From globeandmail.com, Tuesday, December  3, 2002

Community medical clinics 'are the best-kept secret' in the health-care system

ANDRÉ PICARD



OTTAWA -- Like an old-fashioned country doctor, Julie Jenner does it all.

Last week, she delivered a baby, was at the bedside when a terminally ill
patient died, performed minor surgery, did some psychiatric consultations and
tended to dozens of her regular patients, from newborns and their moms to
seniors.


"I do the full spectrum of care and I love it. It's very satisfying," Dr. Jenner
says.


She doesn't practise in the country, but in downtown Ottawa, just a few blocks
from Parliament Hill. And she isn't a fee-for-service practitioner, but a
salaried doctor, employed by the non-profit Centretown Community Health Centre.


Unlike the country doctor of old, Dr. Jenner is also part of a multidisciplinary
health-care team that includes nurse-practitioners, physiotherapists,
nutritionists, lactation consultants, counsellors and social workers.


In fact, only a fraction of the patients who come to the clinic actually see a
doctor. The majority are treated by a nurse or a nurse-practitioner who has the
ability to diagnose, order laboratory and diagnostic tests and prescribe drugs.
Here, the approach Roy Romanow touted as a way to relieve the burden on
overworked family physicians works like a charm.


Silvana Rotili, who worked previously as an outpost nurse in the Far North --
where she did everything from delivering babies to patching up trauma patients
because there was no doctor -- likes the responsibility, but she also likes
being part of a team. She thinks it makes for better caregivers, and better
care.


"I don't think there's any doubt that our outcomes are better."


Dr. Jenner agrees. "I feel that we provide the kind of care that patients need
and deserve." She feels the approach is more efficient because
nurse-practitioners can handle a lot of things that are routine for family
physicians; she can concentrate on more complex cases and invest time in doing
preventive care that will pay dividends in the long run.


Critics say the approach, with salaried doctors and nurses, is more costly and
inefficient, but Dr. Jenner -- who has worked in both models -- disagrees.


"I certainly don't see as many patients as I would in a fee-for-service
practice. But we provide much better care here than the five- to 10-minute
visits that the fee-for-service setting allows." She also sees many patients who
would otherwise fall through the cracks.


While community health centres reach out to challenging groups such as the
homeless, people with HIV-AIDS, refugees and isolated seniors, they have varied
clienteles. Centretown CHC, for example, caters to Centretown, one of Ottawa's
poorest neighbourhoods, and the Glebe, one of its wealthiest. It also attracts a
lot of government employees and street people, both of whom are plentiful in the
catchment area.


Ken Hoffman, a long-time patient, says "CHCs are the best-kept secret in health
care." Because the staff is salaried, he feels the care is unhurried, but
efficient.


But Mr. Hoffman's frustration is that the health centres do not operate around
the clock, seven days a week; currently, they don't have the funds to open
evenings or weekends.


There are 66 CHCs across Ontario, and 104 other communities that have made
formal requests to get their own centre.


While CHCs are often compared to CLSCs, the network of community health clinics
across Quebec, they are quite different because they are not state institutions
but private, not-for-profit clinics administered by community boards, though the
bulk of their funding comes directly from the Ministry of Health.


In addition to medical care, the CHCs are community hubs. Down the hall from the
Centretown clinic there is a community kitchen, a playroom for children, a
drop-in centre for homeless people, a computer room for job seekers and meeting
rooms that are always full.


The centre does citywide diabetes education, runs a substance-abuse program for
seniors, a cancer-screening program for Hispanic women, a laundry co-op, and
hosts seniors exercise classes, parenting classes, gay and lesbian youth groups,
and all kinds of volunteer endeavours, including a group that promotes sidewalk
safety and shovels the walks of local seniors.


Marguarite Keeley, the executive director of the Centretown CHC, says the model
is precisely what Mr. Romanow is advocating in his report.


But while the CHCs continue to be touted as an ideal model for primary-care
reform, they operate at the fringes of health-care delivery, more curiosity than
an integral part of the health system.


Ms. Keeley says that is a constant frustration.


"Romanow talks about how it is important to keep people healthy longer. That's
our approach, to go beyond critical care and tackle the determinants of health,"
she said.


"Our model works marvellously -- it keeps people healthy and it builds community
-- but nobody seems to be listening."


She hopes the emphasis on primary-care reform in the new report will change
that.


As Mr. Romanow said: "We need to extend that team approach to primary care, so
that patients receive the right care, at the right time, from the right
professional."






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