Funding:
As the population of Canada ages, there is an increasing need for changes in the healthcare system to meet the increase in chronic diseases. It’s been proven that having primary health care (PHS) professions working in a team approach will result in better health outcomes, improved access to services, improved used of resources, and greater satisfaction for both patients and providers. (Government of Canada, 2007). In an effort to modernize the health care system, it was determined that improvements to the PHS was required. In 2000, the federal government announced the launch of the Primary Health Care Transition Fund (PHCTF). From 2000 to 2006, the PHCTF provided $800 million to provinces, territories, and health care system stakeholders to assist in the development and implementation of new models of PHC delivery. (Government of Canada, 2007). Provincial/territorial initiatives that recognize a need to engage primary care physicians not just as necessary participants but necessary leaders in CDM could be described as having achieved broader and more sustainable success. (Government of Canada, 2007).
As chronic diseases rates increase nationwide, it’s important to note the concepts of chronic disease prevention (CDP) and chronic disease management (CDM). In accordance to the PHCTF launched in 2000, the government of Ontario acknowledged that improvements to the PHC were required in order to optimize health services. Ontario and Alberta collaborated with the Canadian Home Care Association to conduct the National Home Care and Primary Health Care Partnership Initiative. The focus of this program was to include case and disease management approaches for people with chronic disease. (Government of Canada, 2007). This program aimed to look outside the traditional clinical partnership between the family physician and home care case manager as it also looked to collaborations with other stakeholders to providing patients’ additional resources for care. The role of homecare was augmented to include case and disease management approaches for people with chronic disease – including application of care plans and use of IT and decision supporting tools. (Government of Canada, 2007). The main takeaway from this initiative was that by having an effective care plan with IT solutions in place, it will ultimately result in minimizing system barriers. (Government of Canada, 2007).
Ontario:
With the funding from the PHCTF, Ontario launched PHC renewal initiatives in an effort to:
Improve access to PHC
Improve the quality and continuity of PHC
Increase patient and provider satisfaction
Boost the code-effectiveness of PHC Services
Over the four years of the initiative, Ontario focused on:
Supporting physician and patient enrolment in other PHC models
Developing and implementing information technology systems, including a decision support and a workflow management system
Developing several resources for patients and providers
Developing a new curriculum to build knowledge and skills in continuous quality improvement and interdisciplinary collaboration
Designing a new accreditation process
Alberta:
Alberta, on the other hand, was able to establish objectives of its own with the funding from the PHCTF:
Develop and integrate innovative health promotion, disease and injury prevention and chronic disease management programs
Develop, support, and use integrated care models and other innovative service delivery methods
Develop and implement effective change management strategies at regional and provincial levels
Establish and implement education and training services to support new models of service delivery
Identify and develop infrastructure that supports the delivery of PHC
Chronic Disease Management (CDM)/Chronic disease Prevention and Management (CDPM):
Ontario The Ministry of Health and Long-Term Care (MOHLTC) has developed a policy framework to guide redesign of health care practices and systems to improve chronic disease prevention and management in Ontario. The Ontario Chronic Disease Prevention and Management (CDPM) Framework (see image below) is an approach to CDPM that is evidence-based, population-based, and client centered. It supports health care system changes from one that is designed for episodic, acute illness to one that will support the prevention and management of chronic disease. (Government of Ontario, 2007)
The Framework’s approach to chronic disease prevention and management is based on the Chronic Care Model (CCM) developed in the U.S, and British Columbia’s ‘Expanded Chronic Care Model (ECCM). (Government of Ontario, 2007). The aim of this model is to provide effective chronic disease management by addressing the needs of those with chronic disease(s) while providing a multifaceted, planned, pro-active seamless care, while ensuring the clients are full participants in managing their care and are supported to do this at all points in the system. Ontarians with chronic conditions will experience a change both in their care and their disease management. They will become equal partners in their own health and full collaborators in managing their conditions, and they will be supported in this. (Government of Ontario, 2007). Prevention in the Charter includes interventions both to reduce the risk of disease among chronically ill individuals and individuals at high risk of developing disease, as well as broad initiatives to improve health within the population as a whole and prevent new cases of chronic disease from occurring. (Government of Ontario, 2007).
