Pan-Canadian Primary Health Care Indicators Report 1, Volume 2 Pan-Canadian Primary Health Care

Pan-Canadian Primary Health Care Indicators Report 1, Volume 2 Pan-Canadian Primary Health Care
Pan-Canadian Primary
Health Care Indicators
Report 1, Volume 2
Pan-Canadian Primary Health Care
Indicator Development Project
The contents of this publication may be reproduced in whole or in part, provided
the intended use is for non-commercial purposes and full acknowledgement is
given to the Canadian Institute for Health Information.
Canadian Institute for Health Information
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ISBN 1-55392-829-6 (PDF)
© 2006 Canadian Institute for Health Information
Cette publication est aussi disponible en français sous le titre
Indicateurs pancanadiens de soins de santé primaires, Rapport 1, Volume 2
ISBN 1-55392-831-8 (PDF)
Report 1, Volume 2
Acknowledgements
The Canadian Institute for Health Information (CIHI) would like to acknowledge
and thank the many individuals and organizations that have contributed to the
development of this report.
The content of this report could not have been produced without the support and
participation of many individuals and organizations over the last 12 months. With
over 100 individuals, it is not possible to list all their names here. Their willingness
to contribute above and beyond our initial requests for involvement is much
appreciated, and we hope the quality of their input is well captured in the report.
The Canadian Institute for Health Information also wishes to acknowledge and
thank the individuals who so willingly shared their time, experience and knowledge
as a member of the project Advisory Committee.
• Marsha Barnes—Ontario Ministry of
Health and Long-Term Care
• Juanita Barrett—Newfoundland and
Labrador Department of Health and
Community Services
• Bachir Belhadji—Health Canada
(ex officio)
• Jeanine Bustros—Health Canada
(ex officio)
• Nandita Chaudhuri—
Saskatchewan Health
• Nancy Darcovich—
Statistics Canada
• Melanie Grace—Canadian
Association of Social Workers
• Jeannie Haggerty—
Université de Sherbrooke
• Brian Hutchison (Chairperson)—
McMaster University
• Betty Jeffers—Alberta Health
• Alan Katz—University of Manitoba
• Marian Knock—Canadian
Nurses Association
• John Maxted—The College of
Family Physicians of Canada
• Louise Rosborough—Health Canada
(ex officio)
• Jim Rourke—Memorial University
of Newfoundland
• Marsha Sharp—Dietitians of
Canada
• Merv Ungurain—Nova Scotia
Department of Health
• Diane Watson—Centre for Health
Services and Policy Research,
University of British Columbia
• Greg Webster—Canadian Institute
for Health Information (ex officio)
• Ron Wray—Canadian Institute for
Health Information (ex officio)
and Wellness
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We also extend our sincere appreciation to the working group participants and, in
particular, the leads of the working group: June Bergman, Astrid Guttmann, Pierre
Tousignant, and Sabrina Wong.
The feedback we received from the Advisory Committee and working groups was
invaluable and forms the basis of this report, but CIHI is responsible for the content
of the report.
The PHC Indicator Development Team included Shamali Gupta, Natalia Lobach,
Judith MacPhail, Diane McKenzie, Lisa Mitmaker, Joanna Vlachakis, Vicky Walker,
Ron Wray and Marta Yurcan. Much appreciated was the direction and advice
provided to the Team by Indra Pulcins, Greg Webster and Jennifer Zelmer over the
course of the project.
The production of this report involved many people and many aspects of the CIHI
organization including individuals from Publications, Translation Services,
Communications and Health Indicators. We extend a special thank you also to
Eugene Wen, Joan Porter, Susanne Porter-Bopp, Steve Slade and Patricia Finlay for
their extra support.
Production of this report has been made possible through a financial contribution
from the Primary Health Care Health Care Transition Fund, Health Canada. The
views expressed herein do not necessarily represent the views of Health Canada.
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Table of Contents
Acknowledgements......................................................................................... i
About CIHI.................................................................................................... v
Forward.......................................................................................................vii
Executive Summary....................................................................................... ix
1.0 Indicator Development Process and Template .............................................. 1
2.0 Indicator Specifications............................................................................. 5
Objective 1: Access to PHC Through a Regular PHC Provider ........................ 5
Objective 2: Enhancing the Population Orientation of PHC........................... 12
Objective 3: Fostering Comprehensive Whole Person Care .......................... 22
Objective 4: Enhancing an Integrated Approach to 24/7 Access................... 47
Objective 5: Strengthening the Quality of PHC........................................... 55
Objective 6: Building PHC Through Patient-Centred Care........................... 110
Objective 7: Promoting Continuity Through Integration and Coordination..... 119
Support 1: Health Human Resources ...................................................... 128
Support 2: Interdisciplinary Teams ......................................................... 141
Support 3: Information Technology ........................................................ 150
Support 4: Needs-Based Resource Allocations ......................................... 156
Support 5: Provider Payment Methods.................................................... 159
Support 6: Support From Policy-Makers .................................................. 163
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About CIHI
The Canadian Institute for Health Information (CIHI) collects and analyzes
information on health and health care in Canada and makes it publicly available.
Canada’s federal, provincial and territorial governments created CIHI as a not-forprofit, independent organization dedicated to forging a common approach to
Canadian health information. CIHI’s goal: to provide timely, accurate and
comparable information. CIHI’s data and reports inform health policies, support the
effective delivery of health services and raise awareness among Canadians of the
factors that contribute to good health.
For more information, visit our Web site at www.cihi.ca.
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Forward
The following is the second volume that accompanies Pan-Canadian Primary Health
Care Indicators, Report 1, Volume 1. It is also a companion report to Enhancing The
Primary Health Care Data Collection Infrastructure In Canada, Report 2.
Volume 1 of Pan-Canadian Primary Health Care Indicators presents the context and
background for the 105 agreed upon pan-Canadian PHC indicators. The PHC
indicators were developed as part of the National Evaluation Strategy (NES) process
funded by Health Canada for the Primary Health Care Transition Fund. Volume 2
includes detailed indicator specifications for all of the agreed-upon PHC indicators.
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Executive Summary
Primary health care (PHC) has been called the foundation of Canada’s health system
and is the most common type of health care that Canadians experience.1 The
Primary Health Care Transition Fund (PHCTF) was established in September 2000
as a shared commitment between federal and provincial/territorial governments to
work together on improving PHC across the country, and to explore new ways of
delivering PHC.
Currently, we know little about how the structure of our PHC system is evolving or
about the way services are delivered and the results of these services. Measuring
PHC renewal in Canada requires harnessing and enhancing data sources at the local,
regional, provincial/ territorial and pan-Canadian levels. PHC indicators and the data
required to report these indicators can contribute to the measurement and
management of PHC in Canada.
The PHCTF National Evaluation Strategy (NES)—The Context of the PHC
Indicator Development Project
The PHC indicators, described in this report, were developed to correspond to a
series of agreed-upon NES Objectives, Supports and Evaluation Questions. This
guiding framework was developed in April 2005 through a collaborative process of
literature review, expert advice and stakeholder participation.2
Building on this process, the CIHI led pan-Canadian Primary Health Care Indicator
Development Project, funded through Health Canada’s PHCTF, aimed to:
• Develop a set of agreed-upon PHC indicators with which to compare and
measure PHC at multiple levels within jurisdictions across Canada.
• Provide advice on a future data collection infrastructure that could supply the
data to report these indicators across Canada.
This two-volume report is one of two reports produced by the Canadian Institute for
Health Information (CIHI) for this project. This report reflects the outcome of a
collaborative process to develop a list of agreed-upon PHC indicators. A companion
report outlining options for enhancing the pan-Canadian data collection
infrastructure (Enhancing the Primary Health Care Data Collection Infrastructure in
Canada) is also available.
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A Process for Establishing a List of PHC Indicators
In early 2005, CIHI launched an extensive process to develop an agreed-upon
list of pan-Canadian PHC indicators, relevant to the previously agreed upon
evaluation questions. A variety of strategies were used to generate input and build
agreement, including:
• Environmental Scan—National and international documents on PHC frameworks
and indicators were reviewed in order to develop a preliminary list of indicators.
• Two Consensus Conferences—Over 80 policy makers, providers, researchers
and system managers participated in consensus conferences to review
potential indicators.
• Working Groups—More than 60 policy makers, providers, researchers and
system managers participated in refining the indicators and developing
technical specifications.
• Pan-Canadian/International Consultations—Throughout the process, we collected
additional input through consultations with provincial/territorial and regional
stakeholders, professional health associations, and international researchers.
• Delphi Process—Over 70 individuals participated in each of the three rounds of
a modified Delphi process to rate the indicators for importance.
Measuring PHC: What Is Important and How Do We Measure It?
Through a consensus building process, 105 PHC indicators were identified and
agreed upon by a broad audience of stakeholders. The development of the 105
agreed-upon PHC indicators was informed by:
• the NES Objectives, Support, and Evaluation Questions;
• advice and support of Canadian PHC policy makers, providers, researchers and
system managers;
• current literature and evidence;
• Canadian and international PHC evaluation and indicator initiatives; and
• Delphi process that confirmed a high level of support for the indicators from a
broad range of stakeholders.
These indicators can be grouped into eight categories:
• access to PHC through a regular provider;
• comprehensive care, preventive health and chronic condition management;
• continuity through integration and coordination;
• 24/7 access to PHC;
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• patient-centred PHC;
• enhancing population orientation;
• quality in PHC—primary prevention, secondary prevention for chronic conditions,
patient safety, treatment goals and outcomes; and
• PHC inputs and supports—health human resources, interdisciplinary teams,
information technology, provider payment method.
The development of the indicators was not limited to those for which data are
currently available. Also, the definition of PHC varies at some policy levels. The
indicators are intended to be useful across a range of PHC definitions and evaluation
frameworks, but it is recognized that, in some circumstances, additional indicators
may be required to report on current or future priorities. It is anticipated that the list
of 105 indicators will be used to create subsets of indicators to serve different
perspectives and purposes. An example of an abridged list of 30 PHC indicators is
attached to this executive summary.
The 105 indicators cover a broad range of important elements of PHC that are
relevant to stakeholders across the country. Reporting these indicators will help fill
information gaps for PHC in Canada.
These indicators can also be used to inform the enhancement of the pan-Canadian
PHC data infrastructure. Over time, enhancements to a pan-Canadian data
collection infrastructure will help provide reliable and comparable information
required for reporting a broader range of these indicators than is possible using
existing data sources. The companion report, Enhancing the Primary Health Care Data
Collection Infrastructure in Canada, provides an overview of the current availability
of data to report the list of agreed-upon indicators, and options for enhancing the
pan-Canadian data collection infrastructure.
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needs populations
• PHC client/patient registries for chronic conditions*
• PHC programs for chronic conditions*
• Specialized PHC programs for vulnerable/special
ENHANCING POPULATION ORIENTATION
• Collaborative care with other health care organizations
CONTINUITY THROUGH INTEGRATION
AND COORDINATION
Treatment Goals and Outcomes
• Glycemic control for diabetes
• Blood pressure control for hypertension
• Treatment of dyslipidemia
• Treatment of depression
• Ambulatory care sensitive conditions
Patient Safety
• Use of medication alerts in PHC
• Antidepressant medication monitoring
QUALITY IN PHC
* Indicator repeated because it reflects multiple dimensions.
Pan-Canadian Primary
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Allocations for PHC
• Average per capita PHC operational expenditures
Interdisciplinary Teams
• PHC FPs/GPs/NPs working in interdisciplinary teams/networks
Provider Payment Methods
• PHC provider remuneration method
Information Technology
• Uptake of information and communication technology in PHC organizations
Health Human Resources
• PHC organizations accepting new clients/patients
PHC INPUTS AND SUPPORTS
Secondary Prevention for Chronic Conditions
• Screening for modifiable risk factors in adults with coronary
artery disease
• Screening for modifiable risk factors in adults with hypertension
• Screening for modifiable risk factors in adults with diabetes
Primary Prevention
• Influenza immunization, 65+
• Cervical cancer screening
• Health risk screening in PHC*
with PHC providers
• Client/patient satisfaction with PHC providers
• Language barriers when communicating
• Difficulties obtaining urgent,
non-emergent PHC on evenings
and weekends
• PHC after hours coverage
• Difficulties accessing routine PHC*
PATIENT-CENTRED PHC
24/7 ACCESS TO PHC
treatment planning
• PHC programs for chronic conditions*
• Client/patient participation in PHC
chronic conditions*
• Scope of PHC services
• Health risk screening in PHC*
• PHC client/patient registries for
• Population with a regular
PHC provider
• Difficulties accessing routine PHC*
COMPREHENSIVE CARE, PREVENTIVE HEALTH
AND CHRONIC CONDITION MANAGEMENT
ACCESS TO PHC THROUGH
A REGULAR PROVIDER
SAMPLE ABRIDGED LIST OF PHC INDICATORS
Y
T
I
U
Q
E
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1.0
Indicator Development Process
and Template
Work groups comprised of policy makers, researchers, providers and system
managers were established to develop detailed specifications for each potential
indicator that were later reviewed through three rounds of a modified Delphi
process. The work groups were assigned a list of NES Objectives, Supports and
Evaluation Questions that were clustered within four themes:
A—Accessibility, Responsiveness and Needs-Based Allocation;
B—Integration, Coordination and Health Human Resources;
C—Quality of Services; and
D—Scope of Services and Whole Person Care.
Developing Detailed Indicator Specifications
Health indicators are standardized measures that can be used to measure any
number of dimensions, such as health status, non-medical determinants of health,
health system performance as well as a variety determinants of health and health
system or community characteristics, across different populations, between
jurisdictions, or over time.3 Primarily, health indicators are a tool to help
provinces/territories, regions and organizations monitor and track progress in the
improvement and maintenance of a population’s health and health system.3
Indicators can be used to measure performance or progress, for strategic planning
and priority setting, supporting quality improvement, and for conveying important
health information to the public, for example.3
This report includes detailed specifications for each of the 105 agreed-upon PHC
indicators that were developed through the CIHI led Pan-Canadian Primary Health
Care Indicator Development Project. The purpose of these specifications is to
describe the measures precisely and with sufficient detail that knowledgeable
persons across a wide variety of settings would be able to understand and apply
them in a consistent manner.4 The detailed indicator specifications provide
information on the key components of each indicator, including:
• A clearly operational definition of the indicator;
• Explicit definitions of the key terms included in the definition;
• Any inclusion or exclusion criteria (Does the indicator pertain to a specific age
group, for example?); and
• The underlying rationale for each indicator, stating why the indicator is
important, what it means and how it should be interpreted, including the
evidence or a specific policy direction on which the indicator is based.
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These detailed indicator specifications identify the type of data required for each
indicator, and serve as a blueprint for the data requirements and computation of the
indicators as well as a guide to their interpretation.
Additional Dimensions of Development, Analysis and Interpretation
Many of the indicators described in this report will benefit from additional analysis
or methodological improvements. For example, standardizing indicators by age
and/or sex, where appropriate, or introducing risk adjustment methodologies can
enhance the comparability of the indicators across jurisdictions, populations, or over
time. The most suitable method for standardization will be identified as detailed
technical specifications are developed.
Further analysis of the indicators can also help identify disparities that may exist
between various socioeconomic groups, age groups, rural versus urban populations
or other dimensions3. Equity can be viewed as a cross-cutting theme, therefore
additional analyses of this nature can be applied to many of the indicators described
here as long as the available data allow. While indicators alone cannot explain
disparities, this type of analysis can serve to identify variations in the availability of
services offered, the type of care received, as well as health outcomes, among
other factors.
This set of indicators will evolve over time. New indicators may be added as new
needs arise, and existing indicators may be modified as new evidence and policy
directions emerge. Rapid advances are being made in our knowledge of clinical
conditions, which are reflected in advances in the scientific literature and changes
in professional opinion. Ensuring that the indicators are in keeping with current
evidence, clinical guidelines and policy will require an on-going process.5
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Understanding the Format for the Indicator Specification Template
The indicator specification describes a number of attributes in a measure’s
summary. The table below provides descriptions of each attribute.
Label: Identifies the title of the measure.
INDICATOR NUMBER
Sequential number assigned to each indicator.
INDICATOR DEFINITION
Description of indicator: Provides a concise statement of the specific aspects of
health care, the PHC client/patient population, providers, setting(s) of care, and time
period that the measure addresses.
DEFINITION OF
RELEVANT TERMS
Objective, standardized and comprehensible definition of key words or phrases
included in the indicator definition.
METHOD OF
CALCULATION
Numerator and denominator for rate-based indicators, or other method of calculation,
is presented.
NUMERATOR
Provides the description of the general specifications of any component
(e.g. screened for depression) that is the basis for inclusions and exclusions in
the numerator.
DENOMINATOR
Provides the description of the general specifications of any component
(e.g. pregnant or post partum) that is the basis for inclusions and exclusions in
the denominator.
DATA SOURCE AND
AVAILABILITY
Identifies the likely data source(s) necessary to calculate the measure (e.g. clinical
administrative data, other administrative or survey) and whether it is available on a
pan-Canadian basis. “Partial” refers to indicators that can be calculated for only some
dimensions of the indicator (e.g. indicator can be calculated for physicians but not all
PHC provider types). “No data source” refers to indicators that either would require a
new data source, or would require that additions (i.e. new survey questions) be made
to an existing data source to support pan-Canadian reporting.
RATIONALE AND
INTERPRETATION
Identifies the justification for the indicator and briefly explains the importance of the
measure (i.e. why it is used), description of the best available evidence or literature
to support the need for the indicator, and how the results can be interpreted. The
evidence/policy base for indicators include:
a. Clinical indicators—Grade A/B recommendations or Level 1 evidence.
b. System indicators (non-clinical)—strong support by health policy initiatives;
systematic literature reviews; NES objectives; participant consensus.
Interpretation of score (directional statement) is classified according to whether the
quantitative summary measure is associated with a higher score, a lower score, a
score falling within a defined interval, or a passing score.
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References
1. Health Council of Canada, Primary Health Care: A Background Paper to
Accompany Health Care Renewal in Canada – Accelerating Change, (Toronto:
Health Council of Canada, 2005).
2. J. Haggerty and C. Martin, Evaluating Primary Health Care in Canada: The Right
Questions to Ask!, (Ottawa: Health Canada, 2005).
3. Canadian Institute for Health Information, The Health Indicators Project: The
Next Five Years, Report from the Second Consensus Conference on Population
Health Indicators, (Ottawa: Canadian Institute for Health Information, 2005).
4. Agency for Healthcare Research and Quality, Child Health Care Quality Toolbox:
Measuring Quality in Children’s Health. Develop Your Own?, (Rockville,
Maryland: Agency for Healthcare Research and Quality, July 2004), [online],
cited June 1, 2005, from <http://www.ahrq.gov/chtoolbx/develop.htm>.
5. M. Marshall, M. Roland, S. M. Campbell, S, Kirk et al, Measuring General
Practice – A Demonstration Project to Develop and Test a Set of Primary Care
Clinical Quality Indicators, (Santa Monica, California: The Nuffield Trust for
Research and Policy Studies in Health Services, 2003), [online], cited Nov. 1,
2005, from <http://www.npcrdc.man.ac.uk/Publications/
MGP_book.pdf?CFID=104671&CFTOKEN=45642223>.
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Indicator Specifications
Access to PHC Through a Regular PHC Provider
Objective 1:
To increase the proportion of the population that receives ongoing
care from a primary health care provider who assumes principal
responsibility for their care and who knows their personal and
health characteristics
Evaluation Question 1—What proportion of the population can identify a primary
care provider who assumes principal responsibility for their care and knows their
health needs and personal values systematically?
1. Population with a regular PHC provider
2. Difficulties accessing routine PHC
3. Difficulties accessing PHC health information or advice
4. Difficulties accessing urgent, non-emergent PHC
Evaluation Question 1.1—Does that proportion differ by geographic region? By
socio-economic group? By health status? By cultural or ethnic group? This question
proposes a number of analytic dimensions to facilitate analysis of results for
indicators included in Evaluation Question 1 and other questions.
Additional analytical dimensions suggested:
Important additions: Age/gender/sex/recent immigration status/special populations
(people with disabilities)/rural or urban
Other dimensions (report by, if available): education/language/aboriginal people/
vulnerable populations (homeless, mentally ill, drug users)/sexual orientation
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POPULATION WITH A REGULAR PHC PROVIDER
INDICATOR NUMBER
1
INDICATOR DEFINITION
% of population who currently have a regular PHC provider, by type of PHC provider.
DEFINITION OF
RELEVANT TERMS
Regular care provider is the primary care provider that a patient identifies as “theirs”.
This relationship implies longitudinality and continuity, and exists for a defined period
of time or indefinitely until explicitly changed.1
METHOD OF
CALCULATION
NUMERATOR
Number of survey respondents who report that they currently have a regular PHC
provider
DENOMINATOR
Total number of survey respondents
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source partially available in the Canadian Community Health
Survey (CCHS), but only for Family Physician and/or General Practitioner (FP/GP)
providers.
RATIONALE AND
INTERPRETATION
6
(Numerator/Denominator) x 100
The 2003 First Ministers’ Accord on Healthcare Renewal identified access to a
regular family doctor as a key performance indicator”.2 In most models of care a
regular care provider is likely to take principal responsibility for their PHC
client/patient and will also build and maintain a provider-patient relationship that
results in strong continuity of care.3 Continuity of care and principal responsibility of
a regular care provider is associated with increased quality of care, patient
satisfaction and effective patient management.3, 4, 5, 6, 7 A high percentage of the
population with a regular care provider is interpreted as a positive result.
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DIFFICULTIES ACCESSING ROUTINE PHC
INDICATOR NUMBER
2
INDICATOR DEFINITION
% of population, 18 years and over, who experienced difficulties obtaining
required routine or ongoing PHC services, from their regular PHC provider, over the
past 12 months.
DEFINITION OF
RELEVANT TERMS
Difficulty obtaining routine or ongoing PHC services could include any of
the following:
• Difficulty contacting regular PHC provider;
• Difficulty getting an appointment with regular PHC provider;
• Do not have a regular PHC provider (due to either lack of PHC providers in area,
lack of PHC providers accepting clients/patients, preference not to have a regular
PHC provider, etc.);
• Waited too long to get an appointment with provider;
• Waited too long to see the PHC provider (in-office waiting);
• Service not available at time required;
• Service not available in the area;
• Transportation problem;
• Language problem;
• Cost;
• Did not know where to go (i.e. information problem);
• Unable to leave the house because of a health problem; and
• Other.8
Routine or ongoing care can include such things as medical exams or follow-up visits,
and is received from a provider over time within a single health episode or over
separate health care episodes.1, 8
METHOD OF
CALCULATION
(Numerator/Denominator) x 100
NUMERATOR
Number of survey respondents who report that they had difficulties obtaining routine
or ongoing PHC services, from a regular PHC provider over the past 12 months for
self, child(ren), elderly family member or disabled family member
DENOMINATOR
Total number of survey respondents, 18 years and over
DATA SOURCE AND
AVAILABILITY
Potential Pan-Canadian data source could be partially available in the CCHS with
modifications to the survey.
RATIONALE AND
INTERPRETATION
Difficulties in accessing primary health care may be due to a variety of factors.8, 9
The ability to obtain routine PHC services when needed is believed to be important in
maintaining health, preventing health emergencies and preventing the inappropriate
use of services (e.g. use of hospital emergency rooms for non-emergencies).9, 10, 11
A low percentage of the population experiencing difficulty accessing routine PHC care
for self, a family member or dependent is interpreted as a positive result.
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DIFFICULTIES ACCESSING PHC HEALTH INFORMATION OR ADVICE
INDICATOR NUMBER
3
INDICATOR DEFINITION
% of population, 18 years and over, who experienced difficulties obtaining
required health information or advice, from their regular PHC provider, over the past
12 months.
DEFINITION OF
RELEVANT TERMS
Difficulty obtaining health information or advice from PHC provider could include any
of the following:
• Difficulty contacting a PHC provider;
• Did not have a phone number;
• Could not get through (i.e. no answer);
• Waited too long to speak to someone;
• Did not get adequate info or advice;
• Language problem;
• Did not know where to go/call/uninformed; and
• Other.8
METHOD OF
CALCULATION
NUMERATOR
Number of population survey respondents who report that they had difficulties
obtaining health information or advice, from a regular PHC provider over the past 12
months for self, child(ren), elderly family member or disabled family member
DENOMINATOR
Total number of population survey respondents, 18 years and over
DATA SOURCE AND
AVAILABILITY
Potential Pan-Canadian data source could be partially available in the CCHS with
modifications to the survey.
RATIONALE AND
INTERPRETATION
8
(Numerator/Denominator) x 100
Difficulties in obtaining health information or advice from a PHC provider may be due
to a variety of factors.8, 12 The ability to obtain information and advice when needed
is believed to be important in maintaining health, preventing health emergencies and
preventing the inappropriate use of services (e.g. use of hospital emergency rooms
for non-emergencies).10, 11, 12 A low percentage of the population experiencing
difficulty accessing health information and advice is interpreted as a positive result.
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DIFFICULTIES ACCESSING URGENT, NON-EMERGENT PHC
INDICATOR NUMBER
4
INDICATOR DEFINITION
% of population, 18 years and over, who experienced difficulties obtaining immediate
care for an emergent but minor health problem, from their regular PHC provider, over
the past 12 months.
DEFINITION OF
RELEVANT TERMS
Difficulty accessing immediate care from a regular PHC provider could include any of
the following:
• Difficulty contacting regular PHC provider;
• Difficulty getting an appointment with regular PHC provider;
• Do not have a regular PHC provider (due to either lack of PHC providers in area,
lack of PHC providers accepting PHC clients/patients, preference not to have a
regular PHC provider, etc.);
• Waited too long to get an appointment with provider;
• Waited too long to see the PHC provider (in-office waiting);
• Service not available at time required;
• Service not available in the area;
• Transportation problem;
• Language problem;
• Cost;
• Did not know where to go (i.e. information problem);
• Unable to leave the house because of a health problem; and
• Other.8
Immediate care for an emergent but minor health problem refers to same-day
service for a problem such as a fever, headache, sprained ankle, vomiting or an
unexplained rash.8
METHOD OF CALCULATION
(Numerator/Denominator) x 100
NUMERATOR
Number of survey respondents who report that they had difficulties obtaining urgent
PHC services, from a regular PHC provider over the past 12 months for self,
child(ren), elderly family member or disabled family member
DENOMINATOR
Total number of survey respondents, 18 years and over
DATA SOURCE AND
AVAILABILITY
Potential Pan-Canadian data source could be partially available in the CCHS with
modifications to the survey.
RATIONALE AND
INTERPRETATION
Difficulties in obtaining immediate care from a PHC provider may be due to a variety
of factors.8, 13 The ability to obtain urgent PHC services when needed is believed to
be important in maintaining health, preventing health emergencies and preventing the
inappropriate use of services (e.g. use of hospital emergency rooms for nonemergencies).10, 11, 13 A low percentage of the population experiencing difficulty
accessing immediate care is interpreted as a positive result.
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References
1.
Starfield B, Primary Care, Balancing Health Needs, Services and Technology,
(New York: Oxford University Press, 1998).
2.
Government of Canada, First Ministers’ Accord on Healthcare Renewal,
(Ottawa: Government of Canada, 2003.)
3.
S. Ettner, “The Relationship Between Continuity of Care and the Health
Behaviors of Patients: Does Having a Usual Physician Make a Difference?”
Medical Care 37 (1999): pp. 547-555.
4.
M. Love and A. Mainous, “Commitment to a Regular Physician: How Long will
Patients Wait to see their own Physician for Acute Illness,” The Journal of
Family Practice 48 (1999): pp. 202-207.
5.
M. Mathews and J. Barnsley, “Patients Seeking Care During Acute Illness,”
Canadian Family Physician 49 (2003): pp. 1498-1503.
6.
M. Stewart, “Continuity, Care and Commitment: The Course of Patient-Clinician
Relationships,” Annals of Family Medicine 2 (2004): pp. 388-390.
7.
J. Saultz and J. Lochner, “Interpersonal Continuity of Care and Care Outcomes:
A Critical Review,” Annals of Family Medicine 3 (2005): pp. 159-166.
