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Doctors’ Salaries can Determine Diabetes Care

Update Date: Jun 05, 2014 01:36 PM EDT
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According to a new study, the type of care diabetics receive can be highly dependent on a doctor's salary. The researchers from St. Michael's Hospital and the Institute for Clinical Evaluative Sciences (ICES) found that 75 percent of diabetics from Ontario, Canada do not get all of the recommended tests for their health condition due to several factors, with a doctor's salary being one of them.

"When it comes to diabetes, not all Ontarians are getting equal care," said lead author Dr. Tara Kiran, a family physician and an associate scientist in the Li Ka Shing Knowledge Institute of St. Michael's Hospital. "Ontarians whose doctors are paid a lump sum per patient are more likely to get the diabetes tests they need. Lump sum funding gives family physicians the flexibility to spend more time with complex patients, collaborate with other professionals, and integrate email and phone calls into their practices."

In this study, the researchers examined data on 757,928 people with type 1 or type 2 diabetes. They were all aged 40 or older and made up of nearly 12 percent of the population residing in Ontario. The team examined the type of care that the diabetics received and found that 68 percent underwent one or more retinal eye exams. 78 percent had at least one HbA1C test, which is used to measure blood sugar control. Only 37 percent of diabetics had the recommended four or more HbA1C tests. 80 percent of the people had at least one cholesterol test whereas 59 percent had the recommended two cholesterol tests.

When the team examined why diabetics were not receiving the recommended tests for their health condition, they found that patients who were not enrolled with a family doctor were less likely to get all the recommended tests. Many of the family doctors in Ontario have switched over to the capitation models, which make access to care more complex.

"Capitation models require evening and weekend clinics, formally enroll patients, and have incentive payments to physicians for immunizations, cancer screening, smoking cessation and management of chronic diseases such as diabetes. The still-existing and traditional physician payment model pays doctors a fee for each service they provide and does not require evening and weekend clinics or include the additional step of formal enrolment," explained in the press release.

"Limited access to good primary care can lead to poor management of chronic diseases, fragmented care through walk-in clinics, and overburdened emergency departments," said Dr. Rick Glazier, a senior scientist at ICES and research director in the Department of Family and Community Medicine of St. Michael's Hospital.

The study was published in the Canadian Journal of Diabetes.

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