 | | Thy Dinh
Senior Research Associate, CASHC |
Canadian healthcare leaders agree that a sustainable health care system requires robust and well-functioning primary health care. This view was confirmed again at the Conference Board’s inaugural Summit on Sustainable Health and Health Care held October 30-31 in Toronto. So how is primary health care working in Canada?
Primary health care, your first and most common point of contact with the health care system, is changing. Various initiatives were implemented from 2000 to 2006 with the goal of “ensuring Canadians receive the most appropriate care, by the most appropriate providers, in the most appropriate settings.”1
These changes were supported by the Primary Health Care Transition Fund, an $800 million federal transfer to provinces and territories.
Many of the regional initiatives included the development and implementation of interprofessional primary care (IPC) teams. An IPC team is a group of professionals from different disciplines who work and communicate together in a formal arrangement to provide care for patients in a primary care setting (e.g. family doctors’ offices). These IPC teams involve the integration of non-physician health professionals from different disciplines, including nurses, pharmacists, dietitians or nutritionists, social workers, psychologists, physiotherapists, and physician assistants.
However, current access to teams is still surprisingly low, considering the amount of research supporting their use. The evidence shows that IPC teams improve health outcomes and access for patients with chronic and complex conditions through the development of individualized care plans, the provision of medical and social services and supports, and enhanced coordination of care. Only 38% of diabetic patients and 44% of patients with depression have access to an IPC team (see chart). All diabetes and depression patients should have access to interprofessional care, since IPC teams reduce the risk of diabetes complications including heart attack, stroke, leg amputations, and need for cataract surgery, and improve quality of life of patients with depression. Greater use of IPC teams can reduce disease complications, improve quality of life and generate significant cost savings for society.
We are now doing a series of briefings on improving primary health care through collaboration, under the Canadian Alliance for Sustainable Health Care, or CASHC. In the first two briefings, Current Knowledge About Interprofessional Teams in Canada, and Barriers to Successful Interprofessional Teams, we reviewed the different interprofessional primary care (IPC) team models in Canada, and the barriers to effective collaboration. Although the implementation of interprofessional teams has increased over the past decade, the extent and effectiveness of collaboration in primary care varies. And there are individual-, practice-, and systems-level barriers to effective collaboration. These include the lack of role clarity and trust within the team, inadequate payment models and incentives to improve and sustain collaborative practice, lack of interprofessional education and training for health professions, and sub-optimal monitoring and evaluation. So there is work to do to get the IPC team model right.
In the final two briefings, we will provide an estimate of the potential health and economic savings, specifically from increasing access to IPC teams for high risk patients with diabetes and depression. Ultimately, we intend to provide recommendations on how to move forward with IPC teams and ways to optimize their use.
Health care providers and health care system administrators are becoming more aware that meeting the health and social needs of the population for today and tomorrow requires changing the way we do things. This includes working and communicating together to provide the best care and information to patients so that they can live healthy and productive lives. In addition to better access to better care, patients want to be provided with the right information and tools to take care of themselves and their loved ones. IPC teams can do all these things if they are well-designed and made operational, and accessible to the people who need them the most.