8.
Statistics Canada, Canadian Community Health Survey, Cycle 3.1, (Ottawa:
Statistics Canada, 2004).
9.
Statistics Canada, Comparable Health Indicators 2004, (“1PC: Difficulty
Obtaining Routine or Ongoing Health Services”), [online], last updated February
27, 2006, cited February 27, 2006, from <http://www.statcan.ca/english/
freepub/82-401-XIE/2002000/considerations/pc/1pc.htm>.
10. R. Leibowitz, S. Day, D. Dunt, “A Systematic Review of the Effect of Different
Models of After-Hours Primary Medical Care Services on Clinical Outcome,
Medical Workload and Patient and GP Satisfaction,” Family Practice 20, 3
(2003): pp.311-317.
11. C. van Uden and H. Crebolder, “Does Setting up Out of Hours Primary Care
Cooperatives Outside a Hospital Reduce Demand for Emergency Care?”
Emergency Medicine Journal 21 (2004): pp. 722-723.
10
Pan-Canadian Primary
Health Care Indicators
Report 1, Volume 2
12. Statistics Canada, Comparable Health Indicators 2004, (“2PC: Difficulty
Obtaining Health Information or Advice”), [online], last updated February 27,
2006, cited February 27, 2006, from <http://www.statcan.ca/english/
freepub/82-401-XIE/2002000/considerations/pc/2pc.htm>.
13. Statistics Canada, Comparable Health Indicators 2004, (“3PC: Difficulty
Obtaining Immediate Care”), [online], last updated February 27, 2006, cited
February 27, 2006, from <http://www.statcan.ca/english/freepub/82-401-XIE/
2002000/considerations/pc/3pc.htm>.
Pan-Canadian Primary
Health Care Indicators
11
Report 1, Volume 2
Enhancing the Population Orientation of PHC
Objective 2:
To increase the number of primary health care organizations
who are responsible for providing planned services to a
defined population
Evaluation Question 2—Do PHC organizations know the composition of their
catchment and practice populations in terms of age structure, morbidity profile,
cultural diversity, socio-economic status, social and physical environment?
5. PHC needs-based planning
Evaluation Question 2.1—Do PHC organizations have a registry of patients with
chronic conditions (diabetes, asthma, heart disease, stroke, depression) for whom
they develop specific programs?
6.
PHC client/patient registries for chronic conditions
7.
PHC programs for chronic conditions
Evaluation Question 3—What processes for planning services for their defined
population do PHC organizations have?
5.
PHC needs-based planning
8.
Community input for PHC planning
Evaluation Question 4—Do regional health authorities support PHC organizations
with information and processes that allow them to target services and provide
referrals to hard-to-reach individuals and communities (e.g. ethnic minorities,
intravenous drug users, shut-ins, adolescent parents, those in remote areas)?
9.
PHC outreach services for vulnerable/special needs populations
10. Specialized programs for PHC vulnerable/special needs populations
11. Support for PHC vulnerable/special needs populations
12
Pan-Canadian Primary
Health Care Indicators
Report 1, Volume 2
PHC NEEDS-BASED PLANNING
INDICATOR NUMBER
5
INDICATOR DEFINITION
% of PHC organizations who used information on the composition of their practice
population to allocate resources for programs/services, over the past 12 months.
METHOD OF
CALCULATION
(Numerator/Denominator) X 100
NUMERATOR
Number of PHC organizations who used information on the composition of their
practice population to allocate resources for programs/services, over the past 12
months
DENOMINATOR
Total number of PHC organization survey respondents
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source currently not available. Survey data source required.
RATIONALE AND
INTERPRETATION
This indicator measures the extent to which needs-based planning is used by PHC
organizations to allocate resources to serve their practice population. In the Primary
Health Care Transition Fund, there is a common objective “to increase the proportion
of the population with access to primary health care organizations which are
accountable for the planned provision of comprehensive services to a defined
population.”1 Important elements of strategic and service planning for primary health
care organizations include demographic and epidemiological information on their
practice population and/or community.2, 3, 4 A high percentage rate of PHC
organizations using needs-based information to allocate resources for
programs/services can be interpreted as a positive result.
Pan-Canadian Primary
Health Care Indicators
13
Report 1, Volume 2
PHC CLIENT/PATIENT REGISTRIES FOR CHRONIC CONDITIONS
INDICATOR NUMBER
6
INDICATOR DEFINITION
% of PHC organizations who currently have a client/patient registry for
chronic conditions.
DEFINITION OF
RELEVANT TERMS
Registry: Electronic, searchable directory that uniquely identifies PHC clients/patients,
health care providers and facilities to correctly link information electronically.
METHOD OF
CALCULATION
(Numerator/Denominator) X 100
NUMERATOR
Number of PHC organizations that currently have a PHC client/patient registry for
chronic conditions
DENOMINATOR
Total number of PHC organization survey respondents
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source currently not available. Survey data source required.
RATIONALE AND
INTERPRETATION
Chronic care registries are considered a critical first step toward the active care
management of chronic conditions through PHC programs and services.5, 6, 7, 8, 9
Registries separate the organizational management of chronic diseases from acute
problems to plan and implement processes of care including planned visits, case
management of high risk and complex clients/patients, as well as reminders to the
PHC team of follow-up requirements.5, 6 A high percentage of PHC organizations using
registries in their practices indicate that preventive action is being taken to manage
chronic conditions and can be interpreted as a positive result.
14
Pan-Canadian Primary
Health Care Indicators
Report 1, Volume 2
PHC PROGRAMS FOR CHRONIC CONDITIONS
INDICATOR NUMBER
7
INDICATOR DEFINITION
% of PHC organizations who currently have specific programs for PHC
clients/patients with specific chronic conditions.
DEFINITION OF
RELEVANT TERMS
Specialized programs may include health promotion, case coordination for high need
clients/patients,10 and the enhancement of skills required for self-management,
disease problem-solving and health decision-making (e.g. glucose monitoring, advice
from a dietitian, foot care and disease management for diabetes).11 Initiatives may
also focus on preventable chronic disease by targeting risk factors such as smoking,
physical inactivity and unhealthy eating.12
METHOD OF
CALCULATION
(Numerator/Denominator) X 100
NUMERATOR
Number of PHC organizations who currently have specific programs for PHC
clients/patients with specific chronic conditions
DENOMINATOR
Total number of PHC organization survey respondents
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source currently not available. Survey data source required.
RATIONALE AND
INTERPRETATION
Provision of special programs for PHC clients/patients with chronic conditions has the
potential to improve the management of these conditions.5, 6 Findings regarding
improved health status and quality of life are mixed depending on the chronic
condition and program interventions being examined.5 A high percentage of PHC
organizations that provide special programs in their practices may be interpreted as a
positive result.
Pan-Canadian Primary
Health Care Indicators
15
Report 1, Volume 2
COMMUNITY INPUT FOR PHC PLANNING
INDICATOR NUMBER
8
INDICATOR DEFINITION
% of PHC organizations who currently have processes for community input for
planning the organization’s services (e.g. advisory committees, focus groups).
METHOD OF
CALCULATION
(Numerator/Denominator) X 100
NUMERATOR
Number of PHC organizations who currently have processes for community input into
planning the organization’s services (e.g. advisory committees, focus groups)
DENOMINATOR
Total number of PHC organization survey respondents
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source currently not available. Survey data source required.
RATIONALE AND
INTERPRETATION
16
This indicator measures the extent to which community input is used by PHC
organizations to inform the organizations planning. In the Primary Health Care
Transition Fund, there is a common objective “to increase the proportion of the
population with access to primary health care organizations which are accountable
for the planned provision of comprehensive services to a defined population”.1
Important elements of strategic and service planning for primary health care
organizations include community feedback on health issues and service
preferences.2, 3, 4 Different processes may include education and feedback on the web
or via telephone, survey, focus groups, public advisory panels on specific issues, and
expert advisory committees.13, 14 A higher proportion of PHC organizations that have
processes for obtaining input into their services may be interpreted a positive result.
Pan-Canadian Primary
Health Care Indicators
Report 1, Volume 2
PHC OUTREACH SERVICES FOR VULNERABLE/SPECIAL NEEDS POPULATIONS
INDICATOR NUMBER
9
INDICATOR DEFINITION
% of PHC organizations that currently do outreach to deliver PHC services to
vulnerable/special needs populations.
DEFINITION OF
RELEVANT TERMS
Vulnerable/special needs populations characterize groups of individuals who have a
greater probability of having poor health status and outcomes because of social,
environmental, health, or economic conditions, and/or whose needs are not often
well addressed by traditional service delivery. Issues affecting these groups can
include, but are not limited to, language, culture, gender, socio-economic status, age,
serious mental illness and substance abuse.
METHOD OF
CALCULATION
(Numerator/Denominator) X 100
NUMERATOR
Number of PHC organizations that currently do outreach to deliver PHC services to
vulnerable/special needs populations
DENOMINATOR
Total number of PHC organization survey respondents
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source currently not available.
Survey data source required.
RATIONALE AND
INTERPRETATION
This indicator measures the extent to which PHC organizations actively try to engage
hard-to-reach population groups in need of health care. Many marginalized, vulnerable
and hard-to-reach populations face unique challenges in the access and availability of
continuous PHC services. Outreach activities that actively seek out and engage hardto-reach individuals are more likely to reduce barriers, and use a whole person care
approach that requires inter-organizational linkages beyond health care.15 A higher
proportion of PHC organizations reporting outreach PHC services can be interpreted
as a positive result.
Pan-Canadian Primary
Health Care Indicators
17
Report 1, Volume 2
SPECIALIZED PROGRAMS FOR PHC VULNERABLE/SPECIAL NEEDS POPULATIONS
INDICATOR NUMBER
10
INDICATOR DEFINITION
% of PHC organizations that currently provide specialized programs for
vulnerable/special needs populations.
DEFINITION OF
RELEVANT TERMS
Vulnerable/special needs populations characterize groups of individuals who have a
greater probability of having poor health status and outcomes because of social,
environmental, health, or economic conditions, and/or whose needs are not often
well addressed by traditional service delivery. Issues affecting these groups can
include, but are not limited to, language, culture, gender, socio-economic status, age,
serious mental illness and substance abuse.
METHOD OF
CALCULATION
(Numerator/Denominator) X 100
NUMERATOR
Number of PHC organizations that currently provide specialized programs for
vulnerable/special needs populations
DENOMINATOR
Total number of PHC organization survey respondents
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source currently not available. Survey data source required.
RATIONALE AND
INTERPRETATION
18
This indicator monitors the extent to which PHC organizations provide specialized
programs for people with vulnerable/special needs. Many vulnerable/special needs
populations face unique challenges in the access and availability of continuous PHC
services that meet their needs in their community. Issues affecting these groups can
include language, culture, gender, socio-economic status, age, serious mental illness
and substance abuse.15 A high proportion of PHC organizations that provide
specialized programs is interpreted as a positive result.
Pan-Canadian Primary
Health Care Indicators
Report 1, Volume 2
SUPPORT FOR PHC VULNERABLE/SPECIAL NEEDS POPULATIONS
INDICATOR NUMBER
11
INDICATOR DEFINITION
% of PHC organizations that currently receive information or process support from
their health region to serve vulnerable/special needs populations.
DEFINITION OF
RELEVANT TERMS
Vulnerable/special needs populations characterize groups of individuals who have a
greater probability of having poor health status and outcomes because of social,
environmental, health, or economic conditions, and/or whose needs are not often
well addressed by traditional service delivery. Issues affecting these groups can
include, but are not limited to, language, culture, gender, socio-economic status, age,
serious mental illness and substance abuse.
METHOD OF
CALCULATION
(Numerator/Denominator) X 100
NUMERATOR
Number of PHC organizations that currently receive information or process support
from their health region to serve vulnerable/special needs populations
DENOMINATOR
Total number of PHC organization survey respondents
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source currently not available. Survey data source required.
RATIONALE AND
INTERPRETATION
This indicator measures whether PHC organizations receive help to address the
specialized needs of their practice populations. Although generalized information is
often available at the provincial or national level, the unique characteristics of
vulnerable/special needs populations often require localized knowledge to develop
effective programs. A higher percentage of PHC organizations that report they
receive support from their health regions to serve vulnerable/special needs population
groups is interpreted as a positive result.
Pan-Canadian Primary
Health Care Indicators
19
Report 1, Volume 2
References
1.
Health Canada, Primary Health Care Transition Fund, [online], cited March 7,
2006, from <http://www.hc-sc.gc.ca/hcs-sss/prim/phctf-fassp/index_e.html>.
2.
J. Shanks, S. Kheraj, S. Fish, “Better Ways of Assessing Health Needs in
Primary Care,” in British Medical Journal 310 (February 25, 1995): pp. 480-481.
3.
J. Wright, R. Williams, J.R. Wilkinson, “Development and Importance of
Health Needs Assessment,” British Medical Journal 316 (April 25, 1998):
pp. 1310-1313.
4.
J.R. Wilkinson and S.A. Murray, “Assessment in Primary Care: Practical Issues
and Possible Approaches,” British Medical Journal 316 (May 16, 1998):
pp.1524-1528.
5.
C.M. Renders, G.D. Valk, S.J. Griffin, E.H. Wagner et al., “Interventions to
Improve the Management of Diabetes Mellitus in Primary Care, Outpatient and
Community Settings: A Systematic Review,” Diabetes Care 24, 10 (October
2001): pp.1821-33.
6.
A.C. Tsai, S.C. Morton, C.M. Mangione, E.B. Keeler, “A Meta-analysis of
Interventions to Improve Care for Chronic Illnesses,” The American Journal of
Managed Care 11, 8 (August 2005): pp. 478-488.
7.
D. Si, R. Bailie, C. Connors, M. Dowden, et al., “Assessing Health Centre
Systems for Guiding Improvement in Diabetes Care,” BMC Health Services
Research 5, 56 (2005).
8.
World Health Organization, Innovative Care for Chronic Conditions: Building
Blocks for Action, (Geneva, Switzerland: World Health Organization, 2002)
[online], cited September 10, 2005, from <http://www.who.int/
chronic_conditions/icccreport/en/>.
9.
Government of British Columbia, Chronic Disease Management: British
Columbia’s Expanded Chronic Care Model (2005), [online], cited January 10,
2006, from, <http://www.healthservices.gov.bc.ca/cdm/cdminbc/
chronic_care_model.html>.
10. Alberta Health and Wellness. Key Health Initiatives: Primary Health Care
Capacity Building Fund (2002-2006), [online], cited February 1, 2006, from,
<http://www.health.gov.ab.ca/Key/phc_BuildingFund.html>.
20
Pan-Canadian Primary
Health Care Indicators
Report 1, Volume 2
11. United Kingdom Department of Health, The Expert Patient: A New Approach to
Chronic Disease Management for the 21st Century, (London, England: United
Kingdom Department of Health, September 14, 2001) [online], cited January
10, 2006, from, <http://www.dh.gov.uk/PublicationsAndStatistics/Publications/
PublicationsPolicyAndGuidance/PublicationsPolicyAndGuidanceArticle/fs/
en?CONTENT_ID=4006801&chk=UQCoh9>.
12. Government of British Columbia, The Challenge of Chronic Disease
Management in British Columbia, [online] cited January 10th, 2006, from
<http://www.healthservices.gov.bc.ca/cdm/practitioners/challenge.pdf>.
13. Z. Simces and Associates, Exploring the Link Between Public
Involvement/Citizen Engagement and Quality Health Care: A Review and
Analysis of Current Literature, (Ottawa: Health Human Resources Strategies
Division, Health Canada, May 2003).
14. M.J. Crawford, D. Rutter, C. Manley, T. Weaver et al., “Systematic Review of
Involving Patients in the Planning and Development of Health Care,” British
Medical Journal 325 (November 30, 2002): pp.1263-1267.
15. C.P. Shah, and B.W. Moloughney, A Strategic Review of the Community Health
Centre Program, (Toronto: Ontario Ministry of Health and Long Term Care,
2001), [online], cited February 27, 2006, from
<http://www.health.gov.on.ca/english/public/pub/
ministry_reports/chc_stratreview/chc_review.pdf>.
Pan-Canadian Primary
Health Care Indicators
21
Report 1, Volume 2
Fostering Comprehensive Whole Person Care
Objective 3:
To enhance the provision of whole-person, comprehensive primary
health services, including acute episodic and ongoing care with
increased emphasis on health promotion, disease and injury
prevention, management of common mental health conditions and
chronic diseases
Evaluation Question 5—Do PHC organizations have defined policies to ensure that
their practice populations receive: rapid management of acute, urgent health
problems; timely provision of non-urgent routine care (including well care and
chronic illness management), recommended preventive services; referral to hospitals
and specialist; follow-up care after hospitalization; primary mental health care; full
maternity and child care; coordinated care of the frail elderly; end-of-life care?
12. Scope of PHC services
Evaluation Question 6—Has there been a reduction in health risk (lower BMI, lower
smoking rates, higher activity, lower rates of sexually transmitted disease, lower
adolescent pregnancy rates, less substance misuse)? Do people attribute reduced
health risks to orientation and advice that they received in primary health care?
13. Health risk screening in PHC
14. Smoking cessation advice in PHC
15. Alcohol consumption advice in PHC
16. Dietary advice in PHC
17. Advice on physical activity in PHC
18. PHC initiatives for reducing health risks
19. Health region programs for reducing health risks
20. Smoking rate
21. Fruit and vegetable consumption rate
22. Overweight rate
23. Physical activity rate
24. Heavy drinking rate
22
Pan-Canadian Primary
Health Care Indicators
Report 1, Volume 2
Evaluation Question 7—Do PHC organizations enable patients with chronic health
conditions (e.g. diabetes, asthma, coronary heart disease, depression, hypertension)
develop competencies and self-efficacy for better managing their health?
25. PHC resources for self-management of chronic conditions
26. PHC support for informal caregivers
27. Time with PHC provider
28. Client/patient participation in PHC treatment planning
Evaluation Question 7.1—Do self-management strategies for patients with chronic
conditions significantly improve quality of life, reduce the number of visits to
specialists, reduce hospital admissions (number and length of stay) and achieve
better health outcomes? Other analytical approach required.
Pan-Canadian Primary
Health Care Indicators
23
Report 1, Volume 2
SCOPE OF PHC SERVICES
INDICATOR NUMBER
12
INDICATOR DEFINITION
% of PHC organizations who currently provide the following services:
• Management of care for an emergent but minor health problem (e.g. sprained
ankle, unexplained rash);
• Non-urgent routine care (e.g. well care [baby, child, woman and/or man], chronic
illness management);
• Prevention and health promotion and/or education services;
• Full maternity and child care;
• Primary mental health care;
• Psychosocial services (e.g. counselling advice for physical/emotional/
financial problems);
• Liaison with home care;
• Referral to and follow-up care from specialized agencies such as hospitals, youth
centers, specialists and/or other providers (through formalized arrangements
and/or agreements);
• Rehabilitation services;
• Nutrition counselling services;
• Provision of home visits by PHC physicians/nurses/nurse practitioners/
pharmacists; and
• End-of-life care.
24
Pan-Canadian Primary
Health Care Indicators
Report 1, Volume 2
SCOPE OF PHC SERVICES (cont’d)
DEFINITION OF
RELEVANT TERMS
Health promotion is the process of enabling people to increase control over and to
improve their health (e.g. health literacy).1
Prevention is the concept of stopping or slowing the development of disease and
promoting health through screening programs and lifestyle guidelines.2
Mental health in primary care is the provision of basic preventive and curative mental
health at the first level of the health care system. Usually this means that care is
provided by a non-specialist who can refer complex cases to a more specialized
mental health professional.3
Rehabilitation is the restoration of a person by therapeutic measures and re-education
to participation in the activities of normal life within the limitation of the person’s
disorder or disability.2
Well baby care: The goals of visits for well-baby care are to 1) immunize, 2) provide
parents with reassurance and counselling on safety, nutrition and behavioral
problems; and 3) identify and treat physical, developmental and parenting problems.4
Well child care: Pediatric well-child visits are most frequent when the child’s
development is most rapid. Each visit includes a complete physical examination.
This will assess the infant or young child’s growth and development and help
identify problems early. Height, weight, and other important information is recorded
and considered. Hearing, vision, and other tests will be a part of some visits.
Such preventive care is important for raising healthy children.5
Well woman care: A well woman visit involves a physical assessment including a pap
smear, pelvic exam, breast exam, and blood pressure check.6
Well man care: A well man examination includes screening to determine risk factors
and a physical assessment and education around pertinent health issues, such as
testicular self-exams.6
End-of-life care is care of persons who are dying.7
METHOD OF
CALCULATION
(Numerator/Denominator) x 100
NUMERATOR
Number of PHC organizations that report they provide a range of PHC services to
their practice population
DENOMINATOR
Total number of PHC organizations
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source currently not available. Survey data source required.
RATIONALE AND
INTERPRETATION
This indicator measures the comprehensiveness of services offered by PHC
organizations.8, 10 Comprehensive service provision and continuity of care by PHC
organizations are important factors in comprehensive care and patient outcomes. 8, 9, 10
A high rate for this indicator can be interpreted as a positive result.
Pan-Canadian Primary
Health Care Indicators
25
Report 1, Volume 2
HEALTH RISK SCREENING IN PHC
INDICATOR NUMBER
13
INDICATOR DEFINITION
% of PHC clients/patients, 12 years and over, who were screened by their PHC
provider for the following common health risks over the past 12 months:
• Tobacco use;
• Unhealthy eating habits;
• Problem drug use;
• Physical inactivity;
• Overweight status;
• Problem alcohol drinking;
• Unintentional injuries (home risk factors);
• Unsafe sexual practices; and
• Unmanaged psychosocial stress and/or depression.
METHOD OF
CALCULATION
NUMERATOR
Number of PHC clients/patients who report being screened by their PHC provider for
common health risks over the past 12 months
DENOMINATOR
Total number of PHC clients/patients, 12 years and over
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source currently not available. Survey data source required.
RATIONALE AND
INTERPRETATION
26
(Numerator/Denominator) x 100
The Canadian Task Force on Preventive Health Care (CTFPHC) recommended a
number of areas in which PHC providers should provide screening and advice on
common health risks.11 These recommendations were based on strong evidence
indicating that PHC can have a positive effect on long-term behavioural changes.
A high rate for this indicator can be interpreted as a positive result.
Pan-Canadian Primary
Health Care Indicators
Report 1, Volume 2
SMOKING CESSATION ADVICE IN PHC
INDICATOR NUMBER
14
INDICATOR DEFINITION
% of PHC clients/patients who are smokers, 12 years and over, who received
specific help or information to quit smoking from their PHC provider, over the past
24 months.
DEFINITION OF
RELEVANT TERMS
Current smoker refers to those people who report that they are daily or
occasional smokers.12
METHOD OF
CALCULATION
(Numerator/Denominator) x 100
NUMERATOR
Number of PHC clients/patients who are current smokers who report that they
received specific help or information to quit smoking by their PHC provider, over the
past 24 months
DENOMINATOR
Total number of PHC clients/patients, 12 years and over, who are current smokers
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source could be partially available in the CCHS, but only for FP/GP
provider support.
RATIONALE AND
INTERPRETATION
Measuring the number of current smokers that are receiving help and information to
quit smoking from their PHC provider estimates whether PHC providers are offering the
necessary support to individuals engaging in this health risk behaviour. Tobacco
smoking is widely acknowledged as the most important preventable cause of death in
industrialized countries.13 Smoking cessation counselling and/or nicotine replacement
therapy provided to PHC clients/patients by PHC providers has a positive effect on
reducing smoking rates in the population, a manoeuvre that is a Grade A
recommendation by the Canadian Task Force on Preventative Health Care.11, 14 A high
rate for this indicator can be interpreted as a positive result.
Pan-Canadian Primary
Health Care Indicators
27
Report 1, Volume 2
ALCOHOL CONSUMPTION ADVICE IN PHC
INDICATOR NUMBER
15
INDICATOR DEFINITION
% of PHC clients/patients with problem alcohol drinking, 12 years and over, who
received specific help or information to manage alcohol consumption, over the past
24 months.
DEFINITION OF
RELEVANT TERMS
Problem drinking refers to alcohol consumption patterns (either excessive regular
consumption or binge drinking) that put individuals at high risk for physical,
psychological or social consequences, are termed problem, hazardous, harmful,
heavy, or excessive drinking, or mild to moderate alcohol dependency (no
internationally-recognized criteria have been developed to classify problem drinking).15
METHOD OF
CALCULATION
(Numerator/Denominator) x 100
NUMERATOR
Number of PHC clients/patients with problem alcohol drinking who report that they
received specific help or information on problem drinking by their PHC provider, over
the past 24 months
DENOMINATOR
Total number of PHC clients/patients, 12 years and over, with problem
alcohol drinking
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source currently not available. Survey data source required.
RATIONALE AND
INTERPRETATION
28
This indicator will provide an estimate of whether PHC providers are offering the
necessary support to PHC clients/patients engaging in this health risk behaviour.
Problem alcohol drinking may put PHC clients/patients at high risk for negative
physical, psychological or social consequences.16 Primary care providers can identify
problem drinkers through screening measures and successfully treat them with brief
counselling intervention.16, 17 A Grade B recommendation by the Canadian Task Force
on Preventative Health Care indicates the manoeuvre of routine detection and
counselling advice by PHC providers helps to reduce rates of problem PHC
client/patient alcohol consumption.11 A high rate for this indicator can be interpreted
as a positive result.
Pan-Canadian Primary
Health Care Indicators
Report 1, Volume 2
DIETARY ADVICE IN PHC
INDICATOR NUMBER
16
INDICATOR DEFINITION
% of PHC clients/patients with unhealthy eating habits, 12 years and over, who
received specific help or information on healthy dietary practices from their PHC
provider, over the past 12 months.
DEFINITION OF
RELEVANT TERMS
Health dietary practices refers to the average number of times per day an individual
consumes fruits and vegetables.12
METHOD OF
CALCULATION
(Numerator/Denominator) x 100
NUMERATOR
Number of PHC clients/patients with unhealthy eating habits who report that they
received specific help or information on healthy dietary practices from their PHC
provider, over the past 12 months
DENOMINATOR
Total number of PHC clients/patients, 12 years and over, with unhealthy eating habits
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source currently not available. Survey data source required.
RATIONALE AND
INTERPRETATION
This indicator will provide an estimate of whether PHC providers are offering the
necessary support to PHC clients/patients engaging in this health risk behaviour.
A Grade B recommendation for the manoeuvre of general dietary advice by the
Canadian Task Force on Preventative Health Care18 suggests that counselling by PHC
providers may produce long-term behavioural changes for a number of health risk
behaviours including unhealthy dietary practices.11 A high rate for this indicator can
be interpreted as a positive result.
Pan-Canadian Primary
Health Care Indicators
29
Report 1, Volume 2
ADVICE ON PHYSICAL ACTIVITY IN PHC
INDICATOR NUMBER
17
INDICATOR DEFINITION
% of inactive PHC clients/patients, 12 years and over, who received specific help
or information on regular physical activity from their PHC provider, over the past
12 months.
DEFINITION OF
RELEVANT TERMS
In the CCHS, physical activity is classified into three groups: active, moderately
active or inactive based on an index of average daily physical activity over the past
3 months. For each leisure time physical activity engaged in by the respondent, an
average daily energy expenditure is calculated by multiplying the number of times the
activity was performed by the average duration of the activity by the energy cost
(kilocalories per kilogram of body weight per hour) of the activity. The index is
calculated as the sum of the average daily energy expenditures of all activities.
Respondents are classified as follows: 3.0 kcal/kg/day or more = physically active;
1.5–2.9 kcal/kg/day = moderately active; less than 1.5 kcal/kg/day = inactive.12
METHOD OF
CALCULATION
(Numerator/Denominator) x 100
NUMERATOR
Number of inactive PHC clients/patients who report that they received specific
help or information on regular physical activity from their PHC provider, over the past
12 months
DENOMINATOR
Total number of inactive PHC clients/patients, 12 years and over
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source currently not available. Survey data source required.
