Overview

1
(No Transcript)
2
Overview

• What is Primary Health Care?
• Primary Care
• Primary Care Reform
• Models of Primary Care
• Current Scenarios placeholder slides
• Primary Care Toolkit Modules
• Region and/or Topic-Specific Issues placeholder
  slides
• Concluding Remarks placeholder slides

3
What is Primary Health Care?

• Primary Health Care is defined by Health Canada
  as the first level of contact with the health
  system to promote health, to prevent, diagnose
  and treat illness and injury, and to manage
  ongoing health problems.
• Primary Health Care extends beyond the
  traditional health sector and includes services
  which play a part in addressing the inter-related
  determinants of health.

Adapted from Health Canada
4
What is Primary Health Care?
Appropriateness
Accessibility
Intersectoral / Interdisciplinary
Population Health
Continuity of Care
Community Participation
Efficiency
Affordability Sustainability
Principles Associated with Primary Health Care
From presentation by Arlene Wilgosh, DM of
Health, Manitoba 2005
5
Primary Care

• 88 of Canadians say that having
• a family physician
• allows them to feel much more confident
• in their ability to access
• appropriate and timely care.

Decima Research 2004
6
Primary Care

• Primary Care is health care delivered by
• Family physicians, nurses, pharmacists, mental
  health professionals (behaviourists, social
  workers, psychologists), dietitians, therapists
  (physio and occupational) public health
  professionals
• And includes health care services such as
• Health promotion, illness prevention, health
  maintenance, home support, community
  rehabilitation, pre-, during post-hospital
  services, coordination of care referral to
  other areas of health care

7
Primary Care

• The delivery of Primary Care is different in each
  community depends on
• Population individual health needs of residents
• Access to family doctors other health care
  providers resources in the community
• Proximity to and availability of health care
  services required to support the patients
  continuum of care

8
Primary Care Reform
Let's deal first with making health services
available primary care. It's the first line of
contact between us and the health care system
when we're in need Health ministers have said
that we must address primary care reform as a
fundamental need Promising innovations hold the
real promise of improvement in quality and
access. There are innovative proposals being
made by various groups on primary care reform
the College of Family Physicians of Canada with
ideas like multi-disciplinary teams, group
practices, patient rostering, broad choices in
payment for family physicians including blended
funding mechanisms These are the kinds of
constructive changes that health ministers
believe are needed to overcome the structural
problems in delivering health care services. Our
challenge now is to take them, in partnership
with the professions, beyond the isolated
exceptions, beyond the pilot projects and pull
them together as broad systemic changes to
produce true improvement where people will notice
it.
Alan Rock Canadas Health Care System March
2000
9
Primary Care Reform
Traditional Model Primary Health Care
? Treatment ? Health promotion
? Illness ? Health
? Cure ? Prevention, care, cure
? Episodic care ? Continuous care
? Specific problems ? Comprehensive care
? Individual practitioners ? Teams of
practitioners
? Health sector alone ? Intersectoral
collaboration
? Professional dominance ? Community
participation
? Passive reception ? Joint responsibility
Dr. B. Starfield, Johns Hopkins University
10
Primary Care Reform

• Access to the right provider for the right
  service at the right time in the right
  environment
• Emphasizing community health care resources to
  provide care as close to home as possible
• Flexibility for tailored solutions that fit
  peoples specific needs

11
Models of Primary Care

• Many different models and approaches but a
  number of common attributes
• First access through a family physician
• Interdisciplinary collaboration
• Comprehensive care
• Coordination of care and system access
• Access to specialty and community resources
• Information technology as an enabler (integrated
  systems)

12
Current Scenario sample slide

• Placeholder for case description of patient and
  family receiving health care from a family
  physician through a primary care model for
  example
• Family physician providing care in association
  with other providers to an older couple, one of
  whom requires management for a chronic condition,
  e.g. Alzheimers, with various co-morbidities,
  and the other of whom requires care for an acute
  shorter term illness, e.g. fractured hip

13
Current Scenario sample slide

• Placeholder for discussion of previous case for
  example
• What are some of the challenges facing the family
  physician under the current model of primary care
  delivery?
• How could the delivery of care to this couple be
  improved?
• How does the primary care system respect the
  roles of the various providers in this case?

