Who goes to the doctor, where and why?

Many Manitobans choose to see a family doctor or nurse practitioner who is not located close to their home, a University of Manitoba study has found.

This and other insights from the study Describing Patient Populations for the My Health Team Initiative will help Manitoba Health, Seniors and Active Living (MHSAL) to make informed decisions as it gradually introduces a team-based model of primary care called My Health Team. Primary care, usually provided by family doctors and nurse practitioners, is the initial access point to health-care services for Manitobans.

While developing the My Health Team initiative, health-care planners mapped out geographic areas based on where people live. But the new study, commissioned by MHSAL and carried out by the U of M’s Manitoba Centre for Health Policy (MCHP), reveals that within Winnipeg, 45 per cent of residents travel outside their My Health Team area for primary care.

Of people living near Winnipeg, 50 per cent travel into the city for primary care, rather than seeking it in their My Health Team area.

And of Manitobans who live far from Winnipeg, such as in the Prairie Mountain Health Region in western Manitoba, 60 per cent stay within their My Health Team boundaries for care, with 40 per cent travelling.

“These findings tell us that in order to plan primary care services, we need to focus more on where Manitobans actually get their care, and less on where they live,” said the lead author of the study, Dr. Dan Chateau, assistant professor of community health sciences at the Max Rady College of Medicine and a research scientist at MCHP.

“People often access a clinic close to their workplace, or a clinic that has been recommended to them, but isn’t close to their home,” Chateau said. “Another factor is that people will move some distance away, but continue to see the same family doctor.”

For the study, researchers analyzed de-identified health data for a three-year period (2011 to 2014). They found that about one-third of Manitobans don’t see a primary care provider regularly (meaning they see a family doctor or nurse practitioner less than once per year). Researchers then looked closely at the two-thirds who do make regular visits.

“People who are frequent users of the system or have complex health needs are likely to benefit most from the new My Health Team model of care,” Chateau said. “We need to understand their needs. For example, some patients are medically complex because of their physical health, and others because of mental health concerns. Different types of inter-professional teams might be needed to serve these patient populations.”

Other key findings include: 

• Twenty per cent of Manitobans who regularly see a primary care provider fit into at least one of three categories of complex patient: (i) frequent user of health services (ii) medically complex care needs (iii) socially complex care needs. The largest overlap is between frequent users and medically complex patients. But frequent users are not necessarily medically complex, and vice versa.
• Frequent users of health services are much more likely to be older, more likely to be female, and more likely to reside in a low-income area.
• People with mental health complexities tend to be younger and from lower income areas than people with physical health complexities.
• About 13 per cent of Manitobans have three or more social factors that pose challenges to their health – factors such as poverty, being a teen mom or being a newcomer to Canada. Many Manitobans with social complexities are young (more than 25 per cent are under 18).
• Socially complex patients are quite separate from the other two types, with only a very small overlap.
• Less than 1 per cent of Manitobans who regularly access primary care belong to all three categories.

The full report is available online: mchp-appserv.cpe.umanitoba.ca/deliverablesList.html

Information on the Province’s My Health Team initiative: www.gov.mb.ca/health/primarycare/public/myhts/faq.html

 ALISON MAYES