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Study: Primary Care Doctors Increase Life Expectancy, But Does Anyone Care?

April 14, 2019

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Robert Pearl, M.D.
Contributor

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In a shocking development that could transform the medical profession, the International Journal of Health Services published the findings of a study titled, “Primary care, specialty care, and life chances.”

Using multiple regression analysis, the researchers concluded that “primary care is by far the most significant variable related to better health status,” correlating with lower mortality, fewer deaths from heart disease and cancer, and a host of other beneficial health outcomes. By contrast, and perhaps equally deserving of shock-value, the researchers determined “the number of specialty physicians [i.e., surgeons, cardiologists, orthopedists, etc.] is positively and significantly related to total mortality, deaths due to heart diseases and cancer, shorter life expectancy,” along with a host of other worrisome health outcomes.

What might these findings mean for the future of medical care?

“From a policy perspective, a likely implication is to reorient the medical profession from its current expensive, clinically based, treatment-focused practice to a more cost-effective, prevention-oriented primary care system,” according the study’s research abstract, which was published July 1, 1994.

That’s correct, the study was published 25 years ago.

This isn’t a belated April Fool’s joke. It’s a reminder of medicine’s reluctance to change in the face of powerful data. Instead of acknowledging the inconvenient facts and heeding the conclusions of the study, the healthcare system hasn’t budged in the last quarter century.

As a result, our nation’s primary-care problem has only gotten worse. So, too, has the health of American patients.

The most recent study to analyze the value of primary care – published February 18, 2019 in JAMA Internal Medicine – not only confirms decades of prior research, but also spotlights troubling trends in workforce planning, physician reimbursement and residency training.

Read more »

Want more family doctors? Change how they work and get paid, says B.C. researcher Social Sharing

March 24, 2019

Many grads ‘don’t want to run a business — that’s not what they went to medical school for’

Maryse Zeidler · CBC News · Posted: Mar 24, 2019 7:30 AM PT | Last Updated: 9 hours ago

Dr. Rita McCracken, left, with a patient at a nursing home she works at. McCracken wants the province to provide more team-based care for patients. (Providence Health Care)

Dr. Rita McCracken, left, with a patient at a nursing home she works at. McCracken wants the province to provide more team-based care for patients. (Providence Health Care)

A Vancouver doctor says the tentative agreement British Columbia recently reached with the province’s 14,000 doctors doesn’t do enough to change family medicine and address what she describes as a crisis in primary care.

Dr. Rita McCracken, a physician and University of British Columbia researcher, says the agreement doesn’t include newer ways for doctors to work and get paid.

“The care that has been provided through the old system has, by and large, been pretty good care,” McCracken said.

“We’re seeing that other systems might be better for population health.”

‘A sense of urgency’

Currently, most family doctors in B.C. are paid about $30 per patient visit — whether they’re treating a cold or a complex health problem.

Physicians run their practice as a business, and pay out overhead costs like staff and office space at an average rate of about $60 per hour or more.

SECOND OPINIONCanadian health care’s ‘one issue per visit’ problem

McCracken says many doctors want to work instead as part of a team of health-care practitioners like nurse practitioners, physiotherapists and social workers who are paid by salary to provide care for a community.

The province would fund the clinic and the health practitioners would draw a salary.

McCracken’s UBC research shows about half of the province’s doctors would prefer that approach — especially younger doctors.

“A lot of new graduates have commented to me that they don’t want to run a business — that’s not what they went to medical school for,” she said.

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New physicians are avoiding family practice and finding jobs that do pay on salary, McCracken says — like working directly for hospitals. That shift, she said, contributes to the province’s family doctor shortage.

The tentative agreement does include the possibility of moving towards more salary and team-based pay, but McCracken says that’s not enough.

“I think there is a sense of urgency, and British Columbians need more family doctors,” she said. “More of the same old model is 

not going to increase the availability of good primary care.”

‘A small bandage’

West Vancouver family physician Dr. Maryam Zeineddin agrees those new models are attractive, and beneficial.

However, she says there needs to be some provisions for the majority of doctors currently operating under the pay-per-visit model.

“I think the agreement is the beginning of something,” she said. “At least it will give us some relief of pressure.”

SECOND OPINIONWhy is $350,000 in Canadian aid being used to send homeopaths to Honduras?

Overhead costs like staff and offices have increased exponentially in the last few years, Zeineddin says, whereas provincial payment rates haven’t.

“This is probably one of the better agreements that I’ve seen in 15 years,” she said.

“The system is at a complete bleeding period — a small bandage may not be enough. But at least as a bandage, at least there’s some form of stopping the bleeding.”

New centres in Burnaby

Doctors of B.C., the association that represents the 14,000 physicians, residents and medical students in the province, and the Ministry of Health refused to comment on the issue because the agreement has yet to be ratified.

But the province noted that it has indeed opened team-based primary care centres, like the three it recently announced in Burnaby.

Health Minister Adrian Dix said in a written statement that the centres will be “the backbone of the new primary-care system in B.C.”

SECOND OPINIONPrivacy: A hole in the virtual medicine cabinet

McCracken acknowledges that there are a handful of primary care clinics operating under the team-based model, but said there are too few of them and more needs to happen now.

