BRIEF FROM THE COLLEGE OF
FAMILY PHYSICIANS OF CANADA
EXECUTIVE SUMMARY
The College of Family Physicians of Canada (CFPC) represents over
25,000 family physician members nationally. The College is the voice of family
medicine in Canada and advocates on behalf of its members to ensure high
quality in the delivery of care. Education is a key element of our mandate, and
the CFPC establishes standards for the training, certification and ongoing
education of family physicians; it is responsible for accrediting postgraduate
family medicine training in Canada’s 17 medical schools.
On behalf of our family physician members and their patients the
CFPC presents three recommendations to the House of Commons Standing Committee
on Finance’s deliberations leading to Budget 2012. Our recommendations focus on
timely access, chronic disease management, and value for money. Federal
leadership and investment in these recommendations is crucial in achieving an
overall reduction in health care spending.
1. Timely Access
Access to care is one of the most important issues for Canadians.
Recent studies have indicated that, compared to those in other developed
nations, Canadians today are less satisfied with their access to and quality of
care.[i] To improve access for patients, Canada needs
well-supported team-based care, the implementation of advanced scheduling
systems in family practice, and support for health information systems and
technology.
Recommendation 1: That the Government of Canada provide appropriate support and funding for
Patient’s Medical Homes - incorporating the goals and recommendations that will
define these practices:
· Health Human Resources - a personal family physician for each
patient; physicians and other health care professionals including nurses on
teams working with each family physician.
· Encourage advanced access booking systems, and strategies for
after-hours coverage that may enable physicians and practices to consider
increasing “panel size” (the number of patients that can be registered with
that practice).
· Provide support and governance systems for health information
systems and technology.
2. Chronic Disease Management
The cost of chronic diseases to Canadians is estimated to be $80
billion annually due to illnesses and disabilities.[ii] The mortality and morbidity of chronic disease places a significant burden on
the Canadian economy. Patients’ Medical Homes should be supported by the
federal government to ensure their key role in health promotion and prevention,
management and coordination of care for patients with chronic diseases.
Recommendation 2: That the Government Canada invests in ongoing
research related to chronic diseases including: studies of the incidence and
patterns of diseases, health system resource utilization (hospitalizations,
emergency visits, etc.), the effectiveness of different medical and health care
interventions and management approaches, individual and population health
outcomes, and cost-effectiveness.
It has been shown that patients with their own family physician as
a regular care provider have lower rates of hospitalization and better health
outcomes.[iii] Well-supported family
practices that function as a Patient’s Medical Home will have the opportunity
to possibly lead to lower costs and better health outcomes.
Recommendation 3: That the Federal government move to strengthen
and support primary care in Canada through: 1) sufficient physician and health
care provider resources, and 2) support the infrastructure and governance to
promote the Patient Medical Home model nationally.
INTRODUCTION: A healthy primary care system leads to a healthy society.[iv]
The sustainability of Canada’s health care system depends on
ensuring a strong foundation of primary care and family practice. In recent
years, there has been much discussion about the sustainability of the health
care system and the level of quality and service available to Canadians.
Access issues, the lack of institutional and community support for patients
with chronic health conditions, and changing demographics can lead to
inefficiencies and be costly. To address the issues of health care at the core
of health care delivery, systems for family physicians and patients must be
strengthened.
International research provides evidence of the correlation of
access to effective family practices with better population health outcomes.[v] A strong and high-performing primary healthcare system with an essential role
played by family physicians has the potential to deliver better health care for
the population as a whole and specific groups such as those with chronic
diseases.[vi] [vii]
To preserve a single-payer, publicly-funded Canadian health care
system, the health transfers in the current federal /provincial/territorial
Health Accord must be extended for at least a decade beyond 2014.
I. FEDERAL LEADERSHIP IN HEALTH CARE- SUPPORT FOR THE PATIENT’S MEDICAL HOME, A NEW MODEL FOR DELIVERY OF CARE
We invite the federal government to consider the advantages of
implementing a new and effective family practice model, and to ensuring that
resources are available to those who are working toward improving the delivery
of care. We value and acknowledge the role of family doctors can play in
improving and their practices, and recognize that federal leadership is
essential to system changes.
