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Definitions

Outcomes
Health need
Predisposing characteristics
Enabling characteristics

Outcomes

Three outcome measures — consultation with a general practitioner (GP), multiple general practitioner consultations, and consultation with a specialist — were examined. 

To determine consultation with a GP, respondents to the Canadian Community Health Survey (CCHS) were asked, “Not counting when you were an overnight patient in the hospital, in the past 12 months, how many times have you seen or talked on the telephone with a family doctor or general practitioner about your physical, emotional or mental health?”  Respondents who had contacted a GP at least once were classified as having consulted a general practitioner in the previous year.  This definition includes telephone consultations as well as face-to-face visits, but less than 2% of respondents reported a telephone consultation.

A derived variable was constructed to measure the number of GP consultations.  The average number of GP consultations in the previous year was three; frequent use was defined as four or more consultations.

To measure consultation with a specialist, respondents were asked, “Not counting overnight hospital stays in the past 12 months, how many times have you seen or talked on the telephone with other medical doctors (such as a surgeon, allergist, gynecologist, or psychiatrist) about your physical, emotional or mental health.”  Respondents who had contacted a specialist at least once were classified as having consulted a specialist in the previous year.

Health need

Number of chronic conditions is an indicator of need.  Respondents were asked if they had “long-term conditions that had lasted or were expected to last six months or more and that had been diagnosed by a health professional.”  The interviewer read a list of conditions; those included in this analysis were coronary heart disease, diabetes, high blood pressure, stroke, cancer, arthritis, stomach ulcer, asthma and emphysema. 

Self-perceived general health was assessed with the question, “In general, would you say your health is:  excellent, very good, good, fair or poor?”

Self-perceived mental health was assessed with the question, “In general, would you say your mental health is: excellent, very good, good, fair or poor?”

Predisposing characteristics

Separate analyses were conducted for the 18-to-64 age group and for seniors (65 or older).  Five age groups were established in each category:  18 to 24, 25 to 34, 35 to 44, 45 to 54 and 55 to 64; and 65 to 69, 70 to 74, 75 to 79, 80 to 84, and 85 or older. 

To determine racial/cultural group, the CCHS interviewer read the following statement:  “People living in Canada come from many different cultural and racial backgrounds,” and then asked if the respondent was White, Black, South Asian (for example, East Indian, Pakistani, Sri Lankan), Southeast Asian (for example, Cambodian, Indonesian, Laotian, Vietnamese), Filipino, Latin American, Arab, West Asian (for example, Afghan, Iranian), Japanese, Korean, Aboriginal, or other.  For this analysis, racial/cultural group was classified into four categories:  White, Black, Aboriginal, and all other visible minority groups. 

Enabling characteristics

Respondents were asked, “In what languages can you conduct a conversation?”  For this analysis, language was classified into two groups:  English or French (if they were among the languages in which the respondent could comfortably converse) and other (if English or French was not among those languages). 

Level of education, based on the highest level attained, was classified into four groups:  less than secondary graduation, secondary graduation, some postsecondary, and postsecondary graduation.

Household income was derived by calculating the ratio between the total income of the respondent’s household in the past 12 months and the 2004 low income cutoff (LICO) corresponding to the number of people in the household and the size of the community.  The low income cutoff is the threshold at which a household would typically spend a larger portion of its income than the average household on food, shelter and clothing.  The ratios were sorted from smallest to largest, and adjusted ratios were calculated by dividing the original ratios by a factor of 10 to convert them into ratios less than or equal to one.  The ratios were grouped in deciles across Canada (10 intervals, each with approximately the same number of respondents). The deciles were generated using weighted data.  These deciles were then grouped into five household income categories:  lowest, lower-middle, middle, upper-middle, and highest, plus a missing category.

In the CCHS, urban or rural residence is a derived variable and is based on census geography.  Urban areas are continuously built-up areas having a population concentration of 1,000 or more and a population density of 400 or more per square kilometre, based on current census population counts.  All other areas are considered to be rural, and include about 5% of postal codes where information about urban status is missing.

Having a regular family doctor was determined with the question, “Do you have a regular family doctor?”

 


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