Fragmented health-care needs to be addressed in Alberta
By Lethbridge Herald on September 1, 2022.
Dr. Vesta Michelle Warren
ALBERTA MEDICAL ASSOCIATION
As the nation-wide crisis in primary care continues, the AMA is very aware there are not enough family physicians to provide Albertans the care they need in the current system.
Lethbridge is often mentioned as a critical case, but there are many other communities with similar struggles. In the first report last week of 8,000 surveys from the Alberta Medical Association PatientsFirst.ca community, over 35 per cent of those who signed up to participate in our survey because they are waiting for care reported they do not have a family doctor while they are struggling with complex issues after two pandemic years: 24 per cent say they are waiting for a surgical procedure and nearly 30 per cent are waiting to see a specialist or for referral to one.
Across the province, over 20 per cent of those surveyed have indicated a wait time of over a year. Nearly 35 per cent have an unknown wait time. In this environment, patients have been trying to find immediate aid to provide much needed stop-gap care.
We are fortunate to enjoy top-notch skills and knowledge of allied health professional colleagues such as pharmacists, nurse practitioners, physiotherapists, occupational therapists and more whose skills and knowledge contribute to the overall care of Alberta patients.
They should be enabled to work to their full capabilities. What we know, however, from studies around the world is that, when all providers work together in a patient-focused team, there is not only better access to care, but better outcomes and patient satisfaction from care received. The team approach also reduces pressure on existing wait lists. When we invest in a robust primary care system like this, patients just do better and there is less duplication, error and waste.
We believe that the solution to our primary care crisis is ensuring that every Albertan has a family doctor at the heart of a high-value primary care team involving many health professions.
The patient-physician relationship is the core so that patients receive what they need, when they need it. For the role that they play, family medicine specialists receive training that is second to none and creates physicians who are as at home in rural areas working in acute care and emergency rooms as they are delivering babies or doing cradle-to-grave medicine in community medical clinics.
With the training they receive, they are uniquely placed to help sort the medical problems brought to them, and by managing those problems, keep patients in the community and out of the hospital.
To serve the patient best and improve efficiency in primary care, our focus and resources should be on the team approach. Every Albertan deserves to have a team wrapped around them as they live their lives and travel the health care system.
Physicians know that access is not what it should be and we understand the desire to fill the gap by multiplying independent clinics operated by other professionals. When there are not enough family doctors to go around, patients may see an independent pharmacist-led clinic as a solution.
The care they can obtain, however, is limited to what is actually feasible with the limited training pharmacists receive in the key components of the physical exam and everything involved in assessing, diagnosing and managing patients’ common primary care issues.
For this reason, there will be many patients who will still be redirected from the pharmacy to the emergency room when it is apparent their issues require the skills of a physician. Without tracking and sharing the data and outcomes of those encounters and no one aware of all the things that are going on, the patient ends up being responsible for holding all knowledge of their care without anyone to help them manage it.
To be clear, this happens today already. We should work hard to prevent it from happening in the future, not make the problem worse.
Popping up new stand-alone points of access is not the solution or what patients deserve for their primary care.
They deserve teams of complementary professional services, coordinated by the family physician with full information sharing so that everyone knows what is happening and can work together.
This should be the goal and it’s going to take time to get there. In the meantime, let’s put our efforts into breaking down silos instead of letting them multiply.
When it comes to the primary care needs of Albertans, health care that is fragmented into different piece will have to be reassembled at some point, often in times of crisis. If we continue to encourage the proliferation of multiple, disconnected avenues for primary care, by the time we can restore our physician workforce, it will be the patient left holding the bag.
Dr. Vesta Michelle Warren, President,
Alberta Medical Association
21-20
So many doctors are leaving because they are weary of the continuous requests for prescription opioids. Walk in clinics and ERs in Lethbridge are being overwhelmed by addicts looking for a free hit. But it is politically incorrect for them to state that in public.
One place in the world who does excellent primary care is The Netherlands, touted as having one of the best universal public health care systems in the world. What is offered there by private operators is their health insurance. It is the law that everyone living in The Netherlands have health care coverage. If one cannot afford it, they are given assistance by the government. There are also levels of coverage which can provide increased coverage, if one can afford it, but basic coverage is always available.
It never hurts to have a look at where things are being done successfully.
At first reading, The Netherlands appear to have a a public/private health care insurance approach to providing universal health care. As you may recall, Southern Albertan, Alberta used to have a provincial health care insurance program which was scrapped by the provincial Conservative government of Ed Stelmach. But is this an event that initiated a domino downward spiral in our health care? Could it be more correctly stated that it’s been an ideological political approach to funding health care in this province that is the culprit? From blowing up hospitals, to the centralizing of bureaucracy with the mega board, ripping up contracts with doctors, firing front line staff et al. One might argue, “Well, this is happening right across the country?” Yes, it is and perhaps it could be argued that political ideology is the fault here as well. In any event, thank you for directing attention to the system currently in place in The Netherlands. A link below provides information for those wishing to follow-up on your suggestion.
https://www.commonwealthfund.org/international-health-policy-center/countries/netherlands