A new international survey of family doctors gives Canada poor marks, finding patients face longer waits than in nine other industrialized countries, and there is less co-ordination of care and use of electronic records.

The study, based on responses from primary-care physicians in 10 countries, shows Canada comes up short on the majority of measures, and also highlights the variation in care levels among provinces.

These latest findings come as the provinces and the federal government begin year-long discussions on a health accord that are expected to look at standards and system reform.

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Kathleen Morris, vice-president of research and analysis at the Canadian Institute for Health Information, which released the survey on Thursday, said this and other international rankings are important for identifying existing gaps and emerging challenges.

"Understanding where Canada fits in a broader system highlights the big opportunities for us to improve health care," Ms. Morris said. "It allows us to look for ideas beyond our borders."

The survey was conducted by the Commonwealth Fund, a private U.S. foundation, and compares responses of Canadian family doctors with those of their peers in the United States, Britain, Switzerland, Germany, the Netherlands, Norway, Sweden, Australia and New Zealand.

While it finds improvements in key measures from six years ago, when the last survey was conducted, Canada continues to rank below average on 19 out of 28 indicators.

Areas for concern include timely access to family doctors and waits to see specialists, as well as price barriers to prescription drugs and other out-of-pocket expenses.

The report also says Canadian family doctors had more difficulty co-ordinating care with specialists, hospitals and home-care providers – a key finding given the increasing emphasis the provinces and the federal government are placing on home and community care.

Almost one-quarter of Canadian family doctors said they wait more than two weeks for information when their patients are discharged from hospital – the highest percentage of any country. In Germany, 68 per cent of doctors said they usually got that information in less than two days.

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"If we see family doctors as a lynch pin of managing care in the community, they need to have that information," Ms. Morris said. "Canadian family physicians are struggling in a much bigger way to get the information they need to manage their patients."

The survey also found Canadian doctors were less likely to use electronic medical records than their peers in other countries, although the rate of use has doubled from six years ago and also is higher in B.C., Alberta and Saskatchewan.

The survey findings also include: