Regular Medical Doctor Research Articles

Population Patterns of Chronic Health Conditions, Co-morbidity and Healthcare Use in Canada: Implications for Policy and Practice

Managing chronic health conditions is a daily reality for approximately nine million Canadians, and the numbers of people affected are expected to increase as our population ages, particularly if risk factors that contribute to poor health continue to rise. These conditions impact health and well-being and represent a significant, and growing, healthcare and economic burden. The Health Council of Canada has focused its attention on the prevention and management of chronic conditions to encourage discussion of the changes to public policy, healthcare management and health services delivery required to improve health outcomes for Canadians. In December 2007, the Health Council released a report that described the health and healthcare use among Canadians who have chronic conditions as well as their self- reported experiences with chronic illness care. It highlighted initiatives under way in all jurisdictions to improve the situation. In order to inform that report, we analyzed population-based survey data from the Canadian Community Health Survey to report on patterns of health and healthcare use by community-dwelling youth and adults who have one or more of seven high-prevalence, high-impact chronic conditions. We demonstrated that the vast majority of people with chronic conditions have a regular medical doctor and visit community-based doctors and nurses frequently. Not surprisingly, people with chronic conditions use healthcare services more often and more intensively than do those without, and the intensity of service use increases as the numbers of conditions go up. The 33% of Canadians with one or more of seven chronic conditions account for approximately 51% of family physician/general practitioner consultations, 55% of specialist consultations, 66% of nursing consultations and 72% of nights spent in a hospital. This information highlights the imperative of immediate, comprehensive and sustained attention to undertake proven strategies to delay or prevent the onset of chronic conditions and to improve the quality of primary healthcare to prevent complications, reduce the need for more expensive health services and secure a better quality of life for Canadians.

Do Canada and the United States Differ in Prevalence of Depression and Utilization of Services?

Do Canada and the United States Differ in Prevalence of Depression and Utilization of Services?

Gaining: Pediatric Patients and Use of Atypical Antipsychotics

Gaining: Pediatric Patients and Use of Atypical Antipsychotics

Determinants of a healthy lifestyle and use of preventive screening in Canada.

BackgroundThis study explores the associations between individual characteristics such as income and education with health behaviours and utilization of preventive screening.MethodsData from the Canadian National Population Health Survey (NPHS) 1998–9 were used. Independent variables were income, education, age, sex, marital status, body mass index, urban/rural residence and access to a regular physician. Dependent variables included smoking, excessive alcohol use, physical activity, blood pressure checks, mammography in past year and Pap smear in past 3 years. Logistic regression models were developed for each dependent variable.Results13,756 persons 20 years of age and older completed the health portion of the NPHS. In general, higher levels of income were associated with healthier behaviours, as were higher levels of education, although there were exceptions to both. The results for age and gender also varied depending on the outcome. The presence of a regular medical doctor was associated with increased rates of all preventive screening and reduced rates of smoking.ConclusionThese results expand upon previous data suggesting that socioeconomic disparities in healthy behaviours and health promotion continue to exist despite equal access to medical screening within the Canadian healthcare context. Knowledge, resources and the presence of a regular medical doctor are important factors associated with identified differences.

