By DAVID ZITNER (AIMS Senior Fellow)
Modern health systems enable convenient health care by bringing medical skills and advice to patients.
“Last year half of consultations offered by Kaiser Permanente, an American health care organization, were not face-to-face. Medical professionals communicated with patients by phone, e-mail or videoconference.” (Economist, April 8, 2017).
The April 3, 2017 issue of the Canadian Medical Association Journal reported that people with better access to personalized primary care have fewer heart attacks, fewer strokes, lower cardiovascular death rates, and better blood pressure control.
They also report that women who have access to local obstetrical services have shorter hospital stays and are less likely to use epidural anesthesia. There was no increase in adverse events during labor and delivery when obstetrical care was provided by low volume local facilities.
Seniors and children benefit and are less likely to die when they have convenient access to primary care.
Centralizing services might be cost saving to government, but inconvenient, expensive and harmful to patients.
Janet Knox, CEO of the Nova Scotia Health Authority emphasized the important role of the Department of Health in the failing Nova Scotia primary care experiment. She said “the role of the health department is to fund the health system, set overall direction, and monitor progress”.
Nova Scotian health workers and the general public are alarmed when the health department fails to notice or act on the lack of progress and the failures of the Nova Scotia Health Authority.
Kaiser Permanente succeeds, in part, because they hire people who implement simple but important ideas related to networking and standards. Primary care in Nova Scotia is flailing and failing because the Health Authority and regulators seem to ignore or misinterpret important ideas about networking and standards.
Networking and Primary Care: The Nova Scotia Health Authority, without a mandate from Nova Scotians, is regulating and reducing the places where doctors can practice. The Authority is preventing clinicians from working in areas of high demand. Communities cannot recruit replacements for retiring physicians.
Instead, the Authority claims to support collaborative care clinics where several professionals work out of the same location.
Most patients do not need a team to care for most problems and health workers have always collaborated when necessary.
Your doctor always relied on formal and informal networks of experts. She called a dietician, physiotherapist, medical specialist or social worker if you needed one.
About 10% of patients, mainly people with chronic disease regularly need advice from several different disciplines. An expensive and inconvenient way to achieve this is to encourage primary care nurses, or dieticians, or psychologists to share office space all of the time.
A better way is to invite different practitioners to come to a practice periodically to care for people who need a team. Rather than have all patients travel to a central location defined as convenient by the Nova Scotia Health Authority the health professionals would do the traveling to care for people who need more than one type of advice.
Worthwhile networks enable health professionals to network and function to their full capacity. Patients would have teams whenever necessary.
Information Technology Networks and Standards:
As the Health Authority promotes multi-tiered care some Nova Scotians have around-the-clock telephone, email, and voice mail access to their doctors and health information. Others cannot find a family physician. Most Nova Scotians do not have convenient access to their own health information.
Health information experts recognize the importance of standards in developing health information networks. You can send e-mail messages or communicate with banks and retail stores regardless of which computer you own or which browser you use.
Rather than accept international standards the Nova Scotia Department of Health insists on selecting the particular companies that will support primary care offices. This antiquated position means that patients and clinicians cannot choose and use the systems they find most convenient and cost-effective.
Nova Scotians are harmed when the Health Authority mulishly sticks to a path that reduces access to personalized primary care while the Department of Health neglects its responsibility to enforce standards and report on progress.
David Zitner, MD is a Senior Fellow at the Atlantic Institute for Market Studies (AIMS.ca).