Population patterns of chronic health conditions, co-morbidity and healthcare use in Canada: implications for policy and practice.

Managing chronic health conditions is a daily reality for approximately nine million Canadians, and the numbers of people affected are expected to increase as our population ages, particularly if risk factors that contribute to poor health continue to rise. These conditions impact health and well-being and represent a significant, and growing, healthcare and economic burden. The Health Council of Canada has focused its attention on the prevention and management of chronic conditions to encourage discussion of the changes to public policy, healthcare management and health services delivery required to improve health outcomes for Canadians. In December 2007, the Health Council released a report that described the health and healthcare use among Canadians who have chronic conditions as well as their self- reported experiences with chronic illness care. It highlighted initiatives under way in all jurisdictions to improve the situation. In order to inform that report, we analyzed population-based survey data from the Canadian Community Health Survey to report on patterns of health and healthcare use by community-dwelling youth and adults who have one or more of seven high-prevalence, high-impact chronic conditions. We demonstrated that the vast majority of people with chronic conditions have a regular medical doctor and visit community-based doctors and nurses frequently. Not surprisingly, people with chronic conditions use healthcare services more often and more intensively than do those without, and the intensity of service use increases as the numbers of conditions go up. The 33% of Canadians with one or more of seven chronic conditions account for approximately 51% of family physician/general practitioner consultations, 55% of specialist consultations, 66% of nursing consultations and 72% of nights spent in a hospital. This information highlights the imperative of immediate, comprehensive and sustained attention to undertake proven strategies to delay or prevent the onset of chronic conditions and to improve the quality of primary healthcare to prevent complications, reduce the need for more expensive health services and secure a better quality of life for Canadians.

Why healthcare renewal matters: lessons from diabetes.

In this commentary, we offer evidence about the burden of chronic conditions and use diabetes as a case study to reveal the gap between recommended and actual care in Canada. What we found through our research is cause for concern - namely, that the care that Canadians with diabetes receive is simply not good enough (an inconvenient truth) and that the country has tremendous untapped potential to prevent chronic illness and improve the quality of care (a convenient truth). Our work and the work of others help Canadians understand the benefits that will accrue to them from investments to close the gap between what we know and what we do. Given the extent of recent initiatives highlighted in this commentary - initiatives that align with evidence regarding optimal prevention and chronic illness care - we should expect governments to simultaneously invest in assessing the degree to which progress is being attained. Without better data, more transparency and comprehensive reporting, Canadians will not be kept fully informed about the results of critical healthcare investments and governments will find it increasingly difficult to demonstrate that they are meeting their commitments.