PRINCIPLE
Enhance the health care experience
Patient-centred: The patient must be at the centre of health care. Patient-centred care is seamless access to the continuum of care in a timely manner, based on need and not the ability to pay, that takes into consideration the individual needs and preferences of the patient and his/her family, and treats the patient with respect and dignity. Improving the patient experience and the health of Canadians must be at the heart of any reforms.
Quality: Canadians deserve quality services that are appropriate for patient needs, respect individual choice and are delivered in a manner that is timely, safe, effective and according to the most currently available scientific knowledge. Services should also be provided in a manner that ensures continuity of care. Quality must encompass both the processes and the outcomes of care. More attention needs to be given to ensuring a system-wide approach to quality.
Given today’s overtaxed health care system, it can be difficult to see what’s at its centre: patients.
“Patient-centred care” is increasingly the focus of reforms and initiatives across the health care spectrum, from improving patient access and delivering more timely care to helping family physicians cope with exponential demand.
“When you have an over-loaded, over-stressed system, constantly running at 100 per cent capacity, it becomes increasingly difficult to maintain a patient focus,” says Dr. Linda Slocombe, president of the Alberta Medical Association and a family physician in Calgary specializing in low-risk maternity cases. “It’s a different world for doctors out there now, and patients need more support.”
Alberta has responded by creating Primary Care Networks (PCNs), multidisciplinary teams, led by family physicians and organized under formal arrangements with Alberta Health Services, that co-ordinate primary care services for patients. There are currently 40 PCNs in Alberta, involving 80 per cent of family physicians and looking after more than 2.5 million Albertans.
PCNs are tailored to needs and are “the connective tissue” allowing for better integration of care, while fostering innovation and increasing capacity and access, says Dr. Slocombe, who’s been practising for 28 years. She is a member of the Calgary Foothills Primary Care Network, which includes 350 practitioners, while some PCNs have just a handful of doctors, she says. “It’s a co-ordinated approach to care for that group of patients and that group of doctors.”
Barry Stein, a corporate lawyer and businessman in Quebec who is president of the Colorectal Cancer Association of Canada, says that patient-focused initiatives need to “put the patient in the driver’s seat,” while “incorporating business models” to improve how services are delivered.
“We’ve become accustomed to being at the will of a very outdated system,” says Mr. Stein, a survivor of metastatic colorectal cancer who sought health care outside of Canada to fight his disease and was reimbursed by the province following a judgement in the Superior Court of Quebec. Today he’s an advocate for cancer awareness and educational and support programs for patients and their families.
“Nurse-navigators,” who help cancer patients co-ordinate their treatments, are “a step in the right direction,” but they are rare and only come into the picture once patients are in specialist care, Mr. Stein says. Solutions such as “communities of practice” that focus on certain types of patients and creative models and systems for delivering health care services are critical, he adds. “This is a huge challenge.”
Dr. Slocombe says that as well as focusing on patients and better co-ordinating their care, it’s been important to offer support to family physicians, who are dealing with more significant cases, often in isolation
“The solutions are complex,” she explains. “We’ve got a ways to go, but we are seeing real benefits.”
The development of the PCN model in Alberta “is a start,” Dr. Slocombe adds. “It’s brought family doctors together, and it’s given them extra support to provide patient-centred care.”
TOWARD A STRATEGY FOR PATIENT CENTRED CARE
