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The Globe and Mail

Alberta expanding primary health-care with little statistical info: auditor general

Alberta's auditor general says the government is preparing for a multibillion-dollar expansion of primary health-care services without knowing if they work.

The province has never done a thorough, ongoing study on their effectiveness, even though primary-care networks have been around for seven years, Merwan Saher said in his latest report released Wednesday.

"We found significant weaknesses in the design and implementation of the accountability systems for the (primary-care network) program," Mr. Saher said. "Evaluation initiatives to date have not been adequate given the magnitude of the public investment and significance of the ... program."

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The province has 40 primary-care network clinics which are to receive $170-million in public funding this year for a total of $700-million since they began operating in 2005.

The clinics are privately run by doctors. Teams of specialists treat patients with illnesses and other health issues before they worsen. The clinics are designed to save taxpayers money by keeping patients out of clogged emergency rooms and hospitals.

Premier Alison Redford has announced plans to create 140 new family-care clinics. They will perform essentially the same services as primary-care facilities, but will not be privately run.

Three family-care clinics are operating on a trial basis. The premier has not set a deadline to get the other 137 in place. Government members are having informal discussions with stakeholders this summer.

Mr. Saher said lack of information on primary-care networks should give politicians pause before embarking on the family-care model.

For instance, he said, while the government has set up five objectives for the networks, it never developed targets and measures needed to determine if objectives are met.

The networks are supposed to draw from patients in certain geographic zones, Mr. Saher pointed out, but the result has been mass confusion over who is in charge of delivering demographic information. It's also unclear whether each list is based on where patients live or on where they traditionally go for care.

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And the rules are too loose, he suggested.

The clinics are supposed to provide around-the-clock care. While that means some clinics stay open nights and weekends, others provide recorded messages that redirect people to emergency wards.

When it comes to helping a patient through the system, he said, some networks actively do so, while others just provide patients with phone numbers.

The networks must have multidisciplinary teams in place, but there is no set expectation on what skills they should have.

A key component is treating chronic diseases which, if allowed to worsen, can harm not only the patient but cost the system $10,000 per patient per year — more than twice the cost of treating a cancer patient.

But the networks aren't told which chronic diseases to focus on, aren't given minimal expectations on how to treat them and don't have to follow basic clinical standards or guidelines, Mr. Saher said.

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With no expectations, he said, some primary-care networks can meet the mandate of treating chronic illnesses through active treatment while others can simply hand out pamphlets.

Health Minister Fred Horne says the government accepts the recommendations and will act on them as it moves forward with family-care clinics.

"I've had some of these concerns and I have discussed them. Ultimately, now as minister, it's my responsibility that we deliver on the accountability, and I will do that."

Mr. Horne, like Mr. Saher, said there have been success stories in individual clinics.

"A lot has been achieved ... in different ways," said Mr. Horne.

"It took a lot of commitment on health professionals to start working in teams and offering these programs. I don't read (the) report as a criticism of their work."

NDP health critic Rachel Notley said it's hard to fathom the lack of basic due diligence, especially for a government now determined to expand primary care.

"What this report shows is that this government has essentially spent almost a billion dollars on a project that they never bothered to check whether it's working," said Ms. Notley. "It's grossly irresponsible."

Danielle Smith, leader of the Wildrose Opposition, said Ms. Redford needs to stop primary-care expansion until it's determined whether the network is working.

"The government might be fixing what isn't even broken," Ms. Smith said in a news release. "It's reckless and irresponsible to proceed with this massive restructuring without even knowing what the current situation is.

"It is typical of this government to rush through big changes to the health-care system with no consultation or regard for the facts."

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