Chronic Disease Management

1

Chronic Disease Management
2
Percentage of adults newly diagnosed with
congestive heart failure (CHF) () in 2002/03,
who received an echocardiogram, or an
angiotensin-converting enzyme (ACE) inhibitor
prescription within one year of diagnosis
By Local Health Integration Network (LHIN) and
for Ontario
in those aged 20 years and older in
those aged 65 years and older
There was variation across LHINs in the
proportion of newly diagnosed CHF patients who
received an echocardiogram.  The lowest
proportions were seen in the North West (28) and
South West (29) LHINs, and the highest
proportions were experienced in the Central
East (46) and Central West (45) LHINs.
There was some LHIN variation in prescriptions
for ACE inhibitorslowest in the Champlain (68)
and South West (69) LHINs, and highest in the
Hamilton Niagara Haldimand Brant (76) and
Central West LHINs (76).
3
Number and percentage () of patients newly
hospitalized for congestive heart failure (CHF),
1997/982001/02
By Local Health Integration Network (LHIN) in
Ontario
Percentage of patients newly hospitalized for CHF
Number of patients newly hospitalized for CHF
There was considerable variation in the
distribution of CHF patients across LHINs. The
greatest proportion of the Ontario population
with CHF lived in the Hamilton Niagara Haldimand
Brant (14) and Central East (11) LHINs.
4
Distribution of physician type most responsible
for the care of newly hospitalized congestive
heart failure (CHF) patients, 1997/982001/02
By Local Health Integration Network (LHIN) and
for Ontario
All Ontario
GP/FP
7. Toronto Central
Cardiologist
8. Central
Internist
5. Central West
4. Hamilton Niagara Haldimand Brant
Other specialist
6. Mississauga Halton
9. Central East
GP/FP General practitioner/family physician
3. Waterloo Wellington
1. Erie St. Clair
10. South East
11. Champlain
2. South West
13. North East
14. North West
12. North Simcoe Muskoka
0 20 40
60 80
100
Distribution of physician type ()

• The type of physician most responsible for the
  care of patients newly diagnosed with CHF varied
  by LHIN.
• The highest proportions of CHF patients cared for
  by GP/FPs were found in the northern LHINsNorth
  Simcoe Muskoka (77), North West (74) and North
  East (69).

5
Percentage of newly hospitalized congestive heart
failure (CHF) patients () with a general
practitioner/family physician (GP/FP) as the
mostresponsible physician, who received a
specialist consultation, 1997/982001/02
By Local Health Integration Network (LHIN) in
Ontario
Average rate for Ontario 47

• Patients newly hospitalized for CHF with a GP/FP
  as their most responsible physician had the
  lowest specialist consultation rates in the
  Central (30), North East (30) and South West
  (34) LHINs.
• Although CHF patients cared for by a GP/FP in the
  Central LHIN had the lowest percentage of
  specialist consultations, only 7 of patients
  with CHF in the Central LHIN were primarily cared
  for by GP/FPs.

