Primary Care Reform: Implications for Public Health

Page 3

So: system redesign is needed

• Every system is perfectly designed to deliver the results it gets ‘- Berwick
• First Ministers(2000): “planned provision of comprehensive services to a defined population…(with) …multidisciplinary teams..(and)…emphasis on health promotion, disease and injury prevention, and chronic disease management ..(and)..24/7 access to essential services”

Chronic Disease Management

• Good early success with IHI collaborative model : diabetes, CHF
• Challenge – many patients present with clusters of chronic disease e.g. ‘frail elderly’, DM,CHF, renal failure & mental health problems or chronic mental illness, addiction and HIV/hepatitis.
• Urgent need for real system re-design

Important New Concepts

• PHC teams providing care for a defined population
• System re-design: improved health of population
• Partnerships – clinicians, community agencies
• Communication, information, decision supports
• Shared care
• Self-management/self efficacy
• Navigation- care maps, resource maps
• Better prevention
• Evidence-based care- guidelines, protocols, algorithms, care pathways
• Better information & decision supports

But what health system model?

• Existing model – acute episodic care
• Best available Canadian evidence – if focus is onimproving the health of a defined population then an ‘integrated community health model’ holds the most promise
• Means an expanded primary care team integrated with hospitals, public health, home care, mental health, etc serving a defined (geographic) population

Achieved anywhere?

• UK – PCTs & regional authorities
• New Zealand – all personal (face-to-face) public health services delivered in primary care. PHO model.
• Both countries achieved the transition to a new system through:
  • Vision – bottom-up & top-down
  • Organisation change management
  • Increased income for family docs
  • Significant investments in an EHR