Referral processes and wait times in primary care.

OBJECTIVE: To evaluate the response times to requests for consultations from FPs and the wait times for patient appointments. DESIGN: Mailed invitation to participate in a survey about non-FP specialist consultation requests from April 28 to May 9, 2014. SETTING: Hamilton, Ont. PARTICIPANTS: All active physicians with community practices from the Department of Family Medicine at St Joseph's Healthcare Hamilton and Hamilton Health Sciences. MAIN OUTCOME MEASURES: All non-FP specialist consultation requests for a 2-week period. RESULTS: Thirty-four practices (9.6% response rate) collected data on 816 consultation requests. Requests for referrals were most commonly made to the following 5 specialties: dermatology, surgery, gastroenterology, orthopedics, and obstetrics and gynecology. Overall, 36.4% of the requests for consultation received no response from the non-FP specialist's office by the end of the follow-up period. The mean wait time for a patient appointment was 60.1 days (range 23.3 to 168.5 days). Five specialties had particularly lengthy wait times of 105.9 to 168.5 days. CONCLUSION: Allowing 5 to 7 weeks for a response from a non-FP specialist, there was still a 36.4% nonresponse rate (similar to a pilot survey administered in 2010). Patient and physician frustration is certainly heightened and more office time and energy is expended when no acknowledgment of a referral is received within 7 weeks. This gives our community wait times much longer than those reported by any of the national bodies.

Role of family physicians in an urban hospital: Tracking changes between 1977, 1997, and 2014.

OBJECTIVE: To investigate changes in family doctors' attitudes about and participation in hospital activities and inpatient care in an urban hospital family medicine department from 1977 to 1997 and 2014. DESIGN: Cross-sectional survey design. SETTING: The Department of Family Medicine at St Joseph's Healthcare Hamilton in Ontario. PARTICIPANTS: Family physicians affiliated with the Department of Family Medicine at St Joseph's Healthcare Hamilton were surveyed in 2014. Data were compared with findings from similar surveys administered at this institution in 1977 and 1997. MAIN OUTCOME MEASURES: Family physicians' roles in hospital activities, attitudes toward the role of the family physician in the hospital setting, and the barriers to and facilitators of maintaining this role. RESULTS: A total of 93 physicians returned completed surveys (37.3% response rate). In 2014, half of the respondents provided some inpatient care. This patient care was largely supportive and newborn care (71.7% and 67.4%, respectively). In 2014, 47.3% believed the quality of care would suffer (compared with 92.1% in 1977 and 87.5% in 1997) if they were not involved in patient care in the hospital. There was also a considerable shift away from the 1977 and 1997 perception that the family physician had a role as patient advocate: 92.0% and 95.3%, respectively, compared with only 49.5% in the 2014 survey. CONCLUSION: Family physicians' hospital activities and attitudes continued to change from 1977 to 1997 and 2014 in this urban hospital setting. Most of the respondents had stopped providing direct inpatient care, with a few continuing to provide supportive care. Despite this, most respondents still see a role for the Department of Family Medicine within the hospital as a focus for identifying with their family physician community, a place to interact with other specialist colleagues, and a source of some continuing medical education.

Self-reported physician adherence to guidelines for measuring blood pressure.

BACKGROUND: Diagnosis of hypertension, treatment, and follow-up depend on accurate measurement. This research study attempted to determine whether family physicians are all measuring blood pressure (BP) according to Canadian guidelines. METHODS: A short survey was mailed to all physicians within the Department of Family Medicine, St. Joseph's Healthcare, Hamilton, Ontario, Canada. RESULTS: Fifty-one percent of the surveys were completed and returned. Eleven of the recommendations were followed "always or most of the time." BP is measured manually by 63% of the respondents, and the most frequent barrier to following the recommendations was time. CONCLUSION: The results of the survey indicated that measurement of BP according to Canadian Hypertension Education Program recommendations was felt to be important and conducted in most cases, but there is room for improvement.