Canadian seniors less satisfied with quality of health care in international survey

Nearly 33 per cent of Canadian seniors said they were dissatisfied with the quality of the health care they received, compared with an average of 24 per cent in many other countries, according to a new report. 

The Canadian Institute for Health Information's analysis released Thursday is based on results from the Commonwealth Fund's 2016 survey of adults in 11 countries.

"Seniors depend on their primary health care provider a fair amount to help them coordinate care between the specialists and the hospital and home and they're pretty satisfied with their primary healthcare providers and less satisfied with the healthcare system as a whole," Tracy Johnson, director of health system analysis and emerging issues with CIHI in Toronto, said in an interview. "That may have to do with some of the access challenges that they face." 

One of the biggest challenges was having medical results available when seniors get to their appointment. Another, Johnson said, was hearing conflicting or different information from health-care providers. 

As people are living longer, they may develop more chronic diseases. Yet the health-care system is still designed to deal with acute problems such as appendicitis or a broken bone that needs to be treated in hospital, said George Heckman, a professor at the University of Waterloo and a geriatrician who focuses on aging and cardiovascular disease.Heckman said. He was not involved in CIHI's report.

In Canada, the health-care system has had trouble adapting to meet the needs of seniors with chronic conditions, Heckman said.

Find flares in chronic conditions before they worsen

"The problem with chronic conditions is that you know they're going to flare at some point. The flares usually happen over weeks. There's an opportunity to identify a flare before it get bad enough and you have to end up in the hospital," Heckman said. "That's where the care coordination issues that have been highlighted in this report become more important."

For instance, Heckman pointed to how a home care provider may notice a patient has breathing problems, but there's no way to share that information with the primary care provider.

What's more, health-care providers aren't all using the same language. In contrast, Heckman pointed to Belgium, where home care providers do use the same terminology as other health-care providers, say for cognitive test results. All of them are able to update a patient's electronic health record.

He said another potential solution is to embed specialists in family health teams with physicians, nurse practitioners and pharmacists to care for the most complicated patients. His research suggests that it improves how all the providers manage chronic illness, rather than the current model of sending faxes to specialists who book an appointment three months later.

But funding health-care providers separately makes it harder to shift money around to promote more integrated approaches, Heckman said.

The report includes good news about seniors living longer, accessing primary care such as family doctors, and having better self-perceived health than seniors in other countries, Heckman said.

The report's authors looked at four areas of satisfaction with care:

• Access to specialists.
• Mental health.
• Home care.
• End-of-life planning.

Generally, Canadians reported better experiences with their primary health care provider than the international average, such as for their regular doctor knowing their medical history, involving them in medical decisions, spending enough time with them and encouraging them to ask questions.

Only 65 per cent have a health care professional they can easily contact to ask a question between doctor visits, the report's authors said.

The fact that only two in 10 of those who care for seniors received government help is telling since home care is consistently touted as the solution to expensive health provision, said Stephen Katz, a sociologist at Trent University in Peterborough, Ont. Katz studies aging and gerontology. 

Seniors' safety outdoors

In an email, Katz said CIHI restricted its look at healthy lifestyle to diet, exercise and a sense of choice, without asking about access to safe environments or age-friendly transportation.

Heckman suggested that cities and communities design more age-friendly places to help seniors who have trouble walking distances. For example, if parks lack benches and aren't well lit then seniors will stay inside instead of getting exercise and socializing with others.  

The CIHI authors also found: 

• A third live with at least three chronic conditions.
• 32 per cent take five or more regular medications.
• 14 per cent face a mental health problem such as depression or anxiety.

The 11 participating countries were Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom and the United States.

In Canada, the phone surveys were conducted by land line from March to May 2017 by Social Science Research Solutions. There were 4,549 respondents aged 65 and older. Due to small sample sizes, the territories were not included in the provincial results.

The Commonwealth Fund describes itself as a private U.S. foundation that aims to promote a high-functioning health-care system. CIHI is an independent, non-profit organization that provides information on Canadians' health systems and the health of Canadians.