Many innovative solutions are underway to
address some of the HHR challenges facing health care systems in Canada. This
chapter highlights the innovations occurring in health care delivery across the
country, focussing in particular on interprofessional collaborative practice
and health information technology. It also identifies ways in which the federal
government could further promote and sustain these changes.
It has long been acknowledged in Canada that
changing health care delivery models to include a broad range of health professionals
is a key strategy in addressing shortages in HHR, as well as improving
efficiency in health care delivery. Indeed, in the 2004 10-Year Plan to
Strengthen Health Care, First Ministers committed to 50% of Canadians having
access to multidisciplinary health care teams by 2011. Interprofessional Collaborative Practice (IPC) refers to the provision of
comprehensive health services to patients by multiple care givers who work
collaboratively to deliver quality care within and across sections. It recognizes that the skills required to meet health care needs do not reside
within one professional or even one profession. Closely linked to the full
realization of IPC, is the need to change the way health professionals are
educated so that they have the necessary knowledge and skills to work
effectively in interprofessional teams, which is referred to as
Interprofessional Education and Training.
The Committee learned that Health Canada had
invested in more than 32 interprofessional practice projects, as part of
its Pan-Canadian Health Human Resource Strategy. Health Canada officials told the Committee that these projects had focused on
increasing awareness and sharing of best practices related to collaborative
care; enabling the provision of mandatory interprofessional education courses
by educational institutions; and increasing both the number of educators who
are able to teach interprofessional practice and the number of health
professionals trained for collaborative practice.
The Committee also heard from other witnesses
that many innovative IPC models had been developed across the country as a
result of the funding received through the Health Reform Fund for Primary Care
as part of the 2003 Accord on Health Care Renewal ,
as well as funding received from Health Canada. For example, the Committee
learned about the Somerset West Community Health Centre (SWCHC) in downtown
Ottawa, an interprofessional collaborative practice that included the services
of doctors, nurse practitioners, dietitians, social workers, kinesiologists,
acupuncturists, chiropodists, social service workers, nurses, health promoters
and administrative support staff.
The Committee learned that the SWCHC was
governed by a community board of directors and reflected the population health
needs of its community, including its desire for the inclusion of traditional
Chinese medicine. Witnesses further indicated that the IPC model of practice at
the SWCHC had resulted in significant cost savings due to its effective use of
nurse practitioners.
The Committee heard that alternative health
professionals were also being successfully integrated into intercollaborative
practice across the country. For example, the Committee heard that naturopathic
doctors were contributing to providing innovative integrated care to cancer
patients at InspireHealth, one of four clinics in Vancouver currently
conducting research in the area of service delivery for cancer patients as part
of the Canadian Partnership Against Cancer. The
Committee also heard that chiropractors had been integrated at the Joe
Sylvester Anishnawbe Health Toronto clinic, an urban multidisciplinary clinic
that offers health care to urban Aboriginal populations. Alternative health professionals appearing before the Committee articulated
that their inclusion in the broad range of health care services offered in the
context of interprofessional collaborative health care teams served as a means
of easing some of the workload of mainstream physicians by providing
preventative medicine and complementary treatments for chronic conditions and
musculoskeletal disorders.
Despite the numerous examples of innovation
in health care delivery to incorporate different health professionals, the
Committee heard that there had not been widespread change in health care
delivery across the country. According to witnesses, funding mechanisms such as
the Health Reform Fund for Primary Care had provided a mechanism to promote
innovative pilot projects, but it was not sufficient to create sustainable
change across the country. They
called for the Health Reform Fund to be extended into the next iteration of the
Canada Health Transfer due in 2014 in order to promote sustained change in IPC
across the country. Other witnesses pointed to systemic barriers to establishing IPC, including
provincial legislation governing the scope of practice of professionals, a lack
of interprofessional education and training opportunities, payment schemes for health
care providers, and liability issues.
While witnesses recognized that these
systemic barriers remained under provincial jurisdiction, they articulated that
the federal government could address systemic barriers to IPC within its own
jurisdiction both in the context of federal client groups and the federal
public service. For example, the federal government could address barriers to
IPC within the Public Service Heath Care Plan, such as the requirement that
physician prescriptions are necessary to access non-physician health care
services such as physiotherapy. The
Committee also heard that the federal government could include treatments and
care offered by alternative health professionals such as chiropractors and
naturopathic physicians as part of the services and benefits that it offers to
federal client groups.
The Committee fully respects that many of the
issues related to the implementation of inter-professional collaborative
practice fall under provincial jurisdiction. However, the Committee also recognizes
that the federal government could examine ways to eliminate barriers to
collaborative practice within its own jurisdiction, including federal client groups
and the health benefits provided to its employees through the Federal Public
Service Health Care Plan. The Committee also supports witnesses in their view that
sustained funding mechanisms need to be dedicated towards the implementation of
IPC in provinces and territories. The Committee therefore recommends that:.
Recommendation 7:
The federal government identify and address systemic barriers to
the implementation of interprofessional collaborative practice within its
jurisdiction, including its responsibilities as the employer of the federal public
service and the health benefits and services it offers to federal client
groups, including: First Nations and Inuit; RCMP; veterans; immigrants and
refugees; federal inmates; and members of the Canadian Forces.
Recommendation 8:
The federal government consider the possibility of establishing
sustained funding mechanisms devoted to promoting interprofessional
collaborative practice within the provinces and territories..
Witnesses appearing before the Committee also
emphasized the importance of health information technology in addressing HHR
challenges. Health information technology refers to a broad range of integrated
data sources that provide timely access to patient health information that can
be communicated to different health professionals, as well as the patient and
can include: Electronic Health Records for patients, electronic prescription of
medications, and telehealth, which is the use of telecommunications technologies,
such as the telephone or videoconferencing, to deliver health care services. The Committee heard that current efforts towards development of Electronic
Health Records (EHR) in Canada through Canada Health Infoway Inc. will
promote interprofessional collaborative care by facilitating information
sharing between different health professionals. Furthermore, the Committee heard that health information technology was
empowering Canadians to take responsibility in their own care, in turn easing
some of the workload of health professionals. For example, information
technology was enabling Canadians to conduct home monitoring of blood glucose
levels, saving trips to the doctor.
Indeed, the Committee was able to witness
first-hand during its fact-finding mission to Nunavut the importance of health information
technology in addressing HHR challenges in rural and remote areas. While
visiting the Qikiqtani General Hospital in Iqaluit, the Committee learned that
information technology allowed for the digital transfer of medical imaging,
which reduced the need for travel to the south by patients, as well as visits
to the North by specialists to assess medical test results. In addition, video
conferencing was being used effectively for dermatological and mental health assessments,
continuing medical education, visitation with family members and patient
follow-ups with specialists. Information technology had resulted in reductions
in health transportation costs, which currently represent 18.5% or $50 million
of Nunavut’s total budget for health and social services. In addition,
information technology had further allowed Inuit residents to receive health
care within their communities, reducing the cultural burdens and stress
associated with travel to urban centres in the south.
The Committee therefore continues to support
the federal government’s ongoing investments in health information technology,
including electronic health records, electronic prescribing and telehealth
through Canada Health Infoway, as a means of addressing HHR challenges
across Canada. To date, the federal government has invested approximately $2.1
billion in Canada Health Infoway.
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