title: Do primary care physicians coordinate ambulatory care for chronic disease patients in Canada?
abstract: BACKGROUND
  Adults with chronic disease are the most frequent users of the primary healthcare system. In Manitoba, patients are allowed to seek ambulatory (outpatient) care from the provider of their choosing (primary care physician or specialist), with referrals to specialists preferred but not always required. Some patients receive their routine care from specialists. We conducted this study to determine the patterns by which adults with chronic disease access ambulatory care as a prelude to exploring the impact these patterns may have on the quality of care received.
  
  
  METHODS
  Physician claims for all visits between 2007/8-2009/10 were extracted from the Data Repository at the Manitoba Centre for Health Policy. Patients included in the analysis made at least four ambulatory visits to a primary care physician or specialist within the study period, and met the definition criteria for at least one of six chronic diseases: diabetes mellitus; congestive heart failure; mood disorders; ischemic heart disease; total respiratory morbidity; and/or hypertension. Patients were "assigned" to the physician they visited most regularly. Physician visit patterns were assessed by dividing visits into nine visit types based on the type of physician patients visited (assigned primary care physician, other primary care physician, or specialist) and whether or not they received a referral.
  
  
  RESULTS
  347,606 patients with 7,662,411 physician visits were included in the analysis. Most visits were to the patients' assigned primary care physician. About 50% of the visits to specialists were by referral from the assigned primary care physician. However, 26-29% of all visits to a primary care physician were not to the assigned primary care physician, and non-assigned physicians were more likely to refer patients to specialists than assigned primary care physicians.
  
  
  CONCLUSIONS
  The findings suggest that the current primary care system in Manitoba may not adequately support coordination of ambulatory care. Ambulatory visits to a primary care provider who is not the patient's regular provider may represent a lost opportunity for coordination and continuity of care, and may affect the quality of care patients receive. Primary care renewal initiatives in this province should address this challenge to service provision.
authors.affiliation: Departments of Family Medicine and Community Health Sciences, College of Medicine, Faculty of Health Sciences, University of Manitoba, Manitoba Centre for Health Policy, 408-727 McDermot Ave, Winnipeg, Manitoba R3E 3P5, Canada. Alan_Katz@cpe.umanitoba.ca.
authors.forename: Alan
authors.initials: A
authors.lastname: Katz
authors.forename: Patricia
authors.initials: P
authors.lastname: Martens
authors.forename: Dan
authors.initials: D
authors.lastname: Chateau
authors.forename: Bodgan
authors.initials: B
authors.lastname: Bogdanovic
authors.forename: Ina
authors.initials: I
authors.lastname: Koseva
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000458:organization & administration*; D002170:Canada; D002908:Chronic Disease / Q000628:therapy*; D015331:Cohort Studies; D003266:Continuity of Patient Care; D003695:Delivery of Health Care / Q000458:organization & administration; D003920:Diabetes Mellitus / Q000628:therapy; D005260:Female; D006333:Heart Failure / Q000628:therapy; D006801:Humans; D006973:Hypertension / Q000628:therapy; D008297:Male; D008350:Manitoba; D008875:Middle Aged; D019964:Mood Disorders / Q000628:therapy; D017202:Myocardial Ischemia / Q000628:therapy; D009934:Organization and Administration; D011320:Primary Health Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000458:organization & administration* / Q000706:statistics & numerical data; D012140:Respiratory Tract Diseases / Q000628:therapy; D013038:Specialization / Q000706:statistics & numerical data*; D055815:Young Adult