Primary Care: A foundation for a high performing health system

by Nadine Morris Jennifer Zelmer, President | 23 Jul, 2019 | 23 Jul, 2019

Primary healthcare is at the heart of well-functioning health systems. According to the World Health Organization (WHO), the central focus of primary healthcare is individuals, families and communities. In this model, people’s individual care needs are supported by multi-disciplinary primary care teams who are a first point of contact for integrated health services that will meet most of their health needs over their lifetime.

Evidence shows that health systems with strong primary healthcare at their core deliver better health outcomes, efficiency, and equity.

In thriving primary care systems, health needs are addressed by a team you trust. In both global and Canadian visions of primary care, person-centredness, comprehensive care (including health promotion, disease prevention, treatment, rehabilitation, palliative care, and more), and continuity of care are key. For instance, the College of Family Physicians of Canada recently described the Patient’s Medical Home as a family practice defined by its patients as the place they feel most comfortable presenting and discussing their personal and family health and medical concerns. In this 2019 update, they acknowledge a shift toward interprofessional practice structures that strive to ensure the right provider, at the right time, in the right place, for the right care. Using this model, nobody ‘falls through the cracks’ when moving between different parts of the health system.

In the 21st Century, being able to offer seamless care closer to home and community means we need to take advantage of appropriate digital solutions, such as eConsults. Traditionally, patients have had to attend a face-to-face appointment to get specialist advice. In Canada, this process tends to involve longer waits for care than in a number of other countries, according to surveys conducted by the Commonwealth Fund. With eConsults, information moves, but the patient doesn’t have to. Primary care teams can get advice from specialists via phone, secure messaging, or other technologies. The World Health Organization has said that the “use of remote consultation services or telemedicine can be used to improve information flows between patients and health workers as well as better integrate primary care with referral care.“

We’ve seen the value of eConsults first hand via the Connected Medicine Collaborative. Eleven teams in seven jurisdictions spread leading eConsult services, inspired by the Champlain BASETM eConsult service first launched in Ontario and the Rapid Access to Consultative Expertise (RACETM) model from British Columbia. These services enable primary care providers to connect with specialists via phone, app, and/or secure messaging.

The numbers are impressive. More than 12,000 consults took place during the 18-month collaborative alone, and usage continues to grow. Most were completed in 7 days or less. In many cases, patients no longer needed referrals for face-to-face specialist appointments or visits to an emergency department that would otherwise have taken place.

But it’s the stories that really bring the value of eConsults to life. For instance, Edwina Nearhood has lived with congenital heart disease for 30 years. She has faced major barriers to accessing specialist care from her home in Fort St. John, B.C. As a result of this collaborative, she has benefitted from easier access to care for her urgent needs.

Stories like Edwina’s show that innovations like eConsult can be win-win solutions. Patients receive care closer to home with a healthcare provider they know and trust and who has access to timely advice from specialist colleagues. Primary care providers can offer their patients more comprehensive, seamless care. And specialists can give just-in-time advice to primary care colleagues that supports high quality patient care.

While there is still much to do to enable all people in Canada to benefit from these solutions, the teams who took part in the Collaborative are shining a light on the path to make more improvement available to more people. At CFHI, we look forward to continuing to work shoulder-to-shoulder with these teams and other committed to shaping better healthcare for everyone in Canada. Want to join us? Please explore our opportunities to work together, in primary care and other aspects of the health system, toward the improvement goals we share.