Deliverables: Primary Care
Outpatient Antibiotic Prescribing by Manitoba Clinicians
Ruth C, Fanella S, Raymond C, Dragan R, Prior H, Dik N, Stevenson D, Koseva I, Valdivia J
Antibiotics are essential to the health of Manitobans. However, the more they are used the more bacteria can develop resistance, making the antibiotics less effective. This study looked at antibiotics dispensed in the community from 2011 to 2016, and how they linked to physician visits and diagnoses. The study found that antibiotic use increased from 2011 to 2016, with highest use in adults aged 65+ and in children under age 5; rates of inappropriate antibiotic use was high and increasing. For conditions that may need antibiotics, the antibiotics being given were often not the ones recommended by guidelines. Physicians and other providers varied widely in how often they prescribed antibiotics for a given condition. The study findings clearly indicate the need for antibiotic stewardship programs to improve antibiotic use in the community. Several other recommendations are also included in the report.
Type 2 Diabetes in Manitoba
Ruth C, Sellers E, Chartrand C, McLeod L, Prior H, Sirski M, Dragan R, Chen H, McDougall C, Schultz J
This deliverable, undertaken in partnership with The First Nation Health and Social Secretariat of Manitoba provides an analysis of trends in incidence and prevalence of for all types of non-gestational diabetes from the 1985 to 2017 allowing comparison to national and international statistics. Then, using the wealth of data within the Repository, especially the Diabetes Education Resource for Children and Adolescents (DER-CA) clinical database, Manitobans diagnosed with type 2 diabetes mellitus (T2DM) were identified and their outcomes over the last 6 years were described. This includes diabetes control, complications, mortality and health service use including hospitalizations, continuity of primary care and specialist care. Multiple analyses were undertaken to examine whether the care received by Manitobans living with T2DM met current guidelines. There are also a number of special analyses in cohorts of people matched to those without diabetes for childhood onset T2DM, T2DM in pregnancy, and for mental health outcomes in adults. Information is presented for different age groups, by sex, by health region and by Tribal Council Area and results were compared between registered First Nation Manitobans and all other Manitobans.Revisiting Primary Care Provider Projection Models
Katz A, Chateau D, Taylor C, Koseva I
The 2009 MCHP Deliverable, Physician Resource Projection Models, developed a novel methodology for predicting resource needs for family doctors for Manitoba. The projections were based on previous patterns of services provided by family physicians over 30 years and population projections for Manitoba as a whole for 2015 and 2020. This deliverable validated the methodology by comparing the projections to the current reality. Updated analyses add nurse practitioners to the models as well as analyses at the local level with projections to 2025.
Describing Patient Populations for the My Health Team Initiative
Chateau D, Katz A, Metge C, Taylor C, McDougall C, McCulloch S
The province of Manitoba is in the process of restructuring primary care through the development of My Health Teams, which are networks consisting of primary care providers (physicians and nurse practitioners) and other professionals from health or related disciplines (e.g., dieticians, mental health counsellors, social workers). This study describes the patient populations that current or future My Health Teams could expect to provide care to. We examined where patients access primary care in relation to where they live in order to provide a more accurate description of patient populations. We also examined if patients were high users of services, medically complex, or socially complex. The last category addresses the social determinants of health and this is the first study to apply these social complexity indicators across the province. In addition, we examined the overlap between these three types of patients to determine how distinct patients with social complexities and medical complexities were, and whether these patients were also high user of services.
A Comparison of Models of Primary Care Delivery in Winnipeg
Katz A, Valdivia J, Chateau D, Taylor C, Walld R, McCulloch S, Becker C, Ginter J
This deliverable compares the five models of primary care delivery that exist in Winnipeg: non-PIN FFS, PIN FFS, WRHA Primary Care, Community Health, and family medicine teaching clinics. The main objectives of this project are as follows: 1. Compare/evaluate quality of care indicators for the five models of primary care delivery 2. Discuss the impact of patient social complexity on service provider, quality of care and roster/ panel size Of particular interest is the development of social complexity indicators in this deliverable. Social complexities include patient characteristics such as living in social housing, involvement with the justice system, and having a major mental health diagnosis.
