Blog dedicated primarily to randomly selected news items; comments reflecting personal perceptions

Monday, February 20, 2017

Wait!!! Proceed . . .

"In seven out of eight measures of timely access to care, Canada was significantly below the international average."
"I think timely access to care has been a challenge for a while that we've noted from these surveys and from patient experience more generally in Canada."
"We're not really seeing improvements over the last ten years in timely access to care from a patient's perspective, particularly when we look at timely access to family doctors or primary-care doctors or to specialists and for emergency department wait times."
"[Surveys indicate Canadians have a tendency to arrive at hospital emergency departments more frequently than counterparts in other countries] and often they tell us it's for a problem that could have been treated by their regular doctor."
"So all of these data help to shed light on the bigger picture, which is what is it in our system that may not be working so well and where could we concentrate or focus improvements?"
"When we looked at measures of what we call patient-centred care, where patients have a good experience once they do get their foot in the door with their regular doctor, where care is well co-ordinated for them, we see that's really an area where Canada shines."
"I think that what is useful about a report like this is it really provides that international perspective. You might think you're doing really well here at home in one thing, but when you compare yourself, especially beyond our borders, you can see maybe we can do a lot better."
"The report doesn't provide all of the answers, but it does point to where we should be looking."
Christina Lawand, senior researcher, Canadian Institute for Health Information, Ottawa

The issue of long, really long waits in hospital emergency rooms for hour after hour before a doctor can be made available for consultation and aid, is one that is of long standing in Canada, and it rankles. On the other  hand, if you're a 70-year-old woman and you present on a Sunday with symptoms easily read by the duty nurse logging in each arrival, you will be speedily placed in a wheelchair, wheeled into a room set apart, and immediately be seen by a number of health care workers, including a cardiologist-in-training.

For other things, more routine, you won't be fast-tracked, even if you're concerned, if you're in pain and discomfort, and the wait time feels excruciating. You wait until it comes time for your turn, when a health-care worker can be assigned to you. This works on the assumption that you're not close to expiring, despite how you feel about it. Nurses are pretty good at evaluating people as they present. If a true emergency presents itself it will receive expedient, swift treatment; run-of-the-mill, not so much. No one thinks their problem fits into the run-of-the-mill category, needless to say.

Canadians report in high numbers having experienced extremely long waits in emergency departments, according to a report released by the Canadian Institute for Health Information. And there aren't many Canadians who will be shocked or surprised at this conclusion, it has been well documented and published. Part of the problem is that instead of going to their general practitioner for some health problem, people head for an emergency department. Sometimes that's because their problem erupts out of normal office hours.

And on occasion it can be because they have turned first to their family doctor, who then instructed them to head to a hospital emergency department. Relatively routine and simple things such as stitching up a wound, or lancing a boil or removing a deep splinter that family doctors used to do, they no longer perform; they prefer to send their patients on elsewhere, to stand-alone emergency clinics or to hospitals, or to specialists. Perhaps this can be accounted for by the fact that family doctors take on too heavy caseloads of patients, as a result of a chronic shortage of family physicians.

Could also be that they feel they are not adequately compensated by the universal health care system that pays doctors' salaries. Part of a survey of residents from eleven countries sponsored by the Commonwealth Fund based in the United States, the Canadian survey indicates that 29 percent of Canadians waited in excess of four hours before a practitioner was able to see them, at their most recent visit to an emergency department. Which represents three times the international average of 11 percent of patients waiting that long.

In France, Germany and the Netherlands, only one to four percent of patients reported four-hour-long wait times. Canada also represented the country with the highest proportion of patients reporting long delays after being referred to specialists, as 56 percent of patients waited over four weeks, when the international average was closer to 36 percent. The proportion of patients in Switzerland waiting that long was 2 percent; 24 percent in the United States.

Interviews were conducted between March and May of 2015 with 4,200 Canadian adults. The very same queries took place in ten other developed countries: The U.S., Britain, Australia and Sweden among them. Physicians in Canada have moved increasingly to electronic medical records, though Canada lags other countries using digital health applications. It may be viewed as a positive in some ways, but in others perhaps not, since doctors, instead of focusing on the patient before them using traditional hands-on techniques, focus more on the computers before them, while interviewing patients.

The interesting and most comforting part of this exercise, however, revealed that in 21 of 28 areas measuring patient satisfaction, Canada exceeded the international average, or at least matched them.
More to the point, close to three-quarters of Canadians who were questioned for the purpose of the study, rated the quality of care they were exposed to in the universal health care system in Canada as very good or excellent. That response ranked well above the international average of 65 percent.

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