Teams in Action: Primary Health Care Teams for Canadians

Joe, 60, has diabetes, high blood NO pressure and arthritis. He says that shuttling around town to various health appointments is like a full-time job.

“I’m never sure how much these people talk to each other,” he adds. “I worry that something’s going to get missed somewhere.”

Health concerns — and sometimes just anxiety about his health — have driven Joe to the emergency department more than a few times. His wife adds that Joe doesn’t always follow what he has been told by the different health care professionals about taking care of himself. “I think he’s overwhelmed and depressed,” she adds. Joe isn’t alone. This scenario, and others similar to it, face Canadians across the nation every day.

There is, however, a model of care in Canada that would likely benefit Joe -and many others suffering from chronic health conditions: The Primary Health Care Team. On April 30, the Health Council of Canada released its latest report, titled Teams in Action: Primary Health Care Teams for Canadians, in an attempt to shed light on the state of teams in Canada.

In 2004, as part of a nationwide health accord, all governments committed to ensure that 50% of Canadians have access to multidisciplinary teams for primary health care by 2011 — only two years away. Governments have recognized that, as our population ages, chronic conditions are becoming (and will become) more and more of a challenge for health care delivery. Millions of dollars have been earmarked to support the new model of care.

Broadly speaking, teams are described as two or more health professionals working together in a coordinated, integrated effort to provide a patient’s basic health care.

Research has shown that team-based care offers more comprehensive care and faster access to a range of health care professionals, all working closely with one another and coordinating the services you need. In addition, doctors who are part of a team can focus their time on specific medical issues, allowing other health care professionals to provide their own expertise. This may include areas like patient education on healthy living, or how to manage chronic conditions over time more effectively.

Patients who receive care from teams report that they are more satisfied, knowledgeable, and better skilled in managing their own health conditions.

Now, what do teams REALLY look like across the country?

It’s hard to give a simple answer. The specific makeup and definition of a primary health care team varies among the provinces and territories, with innovative and promising efforts in place across Canada. Many teams are in place in rural and remote areas and many are used to provide after-hours access to care. Every province and territory has developed teams tailored to managing chronic diseases, like diabetes or heart disease. There is also a significant level of activity to use teams to reach out to vulnerable or high risk populations struggling with problems such as poverty, language and cultural barriers, or disabilities.

But with so many different approaches, and varying combinations of health professionals serving on the teams, it’s hard to reach conclusions about which types of teams are most effective. The theory behind team-based care is that with increased health promotion and chronic disease management provided by teams, Canadians’ health will improve and their use of other health services, such as costly hospitalizations, will be reduced.

Some results show this certainly can happen. In B.C., for example, team-based diabetes management has led to a drop in diabetes complications and, therefore, fewer emergency visits and hospital stays. As a result, provincial costs for diabetes care dropped from an average of $4,400 per patient in 2001/2002 to $3,966 in 2004/2005.

There is enough promising evidence from B.C. and elsewhere to be able to recommend that teams be used to improve the way chronic diseases are managed and to care for people with mental health issues. Many provinces and territories are doing this. What we do not know yet is whether teams offer similar benefits to the general population.

Governments need this information to know how to use team-based care most effectively — to make sure it is being offered to the people who will benefit the most. And they need to know whether teams offer good value for money to the health care system.

The Health Council of Canada believes that team-based care has significant potential to improve the health of Canadians. Nevertheless, governments need to make sure that their current efforts are evaluated to determine what types of teams work best, where they offer the greatest benefit to patients and where they provide the most value for money in the health care system.

The Health Council would like to hear from patients and their families about their experiences with and opinions of teams. We invite Canadians to join the discussion at www.healthcouncilcanada.ca. See you there!

By: John G. Abbott

CEO, Health Council of Canada