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Quality of care Patient-centred primary and specialist care Medication reviews Chronic condition management and disease prevention 1 Most older Canadians have a positive experience with their regular doctor When older Canadians needed care or treatment, their regular doctor always or often Canada CMWF average Knew important information about their medical history 87% 87% Spent enough time with them 82% 86% Encouraged them to ask questions 70% 66% Compared with the CMWF average Above average Same as average Below average 2 Patient-centred care from specialists is also relatively good in Canada When specialists provided care or treatment, they always or often Canada CMWF average Told patients about treatment choices 72% 72% Involved patients as much as they wanted to be in decisions about treatment or care 79% 77% Compared with the CMWF average Above average Same as average Below average 3 However, continuity of care between regular doctors and specialists can be improved In the past 2 years, was there a time when Canada CMWF average A specialist did not have basic information or test results from the patient’s regular doctor about the reason for the visit 13% 9% A patient’s regular doctor did not seem informed and up to date about the specialist care received 25% 18% Compared with the CMWF average Above average Same as average Below average 4 How do the provinces compare? B.C. Alta. Sask. Man. Ont. Que. N.B. N.S. P.E.I. N.L. Can. CMWF Avg. Regular doctor always or often Knew important information about patients’ medical history 88% 86% 89% 84% 86% 89% 87% 85% 87% 84% 87% 87% Spent enough time with patients 81% 80% 80% 79% 81% 87% 80% 85% 80% 78% 82% 86% Encouraged patients to ask questions 72% 70% 64% 65% 68% 76% 68% 66% 72% 62% 70% 66% Told patients about treatment choices 74% 74% 75% 78% 77% 58% 73% 76% 80% 77% 72% 72% Involved patients as much as they wanted to be in decisions 81% 79% 83% 76% 80% 76% 81% 85% 88% 79% 79% 77% Specialists always or often Compared with the CMWF average Above average Same as average Below average 5 How do the provinces compare? Continuity of care between primary doctors and specialists was comparable to the international average in most Canadian provinces. Specialist did not have basic medical information from primary doctor Primary doctor did not seem informed or up to date about care from specialist B.C. Alta. Sask. 8% 8% 8% Man. Ont. Que. N.B. N.S. P.E.I. N.L. Can. CMWF Avg. 11% 10% 26% 13% 6% 4% 9% 13% 9% 16% 18% 18% 18% 18% 46% 22% 10% 13% 10% 25% 18% Compared with the CMWF average Above average Same as average Below average 6 Medication reviews are common for older Canadians 80% said a health care professional reviewed their medications in the past 12 months. How does Canada compare (2014)? United States New Zealand CANADA 80%* Germany In Canada, seniors use an average of 7.2 prescription drugs in a year. Australia United Kingdom Switzerland CMWF AVERAGE 70% Netherlands Norway France Sweden Source Canadian Institute for Health Information. Drug Use Among Seniors on Public Drug Programs in Canada, 2012: Revised October 2014. Ottawa, ON: CIHI; 2014. 7 Canadians are more likely to have discussions about medication use In the past 12 months, has a health care professional Explained potential side effects CANADA United Kingdom New Zealand United States Australia Germany CMWF AVERAGE France Netherlands Switzerland Norway Sweden Provided a written list of all medications 74%* 59% Sweden United Kingdom CANADA New Zealand Netherlands United States Australia CMWF AVERAGE Germany Norway Switzerland France 67%* 57% 8 Patient safety incidents related to medication use are common in Canada Proportion of seniors on public drug programs taking a potentially inappropriate (Beers list) drug, 2012 Almost 140,000 hospitalizations for adverse drug reactions among seniors between 2006–2007 and 2010–2011 Source Canadian Institute for Health Information. Adverse Drug Reaction–Related Hospitalizations Among Seniors, 2006 to 2011. Ottawa, ON: CIHI; 2013. 39% Source Canadian Institute for Health Information. Drug Use Among Seniors on Public Drug Programs in Canada, 2012: Revised October 2014. Ottawa, ON: CIHI; 2014. 