Article Figures & Data
Tables
PHC MODEL DESCRIPTION FHT FHTs consist of interprofessional teams of health professionals (eg, family physicians, nurse practitioners, nurses, counselors, dietitians, pharmacists) who provide comprehensive care to patients with a focus on chronic disease management and disease prevention. Most FHTs are physician-governed. FHT physicians are paid using a blended capitation model that includes various incentive payments. Some FHTs are academic FHTs and are also committed to training health professionals FHO FHOs also provide comprehensive care to their patients. Some FHOs have access to additional funds that enable them to hire other health professionals to provide special programs, such as mental health, nutrition, and foot care. FHO physicians are paid using a blended capitation model that includes various incentive payments FFS practices FFS physicians are paid for services rendered and rarely employ health professionals other than nurses CHC Like FHTs, CHCs provide comprehensive care through interprofessional teams. CHCs differ from FHTs in their emphasis on community development and the social determinants of health. CHCs have community governing boards. Physicians in CHCs are paid a salary CHC—community health centre, FFS—fee-for-service, FHO—family health organization, FHT—family health team, PHC—primary health care.
CHARACTERISTICS CASE A CASE B CASE C CASE D Model of primary care FHTs Non-FHT FHOs FFS practices CHCs No. of practices and physicians participating in study 2 FHTs 2 solo practices (2 physicians)
2 small group practices (2 physicians)
2 large group practices (4 physicians)
1 academic practice (3 physicians)
1 solo practice (3 physicians)
2 small group practices (2 physicians)
1 large group practice (1 physician)
2 solo practices (2 physicians)
2 group practices (2 physicians)
2 CHCs 2 physicians
CHC—community health centre, FFS—fee-for-service, FHO—family health organization, FHT—family health team.
CHARACTERISTICS N (%)* Sex • Female 7 (30) • Male 16 (70) Years in practice • 0–14 4 (17) • 15–24 9 (39) • ≥ 25 10 (43) Proportion of older adults (≥ 65 y) in practice • 0.0%–25.0% 12 (52) • 25.1%–50.0% 10 (43) • 50.1%–75.0% 1 (4) • > 75.0% 0 (0.0) Model of primary care† • FHT 11 (48) • Non-FHT FHO 6 (26) • FFS practice 4 (17) • CHC 2 (9) CHC—community health centre, FFS—fee-for-service, FHO—family health organization, FHT—family health team.
↵* Proportions might not add to 100% owing to rounding.
↵† The proportion of physicians recruited in each model of care was broadly representative of the number of practices in the community at the time.
HEALTH CARE PROFESSIONAL N (%) Registered nurses 23 (100) Home-care case managers 23 (100) Mental health worker 17 (74) Dietitian 17 (74) Social worker 15 (65) Pharmacist 12 (52) Nurse practitioners 8 (35) Registered practical nurses 6 (26) Other 9 (39) CSS—community support service.
RECOMMENDATIONS SAMPLE QUOTES 1. Availability of a “one-stop-shop” online database Physicians want a searchable, easy-to-read, regularly updated database that is accessible to both health care providers and clients and their families in the community
The database or directory should have the contact information, the cost, and availability of the different services in the community in addition to a brief description of each service
The database or system rates the various community supports and services in terms of usefulness
“[I would like] a really useful, easy-to-read, accessible, up-to-date database that’s searchable and quick and readily available. I think that would expand the access to that information to other people as well. So it wouldn’t just be a repository in one person who when she retires or goes on vacation we’re screwed. I would like it online. And searchable. Ideally right inside my EMR or on my server so I don’t have to waste time going to somebody else’s website that I’m uncomfortable with. Ideally a kind of searchable database that’s locally available and updated. I think if my nurse has the same thing it would be very helpful. And there are other members of the team that would also take more advantage of it. For example, if the pharmacist or the dietitian are seeing someone who is senior and needs some help in nutrition, if they also had ready access to a database that’s searchable, I think that would be very helpful. So, that others on the team develop that expertise, instead of everyone sort of going to the nurse” (004 FHT)
“I think if there was a system in place to come up with different services and contacts, I would hope that that system would kind of rate them at the same time and say these are the ones we found that are the top 2 or top 3, if you were going to look at them [or that] I wouldn’t recommend these because we didn’t find them useful or [they] are actually detrimental in some cases” (023 FFS)
2. Need for a single referral agency Physicians describe the need for a central agency that assesses and refers patients and their families to appropriate CSSs
The referral agency would also provide suggestions of relevant CSSs for the physician
“If there’s an agency like the [home-care agency name] who is a one-contact service that would look at the problems of the elderly and sort out the dilemma of where people should go [for CSSs], I would think that would be excellent. We have in the adolescent group and children CONTACT. CONTACT is the group you send them [to]. And they sort out what your problems are and where they can be directed. We need a “CONTACT” for [older] adults, if that’s available” (013 FHO)
“I guess it would be nice and maybe this exists so there you go ... to have like a central registry where you could just call or you could send in a quick fax and just outline a very basic [need] and just have them at least even just spit out back or contact you again with suggestions or contact the family with suggestions or however you wanted it to be set up” (006 FHT)
CSS—community support service, EMR—electronic medical record, FFS—fee-for-service, FHO—family health organization, FHT—family health team.
