primary care vs. primary health care
http://www.cna-aiic.ca/CNA/documents/pdf/publications/BG7_Primary_Health_Care_e.pdf
primary care vs. primary health care
Q: What is the difference between primary care and primary health care?
A: Primary care is essentially about care for sick or injured individuals based in the community. It is often based around medical care ('primary medical care') but may also involve a
parimary care
1. first point of contact
2. delivered by doctors and other hcp
3. gneralists focus on whole patient
4. delivered in the community
why should we care abt primary care
because primary care is majority of Health care services, 13700 family physician visits in 24 hours
timeline of primary care reform, 1970-1990 in ONTARIO
FEE for service, solo physician practices
- payment per procedure
-private for profit businesses
- many operated as solo practice, no interaction of others
alternative payment models- community health centres (CHC) and health service organizations (HSO)
-
what is CHC
- non profit org with community elected boards, interprofessional teams, located in high need community, focus on primary care, illness prevention, health promotion etc.
romanow commission on primary health care
transforming hhealth care system by taking away focus on hospitals and medical treamtnes, breaking down barriers that exist between cp and focus on preventing illness and improving healht
primary care vs. primary health care
primary care: physician focused, treatment/illness, episodic care, passive patient
primary health care: primary care, health promotion, teams of practitioners, patient empowerment, community involvment
why has primary care reform been so difficult?
1. federal provincial division of powers-- province or federal responsible for the reform?
2. private practice and public payment
3. powerful physician lobby
primary care reform 2000-2004
primary health care transition fund- 800 million from federal into province for transition into primary hc
2003, first ministers accord on health care renewal- 5 year 16 billion health reform fund (praimry hc, home care, catastrophic drug coverage)
2004 f
what's happening outside of ontarios between 2004-present in BC and alberta
BC: division of family practice (community-based groups of family physicians working together to achieve common health care goals), integrated health networks (IPE)
alberta: primary care network (grp of family physicians and other hcp
primary care reform 2000-2004 iN ONTARIO- physician payments changes
fee for service (family health group, comprehensive care model)
blended capitation (family health networks, family health org)
blended salary(family health careas
blended compliment and other specialied models (rural northern physician group agreement)
primary care reform 2000-2004 iN ONTARIO- changes to model of care!
1. patient enorllment
2. group practice
3. 24/7 access requirement
4. multidisciplinary care in Onatrio (FHT, nurse practioner lead clinics, expansion of comuniity health centre)
patient enrollment
Family physicians are also encouraged to take new patients into their practices. A premium is available to physicians
when they enrol new patients. In order to claim this fee, the physician, in addition to formally enrolling the patient, must
co-sign with
expansion of multidisciplinary care has 2 examples
Family health teams and nurse practitioner led clinics
200 FHTs, 25 NP led clinics, 48 full time phramacist in family health teams
also 76 community health centres (CHC)
community health centres
Community Health Centres (CHCs) are non-profit organizations that provide primary health and health promotion programs for individuals, families and communities. A health centre is established and governed by a community-elected board of directors.
CHCs w
key issues today! (3)
access, cost, quality
enough physicians, appropriate access, equitable access? increasing costs? quality of care imrproved with this increase in cost?
in terms of access
1.1 GP per 1000 population (GP increasing faster than population, and GP more satisfied with their job now)
however, hard to get same day appointment and have to wait 6 days or more
resources (ex diabetes doctors) are not allocated with equitable access.
in terms of cost
the cost to see physicians is going up
in terms of quality
hospital admision rate for preventable hosptial admissions are going down. now is this due to better primary health care reform? we don't know!
what is primary care- WHO defn
first level of contact of the individual, the vamily and the community with teh national health system brining healthcare as close as possible to hwere people live nad owrk and constitutes the first element of a continuing care process
what is primary health care- WHO def
addresses the main health problems in the community, providing promotive, preventive, curative supportive and rehabilitative services accordingly
5 principles of primary care
1. accessibility- available to all people with no unreasonale geographic or financial barrier
2. public participation- invidivals have right to be active partners in decision making abt their health care
3. health promotion- process of enabling people to
gaols of primary care (3)
relational continuity- maintenance of patient provider relationship over time nad consistency of personnel
informational continuity- information on preior events is used to give care appropriate to patients current circumstances
management continuity- car
why care about primary care
strength of country's primary care system decreased mortality, premature mortality, and general better health regardless of GDP per capita
what does primary care deal with
acute problems, chronic problems and prevention (at individual and community level)
nurse practitioners
want to see role expanding, people are comfortable with being treated by nurse practitioners, to manage health care cost also
where is primary care provided
doc's office, health clinics, walk in clinics, emergency department, people's homes!
community health centres (chc)
operate on global budget, physicians on salary???, multidisciplinary, focus on prevention/health promotion and acute care, community board
how do docs work
25% work alone, fewer than 10% work with multidisciplinary, lots not availbe after hours and leave clinic uncovered when on holiday
payment methods (4)
fee for service
capitation (payment/ month per patient registered regardless of whether or not patient has been seen, payment based on age and sex of patient)
blended (portion comes from capitation, portion comes from extra doing like attending births)
sa
theoretical problems with fee for service, capitation and salary
FFS: incentive to providing more than necssary to increase income
capitation: limit effort by restricting access to care, less willingless to devote time to patient
salary: doc will select simplest cases
ease of access to primary care in canada
very difficult to get care in the evening, weekends or holidays without going to emergency
difficult to get same day appointment
Emergency vs. walk in vs. GP
GP> WC> ED for waiting time**, communication and doc's attitude
but ED provide better quality of care
GP are not doing enough preventative measures compared to CHC
true