Health Council of Canada releases report on how physicians' decisions affect healthcare services in Canada

A report released today by the Health Council of Canada, Decisions, Decisions: Family Doctors as Gatekeepers to Prescription Drugs and Diagnostic Imaging in Canada, calls for better management of prescription drugs and diagnostic imaging services in this country. The report examines the increasingly complex role of family physicians and the effects of their decisions on usage of Canada's health care services.

As the first point of contact with the health care system for many Canadians, family physicians make decisions that affect patients' treatments, and also impact the health system as a whole. The report finds that physicians, today, are faced with many challenges, that they are prescribing more medications and ordering more diagnostic imaging tests than ever before, and that they need support to avoid inappropriate and over-use of these costly services.

"Family physicians act as 'gatekeepers' and play a key role in ensuring that our health care services such as drugs, diagnostics, and specialist services are being used appropriately," says John G. Abbott, CEO, Health Council of Canada. "Given the host of factors that influence their decision-making, we can do more to assist family physicians in curbing the overuse of diagnostics and drugs, and make significant improvements in managing our health care system."

Over the past 10 years, the number of prescriptions filled at community pharmacies has almost doubled - from 272 million in 1999 to 483 million in 2009. This suggests that some Canadians are getting drugs they do not need, while others are not getting medications from which they could benefit - putting into question the appropriate use of prescription drugs in Canada. Furthermore, the report indicates that between 1990 and 2009, the number of CT scanners more than doubled from 198 to 465 and within that same period MRI scanners increased from 19 to 266 - resulting from federal investments over the past decade. Compared to 2003, there has been a 58% increase in CT scans and 100% increase in the number of MRIs conducted.

The report acknowledges the difficulty in tracking how physicians' decisions affect the use of health care services. For example, available data do not show conclusively whether the use of family physician services has increased or decreased over the past decade, despite an increase in the number of family physicians in practice.

The report further finds that use and adherence to clinical practice guidelines is too low. Clinical practice guidelines inform providers - family physicians - about appropriate care while helping to reduce the variation in care.

Similarly, improvements are needed in terms of use and access to electronic medical and health records across the country. Canada continues to lag behind many other countries in the use of health information technology. Few family physicians use electronic medical records. The use of computers is often confined to administrative duties such as electronic billing and scheduling appointments, but not clinical work. The increased adoption of better usage of electronic health systems will lead to more comprehensive data on how drugs are prescribed and used, linking them back to effects on health outcomes, while encouraging adherence to clinical practical guidelines.

"We can make up for this lack of information through additional research and the wider adoption of electronic health records by family physicians," stated Abbott. "It is a critical foundation for safe and appropriate prescribing and medication management. It is essential that an electronic system is in place to efficiently assist physicians in following clinical practice guidelines, making the best decisions for their patients and for the sustainability of our health-care system."

Quotes

"Family physicians act as 'gatekeepers' and play a key role in ensuring that our health care services such as drugs, diagnostics, and specialist services are being used appropriately. Given the host of factors that influence their decision-making, we can do more to assist family physicians in curbing the overuse of diagnostics and drugs, and make significant improvements in managing our health care system."

"We can make up for this lack of information through additional research and the wider adoption of electronic health records by family physicians. It is a critical foundation for safe and appropriate prescribing and medication management. It is essential that an electronic system is in place to efficiently assist physicians in following clinical practice guidelines, making the best decisions for their patients and for the sustainability of our health-care system."