6
Percentage of adults aged 30 years and older
diagnosed with diabetes mellitus (DM) () as of
April 1, 2002, who received a routine eye
examination within two years, 2002/032003/04
By Local Health Integration Network (LHIN) and
for Ontario
There was some LHIN variation in the
proportion of people with diabetes mellitus (DM)
who received an eye examination, ranging from
68 in the Toronto Central LHIN to 78 in the
North East LHIN.
7
Percentage of adults aged 65 years and older
newly diagnosed with diabetes mellitus (DM) ()
as of April 1, 2002, who were prescribed
metformin as their first oral hypoglycemic
medication within one year of diagnosis, 2002/03
By Local Health Integration Network (LHIN) and
for Ontario
There were LHIN variations in metformin
prescriptions as the first oral hypoglycemic
agent for people newly diagnosed with DM,
ranging from 66 to 85 in the Central West and
North West LHINs, respectively.
8
Percentage of adults aged 65 years and older
diagnosed with diabetes mellitus (DM) () as of
April 1, 2002, who were prescribed an
angiotensin-converting enzyme (ACE) inhibitor,
an antihypertensive agent, a lipid-lowering
agent, or all three, 2002/03
By Local Health Integration Network (LHIN) and
for Ontario
Includes ACE inhibitors
There was little LHIN variation in adults over
65 years of age diagnosed with DM with respect to
receiving an antihypertensive agent, and very
slight variation in the proportion receiving an
ACE inhibitor. The proportion who received a
lipid-lowering agent as well as those who
received all three medications (antihypertensive
agent, ACE inhibitor and lipid-lowering agent)
did vary by LHIN.
9
Percentage of the total population () surveyed
aged 15 years and older, who self-reported
ambulatory mental health contact, 2001/02
By Sex, Age Group and Local Health Integration
Network (LHIN) in Ontario
Number of people
Percentage of total LHIN population
Ambulatory mental health care provider types
include physicians, social workers, counselors,
psychotherapists, nurses, psychologists and
other professionals. Interpret with
caution due to high sampling variability.
Weighted to represent the 2001 Ontario
population. NR Not reportable due to small
cell size.
Overall, seven percent of Ontarians reported
ambulatory mental health contacts in the previous
12 months. A greater proportion of women than
men reported contact with health professionals
for mental health care. Adults between the ages
of 20 and 64 years reported contact with health
professionals for mental health care more often
than younger or older Ontarians.
10
Percentage of the total population () surveyed
with major depression aged 15 years and older,
who self-reported ambulatory mental health
contact, 2001/02
By Sex, Age Group and Local Health Integration
Network (LHIN) in Ontario
Number of people
Percentage of total LHIN population
Ambulatory mental health care provider types
include physicians, social workers, counselors,
psychotherapists, nurses, psychologists and other
professionals. Interpret with
caution due to high sampling variability.
Weighted to represent the 2001 Ontario
population. NR Not reportable due to small
cell size.
Five percent of Ontarians were surveyed as
having major depression in the previous 12
months, although less than half of these people
reported contact with health professionals for
mental health care during that time.
11
Percentage of the total population () aged 15
years and older, who had ambulatory mental health
contact with physicians, using self-reported
data, 2001/02
By Sex, Age Group and Local Health Integration
Network (LHIN) in Ontario
Number of people
Percentage of total LHIN population
Interpret with caution due to high sampling
variability. Weighted to represent the
2001 Ontario population. NR Not reportable due
to small cell size.
The proportion of Ontarians who self-reported
making an ambulatory mental health contact to a
physician tended to be similar to the proportion
for recorded mental health contacts (calculated
based on the presence of an OHIP claim fee code
that contained a mental health procedure). The
only exception was among the elderly, suggesting
that elderly respondents may often not recall or
identify a mental health contact.
12
Percentage of the total population () aged 15
years and older, who had ambulatory mental
health contact with physicians, based on OHIP
definition 1, using administrative data, 2001/02
By Sex, Age Group and Local Health Integration
Network (LHIN) in Ontario
Number of people
Percentage of total LHIN population
OHIP definition 1 for mental health contact
Presence of an OHIP claim fee code that
contains a mental health procedure Weighted
to represent the 2001 Ontario population.
The proportion of Ontarians who self-reported
making an ambulatory mental health contact to a
physician tended to be similar to the proportion
for recorded mental health contacts (when OHIP
definition 1, OHIP claim fee codes that
contained a mental health procedure, was
used). The only exception was among the elderly,
suggesting that elderly respondents may often
not recall or identify a mental health contact.
13
Percentage of the total population () aged 15
years and older, who had ambulatory mental
health contact with physicians, based on OHIP
definition 2, using administrative data, 2001/02
By Sex, Age Group and Local Health Integration
Network (LHIN) in Ontario
Number of people
Percentage of total LHIN population

• OHIP definition 2 for mental health contact
  Presence of an OHIP claim fee code that contains
  a mental health procedure or a mental health
• diagnostic code.
• Weighted to represent the 2001 Ontario
  population.

When OHIP definition 2 was used, the
proportion of the population with a recorded
ambulatory mental health contact was much higher
than for self-reported contacts across all
categories of age, sex and LHINs.
14
Distribution of physician specialty types
contacted by those aged 15 years and older, with
recorded ambulatory mental health contacts,
2001/02
By Local Health Integration Network (LHIN) and
for Ontario
GP/FP only
All Ontario
Psychiatrist only
7. Toronto Central
GP/FP psychiatrist
8. Central
11. Champlain
4. Hamilton Niagara Haldimand Brant
GP/FP other physician specialty
3. Waterloo Wellington
All other combinations
6. Mississauga Halton
2. South West
These contacts were identified using OHIP
definition 2 An OHIP claim fee code that
contains a mental health procedure or a mental
health diagnostic code. Other physician
specialty only psychiatrist other physician
specialty or, GP/FP psychiatrist other
physician specialty. GP/FP General
practitioner/family physician
1. Erie St. Clair
9. Central East
5. Central West
10. South East
12. North Simcoe Muskoka
13. North East
14. North West
0 20 40
60 80
100
Percent distribution of physician specialty types
contacted ()

• The proportion of ambulatory mental health
  contacts recorded by physician specialty varied
  between LHINs, with the most obvious difference
  occurring between the northern LHINs and the
  Toronto Central LHIN. 
• These findings may be explained by a higher
  proportion of psychiatrists relative to GP/FPs in
  the Toronto Central LHIN compared to the northern
  LHINs, and/or variations in the underlying
  populations of these regions.