The Patient’s Medical Home (PMH) is a conceptual framework for
primary health care and one that the CFPC sees as the way of the future. We
present it to the people of Canada as a vision and a plan - a vision of the
future of family practice - a plan for better patient-centred care and better
health outcomes.
The Patient’s Medical Home (PMH) proposes goals, each supported by
a series of recommendations, including:
· A PMH will be patient-centred.
· A PMH will ensure that every patient has a personal family physician,
who will be the most responsible provider (MRP) of his/her medical care.
· A PMH will offer its patients a broad scope of services carried
out by teams or networks of providers - including each patient’s personal
family physician working together with medical home team nurses and other
health care professionals.
· A PMH will ensure timely access to and coordination of both
appointments in the practice and referrals for other health and medical
services needed outside the practice.
· A PMH will provide its patients with a comprehensive scope of
family practice services that meet population and public health needs,
including those that address the importance of illness and injury prevention
and health promotion.
· A PMH will provide continuity of care throughout the lives of its
patients.
· A PMH will maintain electronic medical records (EMRs) for its
patients.
· Patients’ Medical Homes will serve as ideal sites for training
medical students, family medicine residents and those in other health
professions and for carrying out family practice and primary care research.
· A PMH will carry out ongoing evaluation of the effectiveness of
its services as part of its commitment to a Continuous Quality Improvement
(CQI) program.
· PMHs will be strongly supported by:
i. governance and management structures defined by each practice and
ii. governments and other key stakeholders throughout the health care system.
The PMH would build upon the successes of current practice
patterns; it is flexible and allows each practice to incorporate the best of
all experiences into their individual situations and jurisdictions.
To achieve their objectives, Patients’ Medical Homes will need the
support of governments across Canada through both leadership messaging and
support. This must include the assurance of resources for core practice
components such as electronic medical records and the establishment of the
legal and systemic framework for implementation. All stakeholders including
governments, the public, family physicians, other medical and health
professions and their organizations, should support and participate in
establishing and sustaining Patients’ Medical Homes across Canada.
II. RECOMMENDATIONS
1. Timely Access to Primary Care
Patients’ Medical Homes will offer a broad scope of services
carried out by teams or networks of providers. The mix of health care
professionals include each patient’s personal family physician working together
with nurses and other health professionals. A comprehensive set of health
professional services is available to the patient.
Health Human Resources: Access to primary care/family
practice teams have been shown to reduce emergency room use,[viii] improve access to care, offer more preventive services, and enhance patient
satisfaction.[ix] As has been shown by Starfield
and others, a relationship built and strengthened over time between patients
and their personal physicians contributes significantly to better health
outcomes.[x] These benefits
could potentially be further strengthened through team-based care where relationships
are established between patients and other members of the health care team.
To realize these benefits, sufficient health human resources are
needed to meet patient needs and improve national health outcomes. Health human
resource strategies must not only be provincially focused - we need a
pan-Canadian plan that assesses the health needs of the population in each and
every community and ensures that we have enough doctors, nurses and other
health providers to meet our population’s constantly changing needs.
Information Infrastructure: Timely access to care and
medical information can be achieved through optimal use of communications tools
including, email, telephone, and websites. As appropriate supports (including
resolution of privacy liability and remuneration issues) are introduced,
patient interactions with their physicians and other health professionals will
be increasingly carried out through a range of communication options. Haggerty
et al. found that being available to patients by telephone helped to improve
accessibility and continuity.[xi]
Advanced Access: Same-day scheduling, (also known as open or
advanced access scheduling) has emerged as a strategy that many practices have
introduced to improve timely access to primary care. It is one of the features
of the PMH and has been shown to enhance access for patients and to help
physicians and teams become more organized and satisfied with their practices.
Wait Times: The Wait Time Alliance’s 2011 Report Card and
Ontario Auditor General’s 2010 Report both found that the most significant
cause of wait times are the high numbers of hospital patients waiting for
alternative levels of care such as rehabilitative or long-term care. Patients
would receive more appropriate and cost-effective care outside of the hospital.
