Background: The overall quality of care has been defined in terms of a set of seven core attributes taken from contemporary conceptual frameworks for assessing primary healthcare systems. Attributes are assessed using sub-attribute questions picked from previously developed and validated national level survey instruments. Data has been collected through structured questionnaire survey utilizing Likert items and scale to capture respondents’ perceptions of care. Both descriptive and nonparametric statistical methods have been used for data analysis. Information on demographic factors helped to understand the response patterns across different cohort groups. Key objectives: 1) To determine the perception of patients and physicians regarding the overall quality of care and its constituent elements delivered through the primary healthcare clinics in Winnipeg. 2) To compare the perceptions about different quality of care attributes as expressed by participating patients and physicians. Results: Both patients and physicians have positive views about the overall quality of care (median score >=4 on a 1-6 scale). Regarding individual attributes, “Interpersonal communication” and “Respectfulness” received the highest average score (5) and long-term health management received the lowest score (2). Patient and physician responses were found to be statistically different for access, comprehensiveness and long-term health management. The long wait time for seeing a doctor appeared to be a widely shared concern – only 43% of the patients urgently needing to see a doctor could get a same-day appointment; for non-urgent cases, less than 3% got a same-day appointment. Patients with higher educational levels appeared to be more critical about the quality of care; conversely, patients in good health rated the quality of care attributes more favourably. Conclusion: Patients and physicians are generally satisfied with the overall quality of care. However, patients have identified issues related to access, comprehensiveness of care and long-term health management. Patients concerns were found to be consistent with national level results. Long wait time was also flagged as a key concern. Primary healthcare clinics should proactively seek patient feedback to identify issues and improve their quality of service.

Aim To determine the impact on clinical outcomes of specialist diabetes clinics compared with routine primary care clinics. Methods Observational study measuring clinical performance (process/outcome measures) in the primary care sector. A cohort of patients attending specialist diabetes clinics was compared with a control cohort of patients attending routine primary care clinics. Results Patients seen in specialist diabetes clinics had a significantly higher HbA1c than patients in routine primary care clinics (mean difference 0.58%; P < 0.001) but there was no significant difference in rate of improvement with visits compared with primary care clinics. In contrast, patients seen in the routine primary care clinics had significantly higher cholesterol levels (mean difference 0.24 mmol/l; P < 0.001) compared with patients in specialist diabetes clinics and their improvement was significantly greater over time (mean difference 0.14 mmol/l per visit compared with 0.10 mmol/l; P < 0.006). Patients in routine primary care clinics also had significantly higher diastolic blood pressure (mean difference 1.6 mmHg; P < 0.007) but there was no difference in improvement with time compared with specialist diabetes clinics. Uptake of podiatry and retinal screening was significantly lower in patients attending routine primary care clinics, but this difference disappeared with time, with significant increases in uptake in the primary care clinic group. Weight increased in both groups significantly with time, but more so in the specialist clinic patients (mean increase 0.18 kg per visit more compared with routine clinic primary care patients; P < 0.001). Conclusions This study provides evidence that the provision of primary care services for patients with diabetes, whether traditional general practitioner clinics or diabetes clinics run by general practitioners with special interests, is effective in reducing HbA1c, cholesterol and blood pressure. However, the same provision of care was unable to prevent increasing weight or creatinine over time. No evidence was found that patients in specialist clinics do better than patients in routine primary care clinics.

I performed a secondary analysis of existing data and determined that when interacting with physicians during primary care visits for chronic illness treatment, patients using opioids are less likely to continue presenting concerns designed to reinforce their social and emotional uniqueness during the second half of primary care visits when physicians provide empathic support of their concerns in the first half of visits.