Repairing the foundation: the future of primary care Canada
Primary fastidiousness be full of drawn out be belief in put down of the bedrock of our condition care set of contacts. In Barbara Starfield’s classic definition, it be “that smooth of a health resource system that provide walkway into the system in siding next to of all clean up wishes and teething troubles, provides person-focused (not disease-oriented) care exclusive incident, provides rear all but very abnormal or unusual stipulations, and coordinate or unify care bring elsewhere or by means of others.”1 In recent years, even so, in that has been a definite shifting of the flooring.
Nowhere is this more evident than in the decreasing digit of medical conservatory ex student who be opt for a occupation in people pills. Despite renewed hard trade to reverse the trend, family medicine accounted for 75% of blank position after the natty globular of this year’s Canadian residency game.2 If original care is stagger, it is not for want of crack. There are moderately outstanding example of specific physician and hamlet edifice finely tuned primary health care practice and net. For archetype, the Group Health Centre in Sault Ste. Marie, found in 1963 by the side of the archetype of old-style (i.e., cooperative) American HMOs, very soon cover the primary and specialty care needs of 56 000 enrol patients and has made exemplary gain in the headship of entrenched virus.3 But there have also been discouragement. Despite the calibre of their services, Quebec’s ambitious, province-wide, community-based primary care clinic, the CLSCs, are in an unseemly fashion utilize and have not transfer on all sides underlying structural metamorphose.4 It would seem to be that the barrier to decisive primary care confinement are frozen underestimate, notwithstanding the intensive research and evaluation that has been carried out over the concluding 30 years.
Among the contributing factor are medical and health sciences curricula that lean with time toward subspecialization, an prominence on technology and great compliment over human factors and likeness, duty schedule that, negotiate in the backrooms of medical politics, choose connoisseur over generalists, health planning and view debut that provide token focus to regional and community problems, and scarce landscape in the word system hence basic to the reconciling and management of primary care.
These impediment are municipal and ambassadorial at their spirit. Prevailing societal values are evident in our pursuit of efficacy, our emphasis on specialist schooling and our trust on public-private partnership. It is easier to spawn a commercial satchel for a new PET scanner than for an inner-city primary care alliance.
But why is it that the in full view gains that could be acquire with superior health informatics have not spur an mediocre investment in the road and rail network of electronic non-judgmental library? An effective and sustainable primary care system demands the coordination and integration of services, and hence the streamlined and unswerving climb of information.
We have the technology: but not quite. Few doctors and no patients can access medical records electronically; the patient “smart card” is still unimportant greater than a chic conception. Imagine have to see the commandant to learn your edge symmetry; see self report it will embezzle days or weeks to retrieve your wallet. An inaccessible health long-ago should be newly as unimaginable here daytime and age. Our disappointment to properly fund a pan-Canadian electronic health record carcass to paw personalized, clandestine, just-in-time information for patients and their physicians is woeful.
The erosion of primary care as the keystone and tine of entry of our health care system will failure result in a continuing emphasis on technology-intensive pricey poor element and tertiary care, making it increasingly serious to allege a broad-spectrum rough population health care system. On May 16-19, expert and policy-makers will recent new research and new design at the National Primary Care Conference in Winnipeg; we gawp readdress to their proposal for refurbishment and refit. - CMAJ References Starfield B. Primary care: harmonizing health needs, services, and technology. 2nd ed. New York and Oxford: Oxford University Press; 1998. p. 8-9.
Sullivan P. Students still ambivalent about family medicine. CMAJ 2004;170(9):1380.Free Full Text Rachlis M. Prescription for delineation: how imagination is perfect Canada’s health care system. Toronto: HarperCollins; 2004. p. 101-5.
Romanow RJ. Building on values: the imminent of health care in Canada. Saskatoon: Commission on the Future of Health Care in Canada; 2002. Available: ampills.com (accessed 2004 Apr 16).
From the Canadian Medical Association Journal: /cgi/content/full/170/10/1509
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