Biomedical subjects

Diane E Watson

Publications and source records attributed to Diane E Watson.

6 recordsLinked to original sources

PubMed2005

Use of physician services by older adults: 1991/1992 to 2000/2001.

Canadians have expressed concern that access to family physicians (FP) has declined. Anonymized physician services data for 1991/1992 to 2000/2001 were used to evaluate changes in supply and age-specific rates of use of FPs and specialists in Winnipeg, Manitoba. Physician-to-population ratios declined 7.5 per cent, FP-to-population ratios declined 4.8 per cent, and specialist-to-population ratios declined 10.0 per cent. Among the general population, FP visit rates declined 3 per cent. Among older adults, physician visit rates increased 2.3 per cent, FP visit rates increased 10.9 per cent, and specialist visit rates declined 15.7 per cent. By comparison, we document declines in FP use by those younger than 5 years (25.5%) and those 6 to 19 years of age (18.6%). Increases in FP and declines in specialist use occurred primarily among those aged 65 to 84 years. By 2000/2001 older adults accounted for 25 per cent of all FP encounters. Gains in FP use among older adults was less attributable to the presence of more seniors and more related to the fact that a higher proportion of them are visiting a FP each year and, potentially, substituting primary for secondary care.

Aged↗

PubMed2005

Growing old together: the influence of population and workforce aging on supply and use of family physicians.

Canadians have expressed concern that access to a family physician (FP) has declined precipitously. Yet FP-topopulation ratios remained relatively stable over the last decade, and there were perceptions of physician surpluses, at least in urban centres, 10 years ago. We evaluated whether demographic changes among patients and FPs, and in the volume of care received and provided over the period, contribute to this paradox. Given the relationship between age and FP use in fiscal year 1991/1992, an aging population should have been associated with a 2 per cent increase in visits by 2000/2001. Likewise, given the relationship between FP age and workloads in 1991/1992, an aging workforce should have been associated with a 12 per cent increase in service provision a decade later. Yet visit rates and average FP workloads remained unchanged. There was an increase in age-specific rates of FP use among older adults and a decline in rates among the young, and an increase in age-specific workloads such that older FPs provided many more services than their predecessors (30%) and younger FPs provided many fewer (20%). In terms of impact on future requirements for FPs, both changes in age-specific rates of use, and changes in age-specific patterns of FP productivity, trump population aging as key drivers.

Age Distribution↗

PubMed2005

Population-based use of mental health services and patterns of delivery among family physicians, 1992 to 2001.

OBJECTIVE: To examine 9-year rates of family physician (FP) and psychiatrist use, as well as patterns of mental health services delivery by FPs. METHOD: We used population-based data from Winnipeg, Manitoba, to construct mutually exclusive cohorts of adults treated for major or minor mental health disorders in fiscal years 1992-1993 to 2000-2001. For each year, we measured patterns of use in this population and patterns of mental health practice among FPs. RESULTS: The treatment prevalence rate was 224 per 1000 in 2000-2001 and 174 per 1000 in 1992-1993, and the rates for major and minor mental health disorders increased over the 9-year period by 15% and 31%, respectively. In 2000-2001, 92% of adults treated for mental illness saw at least one FP, and 45% saw an FP but no psychiatrist. Adults with major or minor mental health disorders visited an FP on average 9.1 and 6.9 times yearly, respectively, and FP visit rates remained relatively stable. There was a gradient in use by socioeconomic status: adults from communities with lower socioeconomic status had the highest rates of use. By 2000-2001, 24% of FPs billed for services related to psychosocial conditions as often as they did for the most frequent conditions seen in primary care. CONCLUSION: Between 1992-1993 and 2000-2001, the study population's patterns of FP and psychiatrist use remained relatively stable. In more recent years, FPs provided more mental health services than in previous years; this related to increased treatment prevalence rather than to increases in use per adult. FPs played a major role in the provision of mental health care.

Adult↗

PubMed2004

Family physician workloads and access to care in Winnipeg: 1991 to 2001.

BACKGROUND: Current perceptions of family physician (FP) shortages in Canada have prompted policies to expand medical schools. Our objective was to assess how FP supply, workloads and access to care have changed over the past decade. METHODS: We used an anonymized physician and population registry and administrative health service data from Winnipeg for the period 1991/92 to 2000/01. We calculated the following measures of supply and workload: ratios of FPs to population, of population to FPs and of FP full-time equivalents (FTEs) to population, as well as FP activity ratios (sum of FTEs/number of FPs), annual number of visits per FP and visits per FP per full-time day of work. Trends in FP remuneration were analyzed by age and sex. We also measured standardized visit rates and stratified the analysis by populations deemed at risk of needing FP services. RESULTS: In 2000/01 FPs between 30 and 49 years of age (64% of the workforce) provided 20% fewer visits per year than their same-age peers did 10 years previously. Conversely, FPs 60 to 69 years of age (11% of the workforce) provided 33% more visits per year than the corresponding group a decade earlier. On a per capita basis, the number of FPs declined by 5%, from 97 per 100 000 population in 1991/92 to 92 per 100 000 population in 2000/01, which paralleled changes in national estimates of FP supply. Per capita visit rates among Winnipeg citizens (3.5 per year in 2000/01) and average workloads among FPs (4193 visits per year in 2000/01) were stable over the decade. INTERPRETATION: Despite relative homeostasis in aggregate FP supply and use, there have been substantial temporal shifts in the volume of services provided by FPs of different age groups. Younger FPs are providing many fewer visits and older FPs are providing many more visits than their same-age predecessors did 10 years ago, a finding that was independent of physician sex. Given these data, the perpetual focus of policy-makers and care providers on increasing numbers of FPs will not help in diagnosing or treating issues of supply, workloads and access to care.

Adult↗

PubMed2004

Effectiveness of occupational therapy following organ transplantation.

BACKGROUND: Individuals who receive a solid organ transplant have pre-operative and post-operative impairments in physical function. PURPOSE: This pilot study evaluated the changes in physical function of 23 individuals with an organ transplant who received 2 or more hours of occupational therapy while inpatients in an acute care facility. These individuals also received physiotherapy treatment that was retrospectively quantified. Post-operative function was evaluated at assessment and discharge from occupational therapy with the Functional Independence Measure (FIM). RESULTS: Significant improvements in FIM scores (mean change +22) were noted at discharge from occupational therapy and there was a positive correlation between attendances or minutes of occupational therapy and study participants' changes in function. Occupational therapy attendances or minutes were also negatively correlated with study participants' initial functional status, which suggests that individuals with lower function received more occupational therapy. PRACTICE IMPLICATIONS: Notwithstanding the benefit of physiotherapy, and the methodological limits of an uncontrolled pre-test/post-test design, this study provides novel, preliminary evidence for the benefit of occupational therapy during the acute care stay of individuals with a solid organ transplant.

Activities of Daily Living↗

PubMedDate not supplied

Intergenerational differences in workloads among primary care physicians: a ten-year, population-based study.

Analyses of population-based services and surveys in Canada from the early 1990s and early 2000s indicate that younger and middle-aged family physicians carried smaller workloads in 2003 than their same-age peers did ten years earlier and that older family physicians carried larger workloads in 2003 than their same-age peers did ten years earlier. Yet family physicians in all age groups worked similar numbers of hours in 2003. Intergenerational effects are similar for male and female physicians, although feminization of the workforce will affect supply, as a result of the falling service volumes delivered by women.

Adult↗