The Charter identifies five action areas in which to do this:
Development of personal skills necessary to staying healthy
Re-orientation of health services to greater health promotion and disease prevention
Building public policies that promote health and prevent disease
Creating environments supportive to health
Strengthening community action.
British Columbia
The Primary Health Care Charter (the Charter) reflects the growing prevalence and impact of chronic disease, and places strong emphasis on populations living with chronic disease and those at risk. The Ministry of Health’s Service Plan, the Medical Services Division’s Strategic Plan, health authority plans and the B.C. government/British Columbia Medical Association negotiated agreement have all underscored the need to shift the system from an acute/episodic orientation towards planned/proactive care. (Government of British Columbia, 2007)
The Charter sets out the following principles and methods that define and reflect the work in and for British Columbia:
Improving patient health outcomes will drive what we do.
Patients and families assume the role of partners in their care.
A population-based approach will ensure inequities and needs are identified and addressed.
We will re-orient health services to align with the patient’s journey through a patient-centred, integrated health system.
Family physicians are the cornerstone of primary health care. They are part of a broader community network and professional team that includes nurse practitioners, public health staff, community nurses, midwives, pharmacists, mental health professionals, clinical counsellors, physiotherapists, chiropractors, home and community care workers, dietitians, specialists, and many other health professionals and non-governmental organizations who work as a team with patients and their extended families. Patients should receive accessible, appropriate, efficient, effective, safe quality care at the right time in the right setting by the right provider.
Patients and their clinicians must receive key information to make informed decisions at the point of care, and decision support also must be available for managing patient populations.
We will implement the Expanded Chronic Care Model through structured collaborative approaches because this model has derived the best results in clinical improvement and system change in B.C.
To achieve the desired results of improved individual and population health outcomes, efforts must be focused on transforming three areas: clinical care, practice and system design, and information technology (Government of British Columbia, 2007)
This primary health care transformation model outlines the Charter’s component objectives and guiding principles:
The Primary Health Care Charter aims to improve individual and population health outcomes. Value for patients is the central premise of the Charter’s agenda.
The focus on priority populations recognizes that targeted approaches for high-risk populations will reduce inequities and yield the greatest overall benefit.
Clinical transformation identifies the most significant gaps in care, and outlines quality improvement initiatives across a wide range of stakeholders to close the gaps to improve outcomes for patients.
Practice and system transformation proposes mechanisms to align funding and business models (such as group practice and team care) to the needs of the population.
Information and technology transformation identifies initiatives to provide health care information that is accessible, when and where it is needed.
Stakeholder coalitions, negotiations and relationships recognize that system change requires the active involvement of many stakeholders.
The current B.C. government/BCMA agreement (the Agreement) is a significant part of the Charter’s context. Components of the Agreement align with and support each of the seven priorities described in the Charter. In addition, the Agreement includes dedicated practice support funding for family physicians and their office staff to identify and work toward goals for improved patient care and outcomes relevant to their own local practice populations. (Government of British Columbia, 2007). One initiative, The Practice Support Program teams, is aimed at having physician champions and local family physicians collaborating to provide better health outcomes and improving health providers professional satisfaction. Along with these programs, additional IT supports for family physicians will assist in providing improved clinical management and decision support at point-of-care and population levels. Both of these are essential to monitoring and improving primary health care’s progress toward the health outcome and system goals outlined in the Charter. (Government of British Columbia, 2007)
Resources:
British Columbia, G. of. (2007). Primary health care charter - ministry of health. British Columbia Ministry of Health. Retrieved March 6, 2022, from https://www.health.gov.bc.ca/library/publications/year/2007/phc_charter.pdf
Canada, H. (2007, March). Chronic Disease Prevention and Management. Canada.ca. Retrieved March 5, 2022, from https://www.canada.ca/en/health-canada/services/health-care-system/reports-publications/primary-health-care/chronic-disease-prevention-management.html
Ontario, G. of. (2007, May). Preventing and managing chronic disease: Ontario’s framework. Government of Ontario. Retrieved March 6, 2022, from https://www.health.gov.on.ca/en/pro/programs/cdpm/pdf/framework_full.pdf
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