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Why Interdisciplinary Health Care Teams Are Better for Canadians and the Health System

Mar 13, 2014
Thy Dinh
Senior Research Associate
Canadian Alliance for Sustainable Health Care

No one can whistle a symphony. It takes a whole orchestra to play it.—H.E. Luccock

A sustainable health care system includes efficient and accessible primary care.

Canadians should be able to access the health care system using an entry door that would lead them to receive the best health services they need, rapidly and cost effectively. Defining and organizing this gateway, or what is often called the "medical home" for Canadians, is central to the debate on the reforms needed to sustain Canada's health care system.

Although our primary health care system has made some significant changes over the past decade, there is still a lot of room for improvement. The enhancement of the primary health care system is included on the list of recommendations to improve the sustainability of the Canadian health care system. Primary health care is the part of the overall health care system that is linked to other specialized health care sectors, as well as community services, often providing a referring or coordinating function. It is where we most frequently receive health care services for most of our lives. Services include check-ups, physicals, diagnosis and treatment of health problems, disease prevention and management, and general health advice. The most common settings for Canadians' primary care services are family doctors' offices or community health centres.

Health care teams are an essential part of a strong and responsive primary health care system.

Interprofessional primary care (IPC) teams are groups of professionals from different disciplines who work and communicate together to care for a patient community within a primary care setting. Team members may include physicians, nurses, pharmacists, social workers, mental health counselors or psychiatrists, physiotherapists, midwives, and others. Other essential team members include administrative personnel and the patients themselves.

There are currently several different types of IPC team models across Canada. In fact, we counted at least 18 unique models under the following categories: community health centres, physician-led practices, nurse practitioner-led practices, and primary care networks. As expected, there are some similarities as well as stark differences across these models in terms of types and number of service providers on the team, who leads and manages the team, the types of services provided, the patient population cared for, and the governance structure and funding model. The level of success of teams can be explained by some of these differences.

In the third briefing from the Canadian Alliance for Sustainable Health Care's (CASHC) research series Improving Primary Health Care Through Collaboration, we found that there is health and economic evidence to support the use of IPC teams for the management of selected chronic conditions, including adult type 2 diabetes and depression. One example used in the analysis was case management and prevention of complications of diabetes and depression that involves three or more types of care and service providers, including a physician, nurse, pharmacist, and psychiatrist. These providers work as an interdisciplinary team to help patients prevent and control disease complications and symptoms that significantly impact health care costs and productivity. We estimated that full coverage of IPC teams for diabetes type 2 adult patients could have saved $262.7 million in direct health care costs and $393.8 million in indirect costs due to productivity losses in the economy in 2011. The benefits to treatment of depression are also significant. We estimated that full coverage of IPC teams, specifically case management, for depression patients could have increased the labour force by 52,000 full-time, fully functional person-years of employment in one year (see chart), resulting in an injection of almost $2.3 billion to the economy.

Image of a chart showing Improvements in Labour Force Participation Attributed to Better Depression Management with IPC Team

Considering that we looked at only two chronic conditions and that IPC teams are effective in managing several other health issues (such as heart disease and respiratory issues), we could be underestimating the true economic impact. Our findings provide a good case for scaling up the use of IPC teams to improve the health of Canadians.

Using better practices in IPC and increasing access to patients should be a priority

We know IPC teams are integral to a strong primary care system, which in turns contributes to a well-functioning health system, improved population health, and increased health equity. However, access to high-performing IPC teams is inconsistent across and within regions. Fewer than half of all Canadians with diabetes or depression have access to any type of IPC team (and among those who do have access, the quality of IPC care will vary).

The low uptake and effectiveness of IPC teams may be explained by several barriers related to factors such as:

  • how health care teams are governed;
  • who leads the team;
  • the organizational culture and whether it promotes or supports IPC;
  • funding models;
  • how and whether team members are educated and trained in IPC;
  • the opportunities and tools to facilitate communication and collaboration.

Recommendations for action

Using information from the literature, a survey of primary care stakeholders, and interviews with key people working in the system, as well as representatives from several health profession organizations, we developed nine recommendations for optimizing IPC teams in Canada. These recommendations were released in a final compendium report on March 10. We will be publishing a series of commentaries delving more deeply into each of the recommendations over the next few weeks, and we encourage all stakeholders to participate in the discussion.

Publications from our Improving Primary Health Care Through Collaboration series:

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