 shows the wait-time to referral for disabled registrants vs. The average wait time across the province was 64 days for non-disabled registrants, and only one day more for disabled—65 days. The longest wait times in the province were found in the North days for non-disabled, for disabled. The wait times in the rest of the province were relatively comparable, averaging between 43 and 57 days. The lowest rates were for disabled registrants in the Central region, and the highest were for disabled registrants in the Eastern region.
The 90th percentile values show the wait times for registrants who were most challenging to link with a family physician. These rates vary from to days. The Central region appears to have made special efforts on behalf of disabled registrants, showing wait times at the 90th percentile considerably lower than non-disabled vs. Again the challenges of the Northern region seem significantly greater than any of the 3 southern regions. The next section presents the qualitative results of interviews with 23 Care Connectors across the province.
The results are organized to correspond with the interview questions, and illustrated where possible with quotes from respondents. The first question in the interview with Care Connectors asked them how frequently they saw disabled patients looking for a family doctor. The Care Connectors tended to identify disabled registrants in terms of their diagnoses. A number of participants mentioned back injuries, degenerative joint disease and chronic pain. There was also a subset of registrants classified as disabled who had mental illness.
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Autism and developmental disability were mentioned by several interviewees. Some disabled registrants were also identified in terms of functional limitation—for example, the fact that they were unable to get around, used a wheelchair, or had a sensory deficit, such as hearing or visual loss. Next we asked Care Connectors what they perceived disabled registrants were looking for. Other preferences clearly had to do with the disability and special considerations that registrants felt they needed from their family physician.
First and foremost, registrants with mobility disabilities sought physicians whose offices were accessible. Issues like stairs, elevators, ramps, and other obstacles were essential considerations, particularly for registrants who used a wheelchair or scooter.
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A third consideration is the willingness to fill out forms, sign or authorize applications for benefits. There were a number of special accommodations that disabled registrants sought from their family physicians, and they wanted to know from the outset that the doctor was amenable to these requirements. A number of registrants acknowledged that they needed more time, more attention, more coordination than their non-disabled counterparts, and wanted a doctor who was at least in principle open to these needs. Many wanted the option for home visits, telephone consults and prescription renewals.
Several prospective registrants noted that they used pain medications, and wanted a physician who was prepared to treat pain aggressively. Finally, registrants indicated that they wanted a physician who was well connected with a web of specialists, and able to get them timely specialist appointments when needed.