RATIONALE AND
INTERPRETATION
This indicator shows that providers are offering the necessary support to their
practice population. A sedentary lifestyle may put individuals at higher risk for
chronic diseases such as coronary heart disease, diabetes, or osteoporosis.19
Studies suggest that counselling about lifestyle changes (e.g. climbing stairs,
walking) can result in higher levels of physical activity among PHC clients/patients.20
The Canadian Task Force on Preventative Health Care states that physical
inactivity is an appropriate target for counselling.11 A high rate for this indicator can
be interpreted as a positive result.
30
Pan-Canadian Primary
Health Care Indicators
Report 1, Volume 2
PHC INITIATIVES FOR REDUCING HEALTH RISKS
INDICATOR NUMBER
18
INDICATOR DEFINITION
% of PHC organizations who currently have specific programs and/or initiatives
(including self help and self management groups) to reduce the following health risks
in their practice population:
• Tobacco use;
• Unhealthy eating habits;
• Problem alcohol drinking;
• Obesity; and
• Physical inactivity.
DEFINITION OF
RELEVANT TERMS
Self-help groups are small, autonomous, open groups that meet regularly and whose
primary activity is mutual aid. Self-help groups are run by group members and do not
have any professional leadership.21
Self-management refers to tasks that individuals must undertake to live well with one
or more chronic conditions, including having the confidence to deal with medical
management, role management and emotional management of their conditions.22
METHOD OF
CALCULATION
(Numerator/Denominator) x 100
NUMERATOR
Number of PHC organizations that have specific programs and/or initiatives (including
self-help and self-management groups) to reduce the certain health risks in their
practice population
DENOMINATOR
Total number of PHC organizations
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source currently not available. Survey data source required.
RATIONALE AND
INTERPRETATION
Preventive health services and health promotion have the potential to influence
the health behaviours of individuals. The Canadian Task Force for Preventive
Health Services has recommended that PHC providers should provide screening
and advice on common health risks.11 A review of counselling recommendations
in primary health care supports the relevance of counselling for high risk behaviours
such as smoking, unhealthy dietary patterns, problem drinking, and physical
inactivity.11, 14, 15, 16, 18, 20 A high rate for this indicator can be interpreted as a
positive result.
Pan-Canadian Primary
Health Care Indicators
31
Report 1, Volume 2
HEALTH REGION PROGRAMS FOR REDUCING HEALTH RISKS
INDICATOR NUMBER
19
INDICATOR DEFINITION
% of health regions who currently have specific programs and/or initiatives
(including self help and self management groups) to reduce the following health risks
in the population:
• Tobacco use;
• Unhealthy eating habits;
• Problem alcohol drinking;
• Obesity; and
• Physical inactivity.
DEFINITION OF
RELEVANT TERMS
Self-help groups are small, autonomous, open groups that meet regularly and whose
primary activity is mutual aid. Self-help groups are run by group members and do not
have any professional leadership.21
Self-management refers to tasks that individuals must undertake to live well with one
or more chronic conditions, including having the confidence to deal with medical
management, role management and emotional management of their conditions.22
METHOD OF
CALCULATION
NUMERATOR
Number of health regions that have specific programs and/or initiatives (including
self-help and self-management groups) to reduce the certain health risks in their
practice population
DENOMINATOR
Total number of health regions
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source currently not available. Survey data source required.
RATIONALE AND
INTERPRETATION
32
(Numerator/Denominator) x 100
Preventive health services and health promotion have the potential to influence
individual behaviours. The Canadian Task Force for Preventive Health Services has
recommended that PHC providers should provide screening and advice on common
health risks.11 A review of counselling recommendations in primary health care
supports the relevance of counselling for risky health behaviours such as smoking,
unhealthy dietary patterns, problem drinking, and physical inactivity.11, 14, 15, 16, 18, 20
A high rate for this indicator can be interpreted as a positive result.
Pan-Canadian Primary
Health Care Indicators
Report 1, Volume 2
SMOKING RATE
INDICATOR NUMBER
20
INDICATOR DEFINITION
% of population, 12 years and over, who are current smokers.
DEFINITION OF
RELEVANT TERMS
Current smokers are those people who report that they are daily or
occasional smokers.12
METHOD OF
CALCULATION
(Numerator/Denominator) x 100
NUMERATOR
Number of survey respondents who report being daily or occasional smokers
DENOMINATOR
Number of survey respondents, 12 years and over
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source available in the CCHS.
RATIONALE AND
INTERPRETATION
Smoking is a highly addictive behaviour that is linked to an increased risk of poor
general health and frequent hospitalization.23 Smoking has also been attributed to
numerous diseases such as cancer, heart disease and stroke.23 Evidence shows that
individuals generally begin smoking in early to middle adolescence, and that adult
smoking patterns are usually established between the ages of 15 to 18.23, 24, 25 A low
rate for this indicator can be interpreted as a positive result.
Pan-Canadian Primary
Health Care Indicators
33
Report 1, Volume 2
FRUIT AND VEGETABLE CONSUMPTION RATE
INDICATOR NUMBER
21
INDICATOR DEFINITION
% of population, 12 years and over, who currently consume five or more servings of
fruits and vegetables daily.
METHOD OF
CALCULATION
(Numerator/Denominator) x 100
NUMERATOR
Number of survey respondents who report that they consume five or more servings
of fruits and vegetables per day
DENOMINATOR
Number of survey respondents, 12 years and over
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source available in the CCHS.
RATIONALE AND
INTERPRETATION
34
According to Canada’s Food Guide to Healthy Eating, people aged four years and
older should eat 5 to 10 servings of fruits and vegetables each day.26 Regular
consumption of fruits and vegetables is an essential contributor to a healthy,
productive population with many benefits including a reduced risk of cancer27, 28
cardiovascular disease, stroke and many age-associated functional declines.26 A high
rate for this indicator can be interpreted as a positive result.
Pan-Canadian Primary
Health Care Indicators
Report 1, Volume 2
OVERWEIGHT RATE
INDICATOR NUMBER
22
INDICATOR DEFINITION
% of population who are currently overweight or obese.
DEFINITION OF
RELEVANT TERMS
Body Mass Index (BMI): For adults, the ratio of body weight (in kilograms) to height
squared (in meters). A normal or healthy BMI ranges from 18.5 to 24.9. A BMI of
25.0 to 29.9 is classified as overweight and a BMI of 30.0 or more is classified as
obese. For children and teens (2–20 years), body fatness changes over the years as
they grow. This is why BMI for children, also referred to as BMI-for-age, is gender
and age specific. BMI-for-age is plotted on gender specific growth charts. A normal
BMI-for-age is classified 5th percentile to < 85th percentile; at risk for overweight
BMI-for-age is classified as 85th percentile to < 95th percentile; and obese BMI-forage is classified as > 95th percentile.29
METHOD OF
CALCULATION
(Numerator/Denominator) x 100
NUMERATOR
For adults: Number of population survey respondents 21 years and over with a
BMI ≥25
For children: Number of population survey respondents 2–21 years of age with a
BMI-for-age ≥ 85th percentile
DENOMINATOR
Number of population survey respondents (or proxy) 2 years and over (excluding
pregnant women and breastfeeding women)
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source available in the CCHS.
RATIONALE AND
INTERPRETATION
Overweight or obesity is a recognized health risk that may lead to an increased
likelihood of certain diseases such as hypertension, dyslipidemia, type 2 diabetes,
coronary heart disease, stroke, gallbladder disease, osteoarthritis, sleep apnea,
respiratory problems and certain cancers.30 In addition, being overweight or obese is
associated with increased overall morbidity and mortality.31 A low rate for this
indicator can be interpreted as a positive result.
Pan-Canadian Primary
Health Care Indicators
35
Report 1, Volume 2
PHYSICAL ACTIVITY RATE
INDICATOR NUMBER
23
INDICATOR DEFINITION
% of population who currently engage in regular physical activity.
DEFINITION OF
RELEVANT TERMS
In the CCHS, physical activity is classified into three groups: active, moderately
active or inactive based on an index of average daily physical activity over the past
3 months. For each leisure time physical activity engaged in by the respondent, an
average daily energy expenditure is calculated by multiplying the number of times the
activity was performed by the average duration of the activity by the energy cost
(kilocalories per kilogram of body weight per hour) of the activity. The index is
calculated as the sum of the average daily energy expenditures of all activities.
Respondents are classified as follows: 3.0 kcal/kg/day or more = physically active;
1.5 - 2.9 kcal/kg/day = moderately active; less than 1.5 kcal/kg/day = inactive.12
METHOD OF
CALCULATION
(Numerator/Denominator) x 100
NUMERATOR
Number of population survey respondents who report engaging in regular
physical activity
DENOMINATOR
Number of population survey respondents
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source available in the CCHS.
RATIONALE AND
INTERPRETATION
36
Physical activity has positive effects in the prevention of chronic diseases including
coronary artery disease, hypertension, non-insulin-dependent diabetes mellitus,
osteoporosis, colon cancer, depression and anxiety.30 Lack of physical activity is a
risk factor for cardiovascular disease, and the principal cause of mortality and
morbidity in developed countries.8 A high rate for this indicator can be interpreted as
a positive result.
Pan-Canadian Primary
Health Care Indicators
Report 1, Volume 2
HEAVY DRINKING RATE
INDICATOR NUMBER
24
INDICATOR DEFINITION
% of population, 12 years and over, who report heavy alcohol drinking behaviour in
the past 12 months.
DEFINITION OF
RELEVANT TERMS
Heavy drinking behaviour refers to current drinkers who reported drinking 5 or more
drinks on one occasion, 12 or more times a year.12
1
•
•
•
METHOD OF
CALCULATION
standard drink: 32
5 oz/142 mL of wine (12% alcohol);
1.5 oz/43 mL of spirits (40% alcohol);
12 oz/341 mL of regular strength beer (5% alcohol).
(Numerator/Denominator) x 100
NUMERATOR
Number of respondents who report heavy alcohol drinking behaviour in the past
12 months
DENOMINATOR
Number of respondents, 12 years and over, who are current alcohol drinkers
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source available in the CCHS.
RATIONALE AND
INTERPRETATION
This indicator is a measure of individuals who engage in episodes of risky drinking
behaviour. Individuals with regular excessive alcohol consumption are at higher risk
of developing alcohol-related health problems (e.g. liver damage, disorders of the
pancreas), socio-economic problems and other chronic health outcomes caused by
excessive alcohol use.33, 34, 35 Alcohol-related problems are also linked to increased
incidence of depression and other health issues, family problems, employment issues,
motor vehicle accidents, crime and violence.33 Left untreated, problem drinking can
contribute to hypertension, diabetes mellitus, gastrointestinal illness, psychiatric
problems and fetal damage.17 A low rate for this indicator can be interpreted as a
positive result.
Pan-Canadian Primary
Health Care Indicators
37
Report 1, Volume 2
PHC RESOURCES FOR SELF-MANAGEMENT OF CHRONIC CONDITIONS
INDICATOR NUMBER
25
INDICATOR DEFINITION
% of PHC clients/patients, 18 years and over, with a chronic health condition(s),
whose PHC organization provided them with resources to support self-management
or self-help groups.
DEFINITION OF
RELEVANT TERMS
Self-help groups are small, autonomous, open groups that meet regularly and whose
primary activity is mutual aid. Self-help groups are run by group members and do not
have any professional leadership.21
Self-management refers to tasks that individuals must undertake to live well with one
or more chronic conditions, including having the confidence to deal with medical
management, role management and emotional management of their conditions.22
METHOD OF
CALCULATION
NUMERATOR
Number of PHC clients/patients with a chronic health condition(s), who report that
their PHC organization provided them with resources to support self-management or
self-help groups
DENOMINATOR
Total number of PHC clients/patients, 18 years and over, with a chronic
health condition
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source currently not available. Survey data source required.
RATIONALE AND
INTERPRETATION
38
(Numerator/Denominator) x 100
It has been suggested that self-management programs have the potential to improve
health status and reduce health care utilization in clients/patients with chronic
diseases.36, 37 PHC organizations that provide easily accessible resources may make it
easier for clients/patients to understand and manage their disease processes,
treatment options and/or self-care practices that may be available to them.8 A high
rate for this indicator can be interpreted as a positive result.
Pan-Canadian Primary
Health Care Indicators
Report 1, Volume 2
PHC SUPPORT FOR INFORMAL CAREGIVERS
INDICATOR NUMBER
26
INDICATOR DEFINITION
% of informal caregivers who received support for their care giving role from their
PHC organization over the past 12 months.
DEFINITION OF
RELEVANT TERMS
Informal caregivers (or informal assistance) refers to help or supervision (usually
unpaid) that is provided to persons with one or more disabilities by family, friends or
neighbours (may or may not be living with them in a household).7
Support for the caregiver can range from:38
• Psychological support;
• Social support;
• Financial and/or employment support;
• Respite (e.g. 1 day/week, vacation, crisis support); and
• Training or education.
METHOD OF
CALCULATION
(Numerator/Denominator) x 100
NUMERATOR
Number of informal caregivers in PHC population who report that they received
support for their care giving role from their PHC organization over the past 12 months
DENOMINATOR
Total number of PHC informal caregivers
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source currently not available. Survey data source required.
RATIONALE AND
INTERPRETATION
Providing care for friends or loved ones remains a strong social value; however, when
care is constantly required, or is prolonged for months and years, the burden of care
giving may become overwhelming.38 Increased demands may be placed on informal
caregivers, without proper consideration to the mental, physical and emotional well
being of the individual(s).39 A lack of resources for caregivers, can create stress and
lead to personal difficulties, particularly among caregivers who are also employed.40
This may lead to a breakdown in relationships between the caregiver, the
client/patient and/or the provider. A high rate for this indicator can be interpreted as a
positive result.
Pan-Canadian Primary
Health Care Indicators
39
Report 1, Volume 2
TIME WITH PHC PROVIDER
INDICATOR NUMBER
27
INDICATOR DEFINITION
% of PHC clients/patients, 18 years and over, with a chronic condition(s), who had
sufficient time in most visits to confide their health-related feelings, fears and
concerns to their PHC provider.
METHOD OF
CALCULATION
(Numerator/Denominator) x 100
NUMERATOR
Number of PHC clients/patients with a chronic condition(s) who report that they had
sufficient time in most visits to confide their health-related feelings, fears and
concerns to their PHC provider
DENOMINATOR
Total number of PHC clients/patients, 18 years and over, with a chronic condition(s)
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source currently not available. Survey data source required.
RATIONALE AND
INTERPRETATION
40
PHC providers care for PHC clients/patients with chronic conditions who require
complex interventions tailored to their individual needs.41 If PHC clients/patients are
provided with sufficient time in their visit, they may more accurately and thoroughly
discuss their medical history and symptoms and share questions and concerns about
medical decisions or procedures, which may pre-empt ineffective treatment or
errors.42, 43, 44 A high rate for this indicator can be interpreted as a positive result.
Pan-Canadian Primary
Health Care Indicators
Report 1, Volume 2
CLIENT/PATIENT PARTICIPATION IN PHC TREATMENT PLANNING
INDICATOR NUMBER
28
INDICATOR DEFINITION
% of PHC clients/patients, 18 years and over, with a chronic condition(s), who
actively participated in the development of a treatment plan with their PHC provider
over the past 12 months.
DEFINITION OF
RELEVANT TERMS
Treatment plan45 refers to a multidisciplinary care plan that includes “specific services
to be delivered, the frequency of services, expected duration, community resources,
treatment goals, and assessment of the patient’s environment. The plan is updated
monthly and modified when appropriate.”45 These plans are developed in collaboration
with the PHC provider, client/patient and/or their caregiver.
METHOD OF
CALCULATION
(Numerator/Denominator) x 100
NUMERATOR
Number of PHC clients/patients with a chronic health condition(s), who actively
participated in the development of a treatment plan with their PHC provider over the
past 12 months
DENOMINATOR
Total number of PHC clients/patients, 18 years and over, with a chronic health
condition(s)
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source currently not available. Survey data source required.
RATIONALE AND
INTERPRETATION
Client/patient participation in treatment and care planning alongside their PHC
provider is an important aspect of patient-centered care. The active involvement of a
PHC client/patient in his/her treatment is associated with higher levels of general
satisfaction and improved outcomes.43 This helps to ensure that treatment plans are
made that take into account the client’s/patient’s family, workplace and community
context and facilitate the their ability to follow clinical advice.46 Also, it has been
suggested that an individual’s ability to manage their disease is strongly associated
with satisfaction with their regular care provider, and their ability to be pro-active in
their own care.46 A high rate for this indicator can be interpreted as a positive result.
Pan-Canadian Primary
Health Care Indicators
41
Report 1, Volume 2
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Pan-Canadian Primary
Health Care Indicators
45
Report 1, Volume 2
39. J. Spector and R. Tampi “Caregiver Depression,” Annals of Long-Term Care 13,
4 (2005): pp. 34-40.
40. Health Canada, National Profile of Family Caregivers in Canada. Final Report,
(Ottawa: Health Canada, 2002).
41. D. Temmink, A.L. Francke, J. Hutten, J. Van Der Zee et al., “Innovations in the
Nursing Care of the Chronically Ill: A Literature Review from an International
Perspective,” Journal of Advanced Nursing 6, 31 (2000): pp. 1449-1458.
42. C. Martin and B.G. Rohan, “Chronic Illness Care as a Balancing Act. A
Qualitative Study,” Australian Family Physician 31, 1 (2002): pp. 55-59.
43. M. Stewart, “Effective Physician-Patient Communication and Health
Outcomes: A Review,” Canadian Medical Association Journal 152, (1995):
pp. 1423-1433.
44. Schoen, R. Osborn, P.T. Huynh, M. Doty et al., “Taking the Pulse of Health
Care Systems: Experiences of Patients with Health Problems in Six Countries,”
Health Affairs, (November 3, 2005): pp. W5-509–W5-525.
45. TriWest Heatlh Care Alliance, Tricare Provider Handbook, [online], cited
December 10, 2005, from <https://www.triwest.com/triwest/unauth/
content/provider/handbook/provider/pro_glossary_of_terms.html>.
46. B. Starfield, C. Wray, K. Hess, R. Gross et al., “The Influence of PatientPractitioner Agreement on Outcome of Care,” American Journal of Public
Health 71, (1981): pp.127-131.
46
Pan-Canadian Primary
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Report 1, Volume 2
Enhancing an Integrated Approach to 24/7 Access
Objective 4:
To enhance 24/7 access for patient-initiated urgent care,
which is effectively linked with the patient’s usual primary
health care provider
29. Difficulties obtaining urgent, non-emergent PHC on evenings and weekends
Evaluation Question 8—What proportion of the population has a usual primary
health care provider that has organizational arrangements for 24/7 access that are
effectively linked to the usual provider?
30. PHC after hours coverage
31. Average number of PHC extended hours
Evaluation Question 9—What are the costs and consequences of providing 24/7
access alternatives for patient-initiated urgent care (other than contact physician
services) in terms of health outcomes, patient and provider satisfaction, and
utilization of health care? Other analytical approach required.
Evaluation Question 10—What is the wait time for acute and episodic care? For
routine non-urgent care (including well care and chronic illness management)? For
referred care?
32. Wait time for PHC urgent, non-emergent PHC
Evaluation Question 10.1—What is the level of patient satisfaction with wait times?
33. Satisfaction with wait times for urgent, non-emergent PHC
34. Satisfaction with wait times for routine PHC
Evaluation Question 10.2—Do wait times differ systematically by urban/rural/remote
region? By socio-economic group? By ethnic group? This question proposes a
number of analytic dimensions for the analysis of the indicators included in
Evaluation Question 10.2 and other questions.
Pan-Canadian Primary
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Report 1, Volume 2
DIFFICULTIES OBTAINING URGENT, NON-EMERGENT PHC ON EVENINGS AND WEEKENDS
INDICATOR NUMBER
29
INDICATOR DEFINITION
% of population, 18 years and over, who experienced difficulties obtaining immediate
care for an emergent but minor health problem, from their regular PHC provider,
during evenings and weekends (5:00 pm to 9:00 pm, Monday to Friday or 9:00 am
to 5:00 pm, Saturdays and Sundays), over the past 12 months.
DEFINITION OF
RELEVANT TERMS
Difficulty accessing immediate care from a regular PHC provider could include any of
the following:
• Difficulty contacting regular PHC provider;
• Difficulty getting an appointment with regular PHC provider;
• Do not have a regular PHC provider (due to either lack of PHC providers in area,
lack of PHC providers accepting PHC clients/patients, preference not to have a
regular PHC provider, etc.);
• Waited too long to get an appointment with regular PHC provider;
• Waited too long to see the PHC provider (in-office waiting);
• Service not available at time required;
• Service not available in the area;
• Transportation problem;
• Language problem;
• Cost;
• Did not know where to go (i.e. information problem);
• Unable to leave the house because of a health problem; and
• Other.1
Immediate care for an emergent but minor health problem refers to same-day
service for a problem such as a fever, headache, sprained ankle, vomiting or an
unexplained rash.1
METHOD OF
CALCULATION
NUMERATOR
Number of survey respondents who experienced difficulties obtaining immediate care
for an emergent but minor health problem, from their regular PHC provider, during
evenings and weekends (5:00 to 9:00 pm, Monday to Friday or 9:00 am to 5:00 pm,
Saturdays and Sundays), over the past 12 months
DENOMINATOR
Number of survey respondents, 18 years and over
DATA SOURCE AND
AVAILABILITY
Potential Pan-Canadian data source could be available in the CCHS with modifications
to the survey.
RATIONALE AND
INTERPRETATION
48
(Numerator/Denominator) x 100
In the 10-Year Plan to Strengthen Health Care, the First Ministers recommended
that 50% of the Canadian population have access to 24/7 PHC services by
multidisciplinary teams by the year 2011.2 The ability to obtain urgent PHC
services when needed is believed to be important in maintaining health, preventing
health emergencies and preventing the inappropriate use of services (e.g. use of
hospital emergency rooms for non-emergencies).3 Several provinces have introduced
policy on after-hours coverage in PHC.4 A low percentage of the population
experiencing difficulty accessing immediate care in extended hours is interpreted as a
positive result.
Pan-Canadian Primary
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Report 1, Volume 2
PHC AFTER HOURS COVERAGE
INDICATOR NUMBER
30
INDICATOR DEFINITION
% of PHC organizations who currently provide after hours coverage (beyond 9:00 am
to 5:00 pm Monday to Friday) for their practice population.
DEFINITION OF
RELEVANT TERMS
After hours coverage could include any of the following:
• Provision of extended regular office hours, beyond MF 9–5;
• Provision of individualized 24/7 medical telephone advice (provided by you jointly
with other PHC providers in the practice or region); and
• Provision of instructions to go to after hours clinic that is staffed by you jointly
with other PHC providers in the practice or region.
METHOD OF
CALCULATION
(Numerator/Denominator)
NUMERATOR
Number of PHC organizations who currently provide after hours coverage (beyond
9:00 am to 5:00 pm Monday to Friday) for their practice population
DENOMINATOR
Number of PHC organization survey respondents
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source currently not available. Survey data source required.
RATIONALE AND
INTERPRETATION
In the 10-Year Plan to Strengthen Health Care, the First Ministers recommended that
50% of the Canadian population have access to 24/7 PHC services by
multidisciplinary teams by the year 2011.2 Several provinces have introduced policies
on after-hours coverage in PHC.4 A higher proportion of PHC organizations providing
after hours coverage can be interpreted as a positive result.
Pan-Canadian Primary
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Report 1, Volume 2
AVERAGE NUMBER OF PHC EXTENDED HOURS
INDICATOR NUMBER
31
INDICATOR DEFINITION
Average number of extended hours (beyond 9:00 am to 5:00 pm, Monday to Friday),
provided by PHC organizations per month, by PHC organization.
DEFINITION OF
RELEVANT TERMS
After hours coverage could include any of the following:
• Provision of extended regular office hours, beyond MF 9–5;
• Provision of individualized 24/7 medical telephone advice (provided by you jointly
with other PHC providers in the practice or region); and
• Provision of instructions to go to after hours clinic that is staffed by you jointly
with other PHC providers in the practice or region.
METHOD OF
CALCULATION
(Numerator/Denominator)
NUMERATOR
Sum of extended hours provided per organization over one year
DENOMINATOR
Number of months in a year (12 months)
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source currently not available. Survey data source required.
RATIONALE AND
INTERPRETATION
50
In the 10-Year Plan to Strengthen Health Care, the First Ministers recommended that
50% of the Canadian population have access to 24/7 PHC services by
multidisciplinary teams by the year 2011.2 Several provinces have introduced policies
on after-hours coverage in PHC.4 A higher average number of extended hours per
organization can be interpreted as a positive result.
Pan-Canadian Primary
Health Care Indicators
Report 1, Volume 2
WAIT TIME FOR PHC URGENT, NON-EMERGENT PHC
INDICATOR NUMBER
32
INDICATOR DEFINITION
Average length of time in days between client/patient appointment request with their
regular PHC provider and the appointment for an emergent but minor health problem.
DEFINITION OF
RELEVANT TERMS
Immediate care for an emergent but minor health problem refers to same-day
service for a problem such as a fever, headache, sprained ankle, vomiting or an
unexplained rash.1
METHOD OF
CALCULATION
(Numerator/Denominator) x 100
NUMERATOR
Number of days from date of client/patient appointment request to the date of the
third available appointment for an emergent but minor health problem
DENOMINATOR
Number of client/patient request studies completed
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source currently not available. Administrative data
source required.
RATIONALE AND
INTERPRETATION
In the 10-Year Plan to Strengthen Health Care, the First Ministers recommended that
50% of the Canadian population have access to 24/7 PHC services by
multidisciplinary teams by the year 2011.2 Excessive wait times can be a barrier to
access to healthcare and are frequently monitored to indicate system performance
and service supply constraints.5 Measurement of the third available appointment
assesses wait time by taking into account same day appointments kept available by
providers for one or two urgent clients/patients.5 A lower average wait time is
interpreted as a positive result.
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Report 1, Volume 2
SATISFACTION WITH WAIT TIMES FOR URGENT, NON-EMERGENT PHC
INDICATOR NUMBER
33
INDICATOR DEFINITION
% of PHC clients/patients, 18 years and over, who are satisfied with wait time to
obtain an appointment with their regular PHC provider for an emergent but minor
health problem.
DEFINITION OF
RELEVANT TERMS
Immediate care for an emergent but minor health problem refers to same-day
service for a problem such as a fever, headache, sprained ankle, vomiting or an
unexplained rash.1
METHOD OF
CALCULATION
(Numerator/Denominator) x 100
NUMERATOR
Number of PHC clients/patients who are satisfied with wait time to obtain
an appointment with their regular PHC provider for an emergent but minor
health problem
DENOMINATOR
Number of PHC client/patient survey respondents, 18 years and over
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source currently not available. Survey data source required.
RATIONALE AND
INTERPRETATION
52
In the 10-Year Plan to Strengthen Health Care, the First Ministers recommended that
50% of the Canadian population have access to 24/7 PHC services by
multidisciplinary teams by the year 2011.2 Excessive wait times can be a barrier to
access to healthcare and are frequently monitored to indicate system performance
and service supply constraints.5 A higher level of client/patient satisfaction is
interpreted as a positive result.
Pan-Canadian Primary
Health Care Indicators
Report 1, Volume 2
SATISFACTION WITH WAIT TIMES FOR ROUTINE PHC
INDICATOR NUMBER
34
INDICATOR DEFINITION
% of PHC clients/patients, 18 years and over, who are satisfied with wait time to
obtain an appointment with their regular PHC provider for non-urgent routine care.
DEFINITION OF
RELEVANT TERMS
Non-urgent care includes such things as a medical exam or follow-up visit.1
METHOD OF
CALCULATION
(Numerator/Denominator) x 100
NUMERATOR
Number of PHC clients/patients who are satisfied with wait time to obtain an
appointment with their regular PHC provider for non-urgent routine care
DENOMINATOR
Number of PHC client/patient survey respondents, 18 years and over
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source currently not available. Survey data source required.
