LYNDHURST, B.C. — For a woman who may have just given birth, or who has had an incontinence attack, the first step to getting a diagnosis and treatment is to seek out her gynecological doctor.
A good doctor will tell you if she has symptoms of an infection or can be helped with treatments.
She will also help you make the diagnosis and make recommendations for treatment.
But what happens when a woman doesn’t get that care, or if her doctor has other concerns?
What happens when she’s in hospital for treatment?
A new study in the journal Obstetrics and Gynecology suggests there is a link between how many patients receive primary care and how many end up in a hospital.
“What we find is that when you get primary care from a primary care provider, the number of patients in hospital increases by 10 to 15 per cent,” said Dr. Michael Siegel, one of the study’s co-authors and an obstetrics specialist at the University of Victoria in British Columbia.
“It’s a pretty significant finding.”
When the researchers compared primary care patients with those who had no primary care, they found that primary care providers were more likely to see women with high risk factors.
“They were the most likely to have symptoms of a UTI or infection, particularly for women who had already had an episiotomy, had had an oral hysterectomy, or had had a vaginal birth,” said Siegel.
“They were also the most commonly seen in a waiting room and were more often seen at emergency departments and primary care.”
For the study, Siegel and his colleagues reviewed data from 1,096 patients admitted to hospital for primary care care during the 2015-2016 academic year.
They looked at outcomes such as discharge and length of stay in hospital, as well as hospital-acquired infections and other serious complications.
The patients who had primary care access had a 2.3 per cent lower rate of UTI than the general population.
When the researchers looked at the characteristics of the patients, including their age, gender, race, and marital status, they also found that the more women in the study had primary health care, the lower their rate of an UTI was.
“We don’t know why that’s the case, but it’s a significant finding,” said co-author Dr. Peter Lohmann, a professor in obstetric surgery at the London School of Hygiene and Tropical Medicine.
“We don?t have an explanation yet, but that’s what we thought.”
The study also found there was a positive relationship between primary care rates and patient length of hospital stay.
For example, patients with primary care were 2.5 per cent more likely than patients without primary care to be discharged within 72 hours of discharge, while patients with more than three visits a day were 2 per cent less likely to be admitted to the hospital with an episioplasty, compared with patients without more than one visit a day.
“There’s this connection between primary health and the length of time patients stay in the hospital,” said Lohman.
“So that might be an explanation for some of the results we’re seeing.”
The findings were supported by an analysis of patient records from the Canadian Paediatric Society, which also found a positive correlation between primary and hospital access rates.
“If you can get access to primary care by having primary care or by having a good primary care doctor, you’re more likely that the odds are higher of getting an episiotic or other complication,” said study co-researcher Dr. Karen Sutter.
“But it’s not always easy to get access.”
Siegel believes the study also highlights the need to make primary care available to people in need of care.
“That’s an important point,” he said.
“If you’re not receiving primary care because you’re in the middle of an emergency, or are in hospital and you don’t have access to care, that’s going to be even more of a challenge for people.”
Siegel is planning to expand his study, which was based on data from the Ontario Health Insurance Plan, to more than 100,000 Ontario patients.
He also hopes to examine the impact of primary care on hospital discharge.
“I think the data is pretty compelling, but we have a long way to go before we have any idea what’s actually going on,” he explained.
The researchers hope to expand the study to other provinces.
“Ultimately, we would like to see a study done in other parts of the world to get a better picture of what’s going on in Canada,” said Professor Siegel about how to get the most benefit from primary care.
The findings of this study are published in the March edition of Obstetric Surgery.