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Primary Care Reform
What it is and how it will help Canada's healthcare
system
Primary care reform has been in the news a lot lately. The Kirby and Romanow Commissions, as well as consulting documents and provincial commissions, have examined health care and found it wanting. All have recommended primary care reform as a way to improve the health care system.
Primary care is the first, non-emergency level of health care most people receive. Reforms will help us use the expertise, knowledge and resources of our health care system efficiently while providing more effective health care to Canadians. Primary care can be defined in many ways. It ranges from the first contact one has with medical care to a broad and inclusive definition involving all the determinants of health. Determinants of health include quality of air and water, good government, access to health and social services, our education, income, gender, employment and genetic background.
Key parts of primary health care reform
The general agreement across Canada for the renewal of primary care involves the following:
More people need ready access to primary health care. Group practices should involve a broad range of doctors and health care providers from other disciplines, including nurses, dietitians, and social workers. Such multi-disciplinary practices would provide more services and manage care for more people.
Co-ordinated 24/7 access to appropriate health care services is needed. Each group of primary care providers should provide care 24 hours a day, seven days a week. Those in need would look here first for help. Care might be given through a clinic, a phone call, a nurse-led advice line or all of these.
Increased emphasis should be placed on health promotion, disease and injury prevention, care of those with complex medical concerns and of patients with chronic disease. Many clinics have developed programs to support this emphasis, with other health care providers working with the doctor.
Co-ordination and integration with other health care services should improve. Primary care clinics need to be connected to the rest of the health care system, including secondary care (specialists or care in larger hospitals), tertiary care (highly specialized diagnosis and treatment) and long-term care. Those needing services not provided by a primary care setting would have rapid access to the next level of care, along with quick transfer of their health information.
Multi-disciplinary teams should provide full primary health care. Clinics would try to provide as many services as possible at the primary care level. Many different methods can be used to bring close and convenient ‘one-stop shopping’ care.
Greater use can be made of electronic medical records. Most provinces are developing an electronic health record that provides a centralized record of everyone’s diagnoses, medications, test results, and list of contacts with the medical system.
These directions mean that you should be seeing changes at your local family doctor’s office or community clinic.
The team of care providers
The first change you are likely to see involves other health care professionals working with your family doctor. Such professionals might include nurses, dietitians, social workers, physiotherapists, pharmacists and others. They would work with your doctor to provide the support and service needed to manage your illness. Those with chronic disease are among the most likely to meet with alternative care providers. (Chronic diseases include diabetes, high cholesterol, heart disease or asthma.)
You might meet other care providers in the same office as your doctor, they might come to your home, or you could visit them at a central location. They will be more closely linked with your family doctor. They work in partnership, sharing information and ideas to help you manage your health concerns.
If you have a chronic disease, it is important that you monitor it. You can be helped during regular visits with the doctor, nurse, dietitian and others, and by phone calls, group classes and other supports.
Mental health services are now available in a variety of ways through your family doctor. Psychologists and social workers may work directly in the office. They sometimes accept referrals quickly. At other times, they might help by finding the best place for you to go with your particular concern. You may see them directly or find they have helped by advising your family doctor.
Pharmacists are also more involved with patient care, especially for those who take many different medications. As the number of medications increases, you have a higher risk of side effects, medication reactions and errors. Pharmacists can help by providing counselling when possible and by providing aids such as pills packed in daily bubble packs.
Electronic medical records
Electronic medical records (EMRs) are now being kept. If your doctor uses EMRs, you will see video terminals in the exam rooms.
Most electronic medical record systems stand alone, with no connection to the rest of the health system. However, over the next few years, connections between individual systems will be made. Some EMRs now receive lab results that are placed directly into your medical record. Some can receive x-ray reports. Some connect to the health region or hospital to share information, usually through a hub that links to the electronic health record. Privacy and confidentiality require very strict rules. You will probably be asked to sign papers allowing the transfer of your information.
Other changes
Over time, more out-of-hours services will develop in a variety of arrangements.
You will always be expected to call your family doctor clinic first for advice
and help. You will find more variety in the ways that you can get your needs
met. Prescription renewals will usually be done through periodic visits. Many
situations may permit automatic prescription renewals with the pharmacy, along
with regular phone calls to check on your condition.
Stronger connections between your family doctor and the health region are
being developed. More services from the health region will become available
through your family doctor. Co-ordination between your family doctor and community
services will ensure you get what you need when you need it.
All of these changes are now underway. Each province has started a program helping family doctors and health regions improve service for you.
FAMILY HEALTH is written with the assistance of |
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FAMILY HEALTH is written with the assistance of |
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