RATIONALE AND
INTERPRETATION
In the 10-Year Plan to Strengthen Health Care, the First Ministers recommended that
50% of the Canadian population have access to 24/7 PHC services by
multidisciplinary teams by the year 2011.2 Excessive wait times can be a barrier to
access to healthcare and are frequently monitored to indicate system performance
and service supply constraints.5 A higher level of client/patient satisfaction is
interpreted as a positive result.
Pan-Canadian Primary
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Report 1, Volume 2
References
1. Statistics Canada, Canadian Community Health Survey, Cycle 3.1, (Ottawa:
Statistics Canada, 2004).
2. Health Canada, First Minister’s Meeting on the Future of Health Care 2004:
A 10-Year Plan to Strengthen Health Care, [online], cited April 10, 2006,
from <http://www.hc-sc.gc.ca/hcs-sss/delivery-prestation/fptcollab/
2004-fmm-rpm/index_e.html>.
3. C. van Uden and H. Crebolder, “Does Setting up Out of Hours Primary Care
Cooperatives Outside a Hospital Reduce Demand for Emergency Care?”
Emergency Medicine Journal 21, (2004): pp. 722-723.
4. R. Bordman D. Wheler, N. Drummond, D. White, et al. “After Hours Coverage,”
Le Medecin de Famille Canadien 51, (April 2005): pp. 536-537.
5. M. Murray and D. Berwick, “Advanced Access, Reducing Waiting and Delays
in Primary Care,” Journal of the American Medical Association 289, (2003):
pp. 1035-1040.
54
Pan-Canadian Primary
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Report 1, Volume 2
Strengthening the Quality of PHC
Objective 5:
To deliver high quality and safe primary health services and to
promote a culture of quality improvement in primary health
care organizations
35. Ambulatory care sensitive conditions
36. Complications of diabetes
37. Emergency department visits for asthma
38. Emergency department visits for congestive heart failure
39. Glycemic control for diabetes
40. Blood pressure control for hypertension
Evaluation Question 11—What percent of recommended preventive care
guidelines by the Canadian Task Force on Preventive Health Services are
implemented by PHC providers?
Health Promotion, Screening and Prevention
41. Influenza immunization, 65+
42. Pneumococcal immunization, 65+
43. Well baby screening
44. Child immunization
45. Breast-feeding education
46. Depression screening for pregnant and post-partum women
47. Counselling on home risk factors for children
48. Colon cancer screening
49. Breast cancer screening
50. Cervical cancer screening
51. Bone density screening
52. Dyslipidemia screening for women
53. Dyslipidemia screening for men
54. Blood pressure testing
Secondary Prevention for PHC Clients/Patients with Coronary Artery Disease,
Hypertension and Diabetes Mellitus
55. Screening for modifiable risk factors in adults with coronary artery disease
56. Screening for modifiable risk factors in adults with hypertension
57. Screening for modifiable risk factors in adults with diabetes
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Report 1, Volume 2
Evaluation Question 12—Does the care for specific key conditions (diabetes,
COPD/asthma, congestive heart failure, depression, hypertension, smoking) conform
to current evidence and commonly accepted standards?
Diabetes Mellitus
58. Screening for visual impairment in adults with diabetes
Asthma
59. Asthma control
Congestive Heart Failure
60. Treatment of congestive heart failure
Coronary Artery Disease
61. Treatment of dyslipidemia
62. Treatment of acute myocardial infarction
Mental Health
63. Antidepressant medication monitoring
64. Treatment of depression
65. Treatment of anxiety
Addictive Substance(s) Use Problems
66. Treatment for illicit or prescription drug use problems
Evaluation Question 12.1—Does the emphasis on management of common chronic
diseases (diabetes, COPD/asthma, heart disease, depression) compromise the
quality of care received by people with other chronic diseases or with multiple comorbidities? Other analytical approach required.
Evaluation Question 13—Do PHC organizations have defined, non-prejudicial
confidential processes for staff to report potential errors in delivery, treatment
or management?
67. PHC support for medication incident reduction
56
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Report 1, Volume 2
Evaluation Question 14—Do PHC organizations measure their performance against
recognized standards and modify their practices in response (including issues of
patient safety)?
68. Use of medication alerts in PHC
69. Implementation of PHC clinical quality improvement initiatives
Evaluation Question 14.1—Are there structures and processes in place to ensure
optimal and safe medication management?
70. Maintaining medication and problem lists in PHC
71. Information about prescribed medication by PHC providers
Evaluation Question 14.2—Do PHC professionals participate in continuing
profession development that reflects the needs of the PHC organization and the
local health needs of the community?
72. Professional development for PHC providers and support staff
Pan-Canadian Primary
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Report 1, Volume 2
AMBULATORY CARE SENSITIVE CONDITIONS (ACSC)
INDICATOR NUMBER
35
INDICATOR DEFINITION
Age-standardized acute care hospitalization rate for conditions where appropriate
ambulatory care prevents or reduces the need for admission to hospital, per 100,000
population 75 years and under.
DEFINITION OF
RELEVANT TERMS
ACSC selected conditions include grand mal status and other epileptic convulsions,
chronic obstructive pulmonary disease, asthma, congestive heart failure,
hypertension, angina and diabetes.1, 2
METHOD OF
CALCULATION
Total number of hospital admissions for selected ACSC/Total mid-year population
75 years and under per 100,000 (age adjusted).
NUMERATOR
Total number of hospital admissions for selected ACSC
DENOMINATOR
Total mid-year population 75 years and under per 100,000 (age adjusted)
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source available in Hospital Morbidity Database (HMDB).
RATIONALE AND
INTERPRETATION
58
Ambulatory Care Sensitive Conditions (ACSCs) include long-term health conditions,
which can often be managed with timely and effective treatment in the community.
ACSCs include chronic conditions such as diabetes, asthma, hypertension and
others. Optimizing management and treatment of these conditions in the community,
including the PHC setting, can potentially contribute to both improved client/patient
health outcomes and more efficient resource utilization. Variations over time, and
differences between regions, should be examined to determine the extent to which
they are attributable to the accessibility and quality of community-based care,
hospital admitting practices, or prevalence and acuity of these chronic health
conditions.3 A low rate for this indicator can be interpreted as a positive result.
Pan-Canadian Primary
Health Care Indicators
Report 1, Volume 2
COMPLICATIONS OF DIABETES
INDICATOR NUMBER
36
INDICATOR DEFINITION
% of PHC clients/patients, ages 18 to 64 years, with established diabetes mellitus
(Type 1 and Type 2) who have had an acute myocardial infarction or above or below
knee amputation or began chronic dialysis within the past 12 months.
METHOD OF
CALCULATION
(Numerator/Denominator) x 100
NUMERATOR
Number of PHC clients/patients with established diabetes mellitus (Type 1 and 2)
who have had an acute myocardial infarction or above or below knee amputation or
began chronic dialysis within the past 12 months
DENOMINATOR
Total number of PHC clients/patients, ages 18 to 64 years with established diabetes
mellitus (Type 1 and Type 2) within the past 12 months
DATA SOURCE AND
AVAILABILITY
Potential Pan-Canadian data source could be available using the Discharge Abstract
Database (DAD) or Hospital Morbidity Database (HMDB) with PHC encounter data.
RATIONALE AND
INTERPRETATION
Impairment caused by complications of diabetes such as cardiovascular disease,
amputation or end-stage renal failure leading to chronic dialysis can be potentially
avoided through successful management of glucose, lipids and blood pressure levels.5
Dialysis is costly, and can have a devastating effect on quality and length of life.4
Research shows that these complications can potentially be avoided or delayed in
clients/patients with diabetes mellitus by effective management, in the community,
of glucose levels, dyslipidemia and hypertension.5 A low rate for this indicator can be
interpreted as a positive result.
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Report 1, Volume 2
EMERGENCY DEPARTMENT VISITS FOR ASTHMA
INDICATOR NUMBER
37
INDICATOR DEFINITION
% of PHC clients/patients, ages 6 to 55 years, with asthma who visited the
emergency department in the past 12 months.
METHOD OF
CALCULATION
(Numerator/Denominator) x 100
NUMERATOR
Number of PHC clients/patients with asthma who visited the emergency department
in the past 12 months
DENOMINATOR
Total number of PHC clients/patients, ages 6 to 55 years, with asthma in the past
12 months
DATA SOURCE AND
AVAILABILITY
Potential Pan-Canadian data source could be available using the National Ambulatory
Care Reporting System (NACRS) with PHC encounter data.
RATIONALE AND
INTERPRETATION
60
The healthcare costs of acute asthma in Canada exceeded $100 million per year
where emergency department (ED) costs were an estimated $22 million and inpatient costs an estimated $84 million per year.6 Despite improved understanding of
disease pathophysiology and pharmacological options, complications still occur.6
The intent of this indicator is to monitor the frequency of an increase in asthma
severity or in any of its signs or symptoms, to monitor adverse events related to
asthma, and to monitor the impact and costs of asthma for the community (in terms
of use of ED services) and the individual.7 A Canadian expert panel convened in 2004
recommended monitoring ED visits to assess the appropriateness of asthma care
management.8 A low rate for this indicator can be interpreted as a positive result.
Pan-Canadian Primary
Health Care Indicators
Report 1, Volume 2
EMERGENCY DEPARTMENT VISITS FOR CONGESTIVE HEART FAILURE (CHF)
INDICATOR NUMBER
38
INDICATOR DEFINITION
% of PHC clients/patients, ages 20 to 75 years, with CHF who visited the emergency
department for CHF in the past 12 months.
METHOD OF
CALCULATION
(Numerator/Denominator) x 100
NUMERATOR
Number of PHC clients/patients with CHF who visited the emergency department for
CHF in the past 12 months
DENOMINATOR
Number of PHC clients/patients, ages 20 to 75 years, with CHF
DATA SOURCE AND
AVAILABILITY
Potential Pan-Canadian data source could be available using the National Ambulatory
Care Reporting System with PHC encounter data.
RATIONALE AND
INTERPRETATION
This outcome measure assesses clients/patients with diagnosed CHF who visited the
emergency department (ED) for an acute exacerbation, as a proxy measure for CHF
community-based management. CHF hospital amissions tend to be related primarily
to behavioural factors (e.g. non-adherence to heart failure medication and dietary
regimen) or social factors (e.g. inadequate social support network, and insufficient
follow-up).9, 10, 11, 12, 13 In 2003, the Canadian Cardiovascular Outcomes Research
Team/Canadian Cardiovascular Society Heart Failure Quality Indicator Panel14
recommended outcome indicators concerning ED visits for CHF within 30 days or one
year of discharge. A low rate for this indicator can be interpreted as a positive result.
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Report 1, Volume 2
GLYCEMIC CONTROL FOR DIABETES
INDICATOR NUMBER
39
INDICATOR DEFINITION
% of PHC clients/patients, 18 years and over, with diabetes mellitus in whom the
last HbA1c was 7.0% or less (or equivalent test/reference range depending on local
laboratory) in the last 15 months.
DEFINITION OF
RELEVANT TERMS
Hemoglobin A1c test (also called the HbA1c or A1c test, or glycated/glycosylated
hemoglobin) “is a laboratory test that reflects the average glucose level over a two to
three month period.”5
METHOD OF
CALCULATION
(Numerator/Denominator) x 100
NUMERATOR
Number of PHC clients/patients with diabetes mellitus in whom the last HbA1c was
7.0% or less (or equivalent test/reference range depending on local laboratory) in the
past 15 months
DENOMINATOR
Total number of PHC clients/patients, 18 years and over with diabetes mellitus within
the past 15 months
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source currently not available. Clinical administrative data
source required.
RATIONALE AND
INTERPRETATION
62
This indicator measures the percentage of clients/patients with diabetes mellitus for
whom the ideal treatment goal of HbA1c less than 7% is met. Type 2 diabetes may
be present for several years before being diagnosed15 and, in some clients/patients
with diabetes, short-term hyperglycemia can result in vascular changes.16 The
Canadian Diabetes Association17 guidelines recommend “aiming aggressively for
glycemic targets as close to normal as early as possible to reduce risk of
microvascular and macrovascular diseases. The glycemic target for most people with
diabetes is HbA1c less than or equal to 7.0% (measured every 3 months).” A similar
HbA1c proxy outcome indicator is included in the Quality and Outcomes Framework
for England.18 A rate for this indicator can be interpreted as a positive result.
Pan-Canadian Primary
Health Care Indicators
Report 1, Volume 2
BLOOD PRESSURE CONTROL FOR HYPERTENSION
INDICATOR NUMBER
40
INDICATOR DEFINITION
% of PHC clients/patients, 18 years and over, with hypertension for duration of
at least one year, who have blood pressure measurement control (i.e. less than
140/90 mmHg).
METHOD OF
CALCULATION
(Numerator/Denominator) x 100
NUMERATOR
Number of PHC clients/patients with hypertension for duration of at least one year,
who have blood pressure measurement control (i.e. less than 140/90 mmHg)
DENOMINATOR
Total number of PHC clients/patients, 18 years and over, with hypertension for
duration of at least one year
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source currently not available. Clinical administrative data
source required.
RATIONALE AND
INTERPRETATION
Achieving a target blood pressure of less than 140/90 mmHg for a PHC client/patient
with hypertension reflects effective control of hypertension. The Canadian Heart
Health Survey19 found that although 22% of adult Canadians have hypertension, only
16% have it controlled with drug therapy. Hypertension management is often
suboptimal; substantial proportions of clients/patients receive no treatment and are
not controlled for hypertension (19%) or have hypertension that is uncontrolled
despite receiving treatment (23%), even though numerous studies have proven the
benefit of lowering blood pressure.20 An estimated one third of Coronary Heart
Disease events in men and more than half of these events in women could be
prevented with satisfactory control of blood pressure in clients/patients with
hypertension.21 A high rate for this indicator can be interpreted as a positive result.
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Report 1, Volume 2
INFLUENZA IMMUNIZATION, 65+
INDICATOR NUMBER
41
INDICATOR DEFINITION
% of PHC clients/patients, 65 years and over, who received an influenza
immunization within the past 12 months.
METHOD OF
CALCULATION
(Numerator/Denominator) x 100
NUMERATOR
Number of PHC clients/patients who received an influenza immunization within the
past 12 months
DENOMINATOR
Total number of PHC clients/patients 65 years and over within the past 12 months
DATA SOURCE AND
AVAILABILITY
No Pan-Canadian clinical administrative data source currently available. CCHS
includes a related survey question.
RATIONALE AND
INTERPRETATION
64
The influenza virus is responsible for substantial morbidity and mortality in Canada
that may, in part, be preventable through immunization programs. The National
Advisory Committee on Immunization (NACI)22 recommends, “to reduce the morbidity
and mortality associated with influenza and the impact of illness in our communities,
immunization programs should focus on those at high risk for influenza-related
complications.” NACI23 recommends that people 65 years and over receive influenza
vaccine every year. For elderly people, influenza and pneumococcal vaccines are
reported as more cost-effective than all other preventive, screening and treatment
interventions that have been studied.23 A high rate for this indicator can be
interpreted as a positive result.
Pan-Canadian Primary
Health Care Indicators
Report 1, Volume 2
PNEUMOCOCCAL IMMUNIZATION, 65+
INDICATOR NUMBER
42
INDICATOR DEFINITION
% of PHC clients/patients, 65 years and over, who have received a pneumococcal
immunization.
METHOD OF
CALCULATION
(Numerator/Denominator) x 100
NUMERATOR
Number of PHC clients/patients who received a pneumococcal immunization
DENOMINATOR
Total number of PHC clients/patients 65 years and over
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source currently not available. Clinical administrative data
source required.
RATIONALE AND
INTERPRETATION
Pneumonia, among other respiratory infections, represents an important threat to
older clients/patients’ health.24 The National Advisory Committee on Immunization23
recommends, “people 65 years and over should receive, on a one-time basis, a dose
of pneumococcal vaccine. For elderly people, influenza and pneumococcal vaccines
are reported as more cost-effective than all other preventive, screening and treatment
interventions that have been studied.” A high rate for this indicator can be interpreted
as a positive result.
Pan-Canadian Primary
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Report 1, Volume 2
WELL BABY SCREENING
INDICATOR NUMBER
43
INDICATOR DEFINITION
% of PHC clients/patients who received screenings for congenital hip displacement,
eye and hearing problems by 3 years of age.
METHOD OF
CALCULATION
(Numerator/Denominator) x 100
NUMERATOR
Number of PHC clients/patients who received screening for congenital hip
displacement, eye and hearing problems by 3 years of age
DENOMINATOR
Number of PHC clients/patients, 3 years of age
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source currently not available. Clinical administrative data
source required.
RATIONALE AND
INTERPRETATION
66
Early detection and treatment of congenital hip displacement, eye and hearing
problems in infants can potentially reduce the burden of suffering related to these
physical conditions. For example, if profound hearing loss is identified within the first
year of life, the resultant problems with speech and learning may be mitigated.27
Tests for strabismus can help detect “wandering” eye and allow for timely
treatment.25 In a study of congenital hip dislocation, the amount of open surgery
required was much less and long-term results much better among infants whose
condition has been diagnosed at birth and treated before 1 month of age than among
those diagnosed later in the first year.26 Evidence reviewed by the Canadian Task
Force on Preventive Health Care (CTFPHC) indicates that the burden of disease can
be reduced if: children have their congenital hip dislocation fixed before the age of
1 month, if infants have their eyes aligned before the age of 24 months, and if
hearing aids and training are introduced before 3 years of age. The CTFPHC
recommends repeated examination of hips, eyes and hearing, especially in the first
year of life (grade A recommendation).27 A high rate for this indicator can be
interpreted as a positive result.
Pan-Canadian Primary
Health Care Indicators
Report 1, Volume 2
CHILD IMMUNIZATION
INDICATOR NUMBER
44
INDICATOR DEFINITION
% of PHC clients/patients who received required primary childhood immunizations by
7 years of age.
METHOD OF
CALCULATION
(Numerator/Denominator) x 100
NUMERATOR
Number of PHC clients/patients who received required primary childhood
immunizations at recommended schedule
DENOMINATOR
Total number of PHC clients/patients 7 years of age
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source currently not available. Clinical administrative data
source required.
RATIONALE AND
INTERPRETATION
Few measures in preventive medicine are of such proven value as routine primary
childhood immunization against infectious diseases. Immunization carried out
according to the recommended schedule provides good basic protection for most
children against these diseases.23 This measure is used to assess the percentage of
seven-year-olds who are up-to-date with their primary series of immunizations. The
Canadian Task Force on Preventive Health Care recommends vaccination with
diphtheria-pertussis-tetanus (DPT) and polio vaccines at 2, 4, 6, 18 months and 4–6
years; hemophilus influenzae type b (Hib) conjugate vaccine at 2, 4, 6 and 18
months and measles-mumps-rubella (MMR) vaccine at 12 months and 4–6 years
(grade A recommendation).28 A high rate for this indicator can be interpreted as a
positive result.
Pan-Canadian Primary
Health Care Indicators
67
Report 1, Volume 2
BREAST-FEEDING EDUCATION
INDICATOR NUMBER
45
INDICATOR DEFINITION
% of women PHC clients/patients who had a live birth and received counseling
on breast feeding, education programs and postpartum support to promote
breast feeding.
METHOD OF
CALCULATION
(Numerator/Denominator) x 100
NUMERATOR
Number of women PHC clients/patients who had a live birth in the past year and
received counseling on breast feeding, education programs and postpartum support
to promote breast feeding
DENOMINATOR
Number of women PHC clients/patients who have had a live birth in the past year
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source currently not available. Clinical administrative data
source required.
RATIONALE AND
INTERPRETATION
68
Breast-feeding has been shown to improve the health of infants and their mothers.29
Studies indicate that breastfeeding counseling during antenatal care is effective at
improving both initiation and continuation of breast-feeding during the first two
months postpartum, compared with usual care.30 The Canadian Task Force on
Preventive Health Care recommends the provision of structured antenatal counseling.
There is good evidence to recommend provision of structured antepartum educational
programs and postpartum support (grade A recommendation).30 A high rate for this
indicator can be interpreted as a positive result.
Pan-Canadian Primary
Health Care Indicators
Report 1, Volume 2
DEPRESSION SCREENING FOR PREGNANT AND POST PARTUM WOMEN
INDICATOR NUMBER
46
INDICATOR DEFINITION
% of women PHC clients/patients who are pregnant or post partum who have been
screened for depression.
METHOD OF
CALCULATION
(Numerator/Denominator) x 100
NUMERATOR
Number of women PHC clients/patients who are pregnant or post partum who have
been screened for depression
DENOMINATOR
Total number of women PHC clients/patients who are pregnant or post partum
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source currently not available. Clinical administrative data
source required.
RATIONALE AND
INTERPRETATION
Pregnancy and post partum is a high-risk time for new onset or reactivated
depression. The literature indicates, “early detection of depression is critical for
initiating treatment and potentially reducing the resultant cognitive, emotional, and
behavioural consequences for mothers and their children.”31 A high rate for this
indicator can be interpreted as a positive result.
Pan-Canadian Primary
Health Care Indicators
69
Report 1, Volume 2
COUNSELLING ON HOME RISK FACTORS FOR CHILDREN
INDICATOR NUMBER
47
INDICATOR DEFINITION
% of PHC clients/patients with children under 2 years who were given information on
child injury prevention in the home.
DEFINITION OF
RELEVANT TERMS
Information is defined as safety advice about preventive measures for childhood
injuries, including: use of car seats for infant/toddler; never leave a young child alone
in bathtub; encourage swimming lessons, diving and boating safety; install smoke
detectors in the home; use non-inflammable sleepwear; use safe toys and safe food
(i.e. avoid hard, small and round, smooth and sticky solid food); do not use baby
walkers; wear bike helmets; have Poison Control Centre number handy, and safety
proof cupboards and drawers containing medicine, cleaners and solvents.32
METHOD OF
CALCULATION
(Numerator/Denominator) x 100
NUMERATOR
Number of PHC clients/patients who were given information on child injury
prevention in the home
DENOMINATOR
% of PHC clients/patients with children under 2 years
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source currently not available. Clinical administrative data
source required.
RATIONALE AND
INTERPRETATION
70
Injuries in the home are a significant problem for preschool children. Evidence
suggests that counselling on home risk factors is effective in improving parental
knowledge and behaviour.33 The Canadian Task Force on Preventive Health Care
recommends the provision of individual counselling on the hazards in the home
(grade B recommendation).33 A high rate for this indicator can be interpreted as a
positive result
Pan-Canadian Primary
Health Care Indicators
Report 1, Volume 2
COLON CANCER SCREENING
INDICATOR NUMBER
48
INDICATOR DEFINITION
% of PHC clients/patients, 50 years and over, who received screening for colon
cancer with Hemoccult test within the past 24 months.
DEFINITION OF
RELEVANT TERMS
Hemoccult Test (also known as FOBT, fecal occult blood test, stool occult blood,
hemoccult, guaiac smear test, gFOBT, immunochemical FOBT, immunoassay FOBT,
and iFOBT) is one or more stool samples to screen for gastrointestinal bleeding,
which may be an indicator of colon cancer.34
METHOD OF
CALCULATION
(Numerator/Denominator) x 100
NUMERATOR
Number of PHC clients/patients who received screening for suspected colon cancer
with Hemoccult test
DENOMINATOR
Total number of PHC clients/patients 50 years and over
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source currently not available. Clinical administrative data
source required.
RATIONALE AND
INTERPRETATION
Colorectal cancer, the third most common cancer, affects both men and women.
An estimated 20,000 new cases are diagnosed annually in Canada, where one-third
of these cases will be fatal.35 Screening may allow detection of tumors at an early
stage, which would improve the prognosis.35 Evidence from randomized controlled
trials show that fecal occult blood testing (FOBT) results in a significant decrease in
mortality from colorectal cancer, but not in overall mortality.36 The Canadian Task
Force on Preventive Health Care, Health Canada and Cancer Care Ontario recommend
that everyone aged 50 and over have a FOBT every one to two years to detect and
even prevent colorectal cancer.37, 38 A high rate for this indicator can be interpreted
as a positive result.
Pan-Canadian Primary
Health Care Indicators
71
Report 1, Volume 2
BREAST CANCER SCREENING
INDICATOR NUMBER
49
INDICATOR DEFINITION
% of women PHC clients/patients, ages 50 to 69 years, who received mammography
and clinical breast examination within the past 24 months.
METHOD OF
CALCULATION
(Numerator/Denominator) x 100
NUMERATOR
Number of women PHC clients/patients who were offered and/or received
mammography and clinical breast exam
DENOMINATOR
Total number of women PHC clients/patients ages 50 to 69 years within the past
24 months
DATA SOURCE AND
AVAILABILITY
Pan-Canadian clinical administrative data source currently not available. CCHS has a
related survey question.
RATIONALE AND
INTERPRETATION
72
Early detection of breast cancer is an important strategy in offering women more
treatment options, as well as improved survival outcomes. Among women aged 50
and older, mammography screening has been shown to reduce mortality by 20 to 40
percent.39 The Canadian Task Force on Preventive Health Care concludes that there is
good evidence for screening women ages 50 to 69 years by clinical breast
examination and mammography (Grade A recommendation). The best available
data support screening every 1–2 years.40 A high rate for this indicator can be
interpreted as a positive result.
Pan-Canadian Primary
Health Care Indicators
Report 1, Volume 2
CERVICAL CANCER SCREENING
INDICATOR NUMBER
50
INDICATOR DEFINITION
% of women PHC clients/patients, ages 18 to 69 years, who received a papanicolaou
smear within the past 3 years.
METHOD OF
CALCULATION
(Numerator/Denominator) x 100
NUMERATOR
Number of women PHC clients/patients who received a papanicolaou smear within
the past 3 years
DENOMINATOR
% of women PHC clients/patients, ages 18 to 69 years
DATA SOURCE AND
AVAILABILITY
Pan-Canadian clinical administrative data source currently not available. CCHS has a
related survey question.
RATIONALE AND
INTERPRETATION
Although the incidence of cervical cancer has declined dramatically since the 1950s,
in 2005, an estimated 1,350 women in Canada will be diagnosed with cancer of the
cervix and 400 will die of their disease.41 Studies show that “cervical smears reduce
the risk of developing invasive carcimona of the cervix in women who have been
sexually active.”42 The Canadian Task Force on Preventive Health Care recommends
papanicolaou smear annual screening following initiation of sexual activity or age 18;
after 2 normal smears, screen every 3 years to age 69 (grade B recommendation).42
A high rate for cervical cancer screening by pap tests can be interpreted as a
positive result.
Pan-Canadian Primary
Health Care Indicators
73
Report 1, Volume 2
BONE DENSITY SCREENING
INDICATOR NUMBER
51
INDICATOR DEFINITION
% of women PHC clients/patients, 65 years and over, who received screening for
low bone mineral density at least once.
DEFINITION OF
RELEVANT TERMS
Bone mineral density tests use X-rays to measure how many grams of calcium and
other bone minerals, collectively known as bone mineral content, are packed into a
segment of bone. And the denser the bones, the stronger they are and the less likely
they are to break. Physicians use a bone density test to determine if one has, or are
at risk of, osteoporosis or fracture.43
METHOD OF
CALCULATION
(Numerator/Denominator) x 100
NUMERATOR
Number of women PHC clients/patients who received screening for low bone mineral
density at least once
DENOMINATOR
Total number of women PHC clients/patients 65 years or older
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source currently not available. Clinical administrative data
source required.
RATIONALE AND
INTERPRETATION
74
One in six Canadian women, over age 50 years, are affected by osteoporosis where
the major clinical consequence is bone fracture.44 The Canadian Task Force on
Preventive Health Care concludes that there is fair evidence to recommend screening
postmenopausal women to prevent fragility fracture (no or low trauma factures)
(grade B recommendation).45 Studies show “although there is no direct evidence that
screening reduces fractures, there is good evidence that screening is effective in
identifying postmenopausal women with low bone mineral density and that treating
osteoporosis can reduce the risk of fractures in this population (grade A
recommendation)”.45 Recommended risk assessment tools for low bone mineral
density screening include S.C.O.R.E.46, and the Osteoporosis Risk Assessment
Instrument.47A high rate for this indicator can be interpreted as a positive result.
