Samuel E.D. Shortt

Family physician views about primary care reform in Ontario: a postal questionnaire

BackgroundPrimary care reform initiatives in Ontario are proceeding with little information about the views of practicing family physicians.MethodsA postal questionnaire was sent to 1200 randomly selected family physicians in Ontario five months after the initial invitation to join the Ontario Family Health Network. It sought information about their practice characteristics, their intention to participate in the Network and their views about the organization and financing of primary care.ResultsThe response rate was 50.3%. While many family physicians recognize the need for change in the delivery of primary care, the majority (72%) did not expect to join the Ontario Family Health Network by 2004, or by some later date (60%). Nor did they favour capitation or rostering, 2 key elements of the proposed reforms. Physicians who favour capitation were 5.5 times more likely to report that they expected to join the Network by 2004, although these practices comprise 5% of the sample.ConclusionsThe results of this survey, conducted five months after the initial offering of primary care reform agreements to all Ontario physicians, suggest that an 80% enrollment target is unrealistic.

Public or Private Magnetic Resonance Imaging: What Do the Patients Think?

Purpose We described the demographic, clinical, and attitudinal profiles of patients awaiting magnetic resonance imaging (MRI) at a private and at a hospital-based facility, and hypothesized that they would not differ significantly. Methods A survey of patients attending a hospital facility and a privately owned venue in an Ontario city. Descriptive, bivariate, and logistic regression analyses were performed. Results A total of 314 patients provided data, with a higher response rate at the private clinic than at the hospital-based clinic (97% vs 60%). For the majority of patients (58%), the MRI was scheduled to follow up known disease; 55.8% waited more than 4 weeks; 6.4% waited more than 6 months. One-third of patients expressed a willingness to travel to the United States and pay for the MRI, 41% expressed a willingness to pay within Ontario, and 66% were willing to travel elsewhere in Ontario. They were more likely to be at the hospital-based MRI if they were being followed up for known disease and had a diagnosis of cancer, whereas those patients at the private MRI facility reported significantly more pain; 59% of the hospital-based sample and 72% of the private clinic sample reported significantly reduced quality of life because of their health problem. Discussion These data provide interesting insights into the characteristics of patients awaiting an MRI and the attitudes of patients towards public and private MRI clinics. There were significant attitudinal differences between those patients attending the 2 facilities. Pain, coupled with a long wait, may create an incentive for patients to conclude that private clinics should be permitted if the hospital environment is unable to improve access times.