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Canadians have expressed concern that access to a family physician (FP) has declined precipitously. Yet FP to population ratios remained relatively stable over the last decade, and there were perceptions of physician surpluses, at least in urban centres, 10 years ago. We evaluated whether demographic changes among patients and FPs, and in the volume of care received and provided over the period, contribute to this paradox. Given the relationship between age and FP use in fiscal year 1991/1992, an aging population should have been associated with a 2 per cent increase in visits by 2000/2001. Likewise, given the relationship between FP age and workloads in 1991/1992, an aging workforce should have been associated with a 12 per cent increase in service provision a decade later. Yet visit rates and average FP workloads remained unchanged. There was an increase in age-specific rates of FP use among older adults and a decline in rates among the young, and an increase in age-specific workloads such that older FPs provided many more services than their predecessors (30%) and younger FPs provided many fewer (20%). In terms of impact on future requirements for FPs, both changes in age-specific rates of use, and changes in age-specific patterns of FP productivity, trump population aging as key drivers.

Background: As part of a recent project focused on needs-based planning for generalist physicians, the authors documented the variety of practice styles of primary care physicians for managing patients with hypertension. They investigated the validity of various explanations for these different styles and the relative contributions of physician and patient characteristics to the rates at which hypertensive patients contact physicians.Methods: Retrospective descriptive study using regression analyses to simultaneously adjust for the influence of key patient and physician characteristics. Hypertensive patients in Winnipeg were identified using Manitoba physician claims data for fiscal years 1993/94 and 1994/95. Patients were included if they were 25 years of age or more and had at least one physician contact in both 1993/94 and 1994/95 during which hypertension was diagnosed. In addition, the primary care physician had to be the physician that the patient contacted most frequently in 1993/94 and 1994/95 and with whom she or he had at least 2 visits during this period. Only patients of family practitioners whose practice included at least 50 hypertensive patients were included.Results: To control for the effects of large samples and to validate the results, the authors conducted all analyses for half (6282) the sample of hypertensive patients who met the study criteria (12,563). A total of 132 primary care physicians who met the study criteria were identified. The patients made on average 9.3 ambulatory visits to physicians (both general practitioners and specialists) in 1994/95. Those who had more complex medical conditions (i.e., were formally referred to a specialist), those who had 3 or more serious medical problems and those who had been admitted to hospital made more visits to their primary care physician than those without these characteristics. After these and other key patient characteristics were controlled for, a primary care physician's patient recall rate in 1993/94 was strongly related to the number of visits his or her hypertensive patients made to all doctors for any reason in 1994/95. Physicians with high patient recall rates (i.e., who saw their hypertensive patients on average 8 or more times) in 1993/94 also had high recall rates in 1994/95.Interpretation: Because patient characteristics most strongly associated with high visit rates were those reflecting patient illness, policy measures aimed at patients (e.g., user fees and deinsurance) do not appear to be the appropriate policy tool for dealing with high visit rates. Given the influence of a physician's patient recall rate on patient visit patterns, physician profiling and feedback may prove more appropriate. [ABSTRACT FROM AUTHOR]

Presents a study to describe characteristics associated with inappropriate hospital use in order to help target utilization reviews in Manitoba. Design of the study; Patients; Outcome measures; Results and conclusion.

Refutes media headlines in British Columbia concerning the downsizing of hospitals. Allegations that the downsizing will increase death rate, decrease access to hospitals, and result in discharge of people who are still sick; Study by Samuel Sheps and colleagues which did not find evidence of negative effects from the downsizing.