Pan-Canadian Primary
Health Care Indicators
Report 1, Volume 2
DYSLIPIDEMIA SCREENING FOR WOMEN
INDICATOR NUMBER
52
INDICATOR DEFINITION
% of PHC women clients/patients, 55 years and over, who had a full fasting lipid
profile measured within the past 24 months.
DEFINITION OF
RELEVANT TERMS
Full fasting lipid profile is a group of tests that are often ordered together to
determine risk of coronary artery disease. Tests that make up a lipid profile are good
indicators of whether someone is likely to have a heart attack or stroke caused by
blockage of blood vessels (hardening of the arteries). Lipid profile includes total
cholesterol, HDL–cholesterol, LDL–cholesterol, and triglycerides.55
METHOD OF
CALCULATION
(Numerator/Denominator) x 100
NUMERATOR
Number of PHC women clients/patients who had a full fasting lipid profile measured
within the past 24 months
DENOMINATOR
Total number of PHC women clients/patients, 55 years and over, within the past
24 months
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source currently not available. Clinical administrative data
source required.
RATIONALE AND
INTERPRETATION
Routine screening for dyslipidemia is recommended for women who are
postmenopausal or over 50 years of age. Patients of any age may be screened if
certain risk factors are present, for example, hypertension, use of tobacco products,
abdominal obesity, or a strong family history.48 A high rate for this indicator can be
interpreted as a positive result.
Pan-Canadian Primary
Health Care Indicators
75
Report 1, Volume 2
DYSLIPIDEMIA SCREENING FOR MEN.
INDICATOR NUMBER
53
INDICATOR DEFINITION
% of PHC men clients/patients, 40 years and over, who had a full fasting lipid profile
measured within the past 24 months.
DEFINITION OF
RELEVANT TERMS
Full fasting lipid profile is a group of tests that are often ordered together to
determine risk of coronary artery disease. Tests that make up a lipid profile are good
indicators of whether someone is likely to have a heart attack or stroke caused by
blockage of blood vessels (hardening of the arteries). Lipid profile includes total
cholesterol, HDL–cholesterol, LDL–cholesterol, and triglycerides.55
METHOD OF
CALCULATION
(Numerator/Denominator) x 100
NUMERATOR
Number of PHC men clients/patients who had a fasting lipid profile measured within
the past 24 months
DENOMINATOR
Total number of PHC men clients/patients 40 years and over
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source currently not available. Clinical administrative data
source required.
RATIONALE AND
INTERPRETATION
76
Routine screening for dyslipidemia is recommended for men over 40 years of age.
Patients of any age may be screened if certain risk factors are present, for example,
hypertension, use of tobacco products, abdominal obesity, or a strong family
history.48 A high rate for this indicator can be interpreted as a positive result.
Pan-Canadian Primary
Health Care Indicators
Report 1, Volume 2
BLOOD PRESSURE TESTING
INDICATOR NUMBER
54
INDICATOR DEFINITION
% of PHC clients/patients, 18 years and over, who had their blood pressure
measured in the past 24 months.
METHOD OF
CALCULATION
(Numerator/Denominator) x 100
NUMERATOR
Number of PHC clients/patients who had their blood pressure measured by their PHC
provider in the past 24 months
DENOMINATOR
Total number of PHC clients/patients 18 years and over, in the past 24 months
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source currently not available. Clinical administrative data
source required.
RATIONALE AND
INTERPRETATION
Regular blood pressure measurement helps identify individuals with hypertension, a
major cause of a heart attack or stroke. Despite advances in the management of
hypertension there remains a gap at the “front-end” of disease management, that is,
in the detection and diagnosis of hypertension.20, 49 Substantial proportions of
clients/patients are unaware they have hypertension (42% in the most recent
Canadian Heart Health Survey),19 even though numerous studies have proven the
benefit of lowering blood pressure.50 A high rate for this indicator can be interpreted
as a positive result.
Pan-Canadian Primary
Health Care Indicators
77
Report 1, Volume 2
SCREENING FOR MODIFIABLE RISK FACTORS IN ADULTS WITH CORONARY ARTERY DISEASE (CAD)
INDICATOR NUMBER
55
INDICATOR DEFINITION
% of PHC clients/patients, 18 years and over, with coronary artery disease (CAD)
who received annual testing, within the past 12 months, for all of the following:
• Fasting blood sugar;
• Full fasting lipid profile screening;
• Blood pressure measurement; and
• Obesity/overweight screening.
DEFINITION OF
RELEVANT TERMS
Coronary artery disease (CAD) (with or without angina): Examples include
clients/patients with prior myocardial infarctions, prior revascularization,
angiographically proven coronary atherosclerosis, or reliable noninvasive evidence of
myocardial ischemia.51
Full Fasting Lipid Profile Screening is a group of blood tests that are performed after
fasting 14 hours and used to guide PHC providers in deciding how a person at risk
should be treated. Lipid profile includes total cholesterol, HDL-cholesterol, LDLcholesterol, and triglycerides. Report may also include HDL/Cholesterol ratio or a risk
score based on lipid profile results, age, sex, and other risk factors.55
Obesity/overweight screening measures may include:
• Body Mass Index (BMI), a method of assessing body weight while taking height
into account; calculated by dividing weight by height squared.5
• Waist to Hip Ratio (WHR), although BMI provides an index for obesity, it has
limitations in predicting risk for cardiovascular events. Research has indicated that
measurement of WHR enables prediction of cardiovascular risk. Obesity,
particularly abdominal adiposity, worsens the prognosis of clients/patients with
cardiovascular disease (CVD).52
METHOD OF
CALCULATION
78
(Numerator/Denominator) x 100
NUMERATOR
Number of PHC clients/patients who received annual testing for all of the following
• Fasting blood sugar
• Full fasting lipid profile screening
• Blood pressure measurement
• Obesity/overweight screening
DENOMINATOR
Total number of PHC clients/patients, 18 years and over, with CAD within the past
12 months
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source currently not available. Clinical administrative data
source required.
Pan-Canadian Primary
Health Care Indicators
Report 1, Volume 2
SCREENING FOR MODIFIABLE RISK FACTORS IN ADULTS WITH CORONARY ARTERY
DISEASE (CAD) (cont’d)
RATIONALE AND
INTERPRETATION
Atherosclerotic vascular disease, particularly CAD, continues to be the leading cause
of death and disability for Canadian men and women. Clients/patients who have had
an Acute Myocardial Infarction remain at high risk for successive ischemic vascular
events and/or death. However, this risk can be lowered through optimal control of
known modifiable cardiovascular risk factors, for example, use of tobacco products,
dyslipidemia, hypertension, diabetes and physical inactivity. Moreover, risk factor
modification in this high-risk population has been shown to be cost-effective.53 Yan
and colleagues54 showed that for individuals with no cardiovascular risk factors as
well as for those with one or more risk factors, those who are obese in middle age
have a higher risk of hospitalization and mortality from CAD, CVD and diabetes in
older age than those who are normal weight. A high rate for this indicator can be
interpreted as a positive result.
Pan-Canadian Primary
Health Care Indicators
79
Report 1, Volume 2
SCREENING FOR MODIFIABLE RISK FACTORS IN ADULTS WITH HYPERTENSION
INDICATOR NUMBER
56
INDICATOR DEFINITION
% of PHC clients/patients, 18 years and over, with hypertension who received annual
testing, within the past 12 months, for all of the following:
• Fasting blood sugar;
• Full fasting lipid profile screening;
• Test to detect renal dysfunction (e.g. serum creatinine);
• Blood pressure measurement; and
• Obesity/overweight screening.
DEFINITION OF
RELEVANT TERMS
Full Fasting Lipid Profile Screening is a group of blood tests that are performed after
fasting 14 hours and used to guide PHC providers in deciding how a person at risk
should be treated. Lipid profile includes total cholesterol, HDL-cholesterol, LDLcholesterol, and triglycerides. Report may also include HDL/Cholesterol ratio or a risk
score based on lipid profile results, age, sex, and other risk factors.55
Obesity/overweight screening measures may include:
• Body Mass Index (BMI), a method of assessing body weight while taking height
into account; calculated by dividing weight by height squared.5
• Waist to Hip Ratio (WHR), although BMI provides an index for obesity, it has
limitations in predicting risk for cardiovascular events. Research has indicated that
measurement of WHR enables prediction of cardiovascular risk. Obesity,
particularly abdominal adiposity, worsens the prognosis of patients with
Cardiovascular Disease.52
• Creatinine is a substance in the blood to determine if the kidneys are functioning
normally and to monitor treatment for kidney disease.56
METHOD OF
CALCULATION
80
(Numerator/Denominator) x 100
NUMERATOR
Number of PHC clients/patients with Hypertension who received annual testing for all
of the following
• Fasting blood sugar
• Full fasting lipid profile screening
• Test to detect renal dysfunction (e.g. serum creatinine)
• Blood pressure measurement
• Obesity/overweight screening
DENOMINATOR
Total number of PHC clients/patients with hypertension within the past 12 months
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source currently not available. Clinical administrative data source
required.
Pan-Canadian Primary
Health Care Indicators
Report 1, Volume 2
SCREENING FOR MODIFIABLE RISK FACTORS IN ADULTS WITH HYPERTENSION (cont’d)
RATIONALE AND
INTERPRETATION
Hypertension is a key modifiable risk factor for myocardial infarction and the third
leading risk factor for death and disability. Optimal control of blood pressure in people
with hypertension could prevent almost half of all atherosclerotic cardiovascular
events in North America.21 Over one-fifth of Canadians have hypertension.19
Evaluating and addressing all modifiable risk factors in adults with hypertension,
including smoking of any amount, elevated blood pressure, elevated serum total
cholesterol, low-density lipoprotein cholesterol, low serum high-density lipoprotein
and diabetes mellitus is a secondary prevention maneuver.20, 57 A high rate for this
indicator can be interpreted as a positive result.
Pan-Canadian Primary
Health Care Indicators
81
Report 1, Volume 2
SCREENING FOR MODIFIABLE RISK FACTORS IN ADULTS WITH DIABETES
INDICATOR NUMBER
57
INDICATOR DEFINITION
% of PHC clients/patients, 18 years and over, with diabetes mellitus who received
annual testing, within the past 12 months, for all of the following:
• Hemoglobin A1c testing (HbA1c);
• Full fasting lipid profile screening;
• Nephropathy screening (e.g. albumin/creatinine ratio, microalbuminuria);
• Blood pressure (BP) measurement; and
• Obesity/overweight screening.
DEFINITION OF
RELEVANT TERMS
Full Fasting Lipid Profile Screening is a group of blood tests that are performed after
fasting 14 hours and used to guide PHC providers in deciding how a person at risk
should be treated. Lipid profile includes total cholesterol, HDL-cholesterol, LDLcholesterol, and triglycerides. Report may also include HDL/Cholesterol ratio or a risk
score based on lipid profile results, age, sex, and other risk factors.55
Hemoglobin A1c test (Also called the HbA1c or A1c test, or glycated/glycosylated
hemoglobin) is a laboratory test that reflects the average glucose level over a two to
three month period.5
Nephropathy screening is looking for the presence of protein in the urine that
might direct the choice of pharmacologic agent for hypertensive clients/patients.
Diabetics require screening for nephropathy with random albumin to creatinine ratio
and have their creatinine clearance estimated (using, for example, the CockcroftGault formula).16 Random microalbumin or microalbumin/creatinine ratio are
screening tests for people with diabetes mellitus that put them at an increased risk
of developing kidney failure. Studies show that identifying very early stages of
kidney disease (microalbuminuria) helps adjust treatment. With better control of
diabetes and hypertension, the progression of diabetic kidney disease can be slowed
or prevented.58
Obesity/overweight screening measures may include:
• Body Mass Index (BMI): a method of assessing body weight while taking height
into account; calculated by dividing weight by height squared.5
• Waist to Hip Ratio (WHR): although BMI provides an index for obesity, it has
limitations in predicting risk for cardiovascular events. Research has indicated that
measurement of WHR enables prediction of cardiovascular risk. Obesity,
particularly abdominal adiposity, worsens the prognosis of clients/patients with
Cardiovascular Disease.52
METHOD OF
CALCULATION
82
(Numerator/Denominator) x 100
Pan-Canadian Primary
Health Care Indicators
Report 1, Volume 2
SCREENING FOR MODIFIABLE RISK FACTORS IN ADULTS WITH DIABETES (cont’d)
NUMERATOR
Number of PHC clients/patients with diabetes mellitus, whose medical record
indicates that they had a HbA1c level, full fasting lipid profile and nephropathy
screening, blood pressure and obesity screening measurement performed at least
once in the last year
DENOMINATOR
Total number of PHC clients/patients, 18 years and over, with diabetes mellitus in the
past 12 months
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source currently not available. Clinical administrative data source
required.
RATIONALE AND
INTERPRETATION
Early screening and aggressive management of diabetic clients/patients is
recommended by the evidence-based Canadian Diabetes Association guidelines.17
Increasing prevalence of Type 2 diabetes in Canada can be traced, in part, to an
aging population, increasing immigration among high-risk ethnic populations,
increasing obesity among children and adults, and low levels of physical activity.
As 80% of people with diabetes will die as a result of a vascular event, all coronary
risk factors must be treated aggressively. Cardiovascular disease (CVD) in diabetic
clients/patients is also the costliest.16, 59 Secondary prevention maneuvers including,
HbA1c testing, lipid profile and nephropathy screening, blood pressure measurement
and obesity screening can potentially overt more serious complications of diabetes.
The National Primary Care Research and Development Centre and RAND Corp.60
recommended an annual HbA1c, lipid profile within past 3 years, and treatment for
sustained proteinuria for all diabetics. A high rate for this indicator can be interpreted
as a positive result.
Pan-Canadian Primary
Health Care Indicators
83
Report 1, Volume 2
SCREENING FOR VISUAL IMPAIRMENT IN ADULTS WITH DIABETES
INDICATOR NUMBER
58
INDICATOR DEFINITION
% of PHC clients/patients, 18 to 75 years, with diabetes mellitus who saw an
optometrist or ophthalmologist within the past 24 months.
METHOD OF
CALCULATION
(Numerator/Denominator) x 100
NUMERATOR
Number of PHC clients/patients with diabetes mellitus who saw an optometrist or
ophthalmologist within the past 24 months
DENOMINATOR
Total number of PHC clients/patients, ages 18 to 75 years, with diabetes mellitus
within the past 24 months
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source currently not available. Clinical administrative data
source required.
RATIONALE AND
INTERPRETATION
84
Effective use of eye exams can potentially minimize diabetes related disease of the
retina. The Canadian Diabetes Association17, 61 recommends that people with type 2
diabetes see, at the time of diagnosis, an experienced professional for retinopathy
assessment. Follow-up assessments are recommended. The recommended interval is
1 to 2 years for individuals with no retinopathy at diagnosis; once per year or less if
retinopathy is present at diagnosis. The procedure used to perform a retinal
assessment is a fundoscopy. This procedure may be performed by an appropriate
PHC provider, but is frequently provided by a regular eye care provider, such as an
optometrist or ophthalmologist.62 A high rate for this indicator can be interpreted as a
positive result.
Pan-Canadian Primary
Health Care Indicators
Report 1, Volume 2
ASTHMA CONTROL
INDICATOR NUMBER
59
INDICATOR DEFINITION
% of PHC clients/patients, ages 6 to 55 years, with asthma, who were dispensed
high amounts (greater than 4 canisters) of short-acting beta2-agonist (SABA) within
the past 12 months AND who received a prescription for preventer/controller
medication (e.g. inhaled corticosteroid—ICS).
DEFINITION OF
RELEVANT TERMS
Preventer medications, predominantly inhaled corticosteroids (ICS), are recommended
treatment for moderate and severe asthma. Their use is directed at improving control,
improving lung function and preventing exacerbations. These drugs are also used in
the management of other respiratory conditions, including chronic obstructive
pulmonary disease.63
Short-acting beta-agonists—SABA have been used for symptom relief and should be
used only on demand at the minimum dose and frequency required.64
METHOD OF
CALCULATION
(Numerator/Denominator) x 100
NUMERATOR
Number of PHC clients/patients with asthma, who were dispensed high amounts
(greater than 4 canisters) of short-acting beta2-agonist (SABA) within the past 12
months AND who received a prescription for preventer/controller medication (e.g.
inhaled corticosteroid)
DENOMINATOR
Total number of PHC clients/patients, ages 6 to 55 years, with asthma within past
12 months
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source currently not available. Clinical administrative data
source required.
RATIONALE AND
INTERPRETATION
Canadian Asthma Consensus Guidelines64 recommend regular use of an inhaled
corticosteroid (ICS) for asthma control if a short-acting beta-agonist (SABA) is used
in excess of recommended quantities (i.e. more than three times per week).
Furthermore, the guidelines recommend that those with poor asthma control receive
at least a moderate dose of ICS. ICS have been shown to reduce symptoms and
exacerbations, prevent hospitalization and reduce mortality.65, 66 An expert panel
convened in 2004 recommends monitoring use of inhaled corticosteroids per
client/patient (e.g. number of inhaled corticosteroid prescriptions filled).8 A high rate
for this indicator can be interpreted as a positive result.
Pan-Canadian Primary
Health Care Indicators
85
Report 1, Volume 2
TREATMENT FOR CONGESTIVE HEART FAILURE (CHF)
INDICATOR NUMBER
60
INDICATOR DEFINITION
% of PHC clients/patients, 18 years and over, with CHF who are using ACE inhibitors
or ARBs.
DEFINITION OF
RELEVANT TERMS
Angiotensin-converting enzyme (ACE) inhibitors: pharmacological treatment for CHF.
METHOD OF
CALCULATION
(Numerator/Denominator) x 100
NUMERATOR
Number of PHC clients/patients with CHF who are using ACE inhibitors or ARBs
DENOMINATOR
Number of PHC clients/patients, 18 years and over, with CHF
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source currently not available. Clinical administrative data
source required.
RATIONALE AND
INTERPRETATION
86
Angiotensin receptor blockers (ARBs): pharmacological treatment for CHF for people
who experience side effects to ACE inhibitors.
As in most Western countries, the burden of heart failure in Canada is increasing,
primarily because of the aging of the population, but also in part because of
improved survival among clients/patients with hypertension and coronary artery
disease.13 Despite major advances in treatment over the past 25 years, there have
been only modest improvements in heart failure outcomes on a population-wide
basis. One factor that contributes to worsening heart failure is under-use (both underprescription and under-dosing) of proven and recommended heart failure therapies
such as angiotensin-converting-enzyme inhibitors and beta blockers.9, 10, 13 In 2003,
the Canadian Cardiovascular Outcomes Research Team/Canadian Cardiovascular
Society Heart Failure Quality Indicator Panel14 recommended this indicator. A high
rate for this indicator can be interpreted as a positive result.
Pan-Canadian Primary
Health Care Indicators
Report 1, Volume 2
TREATMENT FOR DYSLIPIDEMIA
INDICATOR NUMBER
61
INDICATOR DEFINITION
% of PHC clients/patients, 18 years and over, with established CAD and elevated
LDL-C (i.e. greater than 2.5 mmol/L) who were offered lifestyle advice and/or lipid
lowering medication.
DEFINITION OF
RELEVANT TERMS
Coronary Artery Disease (CAD) (with or without angina): Examples include
clients/patients with prior myocardial infarctions, prior revascularization,
angiographically proven coronary atherosclerosis, or reliable noninvasive evidence of
myocardial ischemia.51
LDL-C (low-density lipoprotein-cholesterol): a type of lipoprotein that carries
cholesterol in the blood. LDL is considered to be undesirable because it deposits
excess cholesterol in walls of blood vessel and contributes to “hardening of the
arteries” and heart disease. Hence, LDL cholesterol is often termed “bad” cholesterol.
Test for LDL measures the amount of LDL cholesterol in blood.67
Lipid lowering medications include Statins, Resins, Cholesterol Absorption Inhibitors,
Fibrates and Niacin.
METHOD OF
CALCULATION
(Numerator/Denominator) x 100
NUMERATOR
Number of PHC clients/patients with established CAD and elevated LDL-C
(i.e. greater than 2.5 mmol/L) who were offered lifestyle advice and/or lipid
lowering medication
DENOMINATOR
Total number of PHC clients/patients, 18 years and over, with established CAD and
elevated LDL-C (i.e. greater than 2.5 mmol/L)
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source currently not available. Clinical administrative data
source required.
RATIONALE AND
INTERPRETATION
Association between elevated blood cholesterol levels and cardiovascular disease
(CVD) is well established by several studies. CVD is the leading cause of death in
Canada. Medication therapy to lower LDL-C levels can be considered for primary and
secondary prevention for clients/patients at high risk of CAD.68 The Working Group
on Hypercholesterolemia and other dyslipidemias48 released recommendations for
management of dyslipidemia and prevention of CVD and supports use of this
indicator in relation to high risk category of patients. Clients/patients in the high-risk
category includes individuals with a history of any atherosclerotic disease. The target
lipid levels for these high-risk category clients/patients are a LDL-C level of less than
2.5 mmol/L, and total cholesterol: HDL-C ratio of less than 4.0. For some high-risk
individuals, lifestyle changes have shown to be effective. These changes include
dietary interventions and increased physical activity.48, 53 A high rate for this indicator
can be interpreted as a positive result.
Pan-Canadian Primary
Health Care Indicators
87
Report 1, Volume 2
TREATMENT OF ACUTE MYOCARDIAL INFARCTION (AMI)
INDICATOR NUMBER
62
INDICATOR DEFINITION
% of PHC clients/patients who have had an AMI and are currently prescribed a betablocking drug.
METHOD OF
CALCULATION
(Numerator/Denominator) x 100
NUMERATOR
Number PHC clients/patients who have had an AMI and are currently prescribed a
beta-blocking drug
DENOMINATOR
Number of PHC clients/patients who have had an AMI
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source currently not available. Clinical administrative data
source required.
RATIONALE AND
INTERPRETATION
88
This indicator measures if commonly accepted standards of care are met for
secondary prevention in post-AMI clients/patients. Despite widespread dissemination
of evidence-based guidelines for the management of AMI, many patients are not
receiving recommended treatments. For example, from 1997 to 2000, rates of
prescription for beta blockers within 30 days of discharge for elderly patients with
AMI were as low as 43% in certain Canadian regions.69, 70 In 2003, the Canadian
Cardiovascular Outcomes Research Team/Canadian Cardiovascular Society Acute
Myocardial Infarction Quality Indicator Panel71 recommended this indicator. A high
rate for this indicator can be interpreted as a positive result.
Pan-Canadian Primary
Health Care Indicators
Report 1, Volume 2
ANTIDEPRESSANT MEDICATION MONITORING
INDICATOR NUMBER
63
INDICATOR DEFINITION
% of PHC clients/patients with depression who are taking antidepressant drug
treatment under the supervision of a PHC provider, and who had follow-up
contact by a PHC provider for review within two weeks of initiating antidepressant
drug treatment.
DEFINITION OF
RELEVANT TERMS
Antidepressants are medicines used to help people who have depression. Most
antidepressants are believed to work by slowing the removal of certain chemicals
called neurotransmitters from the brain. Neurotransmitters are needed for normal
brain function. Antidepressants help people with depression by making these natural
chemicals more available to the brain.72
Follow-up contact methods may include a return office visit, home visit or
telephone contact.
METHOD OF
CALCULATION
(Numerator/Denominator) x 100
NUMERATOR
Number of PHC clients/patients with depression who are taking antidepressant
drug treatment under the supervision of a PHC provider, and who had follow-up
contact by a PHC provider for review within two weeks of initiating antidepressant
drug treatment
DENOMINATOR
Total number of PHC clients/patients, 18 years and over, with depression who are
taking antidepressant drug treatment under the supervision of a PHC provider
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source currently not available. Clinical administrative data
source required.
RATIONALE AND
INTERPRETATION
Depressive disorders can impair personal, social and family functioning and increase
the risk of suicide. Studies demonstrate that clients/patients with depression,
compared with a non-depressed group, experience deficiencies in physical and role
functioning, more days lost of work and decreased productivity. They also make
considerable use of health services, with hospitalizations accounting for a high
proportion of costs. Antidepressant medications are effective in ameliorating these
impacts and continuous antidepressant medication treatment in acute phase of an
episode has been shown to have good expectations for continued adherence.73
Guidelines recommend that all clients/patients with major depressive disorder be
followed at least weekly or biweekly until they show clear improvement.74 Regular
follow-up (non-pharmacological treatment) for clients/patients taking antidepressant
medication is important because antidepressants do not begin to have a clinical effect
for some time after initiating therapy (length of time depends on which drug is
prescribed) and clients/patients with major depression are at risk of suicide.75, 76, 77, 78,
62
Katz and colleagues’ study on quality of care included an indicator to track followup after prescribing an antidepressant.62 A high rate for this indicator can be
interpreted as a positive result.
Pan-Canadian Primary
Health Care Indicators
89
Report 1, Volume 2
TREATMENT OF DEPRESSION
INDICATOR NUMBER
64
INDICATOR DEFINITION
% of PHC clients/patients, 18 years and over, with depression who were offered
treatment (pharmacological and/or non-pharmacological) or referral to a mental health
provider.
DEFINITION OF
RELEVANT TERMS
Mental Health Provider is a caregiver with mental health expertise, for example,
Psychologist, Psychiatrist, Occupational Therapist, Psychiatric Registered Nurse or
Social Worker.
NUMERATOR
Number of PHC clients/patients with depression who were offered treatment
(pharmacological and/or non-pharmacological) or referral to a mental health provider
DENOMINATOR
Total number of PHC clients/patients, 18 years and over, with depression
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source currently not available. Clinical administrative data
source required.
RATIONALE AND
INTERPRETATION
90
The significant economic costs and disability associated with depressive illness are
reduced by effective treatment.79 National Institute for Clinical Excellence80 guidelines
on depression recommend that for mild and moderate depression either drug
treatments or psychological treatments specifically focused on depression (such as
problem-solving therapy, Cognitive Behavioural Therapy and counseling) be offered as
treatment options. The Canadian Network for Mood and Anxiety Treatments’75
guidelines for treatment of individuals diagnosed with major depressive disorders
recommend structured, time-limited psychotherapies or pharmacotherapy for mildly to
moderately severe major depression. Combining antidepressant and psychotherapy
treatment is recommended for clients/patients with severe or chronic depression.
A high rate for this indicator can be interpreted as a positive result.
Pan-Canadian Primary
Health Care Indicators
Report 1, Volume 2
TREATMENT OF ANXIETY
INDICATOR NUMBER
65
INDICATOR DEFINITION
% of PHC clients/patients, 18 years and over, with a diagnosis of panic disorder or
generalized anxiety disorder who are offered treatment (pharmacological and/or nonpharmacological) or referral to a mental health provider.
DEFINITION OF
RELEVANT TERMS
Mental Health Provider: a caregiver with mental health expertise (i.e. Psychologist,
Psychiatrist, Occupational Therapist, Psychiatric Registered Nurse or Social Worker).
METHOD OF
CALCULATION
(Numerator/Denominator) x 100
NUMERATOR
Number of PHC clients/patients with a diagnosis of panic disorder or generalized
anxiety disorder who are offered treatment (pharmacological and/or nonpharmacological) or referral to a mental health provider
DENOMINATOR
Total number of PHC clients/patients, 18 years and over, with a diagnosis of panic
disorder or generalized anxiety disorder
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source currently not available. Clinical administrative data
source required.
RATIONALE AND
INTERPRETATION
Anxiety disorders are common, chronic, the cause of considerable distress and
disability, and are often unrecognized and untreated. If left untreated they are costly
to both the individual and society. A range of effective interventions is available to
treat anxiety disorders, including medication, psychological therapies and self-help
(grade A recommendation).81 A high rate for this indicator can be interpreted as a
positive result.
Pan-Canadian Primary
Health Care Indicators
91
Report 1, Volume 2
TREATMENT FOR ILLICIT OR PRESCRIPTION DRUG USE PROBLEMS
INDICATOR NUMBER
66
INDICATOR DEFINITION
% of PHC clients/patients, with prescription or illicit drug use problems who were
offered, provided or directed to treatment by the PHC provider.
