Providing Value
Primary care teams provide value for health dollars by speeding up access to care, and offering a wider range of programs and services to promote health and manage chronic disease. They bring together the variety of skills needed to help people stay as healthy as possible.
Evidence from British Columbia suggests that a very sick patient without access to high quality primary care can cost the province’s system $30,000 a year. The same patient, when aligned with a care model providing comprehensive primary care, can cost just $12,000.
Making Progress
Ontario has made significant progress building a more coordinated and comprehensive primary care system to meet the needs of patients and governments. The building blocks of this new system are inter-professional primary care teams who combine the expertise of a range of health professionals to provide comprehensive primary care.
Primary care teams are participating across the province in new programs to identify our sickest patients and develop new ways to better manage their care. It is work that will help the system manage costs and ensure providers are working with better information and with the same objectives.
MEETING LOCAL CHALLENGES WITH LOCAL SOLUTIONS:
- In Prince Edward County, the local FHT created a cardiac rehab program for residents to easily access a physiotherapist,registered nurse, dietitian, social worker and physician specialist.
- In Kitchener, the local FHT created a dementia clinic for patients to access family physicians, pharmacists, nurses and social workers with geriatric mental health experience.
- In Lambton County, the FHT there created a mental health care team to deliver more cost effective and collaborative care. Its success led to developing a teen suicide prevention program and an early detection program for dementia.
At present, about 25-30% of Ontarians can access team-based primary care. The logical question is – how do we expand access to primary care teams and get the best value from this investment?
AFHTO has combed the research literature to find the answer. From this we assembled the evidence, presented a set of principles for optimizing the value of teams and offered an initial set of recommendations to get started.
Evidence Of Added Value:
TEAMS IMPROVE TIMELY ACCESS TO PRIMARY CARE
Patients in primary care teams report higher levels of access to care, compared to Ontario residents in general. Key drivers for enhancing patient access include after-hours clinical services, reduced wait times, and inter-professional services. Patients are able to see the right provider, at the right time.
- AFHTO Data to Decisions (D2D) report shows that AFHTO members are performing better than the provincial average on same day/next day access (40% better).
- Interprofessional Collaboration in Ontario’s Family Health Teams: A Review of the Literature (2014)
- External evaluation report on family health teams (2014) shows that almost 80% of patients reported that they are able to get an appointment with their family doctor or primary care provider on the same day they need one.
PATIENTS EXPERIENCE BETTER CARE COORDINATION IN PRIMARY CARE TEAMS
Effective care coordination leads to more seamless transitions for patients and families, reduces duplication, increases quality of care, facilitates access, and contributes to better value by reducing costs. Primary care is an anchor for patients and families to navigate through the healthcare system.
The primary care team model improves care coordination by increasing communication between healthcare providers through the use of a common electronic medical record (EMR). Ensuring a level of systems integration that is currently lacking across different models of primary care in Ontario. This kind of seamless integration improves communication among providers, results in less conflicting advice from care providers, and facilitates the transfer of data between providers.
- Patient Experiences of Care Coordination and Communication
- Interprofessional Collaboration in Ontario’s Family Health Teams: A Review of the Literature (2014) found coordination and collaboration to be an outcome of the team approach to care.
- External evaluation report on family health teams (2014) showed that less than 10% of patients receiving care in teams felt they had received conflict advice from different providers.
TEAM-BASED PRIMARY CARE SUPPORTS IMPROVED MANAGEMENT OF CHRONIC DISEASE
About one in three Ontarians live with a chronic condition. For those over age 65, close to 80% have a chronic condition; of these, 70% live with two or more conditions. The bulk of chronic disease management is provided through primary care but most physicians simply do not have enough time to address all chronic disease needs in a standard visit.
The team model gives ready access to interprofessional health providers that deliver diverse professional expertise and access to the resources and skills required to manage the “whole patient”, and the knowledge of and connections to external services and supports in the community.
- Interprofessional Collaboration in Ontario’s Family Health Teams: A Review of the Literature (2014)