Quality Primary Care

Healthcare is a top concern in the midst of this current Alberta election. Family medicine, has been gutted by the past two governments. Nobody has their hands clean. It is easy to forget what good quality primary care involves. We look back on the fundamentals of what primary care should be as we build our primary care (Graf et al.2012, Katz et al. 2009, Spenceley et al. 2013) :

• Timely Acccess to Care
• Population Focused
• Active Patient Engagement
• Continuity of Relationships
• Comprehensive Whole- Person Care
• Co-ordination and Integration around the needs of the Patient and Family
• Team Based Care

Beyond Neighbours takes these elements even further with the direct integration of physicians through health care aides right into the home, providing richer context and nuance. Nobody seems to have time for context and nuance any more in this age algorithms and automation. Ultimately, that attention leads to quality.

Complexity in Medicine.

Primary care is practiced with layers of problems, conflicting priorities and uncertain outcomes, the essence of complexity. The complexity is only increasing. A pertinent example being how the one year mortality for congestive heart failure has plummeted from 50% to 10-25%. As a result, every second patient seems to have heart failure clouding the picture. Another example is a rule of thumb that 1/3 of patients takes their prescriptions correctly,  1/3 take their prescriptions incorrectly and 1/3 take them not at all. That last inch of medicine seems to be a yawning chasm across the front door. Yet we happily ignore it. I have observed that many of  our tools such as algorithms and pathways are complicated instruments wielded in a complex world.

Our goal at Beyond Neighbours is to deliver health care to seniors and redefine how they experience care. This started the first week of medical school where we were taught about patient centred and inter-disciplinary care. The practice of medicine has made great strides. But there’s still a fair distance to go. Inherently, there is a lot of inertia in the form of existing hierarchies and structures limiting healthcare’s response to complexity. It always struck me in the early morning why were we admitting a senior to hospital because they could not get to the bathroom or go up the stairs. Surely there was an alternative. We are rolling the dice and possibly making things worse in the hospital. If we can better connect with a patient, their informal supports and offer more flexible supports in the neighbourhood, then the patient will be healthier and happier, making families and the healthcare system healthier and happier too.