DEFINITION OF
RELEVANT TERMS
Prescription drugs: The three classes or prescription drugs that are most commonly
abused are:
Opioids for pain relief;
Central nervous system depressants used to treat anxiety and sleep disorders; and
Stimulants, which are prescribed to treat the sleep disorder narcolepsy and attentiondeficit hyperactivity disorder.82
Illicit/street drugs are illegal drugs such as crystal meth, marijuana, ecstasy, and
phencyclidine (PCP; “angel dust”). At risk substance use is defined as using any
illicit drugs.83
METHOD OF
CALCULATION
NUMERATOR
Number of PHC clients/patients, with prescription or illicit drug use problems who
were offered, provided or directed to treatment by the PHC provider
DENOMINATOR
Total number of PHC clients/patients with prescription or illicit drug use problems
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source currently not available. Clinical administrative data
source required.
RATIONALE AND
INTERPRETATION
92
(Numerator/Denominator) x 100
Use of addictive substances such as the abuse of prescription and illicit drugs is
problematic and interferes with a productive life. Single and colleagues84 report that
the number of deaths related to illicit drug use in 1995 in Canada was estimated at
805, which represents 0.4% of all deaths. Although deaths caused by illicit drug use
were less common than deaths attributable to alcohol and tobacco use, the people
who died were younger. There is solid research to show that “treatment for a range
of drug and alcohol problems is effective and can improve mental and physical health
and social functioning. Treatment of families minimizes the intergenerational
transmission of substance-use problems. However, most treatment programs engage
only a small proportion of the people with drug and alcohol dependence.”85 A high
rate for this indicator can be interpreted as a positive result.
Pan-Canadian Primary
Health Care Indicators
Report 1, Volume 2
SUPPORT FOR PHC MEDICATION INCIDENT REDUCTION
INDICATOR NUMBER
67
INDICATOR DEFINITION
% of PHC providers whose PHC organization has processes and structures in place to
support a non-punitive approach to medication incident reduction.
DEFINITION OF
RELEVANT TERMS
Non-punitive approaches to reporting medication incidents are voluntary in nature and
sensitive to the privacy of the individuals involved.86
METHOD OF
CALCULATION
(Numerator/Denominator) x 100
NUMERATOR
Number of PHC providers whose PHC organization has processes and structures in
place to support a non-punitive approach to medication incident reduction
DENOMINATOR
Total number of PHC provider survey respondents
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source currently not available. Survey data source required.
RATIONALE AND
INTERPRETATION
It is widely accepted that desired improvements in client/patient safety require a
change in the culture within health care.87 The Institute of Medicine88 report “To Err
Is Human” concluded “the status quo is no longer acceptable… Health care
organizations must develop a culture of safety.” A key attribute of a culture of safety
is to foster a non-punitive approach to reporting client/patient safety incidents.
Assigning blame tends to discourage reporting and can be a powerful barrier to
collaborative problem solving. Conversely, a non-punitive approach assists in focusing
on processes thereby identifying the root causes for the problems and improves the
chances that future events will be reduced.86 A high rate for this indicator can be
interpreted as a positive result.
Pan-Canadian Primary
Health Care Indicators
93
Report 1, Volume 2
USE OF MEDICATION ALERTS IN PHC
INDICATOR NUMBER
68
INDICATOR DEFINITION
% of PHC organizations who currently use an electronic prescribing/drug ordering
system that includes client/patient specific medication alerts.
DEFINITION OF
RELEVANT TERMS
Alert: high priority reminder messages for medications. An alert is a check system to
ensure that the prescription matches the right client/patient to the right medication,
right dose, right frequency, right route, right duration and evaluates for drug
interactions.89
Electronic prescribing/drug ordering system: computer-based system capable of
tracking and analyzing data for online medication screening and risk alerting; not
paper-based.89
METHOD OF
CALCULATION
NUMERATOR
Number of PHC organizations that currently use an electronic prescribing/drug
ordering system that includes client/patient specific medication alerts
DENOMINATOR
Total number of PHC organization survey respondents
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source currently not available. Survey data source required.
RATIONALE AND
INTERPRETATION
94
(Numerator/Denominator) x 100
Adverse clinical events related to inappropriate prescribing practices are a threat to
client/patient safety. Minimizing or eliminating inappropriate prescribing in community
settings, where the majority of prescriptions are written, offers a major area of
opportunity to improve quality of care and outcomes. Electronic medication order
entry systems, with automated clinical risk screening and online alerting capabilities,
appear as a particularly promising tool in such settings. More research will have to be
conducted about physician response to alerts and client/patient outcomes in order to
determine the utility of electronic drug ordering system with client/patient specific
medication alerts as a measure of quality care.89 A high rate for this indicator can be
interpreted as a positive result.
Pan-Canadian Primary
Health Care Indicators
Report 1, Volume 2
IMPLEMENTATION OF PHC CLINICAL QUALITY IMPROVEMENT INITIATIVES
INDICATOR NUMBER
69
INDICATOR DEFINITION
% of PHC organizations who implemented at least one or more changes in clinical
practice as a result of quality improvement initiatives over the past 12 months.
DEFINITION OF
RELEVANT TERMS
Quality improvement is an activity concerning improving care using whatever method
is most suitable (e.g. risk management or practicing safely, developing information
systems, audit, significant event audit, professional development or working out PHC
provider priorities, taking into account local and national priorities and the needs of
her/his practice).90
Examples of a change in clinical practice include: the development of a standardized
form to manage diabetes mellitus or coronary artery disease clients/patients, or
working with Canada-wide priorities such as mental health services for PHC
clients/patients.
METHOD OF
CALCULATION
(Numerator/Denominator) x 100
NUMERATOR
Number of PHC organizations that implemented at least one or more changes in
clinical practice as a result of quality improvement initiatives over the past 12 months
DENOMINATOR
Number of PHC organization survey respondents
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source currently not available. Survey data source required.
RATIONALE AND
INTERPRETATION
Quality has come to the forefront as evidenced by the recent quality initiatives and
emergence of Health Quality Councils in many jurisdictions in Canada. The mandate
of the Ontario Health Quality Council, for example, is “to monitor and report to
Ontarians on access to publicly funded health services and related health human
resources, consumer population health status and health system outcomes. In this
way, it will support continuous quality improvement.”91 PHC organizations can
implement quality improvement initiatives to improve quality of care. A high rate for
this indicator can be interpreted as a positive result.
Pan-Canadian Primary
Health Care Indicators
95
Report 1, Volume 2
MAINTAINING MEDICATION AND PROBLEM LISTS IN PHC
INDICATOR NUMBER
70
INDICATOR DEFINITION
% of PHC organization with a process in place to ensure that a current medication
and problem list is recorded in the PHC client’s/patient’s health record.
METHOD OF
CALCULATION
(Numerator/Denominator) x 100
NUMERATOR
Number of PHC organizations with a process in place to ensure that a current
medication and problem list is recorded in the PHC client’s/patient’s health record
DENOMINATOR
Total number of PHC organization survey respondents
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source currently not available. Survey data source required.
RATIONALE AND
INTERPRETATION
96
Adequate record keeping facilitates good care delivered to PHC clients/patients.
The Council of the College of Physicians and Surgeons of Alberta, the Canadian
Medical Protective Association and the Canadian Medical Association92 encourage
physicians to keep a summary sheet at the front of the chart to highlight important
information such as past history, current medications, and known allergies. This
policy statement notes that the goal of adequate medical records is “to record
sufficient information so that another practitioner is able to assume the
client’s/patient’s care at any point in the course of treatment without loss of
continuity.”92 A peer review of medical records conducted in a randomized sample of
family physicians in Montreal showed a moderate association between good record
keeping and the amount of continuing medical education and quality of care.93 A high
rate for this indicator can be interpreted as a positive result.
Pan-Canadian Primary
Health Care Indicators
Report 1, Volume 2
INFORMATION ABOUT PRESCRIBED MEDICATION BY PHC PROVIDER
INDICATOR NUMBER
71
INDICATOR DEFINITION
% of PHC clients/patients who report that their regular PHC provider (e.g. FP/GP, NP)
has not explained the side effects of medications when prescribed, within the past
12 months.
METHOD OF
CALCULATION
(Numerator/Denominator) x 100
NUMERATOR
Number of PHC clients/patients who report that their regular PHC provider
(e.g. FP/GP, NP) has not explained the side effects of medications when prescribed,
within the past 12 months
DENOMINATOR
Number of PHC client/patient survey respondents
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source currently not available. Survey data source required.
RATIONALE AND
INTERPRETATION
Clients’/patients’ knowledge of the proper use of medications and their associated
side effects enhances compliance.96 The advent of more complex pharmaceutical
care intensifies the need for physician review and discussions with clients/patients to
minimize risks and help clients/patients adhere to medication regimens.94 Recent
survey results from five countries indicated that a high proportion of clients/patients
are not informed of possible medication side effects.95 A 2005 survey of sicker adults
in Australia, Canada, Germany, New Zealand, the United Kingdom and the United
States94, patients report a sizable gap in physicians’ explanations about side effects.
Among those taking multiple medications, this lack of review raises the risk of
adverse drug interactions, as well as potentially undermining the effectiveness of
care. In a study of 43 patients, only 14% were able to state the common side
effect(s) of prescribed medications.96 A low rate for this indicator can be interpreted
as a positive result.
Pan-Canadian Primary
Health Care Indicators
97
Report 1, Volume 2
PROFESSIONAL DEVELOPMENT FOR PHC PROVIDERS AND SUPPORT STAFF
INDICATOR NUMBER
72
INDICATOR DEFINITION
% of PHC providers and support staff whose PHC organization provided them with
support to participate in continuing professional development within the past 12
months, by type of PHC provider and support staff.
DEFINITION OF
RELEVANT TERMS
Support to participate in continuing professional development may refer to either
financial support or providing time (e.g. release from PHC work-related activities,
relief coverage) so that PHC providers and support staff may participate in
professional development activities.
Support staff includes the following roles: Business Officer, receptionist, filing clerk,
Data Manager, secretary, unregulated health care provider such as clinical assistant.
Continuing professional development (CPD) is defined as Professional development of
physicians (and PHC providers, support staff) which is a life-long commitment that
builds on formal and informal opportunities to learn emerging science, apply
innovations in clinical settings, and expand understandings of caring for patients.97
METHOD OF
CALCULATION
(Numerator/Denominator) x 100
NUMERATOR
Number of PHC providers and support staff whose PHC organization provided them
with support to participate in continuing professional development within the past 12
months, by type of PHC provider and support staff
DENOMINATOR
Total number of PHC provider and support staff survey respondents
DATA SOURCE AND
AVAILABILITY
Potential Pan-Canadian data source could be partially available in the NPS with
modifications to the survey, but only for FP/GP providers.
RATIONALE AND
INTERPRETATION
Continuing professional development (CPD) for PHC providers is an important
strategic instrument for improving health care. CPD can help ensure high standards of
care; and can have positive benefits for recruiting, motivating and retaining high
quality staff.98 The majority of Health Professional Regulatory Agencies promote
education as an ongoing, interactive and iterative process. For example, a principle of
“Mainpro,” the College of Family Physicians of Canada’s (CFPC) continuing
professional development program, states that, “maintenance of effective, patientoriented family practice depends on the ongoing responsibility of physicians, both
individually and collectively, to maintain and enhance their knowledge and skills.”99
Research has shown that certain types of continuing education, such as reflective
practice, can influence practice patterns and thereby contribute to improved quality
of care.99 A high rate for this indicator can be interpreted as a positive result.
98
Pan-Canadian Primary
Health Care Indicators
Report 1, Volume 2
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103
Report 1, Volume 2
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53. R. T. Tsuyuki, S. Koshman, G. J. Pearson, Modifiable Risk Factors in Adults at
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55. American Association for Clinical Chemistry, Lipid Profile, [online], last updated
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104
Pan-Canadian Primary
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Report 1, Volume 2
58. American Association for Clinical Chemistry, Microalbumin, [online], last
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59. S. Harris, Diabetes: An Epidemic of the New Millennium Programs and Policy
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60. M. Marshall, M. Roland, S. M. Campbell, S, Kirk et al., Measuring General
Practice – A Demonstration Project to Develop and Test a Set of Primary Care
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61. S. R. Majumdar, J. A. Johnson, S. L. Bowker, G. L. Booth et al., “A Canadian
Consensus for the Standardized Evaluation of Quality Improvement
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pp. 220-229.
62. A. Katz, C. De Coster, B. Bogdanovic, R. A. Soodeen et al., Using
Administrative Data to Develop Indicators of Quality in Family Practice,
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63. Australian Centre for Asthma Monitoring, Enhancing Asthma-Related
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65. S. Suissa, P. Ernst , A. Kezouh, “Regular Use of Inhaled Corticosteroids and
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Corticosteroids and the Prevention of Death from Asthma,” New England
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Health Care Indicators
105
Report 1, Volume 2
67. American Association for Clinical Chemistry, LDL Cholesterol, [online], last
updated November 23, 2004, cited January 15, 2006, from
<http://www.labtestsonline.org/understanding/analytes/ldl/glance.html>.
68. A. Alkhenizan, “Effect of Statin Therapy on Total Mortality: Trial in a More
Varied Population,” Canadian Family Physician 49 (June 2003): pp. 757-759.
69. C.A. Beck, H. Richard, J. V. Tu, L. Pilote, “Administrative Data Feedback for
Effective Cardiac Treatment,” Journal of the American Medical Association
294, 3 (July 20, 2005): pp. 309-317.
70. L. Pilote, C. Beck, I. Karp, D. Alter et al., “Secondary Prevention After Acute
Myocardial Infarction in Four Canadian Provinces, 1997-2000,” Canadian
Journal of Cardiology 20 (January 2004): pp. 61-67.
71. C.T. Tran, D. S. Lee, V.F. Flintoft, L. Higginson et al., “CCORT/CCS Quality
Indicators for Acute Myocardial Infarction Care,” Canadian Journal of
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72. American Academy of Family Physicians, Antidepressants: Medicine for
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73. R. Hermann, S. Matke and the members of the OECD Mental Health Care Panel,
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75. Canadian Psychiatric Association and the Canadian Network for Mood and
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76. J. L. Coulehan, H. C. Schulberg, M. R. Block, M. J. Madonia et al.,
“Treating Depressed Primary Care Patients Improves Their Physical, Mental,
and Social Functioning,” Archives of Internal Medicine 157,10 (May 26,1997):
pp. 1113-1120.
106
Pan-Canadian Primary
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Report 1, Volume 2
77. S. A. Green, “Office Psychotherapy for Depression in the Primary Care
Setting,” American Journal of Medicine 101, 6A (1996): pp. 37S-44S.
78. H. C. Schulberg, P. J. Raue, B. Rollman, “The Effectiveness of Psychotherapy
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79. S.V. Parikh, R.W. Lam and the CANMAT Depression Work Group, “Clinical
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80. National Institute for Clinical Excellence, NICE Guidelines to Improve the
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81. National Collaborating Centre for Primary Care, Anxiety Management of anxiety
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82. United States Department of Health and Human Services, Prescription Drugs
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83. Michigan Quality Improvement Consortium, Screening and Management of
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84. E. Single , J. Rehm , L. Robson, M. V. Truong, “ The Relative Risks and
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Report 1, Volume 2
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87. M. Fleming, “Patient Safety Culture Measurement and Improvement: A “How
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90. M. Roland, R. Baker, Clinical Governance: A Practical Guide for Primary Care
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91. Ontario Ministry of Health and Long Term Care, Ontario Health Quality Council,
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92. College of Physicians and Surgeons of Alberta, Physicians’ Office Medical
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95. C. Schoen, R. Osborn, P. T. Jhuynh, M. Doty, “ Primary Care and Health
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96. A. N. Makaryus, E.A. Friedman, “Patients’ Understanding of Their Treatment
Plans and Diagnosis at Discharge,” Mayo Clinic Proceedings 80 (2005):
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97. N.L. Bennett, D.A. Davis, W. E. Easterling, P. Friedmann et al., “Continuing
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98. C. A. Brown, C. R. Belfield, S. J. Field, “Cost Effectiveness of Continuing
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ency/background%20info/default.asp?s=1>.
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Report 1, Volume 2
Building PHC Through Patient-Centred Care
Objective 6:
To ensure that primary health care is acceptable to patients and that
it meets their reasonable expectations of how they should be
treated (responsiveness)
73. Client/patient satisfaction with PHC providers
74. Client/patient satisfaction with telephone health lines
75. Recommendation of PHC provider to others
76. Client/patient participation in PHC clinical decision-making
Evaluation Question 15—Are patients satisfied that the PHC organization and
providers respect their right to privacy, confidentiality and dignity?
77. Client/patient satisfaction with PHC privacy practices
Evaluation Question 16—Are patients confident that PHC organizations and
providers are responsive to their culture and language needs?
78. Language barriers when communicating with PHC providers
110
Pan-Canadian Primary
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Report 1, Volume 2
CLIENT/PATIENT SATISFACTION WITH PHC PROVIDERS
INDICATOR NUMBER
73
INDICATOR DEFINITION
% of PHC clients/patients, 18 years and over, who were satisfied with the care
received from their regular PHC provider(s) over the past 12 months.
DEFINITION OF
RELEVANT TERMS
A regular care provider is the primary care provider that a PHC client identifies as
“theirs”. In the context of this relationship the provider acknowledges a formal or
informal contract that the provider is the regular source of person-focused (not
disease-focused) care. This relationship implies longitudinality and continuity and
exists for a defined period of time or indefinitely until explicitly changed.1
METHOD OF
CALCULATION
(Numerator/Denominator) x 100
NUMERATOR
Number of PHC clients/patients who were satisfied with the care received from their
regular PHC provider(s) over the past 12 months
DENOMINATOR
Number of client/patient survey respondents, 18 years and over
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source available in the Canadian Community Health Survey
(CCHS) only for Family Physician and/or General Practitioner (FP/GP) providers.
RATIONALE AND
INTERPRETATION
PHC client/patient satisfaction is closely linked to perception of responsiveness
and is positively associated with continuity of care and effective PHC client/
patient management.2, 3 Satisfaction is also related to increased compliance and
follow-up visits.2 A higher level of PHC client/patient satisfaction is interpreted as a
positive result.
Pan-Canadian Primary
Health Care Indicators
111
Report 1, Volume 2
CLIENT/PATIENT SATISFACTION WITH TELEPHONE HEALTH LINES
INDICATOR NUMBER
74
INDICATOR DEFINITION
% of the population, 18 years and over, who were satisfied with the telephone
health information or advice line over the past 12 months.
DEFINITION OF
RELEVANT TERMS
Telephone health information advice line or help line includes HealthLinks, Telehealth
Ontario, HealthLink, Health-Line, TeleCare, and Info-Santé.
METHOD OF
CALCULATION
(Numerator/Denominator) x 100
NUMERATOR
Number of survey respondents who were satisfied with the telephone health
information or advice line over the past 12 months
DENOMINATOR
Number of survey respondents, 18 years and over
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source available in the CCHS.
RATIONALE AND
INTERPRETATION
112
PHC client/patient satisfaction and assessment of services is one way to measure
client/patient perception of responsiveness. Assessment of PHC client/patient
satisfaction can provide information on how useful clients/patients find the service
and if overall needs are being met.3, 4 A high rate of PHC client/patient satisfaction is
interpreted as a positive result.
Pan-Canadian Primary
Health Care Indicators
Report 1, Volume 2
RECOMMENDATION OF PHC PROVIDER TO OTHERS
INDICATOR NUMBER
75
INDICATOR DEFINITION
% of PHC clients/patients, 18 years and over, who would recommend their regular
PHC provider to their family or friends.
METHOD OF
CALCULATION
(Numerator/Denominator) x 100
NUMERATOR
Number of PHC client/patient survey respondents who would recommend their
regular PHC provider to their family or friends
DENOMINATOR
Number of PHC client/patient survey respondents, 18 years and over
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source currently not available. Survey data source required.
RATIONALE AND
INTERPRETATION
This indicator is a measure of client/patient overall satisfaction with the care received
from their PHC provider.5 If the client/patient is willing to recommend the PHC
provider to family or friends, there is likely a high degree of comfort with the provider
and satisfaction with the care received.5, 6, 7 A high rate of PHC client/patient
satisfaction is interpreted as a positive result.
Pan-Canadian Primary
Health Care Indicators
113
Report 1, Volume 2
CLIENT/PATIENT PARTICIPATION IN PHC CLINICAL DECISION-MAKING
INDICATOR NUMBER
76
INDICATOR DEFINITION
% of PHC clients/patients, 18 years and over, who were involved in clinical
decision-making regarding their health, with their regular PHC provider, over the past
12 months.
DEFINITION OF
RELEVANT TERMS
PHC client/patient involvement in clinical decision-making involves the client/patient
and provider working together to develop a treatment plan.
METHOD OF
CALCULATION
(Numerator/Denominator) x 100
NUMERATOR
Number of PHC client/patient survey respondents who were involved in clinical
decision-making regarding their health, with their regular PHC provider, over the past
12 months
DENOMINATOR
Number of PHC client/patient survey respondents, 18 years and over
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source currently not available. Survey data source required.
RATIONALE AND
INTERPRETATION
114
Participation in clinical decision-making reflects responsiveness of PHC providers to
the needs of their practice population and involvement in care planning. A
client’s/patient’s health status may be influenced by their perception of being a full
participant in clinical decision-making.8, 9 Agreements between provider and
client/patient were found to be a key factor influencing health outcomes.8
Involvement of clients/patients in clinical decisions ensures that family, workplace
and community contexts are taken into account, and facilitates the client’s/patient’s
ability to follow clinical advice.9, 10, 11 A high rate of PHC clients/patients reporting
involvement in decision-making is interpreted as a positive result.
Pan-Canadian Primary
Health Care Indicators
Report 1, Volume 2
CLIENT/PATIENT SATISFACTION WITH PHC PRIVACY PRACTICES
INDICATOR NUMBER
77
INDICATOR DEFINITION
% of clients/patients who were satisfied with the level of privacy provided by their
PHC organization (e.g. staff in reception, clinicians in exam room), over the past
12 months.
DEFINITION OF
RELEVANT TERMS
Privacy is the right of individuals to be left alone, and to determine when, how, and
to what extent they share information about themselves with others.12
METHOD OF
CALCULATION
(Numerator/Denominator) x 100
NUMERATOR
Number of client/patient survey respondents who were satisfied with the level of
privacy provided by their PHC organization
DENOMINATOR
Number of client/patient survey respondents
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source currently not available. Survey data source required.
RATIONALE AND
INTERPRETATION
This indicator measures the extent to which clients/patients are satisfied with the
level of privacy received from their PHC organization. Providers who respect the
privacy of PHC clients’/patients’ personal health information show responsiveness to
PHC client/patient needs.13 A high rate of client/patient satisfaction is interpreted as a
positive result.
Pan-Canadian Primary
Health Care Indicators
115
Report 1, Volume 2
LANGUAGE BARRIERS WHEN COMMUNICATING WITH PHC PROVIDERS
INDICATOR NUMBER
78
INDICATOR DEFINITION
% of PHC clients/patients, 18 years and over, who experienced language barriers
when communicating with their regular PHC provider, over the past 12 months.
METHOD OF
CALCULATION
(Numerator/Denominator) x 100
NUMERATOR
Number of PHC client/patient survey respondents who experienced language barriers
when communicating with their regular PHC provider, over the past 12 months
DENOMINATOR
Number of PHC client/patient survey respondents, 18 years and over
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source currently not available. Survey data source required.
RATIONALE AND
INTERPRETATION
116
Difficulties in communicating with PHC providers due to language barriers can affect
the way care is provided and health outcomes.14, 15, 16 The ability of clients/patients to
understand, and are understood by, their PHC providers can also affect satisfaction
with care and perceptions about responsiveness.14, 15 A low rate of PHC
client/patients who experience language barriers when communicating with their
regular PHC provider is interpreted as a positive result.
Pan-Canadian Primary
Health Care Indicators
Report 1, Volume 2
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R. Leibowitz, S. Day, D. Dunt, “A Systematic Review of the Effect of Different
Models of After-Hours Primary Medical Care Services on Clinical Outcome,
Medical Workload and Patient and GP Satisfaction,” Family Practice 20, 3
(2003): pp. 311-317.
5.
J. Ware, and R. Hays, “Methods for Measuring Patient Satisfaction With
Specific Medical Encounters,” Medical Care 26 (1988): pp. 393-402.
6.
S. Haddad, L. Potvin, D. Roberge, R. Pineault et al. “Patient Perception of
Quality Following a Visit to a Doctor in a Primary Care Unit.” Family Practice
17, 1 (2000): pp. 21–29.
7.
J. Kersnik, “Patients’ Recommendation of Doctor as an Indicator of Patient
Satisfaction,” Hong Kong Medical Journal 9 (August, 2003): pp. 247-250.
8.
B. Starfield, C. Wray, K. Hess, R. Gross, P.S. Birk et al., “The Influence of
Patient-Practitioner Agreement on Outcome of Care,” American Journal of
Public Health 71 (1981): pp. 127-131.
9.
M. Stewart, J.B. Brown, A. Donner, I.R. McWhinney et al., “The Impact of
Patient-Centered Care on Outcomes,” Journal of Family Practice 49, 9 (2000):
pp. 796-804.
10. J. Brown, W. Weston, M. Stewart, “Patient-Centred Interviewing. Part II:
Finding Common Ground,” Canadian Family Physician 35 (1989): pp.151-158.
11. M.Stewart, “Effective Physician-Patient Communication and Health Outcomes:
A Review,” Canadian Medical Association Journal 152, (1995): pp.1423-1433.
Pan-Canadian Primary
Health Care Indicators
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Report 1, Volume 2
12. Industry Canada, PIPEDA Awareness Raising Tools (PARTs) Initiative For The
Health Sector, Glossary of Terms, (Ottawa: Industry Canada, 2003), [online],
last updated January 29, 2004, cited February 21, from
<http://e-com.ic.gc.ca/epic/internet/inecic-ceac.nsf/en/gv00223e.html>.
13. J. Murphy, H. Chang, J. Montgomery, W. Rogers, et al., “The Quality of
Physician-Patient Relationships. Patients’ Experiences 1996-1999,” Journal of
Family Practice 50, 2 (February 2001): pp.123-129.
14. Q. Ngo-Metzger, M. P. Massagli, B. R. Clarridge, M. Manocchia et al.
“Linguistic and Cultural Barriers to Care,” Journal of General Internal Medicine
18 (2003): pp. 44-52.
15. Fernandez, D. Schillinger, K. Grumbach, A. Rosenthal et al., “Physician
Language Ability and Cultural Competence,” Journal of General Internal
Medicine 19 (2004): pp. 167-174.
16. Brach, I. Fraser, K. Paez, “Crossing the Language Chasm,” Health Affairs 24
(2005): pp. 424-435.
118
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Promoting Continuity Through Integration
and Coordination
Objective 7:
To facilitate integration and coordination between healthcare
institutions and healthcare providers to achieve informational and
management continuity of patient care
Evaluation Question 17—What types of structures and activities have been
developed to link primary health care organizations with other health care
organizations?
79. Use of standardized tools for coordinating PHC
80. Collaborative care with other health care organizations
81. Intersectoral collaboration
Evaluation Question 17.1—Do these structures and activities lead to active
collaboration and facilitated referral and feedback between primary health
care organizations and other health care organizations? Other analytical
approach required.
Evaluation Question 18—Do patients experience management continuity of care?
82. PHC client/patient experiences with duplicate medical tests
Evaluation Question 18.1—Do patients undergo repeated investigations when they
see different providers?
83. Unnecessary duplication of medical tests reported by PHC providers
Evaluation Question 19—Do providers experience informational continuity of care?
83. Unnecessary duplication of medical tests reported by PHC providers
Evaluation Question 19.1—Do providers have complete information at the
point of care about individual patients’ health and previous care received from
other providers?
84. Point of care access to PHC client/patient health information
Evaluation Question 19.2—Are providers confident that their care plan and
actions will be recognized and considered by other providers? Other analytical
approach required.
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USE OF STANDARDIZED TOOLS FOR COORDINATING PHC
INDICATOR NUMBER
79
INDICATOR DEFINITION
% of PHC organizations who currently coordinate client/patient care with other health
care organizations using standardized clinical protocols or assessment tools.
