Feature Article March 13, 2002
LAND O' LAKES NewsWeb HomeContact Us
Sharbot
Lake Medical Centre in the forefront of reforms of primary health careby David Brison
Dr.
Peter Bell and Nurse Practitioner Mary Woodman of the Sharbot Lake
Medical Centre were on the road this week, and that doesnt mean
that they were making house calls.
They were talking to groups who are interested in some recent
developments that are in the works at the medical centre.
On Tuesday morning, March 5, Peter and Mary were in Toronto to
give a talk to the Ontario Hospital Association (OHA) meeting on the
collaboration between physicians and nurse practitioners.
Later, on Tuesday night, Peter was part of a panel at City Hall
in Kingston, with two other family physicians, which addressed the
issue of access to primary care.
The forum was titled, Is there a doctor in the house?
The provincial, and to some extent national, spotlight is on the Sharbot Lake Medical Centre. It was chosen in the spring of 1998, along with six other sites, to be part of a pilot study of primary care reform in Ontario. Sharbot Lake, along with Verona, Tamworth, Sydenham, and Newburg are designated as the Kingston Rural site initially the only rural site in the province-wide provincial pilot.
The reform of primary care (defined as the first contact that people have with the medical system usually with a family physician) was introduced by the Ontario government in their 2000 Budget. The budget described the governments goal to have, in the next four years, 80% of the family doctors in Ontario practicing in networks of family physicians.
The pilots were set up to demonstrate and evaluate how these networks might operate.
In January 2002, the Ontario Medical Association (OMA) voted to allow the government to offer family doctors a contract to join Family Care Networks in their communities. The Ontario Family Health Network (OFHN), an organization independent from the government, is meeting with family physicians throughout the province to present the goals and objectives of family care networks. Dr. Ruth Wilson, Chair of OFHN, will be orchestrating these presentations. It is expected that she will draw on the work done in the pilot sites, and in the case of rural areas, will make reference to the Kingston rural site and some of the distinctive features of the Sharbot Lake clinic.
In some respects, the Sharbot Lake clinic, which serves a geographically large but sparsely populated area in Frontenac County, already had some of the characteristics of the new Family Care Networks. Dr. Bell came to Sharbot Lake in 1971, and shortly after that time, became part of a system which funded doctors differently. Instead of being funded on a fee-for -service basis, which pays a doctor for each visit he or she has with a patient, the Sharbot Lake clinic was funded on the basis of the number of patients in their area that signed on to a roster. This method of funding is known as a capitation system, and is a key element of the new Primary Care Networks.
Capitation funding is controversial. The reason why it is part of reformed family care, is the idea that doctors will use their time more effectively if they can focus their efforts on what needs to be done to keep a person healthy and treat illnesses, rather than earning their salaries through fees for each service they provide. Many family doctors on a fee-for-service maintain that their practice is actually not shaped by how they are paid. They say that they still focus on what needs to be done to treat illnesses and keep a person healthy. This is an issue that we will examine in future articles.
Another feature of the Primary Care Networks, which has been introduced in Sharbot Lake, is 24-hour access. The clinic is now open from 9 a.m. to 8 p.m. Monday to Thursday, and from 9 a.m. to 5 p.m. on Friday. Appointments are necessary during these hours. There is a Saturday clinic from 10 a.m. to 2 p.m. for urgent and emergent problems, for which appointments are not needed. Emergencies are also accepted during the regular weekday office hours.
When the clinic is closed, patients calling in are referred to a Telephone Triage service. A nurse practitioner goes over the problem with the caller and either directs the person: to go to the nearest emergency department; to wait until the morning and contact the clinic; or tells the caller that a physician will call them back.
In many parts of the province, patients cannot contact their family physician outside of office hours and have to go to emergency departments. In Sharbot Lake, a doctor has always been on call and when necessary has gone to the clinic to see patients after hours. This has placed a very heavy after hours load on doctors and is one of the factors that have made it hard to attract family doctors to rural areas.
The effect of the new ways to provide after hours care will be examined in more detail in future issues.
A big change in the way health services are now provided in Sharbot Lake is the new role of the nurse practitioner. Mary Woodman has been full time at the Centre since February 2000. She had been at the clinic during her nurse practitioner residency prior to that. When Peter Bell was negotiating his agreement for the pilot study with the government, he asked that the clinic be assigned a full time nurse practitioner. Sharbot Lake is the only clinic in the Kingston rural network that has a full time nurse practitioner (another is shared with other clinics in the network), and the ratio of physicians to nurse practitioners is much lower than the ration at any of the other pilot sites.
Marys role in the clinic, the subject of Peter and Marys talk to the OHA in Toronto, will be the subject of another article in this series on primary health care. However, much of what she does is already obvious to those who have attended the clinic since she has arrived. She takes one out of every four of the extended office hours (Monday to Friday), and runs one out of four of the Saturday clinics. One of Marys special areas of interest is womens health and in this area she is often the first contact for many patients. She takes a lead in preventative measures such as immunizations and screening procedures such as mammograms. Nurses are experts at managing care and as part of a team with doctors (including a Queens family practice resident who is assigned to the clinic), and the office staff, she fully participates in the management of health care in the clinic. Her duties are defined by the areas of expertise she brings to the task and governed by provincial legislation. She is able to consult with others when she is not knowledgeable about a presented problem.
Another feature of the new primary care networks is that patient records are now computerized. The process has been difficult (Peter Bell had to learn how to type he still uses the two finger system) but it is on line within the clinic. However, specialists records are presently not sent electronically and are therefore not yet incorporated into the paperless record system at the clinic. However, lab results are now sent electronically and immediately become part of the paperless recording system.
Some of the issues related to the computerization of medial records will be examined in future issues.
One of the problems with health care that is most troubling to users of the system is that there isnt a doctor in the house when an emergency occurs. New residents moving into Kingston cant get a family doctor and the same is true for some of our rural areas such as Cloyne and Northbrook. Nobody in the area gets turns down at the Sharbot Lake clinic. How primary care networks might address problems of access will be the subject of this ongoing series of stories.
Dr. Peter Bell says, We will have to change the way we provide primary care so that physicians and other health care professionals can collaborate so they can operate more effectively. However, reforms in the way we provide services wont be enough on their own. We will also need to put more resources into primary care.
