The WHO defines primary health care as first-level health care made universally accessible through the full participation of the community at a cost it can afford. Services include:
It can be viewed as a system for organized action, in which different players work together to mobilize and use resources to generate activities, goods, and services to obtain objectives and joint projects.
Specialists see a snapshot of a patient in time. Family physicians are involved in watching the video.
Practical benefits
We need to learn how to tell stories - Storied case report.
Learning too late presents problems. Difficult to do
"Our advocacy of the storied case report has not been very successful on the wards. Perhaps
junior trainees find it too hard to determine what is relevant and senior trainees find it too hard to change their habits."
In treating risk factors, you treat a lot of people to help a few (NNT). This takes a lot of work, and it takes a lot of people to get this done.
Today, people put up with a lot less. The younger generation is more demanding and requires more care than the stoic older generations.
Health care needs to be:
The roles of primary health care include:
Be a resource to your practice:
what to do?
An important aspect of primary care is its relationship with acute care. The system of communication and referrals is critical. PHCPs also need to have strong relationships with public health agencies, locally and provincially.
Catch the MI when people are in getting their splinter checked.
Identify the needs in the people of the community and uncover ways to deal with them.
Family physicians are the most commonly thought of primary care provider, but people with long-standing medical conditions can see specialists regularly and consider them as primary care physicians. The following specialists can also provide primary care: internal medicine, allergists, cardiologists, dermatologists, gasteroenterologists, obstetrician-gynecologists, hematologists, respirologists, physiatrists, neurologists, nephrologists, endocrinologists, rheumatologists, and emergency medicine specialists.
(Goldberg and Dietrich, 1985, AIken, Lewis, Craig et al, 1979)
Physicians can in no way provide primary care on their own - the following professionals play key roles in primary care:
AFP is good.
If FFS, visits provided by FPNs can be covered, as long as the GP sees the pt for at least a few minutes.
Primary care needs to be set up for taking care of everyone. It should be in place for the healthy population, as well as those in various health streams.
The process of change is a tough one, and needs an understanding of the nature, pace, and players
According to Lamarche et al, there are four main models of care:
The most common model in Canada.
Physicians work alone or in groups, usually without other providers, not governed by regional or local healthcare, nor the public.
Fee for service is the norm.
Continuity depends on patient loyalty.
Informationsharing is almost non-existent outside the group
People register/subscribe with an organization, which assigns MDs and nurses to provide continuity of services to subscribers.
Funding is primarily capitation or blended.
Information technology allows communication across the organization, and a nurse liases across the health care system to integrate care.
Healthcare service centres are governed by the public and receive lump sum funding from local or regional health authorities.
Professionals are many are are paid for the time they put in.
Information technology allows integration with private practices and acute care, creating a network of services.
Services are available all the time.
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It makes sense to have some accountability re: what can be billed for. It a pap test is not recommended for a given person ie someone who as had a total hysterectomy), a doctor should not be able to bill for it.
LaMarche PA, Beaulieu MD, Pineault R, Contandriopoulos AP, Denis JL, Haggerty J. Choices for Change: The Path for Restructuring Primary Healthcare Services in Canada. Ottawa: Canadian Health Services Research Foundation, 2003