• Baiju R Shah, Morgan Slater, Eliot Frymire, Kristen Jacklin, Roseanne Sutherland, Shahriar Khan, Jennifer D Walker, and Michael E Green.
• ICES (Shah, Slater, Frymire, Khan, Walker, Green); Division of Endocrinology (Shah), Sunnybrook Health Sciences Centre; Department of Medicine (Shah), University of Toronto, Toronto, Ont.; Health Services and Policy Research Institute (Frymire, Khan, Green) and Department of Family Medicine (Slater, Green), Queen's University, Kingston, Ont.; Memory Keepers Medical Discovery Team (Jacklin), Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, Minn.; Chiefs of Ontario (Sutherland), Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; Department of Family Medicine (Green), Kingston Health Sciences Centre, Kingston, Ont. baiju.shah@ices.on.ca.
• CMAJ Open. 2020 Apr 1; 8 (2): E313-E318.

BackgroundFirst Nations people in Ontario have an increased prevalence of diabetes compared to other people in the province. This study examined use of health care services by First Nations people with diabetes and other people with diabetes in Ontario.MethodsUsing linked health administrative databases, we identified all people in Ontario with diabetes as of Apr. 1, 2014. We identified First Nations people using the Indian Register. We looked at outcomes from Apr. 1, 2014, to Mar. 31, 2015. We determined the proportion of people with a regular family physician and their continuity of care with that physician. We also examined visits with specialists for diabetes care, hospital admissions for ambulatory-care-sensitive conditions, and emergency department visits for hypo- or hyperglycemia.ResultsThere were 1 380 529 people diagnosed with diabetes in Ontario as of Apr. 1, 2014, of whom 22 952 (1.7%) were First Nations people. First Nations people were less likely to have a regular family physician (85.3% v. 97.7%) and had lower continuity of care with that physician (mean score for continuity of care 74.6 v. 77.7) than other people in Ontario. They were also less likely to see specialists. First Nations people were more likely to be admitted to hospital for ambulatory-care-sensitive conditions (2.4% v. 1.2%) and to have an emergency department visit for hypo- or hyperglycemia (1.5% v. 0.8%). Disparities were particularly marked for those living in First Nations communities.InterpretationFirst Nations people with diabetes in Ontario had poorer access to and use of primary care than other people with diabetes in the province. These findings may help explain continued disparities in the rates of complications related to diabetes.Copyright 2020, Joule Inc. or its licensors.

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