14
Primary Care Toolkit

• A resource for family physicians to support their
  changes in practice community as a result of
  primary care reform
• Five primary subject areas
• Remuneration
• Governance
• Interdisciplinary collaboration
• Continuity Comprehensiveness of Care
• Information Technology

15
Primary Care Toolkit

• With primary care reform comes uncertainty the
  need for knowledge translation change
  management
• The toolkit outlines approaches to various
  elements of primary care delivery in changing
  models
• The Primary Care Toolkit for Family Physicians is
  provided by The College of Family Physicians of
  Canada to help translate, share and disseminate
  knowledge and management information
• The CFPC maintains this toolkit as an interactive
  web-based resource to family physician leaders
  and their associates experiencing primary care
  reform

16
PC Toolkit Introduction

• The Patient as Central in Health Care
• Family Physicians Primary Care
• Goals ? Principles ? Common Elements of PC
• Other Resources (available in each module)
• Appendices
• Provincial Chapters / Colleges of Family
  Physicians
• Provincial Medical Associations
• Primary Care within Provincial Ministries of
  Health
• Privacy Legislation
• Knowledge Transfer
• Change Management

17
PC Toolkit Remuneration

• Remuneration Methods
• Fee-for-service / Capitation / Payment Incentives
  / Special Premiums / Alternative Payment or
  Funding Plans / Sessional Payment / Salary / etc.
• Key Success Factors and Pitfalls
• Keys to Success / Analysis Evidence to Support
  Changes in Remuneration / Support for Diverse
  Family Practice Roles
• Overcoming Resistance to Current Models
• For Family Physicians / Patients / Provincial
  Territorial Health Systems
• Relation of Remuneration to Governance
• Appendices
• Provincial Medical Associations / Blended Funding
  Mechanism

18
PC Toolkit Governance

• Contracts and Governance
• Definitions of Contracts / Governance Agreements
  (Internal External)
• Key Success Factors and Pitfalls
• Liability / Legal Counsel / Group Decision-Making
  / Administrative Leadership / Community Advisory
  Associations
• Appendices
• Provincial Medical Associations
• Alberta Primary Care Networks Governance Issues
• Incorporation
• Legal Liability
• Liability Insurance

19
PC Toolkit Interdisciplinary Care

• Key Success Factors and Pitfalls
• Needs Assessment / Common Objectives / Transition
  to Interdisciplinary Collaboration / Role
  Identities and Responsibilities / Relationships
  to Patients / Legal Liabilities / Scopes of
  Practice / Negotiating Overlap of
  Responsibilities / Integrating New or
  Under-utilized Skills / Remuneration for
  Providers / Communication / etc.
• Additional Structures and Process Issues
• What is a Team? / Team Development / Community
  Needs Assessment / Co-location / Conflict
  Resolution / Patient Acceptance / etc.
• Other Resources
• Appendix
• Descriptions for Professional Roles

20
PC Toolkit Continuity

• Necessary Elements for CC
• Major System Investments / Primary Care Sites
  Models
• Key Success Factors and Pitfalls
• Factors that Ensure or Hinder Success
• Remuneration Incentives / Infrastructure
  Support / Support for Interdisciplinary Care /
  Cooperative Partnerships with Government /
  Linking Family Physicians Other Physicians,
  Providers Patients
• Other Challenges to CC
• Hospital Institutional Care / Walk-in Clinics /
  Third Party Care / etc.
• Chronic Disease Prevention and Management
• Appendix
• Clinical Guides

21
PC Toolkit Information Technology

• Electronic Records
• Electronic Medical Health Records
• Implementing Information Technology
• Formalizing Implementation / Choosing Technology
  / Connectivity Interfacing / Learning
  Complexity / Improved Access to Information /
  Privacy Issues
• Enabling Factors
• Financial Support / Paperless System / Virtual
  Integration / Clinical and Non-clinical Tools
• Appendices
• Privacy Legislation
• Clinical Links through Information Technology

22
PC Toolkit Supporting Interaction Among Family
Physicians

• Submit a Document
• To enhance Other Resources, contribute to
  Appendices or add to / revise PC Toolkit
  information
• Discussion Forums
• Password username protected
• Print or E-mail
• Links
• To reliable sources of interest to primary care
  providers
• Maintenance of Website -- CFPC contact
  management

23
Governance sample slide

• Placeholder for region-specific slides on any of
  the topics in the PC Toolkit - for example
• Our experiences with governance in our PC
  practice model
• Relevant issues related to PC governance in our
  region
• Discussion on some governance challenges facing
  our changing family practice group

24
Concluding Remarks sample slide

• Placeholder for region-specific concluding slides
  
• for example
• Questions or Comments?
• Contact - names, phone numbers, email addresses
• Next Steps
• Submit additional materials for PC Toolkit
  inclusion
• Use Discussion Forum related to specific PC
  issues
• Provide feedback on ways to improve PC Toolkit