Physician Integrated Network: A Second Look
Katz A, Chateau D, Bogdanovic B, Taylor C, McGowan K-L, Rajotte L, Dziadek J
This deliverable evaluates the impact of the Physician Integrated Network (PIN) initiative on health service provision and primary care. To do this, the study looks at the twelve PIN clinics and describes the patient population during the two years before implementation and two years after. The study uses 23 indicators to compare the care provided before PIN to that provided after the introduction of PIN. The study also compares PIN patient care to a matched group of Manitobans, and considers long-term follow-up at four clinics to see if any gains from PIN are sustained.
Understanding the Health System Use of Ambulatory Care Patients
Katz A, Martens P, Chateau D, Bogdanovic B, Koseva I, McDougall C, Boriskewich E
This study originated in the desire to better understand which types of physicians are providing "primary care type services" to Manitobans and what impact this has on the quality of care received. This study is limited to ambulatory care services provided to Manitobans aged 19 and older over a three-year period between the fiscal years 2007/08 and 2009/10. Ambulatory care services are those provided in the community, outside of hospitals and personal care homes. In particular, the focus is on Manitobans with at least one of six chronic conditions. This group was chosen as the focus of the study because those with a chronic condition tend to use the healthcare system more frequently and they are more likely to benefit from continuity of care and high quality primary care services. This report provides new information about the use of ambulatory care services in Manitoba. This information places current primary care reform initiatives in context. The findings support the focus on reform related to primary care providers (physicians and nurse practitioners) as they provide the vast majority of primary care.
Manitoba Immunization Study
Hilderman T, Katz A, Derksen S, McGowan K, Chateau D, Kurbis C, Allison S, Reimer JN
Researchers from MCHP completed The Manitoba Immunization Study, the most comprehensive analysis of Manitoba's immunization programs ever performed. They looked at childhood and adult immunization rates in the province from April 1, 2000 to March 31, 2008, the impact of immunizations and the safety of vaccines. Overall, immunization rates for two-year-old children in Manitoba were stable over the eight years studied. The study looked at shots for flu and pneumonia in adults with a specific focus on three groups: pregnant women and women with a newborn, people older than 64, and people with chronic illness like diabetes. Manitobans 65 and over have the highest rate of immunizations and people with chronic illness have higher immunization rates than those without illness. Flu immunization reduced hospitalization and mortality in those over 65. The researchers also noted that nothing in the report was found to link vaccinations with rare disorders like Guillain-Barre Syndrome, a concern that prevents some people from getting vaccinations.
Physician Integrated Network Baseline Evaluation: Linking Electronic Medical Records and Administrative Data
Katz A, Bogdanovic B, Soodeen R
Electronic medical records (EMRs) help family doctors provide better care to their patients. Without these records it's difficult to measure what kind of care patients receive. Manitoba Health asked researchers at MCHP to look for patterns among groups of patients in the Physician Integrated Network (PIN). The PIN initiative aims to improve patients' access to doctors and interdisciplinary teams while creating a system to manage information more effectively so doctors can make better decisions. The study found improvements in the use of electronic medical records by helping to define criteria for the use of standard fields. This allows doctors to make better use of their own EMRs and helps manage chronic conditions and the overall health of their patients. Family doctors can use information from EMRs to graph patients' health by measuring weight, blood pressure, and so on with each visit. The same techniques can be used to monitor chronic conditions such as diabetes and more importantly, measurements can be taken on how patients respond to treatment.
Physician Resource Projection Models
Katz A, Bogdanovic B, Ekuma O, Soodeen RA, Chateau D, Burnett C
This project will provide scenarios that incorporate different assumptions that have an impact on the demand for physicians in four key areas identified by Manitoba Health: Family Medicine, Pediatrics, General Surgery and Orthopedic Surgery. Two sets of models will be developed: (1) models that will project the service needs of the population given various characteristics, e.g., age, sex, socioeconomic status, comorbidities; (2) models that will project the number of services that can be provided by the physician workforce given their characteristics, e.g., age, sex, number of years since graduation, average workloads, etc. MCHP will use historical data housed in the Population Health Research Data Repository to develop and test these models. The output of the project will not be a definitive answer to the question: "How many physicians are needed in Manitoba?" but will provide tools that can be used by Manitoba Health and potentially other organizations, such as the University of Manitoba's Faculty of Medicine to project supply and demand under different conditions.
