Some patients with chronic disease not getting proper care

Saskatchewan's medical licensing body may soon take action to make sure patients with chronic conditions and no regular doctor are getting proper care.

Walk-in clinics often not monitoring patients closely

Matthew Parsons uses an inhaler to control his asthma. He gets his prescription renewed at walk-in clinics because he hasn't found a regular doctor yet. (CBC)

Saskatchewan's medical licensing body may soon take action to make sure patients with chronic conditions and no regular doctor are getting proper care.

People with diabetes or depression, for example, may get their prescriptions refilled at a walk-in clinic. The problem is, none of those doctors may be making sure they're on the right medication or have the proper dosage.

Matthew Parsons knows from experience what can happen. "When you go into the doctor's, they're rushed," he said. Now in his early 30's, he has been treated for asthma since he was two years old.

Test long overdue

He hasn't been able to find a regular doctor since he arrived in Regina from Edmonton five years ago, so he goes to walk-in clinics. By his count, he's seen 30 different doctors so far.

"Someone finally about two years ago asked me when's the last time you actually had your pulmonary function test done?" Parsons said.  "And I kind of looked at him and went thirteen years probably, fourteen years.  And he said you should be doing that every two to five years."

He had the test.  The result showed he needed a change in his medication. "It seemed like a Godsend quite honestly 'cause I was waking up once a week probably in the middle of the night unable to breathe," he said.

Guidelines not being followed

Dr. George Carson worries about other patients -- with hypertension or depression for instance -- whose condition isn't well managed. He co-chairs the province's Practice Enhancement Program committee, which checks to make sure doctors are adhering to the guidelines for monitoring various chronic diseases.

He found that in walk-in clinics, it wasn't always happening. For example, diabetics should have their eyes checked periodically, along with kidney function, peripheral circulation, lipid or blood fat levels, and blood sugar levels. "Unfortunately we know that people with diabetes may become blind, they may develop kidney failure, they may have amputations because of essentially poor blood flow to limbs," Carson said.

He believes a doctor shortage only partly explains why some patients only go to  walk-in clinics.

 "There are patients who probably don't understand the importance of actually getting comprehensive continuing care," said Carson.  "So they go to see somebody on a regular basis.  They may think they're getting what they should.  We're pretty sure they're not ... Or they may know better and they simply don't put the effort into finding a family doctor."

Estimated 5,000 patients in Regina getting sub-standard care

He estimates 10 to 15 per cent of walk-in clinic patients have chronic diseases and aren't getting comprehensive care anywhere else -- about five-thousand people in Regina alone. Carson's committee is so concerned that it raised the matter with the College of Physicians and Surgeons.

"In this case, there was an absence of a standard as to what to expect for the patients who make recurrent visits to medicentres or walk-in centres and who aren't getting chronic disease management but have chronic diseases," Carson said.  "And that's why we sought direction from the College and the Saskatchewan Medical Association."

College of Physicians and Surgeons stepping in

At the College's latest council meeting, there was general agreement that walk-in clinic doctors who see repeat visitors with chronic conditions should provide comprehensive care. A policy is now being drafted, and could be finalized in the coming months.

As for what the doctors who are the target of the policy think of it, it's hard to say.  No one in the half dozen walk-in clinics approached were willing to talk about the issue, most because they were too busy, unwilling or simply didn't return calls.  The manager at one clinic said several of its doctors are taking new regular patients -- and so no one there has to go without proper care.