DEFINITION OF
RELEVANT TERMS
Standardized clinical tools and processes can include clinical guidelines, protocols,
assessment tools, model programs and case management systems.
METHOD OF
CALCULATION
(Numerator/Denominator) X 100
NUMERATOR
Number of PHC organizations who currently coordinate client/patient care with other
health care organizations using standardized clinical protocols or assessment tools
DENOMINATOR
Total number of PHC organization survey respondents
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source currently not available. Survey data source required.
RATIONALE AND
INTERPRETATION
120
Coordination of services is one of the main elements of primary health care.1, 2
Standardized clinical tools support integration by promoting common assessment
strategies and consistent inter-organizational communication to improve continuity of
care.3, 4 A high rate of PHC organizations with these processes in place is interpreted
as a positive result.
Pan-Canadian Primary
Health Care Indicators
Report 1, Volume 2
COLLABORATIVE CARE WITH OTHER HEALTH CARE ORGANIZATIONS
INDICATOR NUMBER
80
INDICATOR DEFINITION
% of PHC organizations who currently have collaborative care arrangements with
other health care organizations.
DEFINITION OF
RELEVANT TERMS
Collaborative care arrangements are where health care providers from different
organizations manage patients together.
METHOD OF
CALCULATION
(Numerator/Denominator) X 100
NUMERATOR
Number of PHC organizations who currently have collaborative care arrangements
with health care and other specialists
DENOMINATOR
Total number of PHC organization survey respondents
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source currently not available. Survey data source required.
RATIONALE AND
INTERPRETATION
Interdisciplinary collaboration is increasingly promoted as necessary for continuity.5, 6
The Primary Health Care Transition Fund established the National Strategy on
Collaborative Care on the principle that collaborative care should be a foundation of
PHC renewal.7 Reporting this indicator will enhance our ability to assess the extent to
which interdisciplinary PHC services through collaborative care arrangements are
being offered to Canadians. In a collaborative care arrangement, a PHC provider
establishes a formal working relationship with a provider(s) from another organization
to share client/patient care and information.8 A high rate of PHC organizations with
collaborative care arrangements is interpreted as a positive result.
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INTER-SECTORAL COLLABORATION
INDICATOR NUMBER
81
INDICATOR DEFINITION
% of PHC organizations who currently have collaborative care arrangements with
providers/organizations beyond the health care sector (e.g. housing, justice,
police, education).
DEFINITION OF
RELEVANT TERMS
Collaborative care arrangements are where PHC providers manage PHC
clients/patients together with people working outside of the health care sector.
METHOD OF
CALCULATION
(Numerator/Denominator) X 100
NUMERATOR
Number of PHC organizations who currently have collaborative care arrangements
with providers/organizations beyond the health care sector (e.g. housing, justice,
police, education)
DENOMINATOR
Total number of PHC organization survey respondents
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source currently not available. Survey data source required.
RATIONALE AND
INTERPRETATION
122
This indicator measures the extent to which primary health care organizations
have created arrangements with services provided beyond the health care sector.
The health needs of clients/patients do not function in isolation of factors such as
education, justice, housing and social security.9 Formal relationships between sectors
enable a comprehensive approach to improving health.5 A high rate of PHC
organizations with collaborative care arrangements is interpreted as a positive result.
Pan-Canadian Primary
Health Care Indicators
Report 1, Volume 2
PHC CLIENT/PATIENT EXPERIENCES WITH DUPLICATE MEDICAL TESTS
INDICATOR NUMBER
82
INDICATOR DEFINITION
% of PHC clients/patients, 18 years and over, who felt that unnecessary
medical tests were ordered because the test had already been done, over the past
12 months.
METHOD OF
CALCULATION
(Numerator/Denominator) X 100
NUMERATOR
Number of PHC clients/patients, 18 years and over, who felt that unnecessary
medical tests were ordered because the test had already been done, over the past
12 months
DENOMINATOR
Total number of PHC clients/patient survey respondents
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source is currently not available. Survey data source required.
RATIONALE AND
INTERPRETATION
The unnecessary duplication of medical tests by different health care providers may
reflect challenges in the exchange of information between providers. Duplication may
also affect the continuity of patient-provider relationships when tests are not
available at the point of care.3 A low rate of PHC clients/patients reporting
unnecessary medical tests is interpreted as a positive result.
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UNNECESSARY DUPLICATION OF MEDICAL TESTS REPORTED BY PHC PROVIDERS
INDICATOR NUMBER
83
INDICATOR DEFINITION
% of PHC FPs/GPs/NPs who repeated tests because findings were unavailable over
the past month.
METHOD OF
CALCULATION
(Numerator/Denominator) X 100
NUMERATOR
Number of PHC FPs/GPs/NPs who repeated tests because findings were unavailable
over the past month
DENOMINATOR
Total number of PHC provider survey respondents
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source currently not available. Survey data source required.
RATIONALE AND
INTERPRETATION
124
Inappropriate duplication of tests adds unnecessary cost burden for the provision of
health care.10 It can also reflect problems with information exchange if test results
are not available at the point of care.3 A low rate of duplicated medical tests is
interpreted as a positive result.
Pan-Canadian Primary
Health Care Indicators
Report 1, Volume 2
POINT OF CARE ACCESS TO PHC CLIENT/PATIENT RECORDS
INDICATOR NUMBER
84
INDICATOR DEFINITION
% of PHC providers who had complete information (essential demographic and
clinical information) at the point of care, most of the time, over the past 12 months.
DEFINITION OF
RELEVANT TERMS
Complete information is the essential PHC client/patient demographic and clinical
information necessary for that visit.
METHOD OF
CALCULATION
(Numerator/Denominator) X 100
NUMERATOR
Number of PHC providers who had complete information (essential demographic and
clinical information) at the point of care, most of the time, over the past 12 months
DENOMINATOR
Total number of PHC provider survey respondents
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source currently not available. Survey data source required.
RATIONALE AND
INTERPRETATION
The availability of relevant documented information in primary health care is
considered a measure of continuity of care.3 The indicator assumes that when
information is not available, delays, duplication and potentially inappropriate action
(e.g. treatment) can result.11, 12 A high rate of providers reporting that they have
complete information at the point of care is interpreted as a positive result.
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Report 1, Volume 2
References
1.
Institute of Medicine, Defining Primary Care: An Interim Report, eds. M.
Donaldson, K. Yordy and N. Vanselow, (Washington, D.C.: National Academy
Press, 1994).
2.
B. Starfield, Primary Care: Balancing Health Needs, Services and Technology,
(New York, New York: Oxford University Press, 1998).
3.
R. Reid, J. Haggerty, R. McKendry, Defusing the Confusion: Concepts and
Measures of Continuity of Health Care, (Ottawa: Canadian Health Services
Research Foundation, 2002), [online], cited February 21, 2006, from
<http://www.chsrf.org/final_research/commissioned_research/programs/
pdf/cr_contcare_e.pdf>.
4.
C.J. Stille, A. Jerant, D. Bell, D. Meltzer et al., “Coordinating Care Across
Diseases, Settings and Clinicians: A Key Role for the Generalist in Practice,”
Annals of Internal Medicine 142, 8 (April 2005): pp. 700-708.
5.
Enhancing Interdisciplinary Collaboration in Primary Health Care Initiative, The
Principles and Framework for Enhancing Interdisciplinary Collaboration in
Primary Health Care, (Ottawa: The Conference Board of Canada, 2005).
6.
R. Deber and A. Baumann, Barriers and Facilitators to Enhancing
Interdisciplinary Collaboration in Primary Health Care, (Ottawa: The Conference
Board of Canada, 2005).
7.
Health Canada, Primary Health Care Transition Fund Interim Report, (Ottawa:
Health Canada, 2005), [online], cited February 22, 2006, from
<www.hc-sc.gc.ca/hcs-sss/alt_formats/hpb-dgps/pdf/
phctf-fassp-interm-provisoire_e.pdf>.
8.
D. Macfarlane, Current State of Collaborative Mental Health Care, (Mississauga:
Canadian Collaborative Mental Health Initiative, 2005), cited January 25, 2006,
from <http://www.ccmhi.ca/en/products/documents/EN_CurrentState_paper.pdf >.
9.
C.P. Shah, and B.W. Moloughney, A Strategic Review of the Community Health
Centre Program, (Toronto: Ontario Ministry of Health and Long Term Care,
2001), [online], cited February 27, 2006, from <http://www.health.gov.on.ca/
english/public/pub/ministry_reports/chc_stratreview/chc_review.pdf>.
10. Commission on Medicare, Caring for Medicare: Sustaining a Quality System,
(Fyke, K., Chair), (Regina: Government of Saskatchewan, 2001), [online], cited
February 22, 2006, from <www.health.gov.sk.ca/
mc_dp_commission_on_medicare-bw.pdf>.
126
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Report 1, Volume 2
11. R.I. Cook, M. Render, D.D. Woods, “Gaps in the Continuity of Care and
Program Patient Safety.” British Medical Journal 320 (March 18, 2000):
pp.791-794, [online], cited February 16, 2006, from <www.bmjonline.com>.
12. A. P. Stiell, A.J. Forster, I.G. Stiell, C. Walraven, “Maintaining Continuity of
Care: a Look at the Quality of Communication Between Ontario Emergency
Departments and Community Physicians,” Canadian Journal of Emergency
Medicine 7, 3 (2005): pp. 155-161, [online], cited February 27, 2006, from
<http://www.caep.ca/004.cjem-jcmu/004-00.cjem/
vol-7.2005/v73.155-61.htm>.
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Report 1, Volume 2
Health Human Resources
Support 1:
Adequate supply of health human resources to meet primary
health care needs
Evaluation Question 1—Are there sufficient number of PHC health professionals, in
particular primary care nurse practitioners and family physicians, to meet the
demand for PHC?
85. PHC provider full time equivalents
86. PHC providers entering/leaving the workforce
87. PHC organizations accepting new clients/patients
Evaluation Question 2—What incentives attract and retain health professionals in
PHC organizations (financial, work flexibility, continuing professional development)?
Other analytical approach required.
Evaluation Question 3—Are PHC professionals working to their full scope of
practice (as per training and regulation)?
88. PHC provider satisfaction with use of professional skills
Evaluation Question 4—Is the quality of work-life acceptable to staff and health
care providers?
89. PHC workplace safety
90. PHC workplace injuries
91. PHC provider burnout
92. PHC provider satisfaction with work-life balance
Evaluation Question 5—Does the regional authority have an assessment of health
human resources to meet the community’s needs?
93. Needs-based health human resources planning for PHC
Evaluation Question 6—Do provincial authorities have plans to recruit and train
health human resource requirements to meet the needs of the jurisdiction?
Other analytical approach required.
128
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Report 1, Volume 2
PHC PROVIDER FULL TIME EQUIVALENTS
INDICATOR NUMBER
85
INDICATOR DEFINITION
PHC provider full time equivalent (FTEs) per 100,000 population by type of
PHC provider.
DEFINITION OF
RELEVANT TERMS
The number of full time equivalent (FTE) providers is calculated as the number of
hours worked per year (FTE=37.5 hours X 52 weeks/year (1950 hours)) and
includes full-time, part-time, contract etc. hours worked.
METHOD OF
CALCULATION
Number of FTEs x 100,000/population
NUMERATOR
Number of full time equivalent PHC providers at end of reference year, by type
of provider
• Family physician/General practitioner (FP/GP)
• Nurse practitioner
• Registered nurse
• Audiologist
• Chiropractor
• Dietitian
• Occupational therapist
• Pharmacist
• Physiotherapist
• Psychologist
• Optometrist
• Social worker
• Speech-language pathologist
• Other
DENOMINATOR
Total population
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source available in the Scott’s Medical Database and the National
Physician Database (NPDB), but only for FP/GP providers.
RATIONALE AND
INTERPRETATION
Measuring full time equivalents is a way to assess the intensity of how PHC
providers practice rather than the number of providers.1, 2, 3 This is a standardized
approach that helps quantify variations in the supply of PHC providers. While
provider-to-population ratios are useful indicators of the number of providers relative
to population, inferences regarding the adequacy of provider resources should not be
based on this indicator alone. Many other factors may influence whether the supply
of providers is sufficient. Other strategies for assessing provider resources include
supply forecasting, utilization or demand forecasting, needs-based assessments, and
benchmarking.4 This is a contextual measure that supports the objectives and
questions of other sections.
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Report 1, Volume 2
PHC PROVIDERS ENTERING/LEAVING THE WORKFORCE
INDICATOR NUMBER
86
INDICATOR DEFINITION
Ratio of PHC providers entering/leaving the workforce over the past 12 months, by
type of PHC provider.
DEFINITION OF
RELEVANT TERMS
Entering (net gain) is the providers who i) re-establish registration after a period
away, ii) are new graduates, or iii) migrate from other provinces and countries.
Leaving (net loss) is the providers who do not renew registration because of
retirement, out-migration, career change, illness/injury/disability/maternity, and death.
METHOD OF
CALCULATION
(Numerator/Denominator) x 100
NUMERATOR
Number of PHC providers entering the workforce over the past 12 months, by type
of PHC provider
• FP/GP
• Nurse practitioner
• Registered nurse
• Audiologist
• Chiropractor
• Dietitian
• Occupational therapist
• Pharmacist
• Physiotherapist
• Psychologist
• Optometrist
• Social worker
• Speech-language pathologist
• Other
DENOMINATOR
Total number of providers leaving the workforce over the past 12 months, by type of
PHC provider
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source available in the Scott’s Medical Database and the NPDB,
but only for FP/GP providers.
RATIONALE AND
INTERPRETATION
130
This indicator measures changes in the overall number of PHC providers working in
the health care system. Examining the flow (entering/leaving) of providers in any
given year, factors that lead to an under supply of providers can be identified and
controlled. For example, providers enter the health care system as professionals from
other countries, returning from abroad, and new graduates; they leave the system
through retirements, emigration and death.5, 6 By understanding how these elements
affect changes in supply, strategies can be implemented to ensure that enough
providers are available in a jurisdiction to meet the need of service. This is a
contextual measure that supports the objectives and questions of other sections.
Pan-Canadian Primary
Health Care Indicators
Report 1, Volume 2
PHC ORGANIZATIONS ACCEPTING NEW CLIENTS/PATIENTS
INDICATOR NUMBER
87
INDICATOR DEFINITION
% of PHC organizations that are currently accepting new PHC clients/patients.
METHOD OF
CALCULATION
(Numerator/Denominator) X 100
NUMERATOR
Number of PHC organizations that are currently accepting new PHC clients/patients
DENOMINATOR
Total number of PHC organizations responding to a survey
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source partially available in the National Physician Survey (NPS),
but only for FP/GP providers.
RATIONALE AND
INTERPRETATION
This indicator reflects access to PHC care and assesses how many PHC organizations
can accommodate new patients. Ensuring a sufficient supply of providers to meet
health care needs across Canada is one of the key goals of the 2003 First Ministers
Accord on Health Care Renewal.7, 8 A high rate of practices accepting new PHC
clients/patients is interpreted as a positive result.
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Report 1, Volume 2
PHC PROVIDER SATISFACTION WITH USE OF PROFESSIONAL SKILLS
INDICATOR NUMBER
88
INDICATOR DEFINITION
% of PHC providers who are satisfied that they utilize the full extent of their skills, by
type of PHC provider.
DEFINITION OF
RELEVANT TERMS
Skill is the capacity to perform a set of tasks developed through the acquisition of
training, experience and professional scope of practice.
METHOD OF
CALCULATION
(Numerator/Denominator) X 100
NUMERATOR
Number of PHC provider survey respondents who report that they are satisfied or
very satisfied that they use the full extent of their skills in their employment situation,
by type of PHC provider
• FP/GP
• Nurse practitioner
• Registered nurse
• Audiologist
• Chiropractor
• Dietitian
• Occupational therapist
• Pharmacist
• Physiotherapist
• Psychologist
• Optometrist
• Social worker
• Speech-language pathologist
• Other
DENOMINATOR
Total number of PHC provider survey respondents
DATA SOURCE AND
AVAILABILITY
Potential Pan-Canadian data source could be partially available in the NPS with
modifications to the survey, but only for FP/GP providers.
RATIONALE AND
INTERPRETATION
132
This indicator measures the extent to which PHC providers are satisfied that the full
extent of their professional skills are used in their work. Satisfaction levels tend to be
higher when roles are clearly defined,9 in order to ensure that provider skills are used
in the most efficient manner, and not under-utilized.10 A high satisfaction rate among
PHC providers is interpreted as a positive result.
Pan-Canadian Primary
Health Care Indicators
Report 1, Volume 2
WORKPLACE SAFETY
INDICATOR NUMBER
89
INDICATOR DEFINITION
% of PHC providers who report that there are currently adequate provisions to ensure
their safety in their workplace, by type of PHC provider.
METHOD OF
CALCULATION
(Numerator/Denominator) X 100
NUMERATOR
Number of PHC providers who report that currently there are adequate provisions to
ensure their safety in their workplace, by type of PHC provider
• FP/GP
• Nurse practitioner
• Registered nurse
• Audiologist
• Chiropractor
• Dietitian
• Occupational therapist
• Pharmacist
• Physiotherapist
• Psychologist
• Optometrist
• Social worker
• Speech-language pathologist
• Other
DENOMINATOR
Total number of PHC provider survey respondents
DATA SOURCE AND
AVAILABILITY
Potential Pan-Canadian data source could be partially available in the National Survey
of the Work and Health of Nurses (NSWHN) with modifications to the survey, but
only for nurse providers.
RATIONALE AND
INTERPRETATION
This indicator assesses the extent to which PHC providers believe that provisions
exist to ensure safety in the workplace. Safety initiatives are part of a comprehensive
workplace health strategy that address an organization’s culture, policies and
workplace practices, and includes disability management and injury prevention
programs.11 The BD Safety Conversion Initiative is an example of a 5-step process
that organizations can implement to ensure the safety of their health care
employees.12 A high rate of respondents reporting adequate safety provisions in their
PHC workplace is interpreted as a positive result.
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Report 1, Volume 2
WORKPLACE INJURIES
INDICATOR NUMBER
90
INDICATOR DEFINITION
% of PHC providers who had a workplace related injury over the past 12 months, by
type of PHC provider.
METHOD OF
CALCULATION
(Numerator/Denominator) X 100
NUMERATOR
Number of PHC providers who had a workplace related injury over the past 12
months, by type of PHC provider
• FP/GP
• Nurse practitioner
• Registered nurse
• Audiologist
• Chiropractor
• Dietitian
• Occupational therapist
• Pharmacist
• Physiotherapist
• Psychologist
• Optometrist
• Social worker
• Speech-language pathologist
• Other
DENOMINATOR
Total number of PHC provider survey respondents
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source partially available in the NPS and the NSWHN, but only for
FP/GP and nurse providers.
RATIONALE AND
INTERPRETATION
134
High quality work environments that attract and retain motivated and productive
health care workers have lower rates of absenteeism13 including short and
long-term disability claims. These absences negatively affect the productive use of
available resources and can affect quality of care as well.14 A low rate of PHC
providers reporting a work place related injury in the past year is interpreted as a
positive result.
Pan-Canadian Primary
Health Care Indicators
Report 1, Volume 2
PHC PROVIDER BURNOUT
INDICATOR NUMBER
91
INDICATOR DEFINITION
% of PHC providers who missed work due to burnout (2 weeks or more) over the
past 12 months, by type of PHC provider.
DEFINITION OF
RELEVANT TERMS
Missed work includes absence of 2 weeks or more.
METHOD OF
CALCULATION
(Numerator/Denominator) X 100
Burnout is defined as exhaustion of physical or emotional strength or motivation
usually as a result of prolonged stress or frustration.
NUMERATOR
Number of PHC providers who report having missed work due to burnout over the
past 12 months, by type of PHC provider
• FP/GP
• Nurse practitioner
• Registered nurse
• Audiologist
• Chiropractor
• Dietitian
• Occupational therapist
• Pharmacist
• Physiotherapist
• Psychologist
• Optometrist
• Social worker
• Speech-language pathologist
• Other
DENOMINATOR
Total number of PHC provider survey respondents
DATA SOURCE AND
AVAILABILITY
Potential Pan-Canadian data source could be partially available in the NPS and
NSWHN with modifications to the survey, but only for FP/GP and nurse providers.
RATIONALE AND
INTERPRETATION
There is increasing concern about the prevalence of burnout among health care
providers.15 Related absences affect the effective deployment of available staff in an
organization and can negatively affect quality of care.14 Research has shown that
organizational factors are important to manage stress-related conditions in the
workplace.16 Burnout is related to stress due to workload, client/patient expectations,
challenges of work-life balance, and relationships with other staff.17 A low rate of
PHC providers reporting that they missed work due to burnout in the past year is
interpreted as a positive result.
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Report 1, Volume 2
SATISFACTION WITH WORK-LIFE BALANCE
INDICATOR NUMBER
92
INDICATOR DEFINITION
% of PHC providers who were satisfied with the overall quality of work-life balance
over the past 12 months, by type of PHC provider.
DEFINITION OF
RELEVANT TERMS
Work-life balance refers to a perceived balance of professional and private life.
METHOD OF
CALCULATION
(Numerator/Denominator) X 100
NUMERATOR
% of PHC providers who report being satisfied or very satisfied with the overall
quality of work-life balance over the past 12 months, by type of PHC provider
• FP/GP
• Nurse practitioner
• Registered nurse
• Audiologist
• Chiropractor
• Dietitian
• Occupational therapist
• Pharmacist
• Physiotherapist
• Psychologist
• Optometrist
• Social worker
• Speech-language pathologist
• Other
DENOMINATOR
Total number of PHC provider survey respondents
DATA SOURCE AND
AVAILABILITY
Potential Pan-Canadian data source could be partially available in the NPS and
NSWHN (with modifications to the NSWHN survey), but only for FP/GP and
nurse providers.
RATIONALE AND
INTERPRETATION
136
This indicator measures factors in the work environment that affect provider wellbeing, especially the balance between their work and life roles. Research shows that
work life balance affects provider well-being18 and job satisfaction, which in turn,
influences the quality of the health care experiences of PHC clients/patients.19 The
shift to PHC organizations and interdisciplinary care teams is expected to improve the
quality of life for PHC providers through a better work-life balance. A high rate of
respondents who are satisfied with the quality of their work-life balance is interpreted
as a positive result.
Pan-Canadian Primary
Health Care Indicators
Report 1, Volume 2
NEEDS-BASED HHR PLANNING
INDICATOR NUMBER
93
INDICATOR DEFINITION
% of health regions that are currently implementing a plan to meet their PHC health
human resource needs.
DEFINITION OF
RELEVANT TERMS
Health human resource needs-based planning examines the productivity of providers
(number of services per provider), the health needs of the population, and the level of
services per unit of need (how the need will be met).14
METHOD OF
CALCULATION
(Numerator/Denominator) X 100
NUMERATOR
Number of health regions that are currently actively implementing a plan to meet their
PHC health human resource needs
DENOMINATOR
Total number of health region survey respondents
DATA SOURCE AND
AVAILABILITY
No data source currently available. Survey data source required.
RATIONALE AND
INTERPRETATION
Health regions that use needs-based planning to allocate health human resources
increase their ability to plan for the right number and mix of providers, when and
where they are needed.14 This strategy has an explicit goal of providing timely access
to quality health services as identified in the 2003 First Ministers’ Accord on Health
Care Renewal.7, 8 A high rate of health regions reporting the implementation of an
HHR plan is interpreted as a positive outcome.
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References
1.
Health Canada, “Health Human Resources: Balancing Supply and Demand,”
Health Policy Research Bulletin 8 (May 2004): pp. 1-48, [online], cited August
2005, from <http://www.hc-sc.gc.ca/sr-sr/alt_formats/iacb-dgiac/pdf/pubs/
hpr-rps/bull/2004-8-hhr-rhs/2004-8-hhr-rhs_e.pdf>.
2.
B. Chan, From Perceived Surplus to Perceived Shortage: What Happened to
Canada’s Workforce in the 1990s?, (Ottawa: Canadian Institute for Health
Information, 2002), [online], cited March 1, 2006, from
<http://www.medecine.uottawa.ca/tfg/pdf/A/
CanadasphysicianworkforceChan%20(1).pdf>.
3.
Canadian Institute for Health Information, Full-Time Equivalent Report,
Physicians Report Canada, 2002/03, (Ottawa: Canadian Institute for Health
Information, 2004), [online], cited March 1, 2006, from <www.cihi.ca>.
4.
Canadian Labour and Business Centre and Canadian Policy Research Networks,
Canada’s Physician Workforce Occupational Human Resources Data
Assessment and Trends Analysis; Final Report, (Ottawa: A Physician Human
Resource Strategy for Canada, Task Force Two, 2005), [online], cited February
21, 2006 from <www.caper.ca/docs/articles_interest/
pdf_executive_summary_task_force.pdf>.
5.
Fujitsu Consulting, Setting a New Direction for Planning the New Brunswick
Physician Workforce: Final Report, (New Brunswick Department of Health and
Wellness, 2003), [online], cited March 1, 2006, from
<http://www.gnb.ca/0051/pdf/HRStudy/DirectionPhysicianWorkforce.pdf>.
6.
Canadian Labour and Business Centre, Physician Workforce in Canada:
Literature Review and Gap Analysis, (Ottawa: A Physician Human Resource
Strategy for Canada, Task Force Two, 2003), [online], cited February 24,
2006, from <www.effectifsmedicaux.ca/reports/
literatureReviewGapAnalysis-e.pdf>.
7.
Government of Canada, First Ministers’ Accord on Healthcare Renewal,
(Ottawa: Government of Canada, 2003), [online], cited on Feb 1, 2006 from
<http://hc-sc.gc.ca/hcs-sss/delivery-prestation/fptcollab/2003accord/
index_f.html >.
8.
Institute of Health Services and Policy Research, Spotlight: Health Human
Resources. 2005, (Ottawa: Canadian Institute for Health Research, 2005),
[online], cited August 14, 2005, from <www.cihr-irsc.gc.ca/e/28365.html>.
138
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9.
Ontario Ministry of Health and Long Term Care, Report on the Integration of
Primary Health Care Nurse Practitioners into the Province of Ontario: Executive
Summary, (Toronto: Ontario Ministry of Health and Long Term Care, 2005),
[online], cited February 21, 2006, from <www.health.gov.on.ca/english/public/
pub/ministry_reports/nurseprac03/exec_summ.pdf>.
10. M. Howard, “Collaboration between Community Pharmacists and Family
Physicians: Lessons Learned from the Seniors Medication Assessment Research
Trial,” Journal of the American Pharmacy Association 43, 5 (Sept.-Oct. 2003):
pp. 566-72.
11. Canadian Association of Occupational Therapists, Position Statement on
Workplace Health and Occupational Therapy, (2004), [online], cited February
20, 2006, from <http://www.caot.ca/default.asp?pageID=1137>.
12. Becton, Dickinson and Company, The BD Safety Conversion Initiative, [online],
cited March 1, 2006, from <http://www.bd.com/ca/safety/programs/
conversion_initiative.asp>.
13. Health Care Human Resource Sector Council, A Study of Health Human Resources
in Nova Scotia 2003, (Halifax: Nova Scotia Ministry of Health, 2004), [online],
cited February 21, 2006, from <www.gov.ns.ca/health/hhr/
HHR%20NS%20Study%20Report%202003.pdf>.
14. L. O’Brien-Pallas, D. Thomson, C. Alksnis, S. Bruce, “The Economic Impact of
Nurse Staffing Decisions: Time to Turn Down Another Road?,” Hospital
Quarterly 4, 3 (Spring 2001): pp. 42-50.
15. M.R.M. Visser, E.M.A. Smets, F.J. Oort, H.C. de Haes, “Stress, Satisfaction
and Burnout Among Dutch Medical Specialists,” Canadian Medical Association
Journal 168, 3 (February 4, 2003): [online], cited February 15, 2006, from
<www.cmaj.ca>.
