Connecting the Dots in Primary Care
Bringing quality to primary care is a daunting task.
But, for the committed family doctors, nurse practitioners and other health care practitioners who provide care to more than 13.5 million people in the province on a daily basis, the magnitude of opportunity to do better is great.
Consider this: For each hip or knee replacement done in the province every day there are 2500 times more primary care visits happening over the same time period. Through a quality lens, that means there is a similar order of magnitude in the potential to provide higher quality care.
My work, with others at Health Quality Ontario and at the front lines of care is to establish a comprehensive approach to support and motivate practice improvement in primary care on a large scale, no matter what the funding model or form of care delivery. We will do this by leveraging the existing networks, work of partner organizations and key foundations that already exist.
I have been heartened, impressed and amazed as I come to know the islands of excellence in primary care already present in this province.
There are individuals and teams that have improved access for their patients, improved patient safety by closing the loop on test results and built programs to de-prescribe unnecessary or unsafe medications. We have physicians who have created programs to assess the social factors that could impact patient safety events. Finally, we have individuals and teams that have improved workplace culture, because we know that workplace satisfaction is key to engaging people and care teams in doing their best for their patients.
Some of these initiatives are documented in the Quality Improvement Plans submitted by primary care organizations to Health Quality Ontario on an annual basis. Last year, 294 primary care organizations submitted plans documenting improvements in patient engagement, development of partnerships to better integrate care, and improvement in population screening.
Health Quality Ontario, in conjunction with the Institute for Clinical Evaluative Sciences, also offers family physicians the opportunity to receive Primary Care Practice Reports. These are free, confidential, personal reports on key quality indicators for a physician’s practice and are updated a few times annually. We want to make it easy for the QI process to be embedded into daily routines and seen as part of the practice of family medicine.
Primary care leaders are also involved in the Choosing Wisely initiative in the province to reduce unnecessary medical tests and procedures. Work in that area was reported in another recently released Health Quality Ontario report, including important leadership by other provincial organizations.
Health Quality Ontario regularly hosts Quality Rounds and the event held recently at the Humber River Hospital and transmitted via the Ontario Telemedicine Network was the first to focus on primary care. An event such as this helps connect primary care providers and allows the participants to share, learn and grow.
That session highlighted two outstanding initiatives, the program initiated by the Markham Family Health Team under the direction of Dr. Allan Grill to improve the hospital discharge process and transitions in care, and work to improve the process of safely and effectively referring patients from primary care providers to specialists described by Dr. Steven Pomedli.
Quality Rounds demonstrated outstanding examples of how new initiatives can successfully deal with some seemly intractable challenges.
But it is worth remembering that every day in Ontario, thousands of primary care providers are doing their best to provide care to patients across a limitless spectrum of illness and disease by striving to prevent, diagnose and treat in a way that conforms with all the six dimensions of quality – safety, effectiveness, being patient-centred, efficiency, timeliness and equitable.