Dr. Zitner thank you for stimulating some thinking about Primary Health
Care. Within the current discussion, I would like to add a model of primary
care that often gets overlooked in the primary care discourse.
I work in a Community Health Centre where multidisciplinary teams of
professionals are all paid a salary (FPs, NPs, social workers, chiropodists,
psychologists, dieticians, health promoters, mental health workers etc.) The
MOH funding costs are therefore predictable, teams work collaboratively, the
focus is on health promotion, illness prevention, treatment and community
development. It is a model that has been heralded by Mr. Romanow, Dr.
Michael Rachlis and others...including anyone who partners with, works in,
uses or values multidisciplinary team practice...
CHCs are more than doctors' offices. They are hubs of community based care
and community capacity building activities. They operate with from a
holistic perspective, work with acute and chronic illness, offer 24/7
access, are community-controlled by Boards of Directors and therefore
accountable to and close to the communities in which they were created.
Their focus in urban settings is on individuals with issues of access to
primary health care. In rural and Northern communities they are often the
only game in town. They reduce isolation for practitioners and
patients/clients alike, offer a mix of social and health services and often
work with the most disenfranchised, medically/mentally complex, non-insured
and immigrant communities because we have salaried practitioners. In the
case of outbreaks of concern to public health e.g.TB, SARS, they can move
quickly to reach the unreachable to inform, connect, translate and inoculate
with Public Heath support.
CHCs are products of and advocates for the Canada Health Act, adhere to the
WHO definition of health, and function within a social and health
determinants perspective. The sooner we acknowledge that a broad definition
of primary health care includes Nurses, Nurse Practitioners, Social Workers,
therapists etc. and Health Promotion working in true multidisciplinary,
well -resourced, partnerships with doctors, the sooner we will shift our
concentration from an illness-focused, primarily fee for service system, to
one which promotes building healthier, integrated communities, able to
manage chronic health, social and environmental challenges.
-----Original Message-----
From: Social Determinants of Health [mailto:[log in to unmask]]On Behalf Of
Langill, Corrine
Sent: Wednesday, April 07, 2004 3:09 PM
To: [log in to unmask]
Subject: Re: [SDOH] Primary Care Cooperatives
I was fascinated to read how Dr. Zitmer attempts to co-opt the words of
Tommy Douglas into support for his Primary Care Co-operatives scheme.
Canadians DO make significant contributions to the health care system (which
is, in fact, an illness care system...but that's another posting!), through
our taxes. Dr. Zitmer uses this quote out of context, in my opinion.
I was also struck by Dr. Zitmer's characterization of nurses as
'professional assistants' to physicians, who allow physicians to 'specialize
in higher value activities'. Dr. Zitmer may be surprised to learn that
nurses (along with other regulated health professionals in Canada) have an
established, self regulated scope of practice independent of medicine. I'm
sure that many would question the 'higher value' of activities provided by
physicians. The health of Canadians is promoted by the collaborative work
of many disciplines; with differing approaches, but certainly of equal
value. I'm sure that many physicians would agree that an activity is not of
higher value simply because it is provided by a physician. Perhaps access
to care would be improved if Nurse Practitioners and other regulated health
professionals could be fully reimbursed for their services by provincial
Health Programs. Physicians currently monopolize this billing process, and
are rigidly opposed to opening this up to any other health profession.
I also wonder to whom these proposed monthly fees would be payable?
Physicians? The nurses who provide the service? I find it hard to believe
that anyone's health would be improved by renewing prescriptions by phone,
or getting lab results by email (most people would need to have such results
interpreted for them anyway). People in Ontario already have access to
health information through a provincial telehealth phone line, staffed by
nurses. Many Health Units also provide the same service. Dr. Zitmer seems
to be proposing that people pay more for services that already exist.
I suggest that Health dollars would be more wisely spent by shifting focus
from 'illness care' to those approaches that can prevent visits to
physicians offices and hospitals in the first place.
Corrine Langill RN, BscN
Adolescent Health Specialist, Program Development
City Of Ottawa, Community Services Branch
495 Richmond Rd.
Ottawa, ON
K2A 4A4
(613) 724-4122 ext. 26258
fax: (613) 724-4148
[log in to unmask]
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