As some Ontarians remain without a family doctor, a new study shows not having one can increase your risk of death, but it found the risk is even higher for those with multiple chronic conditions the longer they’re without.
According to the study, those with multiple chronic conditions who went without a family doctor for two or more years had 12-fold higher odds of death, and a nearly 16-fold higher chance of premature death.
“So people with multiple chronic conditions who do have a family doctor compared to similar people in all other ways with multiple chronic conditions and the only real difference being they don’t have a doctor, (of) those two groups, there was double the risk of dying in the next year,” said Dr. Jonathan Fitzsimon, a family physician and lead author of the study.
The study was published in the Health Affairs Scholar journal this month and saw more than 12 million Ontarians’ health records analyzed.
Of that 12 million, approximately 90 per cent or 11.5 million had a family doctor, with 83 per cent having had their physician for five years or more. The remaining 1.2 million did not have a family doctor, with the study finding roughly one-third being without one for five years or more, and 7.4 per cent without a physician for 15 or more years.
That’s a problem because when those who may need that primary care don’t get it, it can mean more burden on the health-care system.
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“Maybe there needs to be a focus as well, and some degree of priority and additional work on those unattached patients who have multiple chronic conditions, because they’re the ones who are at the most risk individually, but they also have the highest burden on our hospital system,” said Fitzsimon, assistant professor at the University of Ottawa’s Department of Family Medicine.
A separate study conducted by Fitzsimon and four other researchers found prolonged periods without primary care were “significantly associated” with increased health-care costs. Those with high comorbidities without a family doctor for a long period of time had a median cost of about $8,100 annually.
He noted the study also showed the risk for those with multiple health issues went up in the years after they lost their family doctor, especially within the first five years.
“People with chronic conditions, well-controlled, well-managed, their medications ordered, their prescriptions refilled on time, and then they lose their family doctor and now they’re having to manage these chronic conditions independently or without professional support,” Fitzsimon said.
“That leads to more emergency department visits, more hospital visits, and what we also found now in this new research, a higher association with mortality.”
Fitzsimon applauded efforts by the provincial government to get Ontarians access, noting their Primary Care Action Plan, but said action should still be taken on ensuring care gets to those who may need it the most.
Dr. Tara Kiran, a family physician at St. Michael’s Hospital in Toronto, said not having a family doctor can pose added issues when a patient has several health issues. Kiran was not involved in the study.
“You end up going for a lot of your care to walk-in clinics or emergency departments, and those settings are actually designed to just deal with an immediate issue,” Kiran said. “They don’t provide ongoing follow-up, and it’s not really their job to manage chronic conditions over time.”
She said while these facilities can refer you to specialists, such as an endocrinologist for diabetes, it would only manage “one part of you.”
“Very different from a family doctor that manages the whole of you and balances all of those chronic conditions and your many needs,” she added.
While Kiran agrees with the need to get those with chronic conditions a family doctor first, it can be difficult to ensure they are reached due to barriers they may face.
She said the focus needs to be getting everyone care.
“In theory, we should be trying to prioritize, but in practice that’s hard and that’s why I also support the efforts to just ensure that everyone has one (a family doctor) because if we get that to everyone, that will include the people who are complex too,” Kiran said.
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