Yesterday's The Medical Post featured an article on how 90% of Alberta family physicians endorse the new approach to team-based primary care. The new model being proposed will deliver more community-based health care and representatives from all zones will form committees to shape this framework and develop a successful service plan.
I have to begin by saying: thank goodness primary care is under such scrutiny! We have some amazing family physicians in Alberta but sometimes the system's obstacles make the practice of primary care ineffective and inefficient. With increasing rates of diabetic patients requiring care or patients seeking mental health support, for example, we need to rethink our care models. More often than not, the standard 10-20 minutes physician appointment is simply not enough. Many recent studies observe how team-based approaches to care are cost-efficient and patient friendly. They allow patients to cover more than the "one issue per visit" stigma, maximizing the time of both patient and physician.
In comes the concept of the "Patient Medical Home," a one-stop shop offering a community of health care workers from pharmacists to specialists. Instead of having a primary care physician at the top of the totem pole, the patient takes the lead and a team works together to anticipate the patient's needs, collaborating effectively to ensure all of the patient's concerns are addressed. As a result, each visit becomes more cohesive and although it may be lengthier, it actually decreases wait times and health care costs since fewer mistakes are made, and fewer visits required. In fact, a study published in 2014 entitled "The Medical Home's Impact on Cost and Quality," demonstrates that the Medical Home model strengthens the larger health care system, improves access to care, decreases costs, and enhances patient satisfaction.
Broken down, the big picture of the Patient Medical Home outlined above offers a more precise framework, as detailed on the Alberta Medical Association website. Some key elements include:
- Connected with and responsive to patients' wants,
needsand preferences. Indeed, as our needs assessment survey of Drumheller illustrated, patients have been dissatisfied with the booking appointment system in the past, which is something Riverside Medical has worked to alter by allowing same day appointments as well as the ability to book more than 3 weeks in advance.
- Every person should have
a personal family physicianswith whom they can trust, to play a key role in coordinating their care (by 2020). Although Dr. Ram is the only permanent physician at this time, we are actively recruiting new doctors that agree with this model of care. Our survey showed that 44% of respondents did not have a family physician in Drumheller itself. This does not improve consistency of care, which is key to quality health delivery.
- Teams that are cohesive and that value continuous relationships with patients that offer a broad scope of services carried out by the teams or network of providers. Our team is slowly growing! Dr. Ram will be joined by Riverside Value Drug Mart in the clinic space on August 1st. We have a new LPN starting with the team in July, several locum physicians, medical residents and we are expanding our network of providers to ensure collaborative interprofessional care.
- Timely access and advocacy for coordinated appointments; same-day access. Dr. Ram always has same day appointments available. We are also gradually going to increase our after-hours availability to service patients that work during the day and might not be able to come to clinic during regular business hours.
- Continuous Quality Improvement (CQI) programs that evaluate quality,
costand patient satisfaction. Gone are the days when physicians get their buddies to perform their evaluations. As a Patient Medical Home we intend to be evaluated by objective parties and by patient assessments. effectiveness
If this model is so successful, why isn't everyone doing it? Well, the answer is easy: it's difficult to teach an old dog, new tricks. Previous generations of medical professionals weren't trained for interprofessional collaboration. Just in my last year of medical training, we started having simulations, which included respiratory therapists, physiotherapists, nurses, pharmacists, and social workers in order to foster team-based medical care. Not only did it feel as though we were more effective in managing the patient's needs, but the team approach made the care consistent. Every member felt part of the team and by the end of the simulation day, a sense of trust was fostered – and this was only in one day! Imagine working with a team for weeks, months, and years. The quality of care and the safety of the patient are inevitably optimized by a high-functioning care team and also leads to improved job satisfaction.
To us, the Patient Medical Home is a key concept to rural medicine in Alberta because the Rural Physician Action Plan recently expanded its mandate to provide support services beyond physicians to other health professionals, for example nurse practitioners. The goal is to respond to community wants versus physician driven agendas. By actually considering the diverse health care needs of rural communities, efforts can be made to improve resources.
We know the ideal Patient Medical Home will take time to grow, but as Kevin Costner hears echo throughout the famous film Fields of Dream: "If you build it, they will come." The new clinic is open and the pharmacy opens August 1st. We have big dreams for this wonderful space with a gorgeous view of the valley, so you can expect new players and many exciting games in the future. Who knows, we might even win a world series.