Treatment Seeking for Depression in Canada and the United States

Treatment Seeking for Depression in Canada and the United States

Complementary and Alternative Medicine Usage by Intercollegiate Athletes

The purpose of this study is to determine the prevalence and types of provider-delivered complementary and alternative medicine (CAM) used by intercollegiate student athletes attending a Division I NCAA University. Survey methodology within a group of intercollegiate student athletes at a Division I NCAA university during the fall semester of 2004. All incoming and returning intercollegiate student athletes were invited to participate. Surveys were completed by 309 (122 women, 187 men) of 482 (64.1%) student athletes representing 20 sports (11 women's, 9 men's teams). A 28-item reliable and valid survey instrument that measured the use of provider delivered CAM and allopathic medical care was administered. Data were analyzed using descriptive statistics, chi2 tests, and logistic regressions. Fifty-six percent of subjects reported using CAM within the past 12 months, including a significantly higher percentage of women (67%) than men (49%) (P < 0.01). Massage was the most commonly used type (38%), followed by chiropractic (29%), Lomilomi (14%), and acupuncture (12%). CAM usage overall did not differ significantly by sport, year in college, nor ethnicity. Hawaiian, Samoan, and Tongan subjects were more likely to use the Hawaiian-originated forms of CAM. Sixty percent of respondents have a regular medical doctor, eighty percent of which are family practitioners. Forty-two percent of subjects were referred to a medical specialist within the previous three years. CAM usage is common among collegiate student athletes and rates are higher than in adults nationwide and within the state of Hawai'i. This study and future investigations will increase the awareness of CAM use patterns by collegiate athletes, and hopefully improve allopathic physicians' abilities to provide optimal athletic health care.

Stats Can under-represents rural shortage

In the 2003 Canadian Community Health Survey, released in June 2004 and summarized in CMAJ ,[1][1] about 4.5% of Canadians residing in urban areas and 5.5% of those in rural areas reported not being able to find a regular medical doctor. Proportionally speaking, these numbers are very similar.

Socio-economic status and the utilisation of physicians' services: results from the Canadian National Population Health Survey

This paper assesses the extent to which Canada's universal health care system has eliminated socio-economic barriers in the use of physician services by examining the role of socio-economic status in the differential use of specific, publicly-insured, primary and specialist care services. Data from the 1994 National Population Health Survey, a nationally representative survey, were analysed using multiple logistic regression. In order to control for the association between primary and specialist utilisation, a two-staged least squares method was used for models explaining specialist utilisation. Health need, as measured by perceived health status and number of health problems, was found to be consistently associated with increased physician utilisation, for both primary and specialist visits. Whereas the likelihood of an individual making at least one visit to a primary care physician was found to be independent of income, those with lower incomes were more likely to be frequent users of primary care, that is, make at least six visits to a primary care physician. Even after adjusting for the greater utilisation of primary care services by those in lower socio-economic groups, and, therefore, their higher exposure to the risk of referral, the utilisation of specialist visits was greater for those in higher socio-economic groups. Canadians lacking a regular medical doctor were less likely to receive primary and specialist care, even after adjustments for socio-economic variables such as income and education. Although financial barriers may not directly impede access to health care services in Canada, differential use of physician services with respect to socio-economic status persists. After adjusting for differences in health need, Canadians with lower incomes and fewer years of schooling visit specialists at a lower rate than those with moderate or high incomes and higher levels of education attained despite the existence of universal health care.

Predicting mammography and breast self-examination in African American women

Breast cancer mortality is significantly greater in African American women than in their Caucasian counterparts. The purpose of this study was to identify variables associated with the breast cancer screening behaviors of mammography utilization and breast self-examination (BSE) in a convenience sample of low income African American women. A total of 328 African American women, living in a large midwestern metropolitan area, who were at < or = 150% of poverty level, and between the ages of 45 and 64 years were included in this study. Data were collected over a period of 18 months. Predisposing, enabling, and need variables from Anderson's theoretical framework included perceived susceptibility, benefits, barriers, confidence, knowledge, physician recommendation, demographic characteristics, and past experiences, as well as health-care and insurance information. Variables that significantly predicted mammography utilization included perceived barriers, mammography suggested by health-care professionals, recent thoughts about mammography, and a regular medical doctor. Variables that significantly predicted either frequency or proficiency of BSE included susceptibility, benefits, confidence, knowledge, barriers, and a regular physician. Implications for clinical practice include (a) recognizing predictors of screening among low-income African American women; (b) addressing culturally specific barriers, e.g., cancer fatalism, in order to increase compliance with screening; (c) establishing consistency in primary care providers; and (d) increasing confidence and knowledge through education.