By: Jennifer Stranges

What good are Ontario's many health services if patients get lost in a maze of telephone numbers and waiting lists trying to access them? That was the dilemma the Toronto health region began tackling ten years ago, when it started introducing centralized intake services to act as a single point of entry for patients or doctors navigating Ontario's complex healthcare system. A patient could call one of several centralized access lines to find a service that meets their needs, such as programs for senior's supports, mental health and addictions, or diabetes services. Or, their family doctor can use it to refer them to that service.

Now a new study is exploring how well it works.

The study, published in Healthcare Policy, looked at how often family doctors are using central intake services and also whether family doctors were more likely to be aware of the program if they worked in an inter-professional team setting like a Family Health Team or Community Health Centre.

The study, which surveyed nearly 250 primary care physicians in Toronto, found that most family doctors are not aware of the centralized intake services available in the city. This creates a barrier between patients and the help they need. We spoke with Dr. Tara Kiran, family physician at St. Michael's Hospital Academic Family Health Team of Unity Health Toronto and lead author of the study, about how the findings could improve in the system.

What were some the study's key findings?

We found that most family doctors were not aware of the centralized intake services available in Toronto, particularly those targeted to support patients with mental health and addictions. But doctors did know about some of the specific services available.

Importantly, we found that awareness of community support services was more than twice as high among family doctors practicing in team-based models.

What is the significance of family physicians lacking an awareness of centralized intake services?

Family doctors play an important role in care coordination – ensuring that their patients are able to access the services they need and supporting their patients to navigate through what is at times a complicated and confusing system. But family doctors can only do this role well if they are aware of the supports and services that are available to patients in their community and how to access them.

As a family doctor, I can say first-hand that staying on top of that information can be pretty tricky as there are so many services out there, each has unique criteria, the information is always changing and there isn't one place where you can easily find the information you need quickly. I'm lucky to work in a team-setting myself and often rely on our social worker to help the patient and I figure out what service we should access.

What do the findings reflect about the health care system currently?

First, our findings show that current efforts to make it easier for family doctors to refer their patients to community support services are not working. We need new strategies to make it easier for patients and family doctors to navigate a complex system. Ideas include integrating service directories into the electronic medical record and directly advertising services to patients and enabling patient self-referral.

Second, our findings suggest that patients who are not part of team-based models are doubly disadvantaged. Not only do they not have direct access to a social worker or other member of the extended healthcare team, but their physicians are less likely to know about available community services. Government has halted expansion of team-based primary care models and many regions have tried to address inequities in access to teams by introducing community supports that are available to all patients, regardless of whether they attend a team-based practice. But our study suggests that approach will not level the playing field and instead can exacerbate inequities because patients of teams are more likely to have providers who know about the services.

How can the findings influence improvements in the system?

Our findings have important implications for Ontario Health Teams (OHTs). These new teams are supposed to help patients seamlessly navigate through the healthcare system. But for that to happen, OHTs will need to work closely with family physicians and patients to design solutions that work – so that providers and patients know what services are available and how to access them.