The Patient’s Medical Home can become the hub or centre that
coordinates the medical care services received by their patients throughout the
“medical community”. The physicians and other health care providers in a
Patient’s Medical Home team can go out into the community and provide care as
needed. These settings may include the family practice office/clinic, patient’s
residence, hospitals, long-term care and other community-based institutions.
Recommendation: That the Government of Canada provide appropriate
support and funding for Patients’ Medical Homes - incorporating the goals and
recommendations that will define these practices:
· Health Human
Resources - a personal family physician for each patient; physicians and other
health care professionals including nurses on teams working with each family
physician.
· Encourage advanced
access booking systems, and strategies for after-hours coverage that may enable
physicians and practices to consider increasing “panel size” (the number of
patients that can be registered with that
practice).
· Provide support and governance systems for health information systems
and technology.
2. Chronic Disease Management
As reported by the World Health Organization (WHO), the leading
causes of death in Canada are often related to chronic illnesses.[xii] The cost of chronic diseases to Canadians is estimated to be $80 billion
annually due to illnesses and disabilities and is increasing.[xiii] The mortality and morbidity of chronic disease places a significant burden to
Canadian economy. The 2010 National Physician Survey (NPS), Canada’s largest
census survey of physicians and physicians-in-training, showed nearly
three-quarters (72%) of respondents reported that the complexity of their
patient caseload is placing increasing demands on their time. Two-thirds (63%)
of respondents said that managing patients with chronic diseases was a factor.
There is evidence that primary care can reduce the burden of
illness for those with chronic disease. In Canada, the work of Hollander et al.
showed more cost-effective care and better outcomes for patients with chronic
diseases who have the benefit of continuing care from a personal family
physician.[xiv] Research has
shown that a population, regardless of socio-economic status, is healthier when
it has access to comprehensive health care services; a more comprehensive
"basket of services" can lead to better health outcomes for all,
including vulnerable populations.[xv] Not only does a wider
range of services provided by primary care practitioners result in better
health outcomes, it does so at lower costs.[xvi]
Family practices in the Patient’s Medical Home model can identify
and provide needed services not only to individuals, but to the populations and
communities they serve. Preventive care, health promotion, chronic disease
management, the delivery of public health information and services are
components of the PMH. Beal et al. found that, "When adults have a medical
home, their access to needed care, receipt of routine preventive screenings,
and management of chronic conditions improve substantially".[xvii]
Recommendation: That the Government Canada invest in ongoing
research related to chronic diseases including: studies of the incidence and
patterns of diseases, health system resource utilization (hospitalizations,
emergency visits, etc.), the effectiveness of different medical and health care
interventions and management approaches, individual and population health
outcomes, and cost-effectiveness.
3. Value for Money
Costly care, such as hospitalization, can often be prevented
through better utilization of public health practices, primary care services,
self-care models, disease prevention, and access to mental health services, and
by optimizing our investment in research and innovation.[xviii]
Well-supported family practices that function as Patients’ Medical
Homes will have the opportunity to be an investment that can lead to lower
costs and better health outcomes. Patients’ Medical Homes can lower costs to
the health care system by minimizing use of after-hours clinics and emergency
rooms. Starfield et al. also found that consistency of provider /continuity of
care has potential benefit for all patient populations, including those with
chronic diseases.[xix]
Recommendation: That the Federal government move to strengthen and
support primary care in Canada through: 1) sufficient physician and health care
provider resources, and 2) support the infrastructure and governance to promote
the Patient Medical Home model nationally.
CLOSING REMARKS
The Patient’s Medical Home envisions a Canadian health care system
that ranks among the world’s best. It is patient-centred and can lead to better
health outcomes. Patients’ Medical Homes can serve as central hubs allowing
access to and coordination of medical services needed by patients.
Focusing on these recommendations and providing solutions will
improve the health of Canadians, reduce burdens on the health care system,
advance quality of care, and help to create an efficient and effective system.