“I really want any British Columbian who wants access to a family doctor to be able to get it, and I think we need new models of care delivery for that to happen,” she said.

ABOUT THE AUTHOR

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Maryse Zeidler

@MaryseZeidler

Maryse Zeidler is a reporter for CBC News in Vancouver, covering news from across British Columbia. You can reach her at maryse.zeidler@cbc.ca.

 

Rx Community: Social Prescribing

March 15, 2019

 

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What would it look like for the healthcare system to see a patient as a whole person, instead of focusing on just their medical diagnoses? What if, along with medication, doctors and nurse practitioners were enabled to prescribe dance lessons, cooking classes, volunteer roles, caregiver supports, single-parent groups, and connections to bereavement networks?

This kind of “social prescription” is sweeping across the United Kingdom and gaining international recognition. That’s because what makes people healthy isn’t just genetics and lifestyle choices. Access to healthy food, education, employment, income, and opportunities for connectedness all have significant impacts on a person’s overall health and wellbeing. Good clinicians know this, and need a trusted system to turn to for the issues their clients face that are outside the providers’ medical expertise, time, or mandate.

Read more »

Recommendations on a national pharmacare program

March 6, 2019

Good news. First steps on Pharmacare. “The recommendations in today’s report have the potential to increase access and move to lower costs if implemented alongside a universal, national, public pharmacare program,” said Hassan Yussuff, President of the Canadian Labour Congress. 

“The creation of a national drug agency and the development of a comprehensive, evidence-based national drug formulary are significant changes that will move Canada in the right direction,” said Yussuff.  “Delivering this through a pharmacare model designed similarly to Medicare will ensure that everyone, no matter where they live, has access to the medications they need, as they do right now with hospitals and doctors,” he continued.

http://canadianlabour.ca/news/news-archive/canadas-unions-welcome-first-steps-pharmacare

The Time has Come for a National Pharmacare Plan

February 25, 2019

Pharma

Nobody should be forced to choose between paying for groceries and paying for the medication they need.

Send a message to your Member of Parliament. Ask them to support establishing a universal national prescription medication system to provide coverage for everyone in Canada—regardless of their income, age, or where they work or live.

It only will take a few seconds out of your busy day.

You can also find out: 1. how many Canadians support a National Pharmacare plan and 2. why pharmacare makes economic sense, as well as other answers to your question.

OK, the answer to the first question is: 91% of Canadians 

http://www.aplanforeveryone.ca/mp?utm_campaign=unopened_february_test_b_2&utm_medium=email&utm_source=canadianlabour

February 5, 2019

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Our AGM was held on January 20, 2019. The following people were elected to the 2019 Board of Directors:

President – Ed Staples
Vice President – Bill Day
Secretary – Nienke Klaver
Treasurer – Jon Bartlett
Directors – Lynn Wells, Rika Reubsaat, and Frank Turner 

SOHC 2019 Board

A few highlights from ‘Our Year in Review’

Research Projects:

  • SOHC participated in a research study exploring community level recruitment and retention of health professionals in rural BC communities. This research is part of the Rural Evidence Review project at UBC Vancouver and involved several communities in the BC Rural Health Network.
  • Kathy Rush and Michael Chiasson (UBCO researchers) shared a Summary of Findings and Key Activities from the research they conducting into theEntrepreneurial Activities of Citizen-Led Coalitions in Supporting Rural Older Adults in Healthcare. SOHC was one of the participants in this research project.
  • Members of the SOHC Executive attended the Rural Health Services Research Conference in Nelson, May 30 – June 1. Of great interest was the presentation by Jude Kornelsen on the Rural Catchment Project: Strengthening local evidence through a catchment methodology that outlined concerns about the organization of geopolitical areas that do not necessarily reflect the natural population catchments of rural communities
  •  In July, SOHC attended a Group Community Meeting at Princeton General Hospital as part of the BC Rural Site Visits Program conducted by the Rural Coordination Centre of BC. The purpose of the meeting was to gather information on the healthcare service challenges in our community.

Read more »

A Photo Exhibit to Share the Results of the Rural Mental Health Photo Voice Study

January 15, 2019

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Photographer: Nola

Photographer: Nola

How does it feel to be an older adult with a mental health concern in a rural community?

“You have to watch what you say, you never know how it will affect someone. When people cross the street to avoid me, I can’t stop thinking about it.

Mental health is a major health issue in Canada. With our aging population, mental health concerns are increasing in this age group. The number of adults 50 and over continue to increase, especially in rural areas, and there is little information about their experiences with mental health concerns. Our research sought to understand the experience of adults 50 and over with mental health concerns in rural areas. Princeton was chosen for our research due to its location and demographics; in Princeton, 55% of people are 50 or older, and 82% of the population qualify as low income. We looked at this age because of significant, common transitions that affect mental health (e.g., new physical health conditions, retirement). Eight participants were a part of this research study and all had a mental health concern. Read more »

BECOME A MEMBER

To become a member of SOHC, please
email the secretary.
Annual membership is $2.
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SOHC Discussion Paper

Developing an Improved and Sustainable Health Care Model for Princeton, B.C
Support Our Health Care has released a discussion paper in order to get feedback from the community, politicians and professionals about the state of local healthcare and what the long term solutions should be.
Download PDF Here