Primary care plays an important role in preventing disease, keeping populations healthy and is the first point of contact to the health care system for many Ontarians.
Drs. Tara Kiran and Rick Glazier’s joint research program is focused on improving how we deliver primary care in Ontario. They conduct patient-centered research to understand how government policies affect the quality of primary care and how primary care can be made better and more inclusive. Our research team uses administrative data collected by the provincial government to study the health care system in Ontario.
Over the last twenty years, the government introduced many primary care reforms including changes in how doctors were paid and organized. Our research aims to understand how these reforms have impacted the quality of care that patients receive. More recently, we have explored variation in timely access and continuity, two key tenets of primary care. Current work is focusing on changes in how we deliver care due to COVID-19.
We hope our research informs policy-makers, clinicians, and patients on what reforms are needed to further improve our primary care system.
Over the last decade, our research has highlighted many shortcomings in the current system including the following:
- Despite investments in primary care, many patients still do not have a family doctor and those who do often have difficulty seeing their doctor in a timely way
- New immigrants, those living in urban areas, and those living in low-income neighbourhoods are less likely to be formally attached (enrolled) to a family doctor and they are more likely to receive poorer quality care
- Financial incentives introduced to physicians have had little to no impact on quality of care. In some cases, such as the “access bonus”, the incentive does not align with health system goals
We have also highlighted strengths of our current system:
- Patients enrolled to team-based care models were more likely to receive recommended diabetes care and experience more improvements in care over time
- Patients of team-based and capitation models were more likely to know of after-hours care options (but patients still reported some difficulty with getting same or next day care when needed). Learn more
- Team-based primary care, coupled with payment reform, can improve patient outcomes and reduce emergency department use.
- Among patients who have a family physician, relational continuity with their own physician was high. There was little difference between practice models even after accounting for differences in patient characteristics