Achieving Comprehensive and Transdisciplinary Primary Health Care Challenges and Opportunities

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Achieving Comprehensive and Transdisciplinary
Primary Health Care Challenges and Opportunities

• June Bergman MD, CCFP

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Alberta Experience

• Shared Care Teams
• Chronic Disease
• Mental Health
• Hospitalist
• Primary Care Networks
• Health Professions Act
• Information Technology
• 50 community offices on EMR
• Netcare
• Trilateral Agreement

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Shared Care factors for success

• Initial co-location of members
• Active engagement of all team members
• Open communication
• Shifting leadership roles, depending on expertise
• Trust and respect between team members
• Shared goals and readiness for change
• Confidence in team competence
• Evolution of roles and functions
• Promotion of the team

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Team Members success factors

• Members possess professional assertiveness,
• Strong clinical skills,
• Communication skills,
• Knowledge of the community and home care systems,
  - expert knowledge
• Ability to contribute in case conferences
• IT skills,
• Experience working in teams.

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Physician supportive factors

• Prior involvement in similar projects
• Positive patient outcomes
• Reduced workload
• Opportunity to participate in system change

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Barriers for physicians

• Reimbursement
• Space
• Difficulty in maintaining strong leadership and
  direction.

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Essential Steps - Local

• Within pilot or demonstration project
• Identify need
• Demonstrate positive patient outcomes
• Identify Common goals and objectives
• Establish roles and overlap of roles
• Quantify costs
• Quantify and create team building models

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Essential Steps Provincially

• Provincial department of health
• Funding agencies
• Regulatory Agencies
• Professional Associations
• Regional Health Authorities
• Each of these will help to solve the problems as
  they become identified and each has the power to
  shift the way we do business in some critical
  way.

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Funding Models

• Shared accountability between regions and
  physician groups potential for each to hire
  other professionals
• New fees for certain services
• Alternative funding plans
• Funding some services only if within
  interdisciplinary models

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Challenges

• Time
• Political posturing put the patient at the
  center
• Short political cycle and demands of culture
  change
• Inadequate evaluation and evaluation expertise
• Supply of health care professionals
• Health care demands
• Strength of the hospital sector

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Opportunities

• Build on current working models
• Developing champions
• Demonstrating effectiveness and efficiency
• Demonstrating shifting patterns of care with
  improved or same outcomes
• IT systems to support communication