What Works? A First Look at Evaluating Manitoba's Regional Health Programs and Policies at the Population Level
Martens P, Fransoo R, The Need to Know Team, Burland E, Prior H, Burchill C, Romphf L, Chateau D, Bailly A, Ouelette C
Decision-makers and planners in Manitoba have access to plenty of research describing the health of the population. What has been missing until now is information that starts to connect the dots between the health of residents and the programs and policies that may be contributing to good health outcomes.
Profiling Primary Care Physician Practice in Manitoba
Frohlich N, Katz A, De Coster C, Dik N, Soodeen RA, Watson D, Bogdanovic B
This is an initial exploration of a new methodolgy designed to compare family practices in Manitoba. Five measures (indicators) cover three main aspects of family practice: type of care (1 indicator), volume (2 indicators) and quality (2 indicators).
Primary Prevention: An Examination of Data Capabilities in Manitoba (January 2005)
Lix L, Finlayson G, Yogendran M, Bond R, Bodnarchuk J, Soodeen R
Different initiatives are offered across Manitoba designed to promote good health�??called primary prevention�??rather than to treat poor health. In this study we look at primary prevention data. Is it sufficient for research purposes? Can we relate it to data we do have on health and the use of health care services?
Using Administrative Data to Develop Indicators of Quality in Family Practice
Katz A, De Coster C, Bogdanovic B, Soodeen R, Chateau D
Is there a way to know how family physicians in Manitoba measure up to each other? Or to physcians outside of the province? MCHP developed a set of thirteen indicators that were used to assess the quality of care Manitoba doctors deliver.
Supply, Availability and Use of Family Physicians in Winnipeg
Watson D, Bogdanovic B, Heppner P, Katz A, Reid RJ, Roos NP
In just over a decade, Manitobans have gone from concerns about having too many doctors to anxieties about a possible shortage. What changed? To find out, this report looks at family physicians in Winnipeg over the last ten years.(
Do Some Physician Groups See Sicker Patients Than Others? Implications for Primary Care Policy in Manitoba
Reid RJ, Bogdanovic B, Roos NP, Black C, MacWilliam L, Menec V
Do some Manitoba clinics treat healthier patients while others treat sicker ones? That is the question we asked in this study. The answer is relevant in the consideration of alternative models of physician reimbursement.
Defining Practice Populations for Primary Care: Methods and Issues
Menec V, Black C, Roos NP, Bogdanovic B
Who is your doctor? Is there a family physician or clinic that you go to most of the time? What does "most of the time" mean? 50% of the time? 65%? 80%? These are the questions that this study explores.
Issues in Developing Indicators for Needs-Based Funding
Frohlich N, Carriere KC
Here we focus on the theoretical question of how to distribute resources for a single sector - physician services - in which the data are good but services are not currently distributed according to need.Issues in the Management of Specialist Physician Resources for Manitoba
Roos NP, Fransoo R, Bogdanovic B, Friesen D, MacWilliam L
In this report, we examine the current supply of specialist physicians in Manitoba, incorporate Statistics Canada data to help project future requirements, and analyze access to specialists by area of residence and socioeconomic status. .
Needs-Based Planning for Manitoba's Generalist Physicians
Roos NP, Fransoo R, Bogdanovic B, Friesen D, Frohlich N, Carriere KC, Patton D, Wall R
How many doctors does Manitoba have and how many does it need? We estimated the need for physicians, based on the population's age, gender, health and socio-economic mix, and then compared need with supply.
Utilization of Physician Resources. Volume I: Key Findings
Tataryn DJ, Roos NP, Black C Utilization of Physician Resources. Volume II: Methods and Tables
Tataryn DJ, Roos NP, Black C
Manitoba Centre for Health Policy
Community Health Sciences, Max Rady College of Medicine,
Rady Faculty of Health Sciences,
Room 408-727 McDermot Ave.
University of Manitoba
Winnipeg, MB R3E 3P5 Canada