16. C. Goehring, M. B. Gallacci, B. Kunzi, P. Bovier, “Psychosocial and Professional
Characteristics of Burnout in Swiss Primary Care Practitioners: A Crosssectional Survey,” Swiss Medical Weekly 135, 7 (2005): pp.101-108, [online],
cited March 1, 2006, from <http://www.smw.ch/docs/pdf200x/2005/07/
smw-10841.pdf>.
17. N. Edwards, M.J. Kornacki, J. Silversin, “Unhappy Doctors: What are the
Causes and What can be Done?,” British Medical Journal 324, 7341 (April
2002): 835-838.
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18. C. Higgins, L. Duxbury, K. Johnson, “Report 3 - Exploring the Link Between
Work-Life Conflict and Demands on Canada’s Health Care System,” National
Study on Balancing Work, Family and Lifestyle, (Ottawa: Health Canada,
2004), [online], cited February 16, 2006, from <www.phac-aspc.gc.ca/
publicat/work-travail/report3/1_e.html >.
19. L. McGillis Hall, D. Doran, D. Tregunno, A. McCutcheon et al., Indicators of
Nurse Staffing and Quality Nursing Work Environments: A Critical Synthesis of
Literature: Executive Summary, (Toronto: Ontario Ministry of Health and Long
Term Care, 2003), [online], cited February 21, 2006, from
<www.health.gov.on.ca/english/providers/project/nursing/
nursing_work_envir/execsummary_moh.pdf>.
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Interdisciplinary Teams
Support 2:
Interdisciplinary primary health care teams
Evaluation Question 7—What is the extent and nature of interdisciplinary teams?
94. Access to interdisciplinary PHC organizations
95. PHC physicians working in solo practice
96. PHC physicians working in group practice
97. PHC FPs/GPs/NPs working in interdisciplinary teams/networks
98. Client/patient satisfaction with available PHC services
Evaluation Question 7.1—How should the mix and number of providers on a
interdisciplinary team reflect the needs of the community or practice population?
Other analytical approach required.
Evaluation Question 8—How do changes in the mix and number of providers on the
PHC team impact on the responsiveness, quality and the cost-effectiveness of care?
Other analytical approach required.
Evaluation Question 9—What factors facilitate health care providers working
together to provide comprehensive PHC (scope of practice regulations, primary
health care funding, training, continuing professional development)?
99. PHC team effectiveness score.
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ACCESS TO INTERDISCIPLINARY PHC ORGANIZATIONS
INDICATOR NUMBER
94
INDICATOR DEFINITION
% of population who received PHC services from an interdisciplinary PHC
organization, over the past 12 months.
DEFINITION OF
RELEVANT TERMS
An interdisciplinary health care organization includes a group of individuals with
diverse training who work as an identified unit to deliver patient care.
METHOD OF
CALCULATION
(Numerator/Denominator) X 100
NUMERATOR
Number of survey respondents who received PHC services from an interdisciplinary
PHC organization, over the past 12 months
DENOMINATOR
Total number of survey respondents
DATA SOURCE AND
AVAILABILITY
Potential pan-Canadian survey data source could be available in the CCHS, with
modifications to the survey.
RATIONALE AND
INTERPRETATION
142
This indicator measures the proportion of Canadians receiving services from an
interdisciplinary PHC organization. In 2004, the First Ministers’ “reaffirmed the
need to meet the objective of 50% of Canadians having 24/7 access to
interdisciplinary organizations by 2011”.1 Reporting this indicator will enhance our
ability to assess the extent to which interdisciplinary PHC services are being offered
to Canadians. The approaches and benefits of interdisciplinary primary health care
teams is still an emerging field.2, 3 Teams may improve the cost effectiveness of PHC,
as well as strengthen services through the use of specialized PHC knowledge.2
A high rate of people receiving care from an interdisciplinary care team is interpreted
as a positive result.
Pan-Canadian Primary
Health Care Indicators
Report 1, Volume 2
PHC PHYSICIANS WORKING IN SOLO PRACTICE
INDICATOR NUMBER
95
INDICATOR DEFINITION
% of FPs/GPs who currently work in a solo PHC practice as their main PHC
practice setting.
DEFINITION OF
RELEVANT TERMS
Solo PHC practice is a primary health care model involving physicians who practice
independently of other providers.
METHOD OF
CALCULATION
(Numerator/Denominator) X 100
NUMERATOR
Number of FPs/GPs who currently work in a solo PHC practice as their main PHC
practice setting
DENOMINATOR
Total number of FP/GP survey respondents
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source available in the National Physician Survey (NPS).
RATIONALE AND
INTERPRETATION
This indicator measures the extent to which FPs/GPs are continuing to practice in
non-group practice, or non-interdisciplinary team PHC settings. This indicator is part
of a set of indicators that monitors changes in the characteristics of the PHC system,
including physician networks, physician/nurse collaborations and interdisciplinary care
teams/networks. In 2004, 25% of family physicians/general practitioners indicated
they were in solo practice. However, some of these respondents also marked other
categories, suggesting that they work in more than one type of practice.4 This is a
contextual measure that supports the objectives and questions of other sections.
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PHC PHYSICIANS WORKING IN GROUP PRACTICE
INDICATOR NUMBER
96
INDICATOR DEFINITION
% of FPs/GPs who currently work in a group physician PHC practice as their main
PHC practice setting.
DEFINITION OF
RELEVANT TERMS
Group practice is defined as an organization of FPs/GPs who work together, share
client/patient records, office space, staff, technology, and on-call coverage.
METHOD OF
CALCULATION
(Numerator/Denominator) X 100
NUMERATOR
Number of FPs/GPs who currently work in a group physician PHC practice as their
main PHC practice setting
DENOMINATOR
Total number of FP/GP survey respondents
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source available in the NPS.
RATIONALE AND
INTERPRETATION
144
This indicator measures the extent to which FPs/GPs work in a group physician PHC
practice. This indicator is part of a set of indicators that monitors changes in the
characteristics of the PHC system, including physician networks, physician/nurse
collaborations and interdisciplinary care teams/networks. In 2004, 61% of FPs/GPs
reported that they were in group practice.4 This is a contextual measure that
supports the objectives and questions of other sections.
Pan-Canadian Primary
Health Care Indicators
Report 1, Volume 2
PHC FPS/GPS/NPS WORKING IN INTERDISCIPLINARY TEAMS/NETWORKS
INDICATOR NUMBER
97
INDICATOR DEFINITION
% of FPs/GPs/NPs who are currently working in an interdisciplinary PHC team or
network as their main practice setting, by type of PHC provider.
DEFINITION OF
RELEVANT TERMS
An interdisciplinary health care team or network includes a group of individuals with
diverse training who work together to deliver patient care.
METHOD OF
CALCULATION
(Numerator/Denominator) X 100
NUMERATOR
Number of PHC providers who are currently working in an interdisciplinary PHC team
or network as their main practice setting, by type of PHC provider:
• Family physician/General practitioner
• Nurse practitioner
DENOMINATOR
Total number of PHC provider survey respondents
DATA SOURCE AND
AVAILABILITY
Potential pan-Canadian data source available for FPs/GPs (e.g. NPS) and nurse
practitioners (e.g. NSWHS).
RATIONALE AND
INTERPRETATION
This indicator measures the extent to which FPs/GPs and NPs work in
interdisciplinary teams or networks. This indicator is part of a set of indicators that
monitors changes in the characteristics of the PHC system, including physician
networks, physician/nurse collaborations and interdisciplinary care teams/networks.
It will also be essential to examine additional descriptive information regarding the
composition of PHC teams. In 2004, the First Ministers’ “reaffirmed the need to meet
the objective of 50% of Canadians having 24/7 access to interdisciplinary
organizations by 2011”.1 The approaches and benefits of interdisciplinary primary
health care teams is still an emerging field.2, 3 Teams may improve the cost
effectiveness of PHC, as well as strengthen services through the use of specialized
PHC knowledge.2 A higher rate of PHC providers working on interdisciplinary teams
indicates a positive result.
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CLIENT/PATIENT SATISFACTION WITH AVAILABLE PHC SERVICES
INDICATOR NUMBER
98
INDICATOR DEFINITION
% of PHC clients/patients who report that the current range of services offered by
their PHC organization meets their needs.
METHOD OF
CALCULATION
(Numerator/Denominator) X 100
NUMERATOR
Number of PHC clients/patients who report that the current range of services offered
by their PHC organization meets their needs
DENOMINATOR
Total number of PHC client/patient survey respondent
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source currently not available. Client/patient survey data
source required.
RATIONALE AND
INTERPRETATION
146
This indicator measures the satisfaction of clients/patients with the range of PHC
services available from their PHC organization. In conjunction with other indicators
that track changing characteristics of the PHC system (e.g. increased interdisciplinary
teams), the indicator can assess, from a client/patient perspective, whether access to
comprehensive PHC services is changing. Interdisciplinary care teams/networks can
provide specialized services that fit the health requirements of their defined
population and include providers with skill sets that reflect the needs of the
community.5 A high rate of PHC clients/patients reporting that PHC services meet
their needs is interpreted as a positive result.
Pan-Canadian Primary
Health Care Indicators
Report 1, Volume 2
PHC TEAM EFFECTIVENESS SCORE
INDICATOR NUMBER
99
INDICATOR DEFINITION
Average team effectiveness score based on:
• Strong leadership;
• Clear objectives shared by all team members;
• Mechanisms for working in and with the community;
• Focus on quality care;
• Client/patient focused goals;
• Efficient and effective communication;
• Appropriate variety of health care providers;
• Mechanisms for conflict resolution;
• Interdisciplinary professional development;
• Shared decision-making; and
• Clear understanding of scope of practice and team role.
METHOD OF
CALCULATION
(Numerator/Denominator)
NUMERATOR
Sum of scores on team effectiveness scale based on
• Strong leadership
• Clear objectives shared by all team members
• Mechanisms for working in and with the community
• Focus on quality care
• Client/patient focused goals
• Efficient and effective communication
• Appropriate variety of health care providers
• Mechanisms for conflict resolution
• Interdisciplinary professional development
• Shared decision-making
• Clear understanding of scope of practice and team role
DENOMINATOR
Total number of PHC provider survey respondents
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source currently not available. Provider survey data
source required.
RATIONALE AND
INTERPRETATION
This composite score reflects team effectiveness that could be derived from a
survey instruments such as the Team Effectiveness Tool.6 Facilitators and barriers
to effective practice within interdisciplinary teams have been identified in the
literature.7, 8, 9 Facilitators of effective teams include clear leadership, shared
knowledge of the community and shared objectives.6 Barriers to effective teams
include organizational resistance, provider-PHC client/patient relationships,
overlapping roles and responsibilities. A high average score is interpreted as a
positive result.
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Report 1, Volume 2
References
1.
Health Canada, First Minister’s Meeting on the Future of Health Care 2004:
A 10-Year Plan to Strengthen Health Care, [online], cited April 10, 2006,
from <http://www.hc-sc.gc.ca/hcs-sss/delivery-prestation/fptcollab/
2004-fmm-rpm/index_e.html>.
2.
K. Grumbach and T. Bodenheimer, “Can Health Care Teams Improve Primary
Care Practice,” Journal of American Medical Association 291, 10 (March 10,
2004): pp. 1246-1251.
3.
C.J. Stille, A. Jerant, D. Bell, D. Meltzer and J.E. Elmore, “Coordinating Care
Across Diseases, Settings and Clinicians: A Key Role for the Generalist in
Practice,” Annals of Internal Medicine 142, 8 (April 19, 2005): pp. 700-708.
4.
Canadian Medical Association, “How the National Survey was Done. Survey
Tables and Statistics”, MD Plus 2005, (Ottawa: Canadian Medical Association,
2004), [online], cited March 6, 2006, from <http://www.cma.ca/Multimedia/
CMA/Content_Images/Inside_cma/WhatWePublish/LeadershipSeries/English/
11_How_NPS.pdf>
5.
Enhancing Interdisciplinary Collaboration in Primary Health Care, Enhancing
Interdisciplinary Collaboration in Primary Health Care in Canada, (Ottawa: The
Conference Board of Canada, 2005), [online], cited March 8, 2006, from
<http://www.eicp-acis.ca/en/resources/pdfs/
Enhancing-Interdisciplinary-Collaboration-in-Primary-Health-Care-in-Canada.pdf>.
6.
Med-Emerg International Inc. and Centre for Strategic Management, Team
Development and Implementation in Saskatchewan’s Primary Health Care
Sector: Final Report to Primary Health Services Branch, (Regina: Saskatchewan
Health, 2004), [online], cited March 8, 2006, from
<www.health.gov.sk.ca/ps_phs_teamdev.pdf>.
7.
C. Borrill, J. Carletta, A.J. Carter, J.F. Dawson, et al., The Effectiveness of
Health Care Teams in the National Health Service Report, (United Kingdom:
Aston Centre for Health Services Organization Research, 1999), [online],
cited March 2, 2006 from <http://homepages.inf.ed.ac.uk/jeanc/
DOH-final-report.pdf>.
148
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8.
D.W. Roblin, T.M. Vogt and B. Fireman, “Primary Health Care Teams:
Opportunities and Challenges in Evaluation of Service Delivery Innovations,”
Journal of Ambulatory Care Management 26, 1 (2003): pp. 36-38.
9.
K. Hurst, J. Ford and C. Gleeson, “Evaluating Self-Managed Integrated
Community Teams,” Journal of Management in Medicine 16, 6 (2002):
pp. 463-483.
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Report 1, Volume 2
Information Technology
Support 3:
Information technology that is adapted to primary health care and
links primary health care organizations with the rest of the health
care system
Evaluation Question 10—Do PHC organizations have computerized information
systems to support clinical activities (decision support, electronic health records,
electronic prescribing, electronic test requisitions and reporting, electronic
consultation reporting)? Which systems are being used?
100. Uptake of information and communication technology in PHC organizations
Evaluation Question 11—Do PHC organizations, in different geographic settings,
have communication linkages with teletriage and advice services? with telehealth
services? with emergency services? with hospitals? with laboratories? with longterm care facilities?
101. Use of information and communication technology modalities in
PHC organizations
102. Use of two-way electronic communication in PHC organizations
150
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UPTAKE OF INFORMATION AND COMMUNICATION TECHNOLOGY BY PHC ORGANIZATIONS
INDICATOR NUMBER
100
INDICATOR DEFINITION
% of PHC organizations that primarily use electronic systems to complete their
professional tasks.
DEFINITION OF
RELEVANT TERMS
Electronic information systems allow for the exchange of PHC client/patient
information between PHC settings and laboratories, hospitals and other
settings, including:
Patient management systems: Information system that supports and links PHC
client/patient information with PHC organizations, hospitals and other health entities.
Registry: Electronic, searchable directories that uniquely identify PHC client/patients,
health care providers and facilities to correctly link information electronically.
Drug information system: Allow physicians to view their PHC client/patients’
prescription drug profile and electronically send prescriptions. Allow pharmacists to
view orders on-line and confirm electronically that a prescription has been filled.
Diagnostic imaging systems: Allow specialists and physicians to view their PHC
client/patients’ lab results and reports on-line.
Public health surveillance systems: Provide real-time ability to share and analyze
health information critical for managing public health problems like SARS.
METHOD OF
CALCULATION
(Numerator/Denominator) X 100
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Report 1, Volume 2
UPTAKE OF INFORMATION AND COMMUNICATION TECHNOLOGY BY PHC ORGANIZATIONS (cont’d)
NUMERATOR
Number of PHC organizations who primarily use electronic systems to complete these
professional tasks
• Electronic patient appointment scheduling
• Electronic records to enter and retrieve clinical patient notes and data
• Email colleagues for clinical purposes
• Email clients/patients for clinical purposes
• Email colleagues for administrative purposes
• Email clients/patients for administrative purposes
• Electronic patient registries for individuals with chronic conditions
• Electronic decision aids (i.e. to assist in evaluating treatment options)
• Electronic access to evidence-based drug information
• Electronic warning systems for patient specific adverse prescribing and/or drug
interactions
• Electronic interface to external pharmacy/pharmacist to send drug prescriptions
electronically
• Electronic interface to external laboratory to send laboratory test requisitions
electronically
• Electronic interface to external laboratory to receive laboratory results
electronically
• Electronic interface to diagnostic imaging to send test requisitions electronically
• Electronically interface to diagnostic imaging to receive text and image results
electronically
• Electronically send referral letters to other PHC providers
• Electronically send requests for home care support
• Electronically receive home care assessment results/reports
• Electronically receive status notifications of admission/emergency room attendance
from hospitals
• Electronically receive discharge summaries from hospitals
• Electronically receive consultation reports from other health care providers
• Electronic billing
• Electronic professional education
• Other
DENOMINATOR
Total number of PHC organization survey respondents
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source currently not available. Survey data required.
RATIONALE AND
INTERPRETATION
152
The Commission of the Future of Health Care in Canada (Romanow Commission) and
Health Council of Canada both emphasized the importance of better information
technology and management in primary health care.1, 2 Reporting this indicator will
enhance our ability to assess the extent to which PHC organizations are using
electronic systems. For example, an estimated 26.3% of all physicians in Canada
have electronic patient records, while only 20.6% actually use them.3 A high rate of
PHC organizations using electronic systems to complete their professional tasks is
interpreted as a positive result.
Pan-Canadian Primary
Health Care Indicators
Report 1, Volume 2
USE OF INFORMATION COMMUNICATION TECHNOLOGY MODALITIES BY PHC ORGANIZATIONS
INDICATOR NUMBER
101
INDICATOR DEFINITION
% of PHC organizations that currently use a variety of electronic communication
modalities in the exchange of health care information with other PHC providers.
DEFINITION OF
RELEVANT TERMS
Electronic communication modalities may include teleconference, videoconference,
Web casting and computer-to-computer messaging (online facilitating services).
METHOD OF
CALCULATION
(Numerator/Denominator) X 100
NUMERATOR
Number of PHC organizations who currently use a variety of electronic
communications modalities in the exchange of health care information with other
PHC providers
DENOMINATOR
Total number of PHC organization survey respondents
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source currently not available. Survey data required.
RATIONALE AND
INTERPRETATION
This indicator measures the increased use of electronic communication modalities in
primary health care. Current research on telemedicine applications provides limited
evidence to support increased use (e.g. email referrals and consultations), and further
research is required for specific modalities and applications.4, 5 An increased rate of
PHC organizations that use electronic modalities is interpreted as a positive result.
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Report 1, Volume 2
USE OF TWO-WAY ELECTRONIC COMMUNICATION BY PHC ORGANIZATIONS
INDICATOR NUMBER
102
INDICATOR DEFINITION
% of PHC organizations that currently have two-way electronic communication
linkages (beyond fax and telephone) with other health care organizations (e.g.
hospitals, community mental health agencies, LTC facilities, public health).
DEFINITION OF
RELEVANT TERMS
Two-way communications is when information is sent and received electronically.
METHOD OF
CALCULATION
(Numerator/Denominator) X 100
NUMERATOR
Number of PHC organizations who currently have two-way electronic communication
linkages (beyond fax and telephone) with other health care organizations (e.g.
hospitals, community mental health agencies, LTC facilities, public health)
DENOMINATOR
Number of PHC organization survey respondents
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source currently not available. Survey data required.
RATIONALE AND
INTERPRETATION
154
This measure reflects the extent to which information technology is integrated into
the business processes of health care. Two-way electronic communication linkages
between PHC and other health care organizations (hospitals, community mental
health agencies, LTC facilities, and others) can enhance the clinical efficiency and
effectiveness of their practice.6 A high rate of PHC organizations with two-way
exchange of information is interpreted as a positive result.
Pan-Canadian Primary
Health Care Indicators
Report 1, Volume 2
References
1. R. Romanow, Building on Values: The Future of Health Care in Canada: Final
Report, (Saskatoon: Commission on the Future of Health Care in Canada, 2002).
2. Health Council of Canada, Primary Health Care, A Background Paper to
Accompany: Health Care Renewal in Canada: Accelerating Change, (Toronto:
Health Council of Canada, 2005).
3. College of Family Physicians of Canada, Canadian Medical Associations and
Royal College of Physicians and Surgeons of Canada, Physician –
Statistics/Tables/Graphs National Physician Survey, (Ottawa: College of Family
Physicians of Canada, Canadian Medical Associations and Royal College of
Physicians and Surgeons of Canada, 2004), [online], cited February 1, 2006,
from, <http://cfpc.ca/nps/English/Physician_Stats.asp>.
4. H. Z. Noorani and J. Picot, Assessment of Videoconferencing in Telehealth in
Canada, (Ottawa: Canadian Coordinating Office for Health Technology
Assessment, 2001).
5. R. Roine, A. Ohinmaa and D. Hailey, “Assessing Telemedicine: A Systematic
Review of the Literature,” Canadian Medical Association Journal 165, 6
(September 18, 2001): pp. 765-771.
6. Canada Health Infoway, End User Acceptance Strategy – Current Assessment,
(Toronto: Canada Health Infoway, May 5, 2005) [online] cited on March 7,
2006, from <http://www.infoway-inforoute.ca/Admin/Upload/Dev/Document/
EndUserAcceptance_CSAv10_2005MAY05.pdf>
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Report 1, Volume 2
Needs-Based Resource Allocations
Support 4:
Needs-based resource allocations for primary health care
Evaluation Question 12—Do regional funding allocations for PHC reflect
population age and morbidity structure and vulnerable groups? Other analytical
approach required.
Evaluation Question 13—Has the range of publicly funded services provided
(directly or indirectly) by PHC organizations increased over time? Other analytical
approach required.
Evaluation Question 14—What is the per capita operational cost of providing
primary health care services at a practice level? At a regional health authority level
(accounting for geographic location)?
103. Average per capita PHC operational expenditures
Evaluation Question 15—Have capital investments increased for new technology
and equipment for PHC? For physical facilities? For information technology?
Other analytical approach required.
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AVERAGE PER CAPITA PHC OPERATIONAL EXPENDITURES
INDICATOR NUMBER
103
INDICATOR DEFINITION
Average annual per capita operational expenditures of PHC services for:
• Health human resources;
− General Practitioners/Family Physicians;
− Nurse Practitioners;
− Other PHC providers;
• Supplies;
• Equipment;
• Administration/overhead; and
• Other.
DEFINITION OF
RELEVANT TERMS
Operational expenditures are the costs of operating the PHC practice.
Health Human Resources are the medical professionals employed within the
organization.
Supplies are the administrative and medical supplies used in the operation of a PHC
organization (e.g. disinfectants, gloves).
Equipment refers to the devices and machinery used in the operation of a PHC
organization (e.g. computer, blood pressure monitor, scale).
Administration/Overhead are costs and can include reception, records management,
file storage, space rental, administrative personnel, utilities, etc.
METHOD OF
CALCULATION
(Numerator/Denominator) x 100
NUMERATOR
Total per-capita operational funding for cost component in one fiscal year
DENOMINATOR
Total mid-year population in one fiscal year
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source currently not available. Administrative data
source required.
RATIONALE AND
INTERPRETATION
Measuring the per capita costs of PHC is an important contextual measure for
measuring variations and expenditures over time and across Canada.1 This indicator
can be calculated at both regional and provincial levels. This is a contextual measure
that supports the objectives and questions of other sections.
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Reference
1. E. McGlynn, “Six Challenges of Measuring the Quality of Health Care,” Health
Affairs 16, 3 (May/June 1997): pp. 7-21.
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Provider Payment Methods
Support 5:
Provider payment methods that align with primary health care goals
Evaluation Question 16—How are PHC providers paid?
104. PHC provider remuneration method.
105. Average PHC provider income by funding model.
Evaluation Question 17—How does provider remuneration method affect the
volume, type and quality of services that are provided? Other analytical
approach required.
Evaluation Question 17.1—Do non-FFS payment systems for physicians
increase the proportion of clinical time dedicated to prevention and chronic
disease management activities? To planning and quality improvement activities?
Other analytical approach required.
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PHC PROVIDER REMUNERATION METHOD
INDICATOR NUMBER
104
INDICATOR DEFINITION
% of PHC providers who were primarily remunerated by the following method over
the past 12 months by type of provider:
• Fee for service;
• Salary;
• Capitation; and
• Mixed System.
DEFINITION OF
RELEVANT TERMS
Salary is the annual wage paid to a PHC provider to work a set number of hours per
week per year.1
Capitation is payment is made for every patient for whom care is provided.1
Fee-for-service refers to reimbursement being provided for each item of service
provided and occurs after care has been provided.1
Mixed System refers to a combination of fee-for-service and capitation, or fee-forservice and salary as payment for one PHC provider.1
Primarily refers to more than 50% of total annual income from one source.
METHOD OF
CALCULATION
(Numerator/Denominator) x 100
NUMERATOR
Number of PHC provider survey respondents in each funding model
DENOMINATOR
Number of PHC provider survey respondents
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source partially available in the National Physician Survey (NPS),
but only for FP/GP providers.
RATIONALE AND
INTERPRETATION
160
PHC provider payment methods vary across Canada and include fee-for-service
payments, salary, capitation, and others. As new models of PHC are adopted across
the country, it can be expected that provider remuneration methods will also change.
Evidence suggests that mode of payment can affect provider clinical behaviour in a
practice setting.2, 3 This is a contextual measure that supports the objectives and
questions of other sections.
Pan-Canadian Primary
Health Care Indicators
Report 1, Volume 2
AVERAGE PHC PROVIDER INCOME BY FUNDING MODEL
INDICATOR NUMBER
105
INDICATOR DEFINITION
Average % of PHC provider income derived from each of the following PHC funding
models for one fiscal year, by type of PHC provider:
• Fee for service;
• Salary;
• Capitation; and
• Mixed system.
DEFINITION OF
RELEVANT TERMS
Salary is the annual wage paid to a PHC provider to work a set number of hours per
week per year.1
Capitation is payment made for every patient for whom care is provided.1
Fee-for-service refers to reimbursement being provided for each item of service
provided and occurs after care has been provided.1
Mixed System refers to a combination of fee-for-service and capitation, or fee-forservice and salary as payment for one PHC provider.1
METHOD OF
CALCULATION
(Numerator/Denominator) x 100
NUMERATOR
Cumulative percentage of salary gained per funding model by provider for one
fiscal year
DENOMINATOR
Number of respondents to provider survey
DATA SOURCE AND
AVAILABILITY
Pan-Canadian data source partially available in the NPS, but only for
FP/GP providers.
RATIONALE AND
INTERPRETATION
PHC provider payment methods vary across Canada and include fee-for-service
payments, salary, capitation, and others. As new models of PHC are adopted across
the country, it can be expected that provider remuneration methods will also change.
Evidence suggests that the mode of payment can affect provider clinical behaviour in
a practice setting.2, 3 This indicator monitors the distribution of payments by different
methods of remuneration to PHC providers. This is a contextual measure that
supports the objectives and questions of other sections.
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References
1. M. Jegers, K. Kesteloot, D. De Graeve, W. Gilles, “A Typology for Provider
Payment Systems in Health Care,” Health Policy 60 (2002): pp. 255-273.
2. A. Giuffrida, T. Gosden, F. Forland, I.S. Kristiansen et al., “Target Payments in
Primary Care: Effects on Professional Practice and Health Care Outcomes,” The
Cochrane Database of Systematic Reviews 4 (1999), catalogue no. CD000531.
3. T. Gosden, F. Forland, I.S. Kristiansen, M. Sutton et al., “Capitation, Salary,
Fee-For-Service and Mixed Systems of Payment: Effects on the Behaviour of
Primary Care Physicians,” The Cochrane Database of Systematic Reviews 3
(2000), catalogue no. CD002215.
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Support From Policy-Makers
Support 6:
Ongoing support from policy-makers for primary health care
Other analytical approaches required for all questions in Support 6.
Evaluation Question 18—What kind of policies are in place to influence or contribute
to ongoing renewal and sustainability of PHC? (e.g. FPT agreements, provincial
plans, tripartite agreements, legislation).
Evaluation Question 19—Have the responsibilities of PHC organizations been clearly
identified in the health system, especially related to a central role in coordination of
patient care?
Evaluation Question 20—What amounts of financial and human resources are
dedicated to PHC? Are there gaps in whole-person, comprehensive care because of
resource limitations?
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Health Care Indicators
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