Are team-based healthcare clinics that serve one geographic area the answer?

Are team-based primary care clinics that serve a specific neighbourhood the answer to Canada's healthcare system woes? The panelists on the Canadian Medical Association’s Bold Choices in Healthcare latest virtual event want to see them proliferate. The conversation focused on the value of and need for interdisciplinary team-based care, with panelists pointing out recent healthcare successes in the province. “I feel that people are losing confidence in our healthcare system,” said Deb Matthews, former Minister of Health in Ontario. “If we don’t take action, we’ll lose our single payer system.” A switch to team-based healthcare doesn’t happen with a simple snap of the fingers, said Dr. Brian Goldman, a Toronto-based emergency physician, CBC radio host and author of a book on teamwork. He suggested those graduating from family medicine residency programs after a certain year should practice only in team-based practices, after training with allied healthcare professionals throughout their medical education. These practices would serve a specific geographic area, the same way a school does, he said. Team-based primary care clinics within a community is a valid goal, said Dr. Rita McCracken, family physician and assistant professor at the University of British Columbia. “I think we need to be asking ourselves 'Why not?' and 'How can we make it happen?'” Dr. McCracken emphasized the discussion should focus on what the healthcare system is supposed to do rather than on who gets paid what amount. One barrier to team-based care is that in most cases, funding models focus on the physician, and not the team, Dr. McCracken noted. A commenter in the virtual event’s chat gave the example of a psychiatry practice in B.C. that had to subsidize team-based initiatives in palliative care and psychotherapy using the physician’s salary. But the conversation on how to move forward can’t simply be between politicians and physicians, she noted. Other healthcare professionals need to be involved. And patient advocate Claire Snyman added that caregivers and patients need to be part of discussions, as well. In order to foster team-based care, the system needs to reexamine what it incentivizes. If a quick clinical meeting is the only way to get paid, that leads to the time crunch pervasive in medicine. That time pressure does not favour team-based care because it causes doctors to focus on their in-group and distance the out-group, or non-physicians, explained Dr. Goldman. This creates hidden hierarchies. In medicine there is an “I alone” mentality. “There is a cultural belief that if I don’t have the answers, what am I doing here?” He said that it was late in his career when he realized he was a better physician when he worked as a team. Read: Logging off? Will updates to fees prove to be the death knell for virtual care in Ontario? The panelists gave examples of healthcare programs that work or could be studied further in Canada: The Oaks in Ottawa, run by the Shepherds of Good Hope. The Oaks is a 55-unit residential facility that houses a managed alcohol program and allows residents to stabilize and address addictions in a safe way that reduces harm and builds community.—Deb Matthews Hamilton Health Sciences Services’ virtual post-operative monitoring program called Surgical Transitions, which is also available at other hospitals across Canada. Matthews said the program started after HCWs reported what they were seeing in homes after patients had been discharged from hospital. - Deb Matthews The Japanese healthcare system takes care of vulnerable elderly. - Dr. Brian Goldman The Buurtzorg home care nursing system in use in the Netherlands, which uses a network of self-managing nursing teams of 12 nurses that take care of specific neighbourhoods. The model is explained in this video. - Dr. Brian Goldman Dr. Alika Lafontaine, CMA president, moderated the Dec. 8, 2022 session. More information about the CMA’s Bold Choices in Healthcare summit is available on the CMA website. Read: B.C. doctors and medical learners have chosen a new CMA president-elect

Are team-based healthcare clinics that serve one geographic area the answer?

Register for free access or login.

Related Topics