TORONTO – The use of electronic health records, telemedicine and e-visits are key ways to provide chronically ill Canadians the care they need, a new report based on a Commonwealth Fund survey recommends. Results from the survey reveal that sicker Canadians struggle to gain access to care.
 
The Health Council of Canada on Dec. 12 released the results from the 2011 Commonwealth Fund International Health Policy Survey. The bulletin, "How Do Sicker Canadians with Chronic Disease Rate the Health Care System?" compares experiences of sicker Canadians with chronic conditions to those of the general public.

Participants numbered 3,958 Canadians, who were interviewed by telephone between March and June 2011. The Health Council of Canada sponsored a portion of the study along with the Alberta Health Quality Council, Health Quality Ontario, and the Quebec Health and Welfare Commissioner.

Canadians with chronic diseases are more likely to be hospitalized, have surgery, use emergency departments and take prescription medication compared to the general public, the report showed. Most of this group is 50 years of age or older, but 34 percent are adults under the age of 50.

Also, Canadians report experiencing considerable barriers to accessing the healthcare they need. Cost is one of the major barriers. Almost a quarter (23 percent) said they skipped a dose of medication or did not fill a prescription due to cost, compared to just 10 percent of the general population. This is a significant number, since 90 percent of sicker Canadians take at least one prescription drug and 54 percent take four or more. In addition, one in eight (12 percent) of respondents have skipped a recommended test of follow up treatment due to cost concerns, compared to just 5 percent of the general population.

The report offered recommendations on how to eliminate cost barriers for prescription drugs and also barriers that prevent patients from following up on recommended tests and treatments. It suggested alternatives to face-to-face visits – such as telemedicine, email and phone consultations – for saving costs on travel time and resources. “To improve coordination of care, electronic medical records can be an important tool and are long overdue in Canada,” the report concluded. It also called for doctors, policymakers and patients to work together to find solutions that increase patient engagement and involvement in their care.

More findings
Sicker Canadians are more likely (59 percent) to have below average household income and lower levels of education than the general population. This means that in addition to primary costs for care and medication, secondary costs like travel to appointments, child care and time away from work can create obstacles to accessing care. Twelve percent of sicker Canadians reported not visiting a doctor due to cost concerns, compared to just 4 percent of the general population. More than a quarter of healthcare services in Canada are paid for through private sources, be it out-of-pocket by patients or through private insurance.

"The experiences of patients with chronic conditions can tell us a lot about the quality of the healthcare system as a whole and the progress we have made," said John G. Abbott, CEO, Health Council of Canada. "The data here tells us, we need to be concerned that there are many Canadians who still cannot afford treatment of their chronic conditions. We need to address this immediately, because medications that prevent complications from chronic disease are vital in contributing to better quality of life for individuals, and reduced health care costs for the system."

The survey also shows that sicker Canadians fare worse when it comes to coordination of their care. People with chronic conditions are likely to see multiple care providers and specialists, yet fewer said they always received help from their doctor's office in coordinating other care they need.

In addition, sicker Canadians felt less engaged in their healthcare than the general public. Sixty-four percent indicated their doctors explained things in ways they could easily understand, and 55 percent felt they had enough time with their doctor. "We need to help sicker Canadians feel more engaged, because we know that more engaged patients perceive themselves to be healthier and make better use of the health services and resources in the system," said Abbott.

"It's important that my doctors know my medical history and are up to speed on my health results," said Frank Austin, a stroke survivor and patient advocate. "There needs to be improved communication among healthcare providers so that time is not wasted and the risk of errors in my care is reduced."

However, there were some positive results from sicker Canadians; more had a regular doctor or clinic where they went for care – 96 percent compared with 86 percent of the general population. They also found it easier to get care after-hours or to get an appointment with a doctor the same or next day.