9 How do the provinces compare? Across provinces, medication management among older patients was equal to or better than that in other countries, on average. In the past 12 months, has a health care professional B.C. Alta. Sask. Man. Ont. Que. N.B. N.S. P.E.I. N.L. Can. CMWF Avg. Reviewed all medications 77% 78% 78% 75% 83% 83% 75% 66% 77% 65% 80% 70% Explained potential side effects 72% 72% 72% 67% 76% 76% 67% 70% 68% 62% 74% 59% Given a written list of all medications 59% 58% 58% 51% 67% 80% 66% 62% 57% 54% 67% 57% Compared with the CMWF average Above average Same as average Below average 10 Care to help manage chronic conditions is above average in Canada 78% of older Canadians had at least 1 chronic condition* (CMWF average 71%). Older people with chronic conditions who Canada CMWF average Had discussions about main goals or priorities with their health providers 60% 55% Received clear instructions about symptoms to watch for 60% 56% Compared with the CMWF average Above average Same as average Below average * Chronic conditions include hypertension or high blood pressure; heart disease, including heart attack; diabetes; asthma or chronic lung disease such as chronic bronchitis, emphysema or chronic obstructive pulmonary disease; depression, anxiety or other mental health problems; cancer; and joint pain or arthritis. 11 However, there is room to improve across countries People with chronic conditions who received a written plan for self-management from their health provider Canada CMWF average 37% 35% Compared with the CMWF average Above average Same as average 21% Routinely Occasionally 58% Below average 21% of family physicians routinely gave their patients with chronic conditions written instructions for self-management. Source The Commonwealth Fund, 2012 Commonwealth Fund International Survey of Primary Care Doctors. 12 Hospitalizations for chronic conditions are declining in Canada but vary widely across the country Ambulatory care sensitive conditions (ACSCs) are chronic conditions that—when treated effectively in community settings—should not, in most cases, lead to hospitalization. ACSC hospitalization rates (per 100,000) Canadian rates 435 417 319 289 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 258 428 419 425 296 267 275 319 289 B.C. Alta. Sask. Man. Ont. Que. N.B. N.S. P.E.I. N.L. Can. Compared with the Canadian average Above average Same as average Below average Source Canadian Institute for Health Information. Your Health System. http://yourhealthsystem.cihi.ca/. Accessed November 27, 2014. 13 How do the provinces compare? In most provinces, management of chronic conditions was similar to the international average experience. In the past 12 months, has a health professional B.C. Alta. Sask. Man. Ont. Que. N.B. N.S. P.E.I. N.L. Can. CMWF Avg. Discussed with patients their main goals or priorities in caring for this condition 59% 59% 61% 57% 61% 61% 56% 60% 61% 58% 60% 55% Given patients clear instructions about symptoms to watch for and when to seek further care or treatment 56% 57% 60% 60% 58% 68% 62% 58% 62% 58% 60% 56% Given patients a written plan to help them manage their own care 42% 32% 36% 34% 35% 38% 35% 41% 42% 39% 37% 35% Compared with the CMWF average Above average Same as average Below average 14 Discussions about healthy life habits are more frequent in Canada But they happened less often in 2014 than they used to. During the past 2 years, has a health professional discussed 61% 57% 50% 54% 51%* 55%* 48% 43% 37% 35% 25% 2010 2014 A healthy diet and healthy eating 2010 2014 Exercise or physical activity Canada 2010 23% 2014 Things in life that worry patients or cause stress CMWF Average Source The Commonwealth Fund, 2010 Commonwealth Fund International Health Policy Survey. 15 Canada leads in smoking cessation discussions 78% of older Canadians who smoked said a health professional talked to them about the health risks of smoking or using tobacco and ways to quit. How does Canada compare (2014)? CANADA United States New Zealand France United Kingdom CMWF AVERAGE Sweden Switzerland Norway Germany Netherlands Australia 78%* 17% of older Canadians smoked, higher than the CMWF average. 63% Lung cancer mortality rates were among the highest in the world for Canadian women at 46 deaths per 100,000 population. Source OECD Health Statistics 2014. 16 How do the provinces compare? During the past 2 years, has a health professional discussed B.C. Alta. Sask. Man. Ont. Que. N.B. N.S. P.E.I. N.L. Can. CMWF Avg. A healthy diet and healthy eating 54% 52% 49% 47% 52% 48% 48% 52% 52% 47% 51% 43% Exercise or physical activity 60% 55% 52% 51% 55% 55% 49% 54% 55% 51% 55% 48% Things in life that worry patients or cause stress 27% 23% 25% 24% 26% 20% 22% 32% 22% 24% 25% 23% Health risks of smoking or using tobacco and ways to quit 92% 75% 66% 84% 79% 71% 72% 72% 60% 59% 78% 63% Compared with the CMWF average Above average Same as average Below average 17