SPECIAL FOCUS ON COMPLEX CARE AND MULTIMORBIDITY Patient-Centred Care in Complexity and Multimorbibity Improving Evidence and Measures of Performance Models of Collaboration Exemplars of Integration and System Change

Good primary care is essential for the effective management of patients with chronic conditions in the community and to ensure their care is well coordinated with other parts of the system. The Commonwealth Fund 2015 International Health Policy Survey compares the views and experiences of primary care physicians in 11 countries including Canada. The survey found nearly all (98%) primary care doctors across countries treat patients with complex needs in their practice. However, when examining questions on chronic disease management and coordination of care with other providers, Canadian results are mixed compared to the international average, and show variation at the provincial level. Opportunities likely exist to learn from other countries that have a more systematic approach to primary care delivery. Introduction For most people, primary care physicians are the first point of contact with the healthcare system. They provide and coordinate care to manage health problems in the community and help to prevent people from getting sick in the first place. Research shows that effective primary care provides better overall care for patients at a lower cost to the health system. Across Canada, there have been many efforts to improve the delivery of primary care (Beaulieu et al. 2013; Government of Canada 2012). By providing comparable information on the experiences of primary care physicians in 11 countries, the Commonwealth Fund 2015 International Health Policy Survey of Primary Care Physicians provides an important perspective on how well primary care works in Canada and where improvements still need to be made (Canadian Institute for Health Information 2016; Commonwealth Fund 2015). Of the many topics covered in the survey, primary care physicians were asked questions about managing complex patients with chronic diseases and coordination of care for these patients across the healthcare system. These questions are highly relevant given that more than 65% of Canadian seniors have multiple chronic conditions such as heart disease, cancer, asthma, diabetes, arthritis and dementia (Public Health Agency of Canada 2010). These individuals are often high users of the health system and face significant challenges to their quality of life. However, many chronic conditions (referred to as ambulatory care sensitive conditions) can be managed in the community through appropriate delivery of primary care, thereby avoiding or delaying costly hospitalizations and further deterioration of health. Methodology The Commonwealth Fund 2015 International Health Policy Survey of Primary Care Physicians polled primary care physicians in 11 countries: Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom and the United States. Data from France were not available at the time this analysis was conducted. In Canada, there were 2,284 respondents and an overall response rate of 31.7%. The survey data for Canada were first weighted within each of the 10 provinces by age and gender. Data were, subsequently, weighted by province to reflect Canada’s primary care physician distribution. Owing to small sample sizes, detailed provincial and territorial results are not shown for Prince Edward Island, Nunavut, Northwest Territories and Yukon. Statistical testing was performed to determine whether Canadian and provincial results were significantly different from the international average of 10 countries. Care for Patients with Complex Needs: Canadian Results from the Commonwealth Fund 2015 International Health Policy Survey of Primary Care Physicians Christina Lawand, Geoff Paltser, Grace Cheung and Alison Ytsma