Promoting greater attachment to family doctors could save millions of health care dollars
People with chronic diseases who are regularly served by the same full-service family practice cost the health care system significantly less money than those patients not closely attached to a family doctor, a landmark study in British Columbia has found.
Most of the savings result from patients not needing to be admitted to hospital or not needing to be seen so often by specialists, the study found.
The study, conducted by Victoria-based Hollander Analytical Services Ltd., examined usage data from more than 98,000 high-needs patients in B.C. in 2007-08. The study focused on two common chronic diseases, diabetes and congestive heart failure (CHF).
“Our study found that the more patients go to the same family practice, the lower the overall annual costs are to the health care system,” said Marcus Hollander, the study’s chief author. “It appears that as little as a 5% increase in attachment to a family, or primary care, practice, for high care needs diabetes and CHF patients, could result in savings of some $85 million annually in BC alone.”
The study, which is now available on the web, is reported in the fall issue of Healthcare Quarterly, a leading Canadian health care journal covering health care policy, administration and practice.
While other studies have shown there is a direct correlation between better health outcomes and regular service by full-service family physicians, Hollander’s study is the most detailed examination yet of the impact family physicians have on direct health care costs. And the impact is considerable.
The study found that the average annual hospital costs for high-needs diabetes patients who were not attached to family practices were almost $17,000 annually. That compares, on average, to just $5,900 for similar patients attached to a family practice. The highest needs patients with CHF cost the overall health system almost $30,000 if they were not attached to a family doctor, but just $12,000 if they were. “The difference in costs can be attributed in large part to the fact that patients without family doctors spend more days in hospital which greatly adds to the cost of the health care they receive,” Hollander said.
Hollander noted that other studies have found that “continuity of care”, particularly the personal relationship that develops between a patient and a family doctor, tends to keep patients healthier and out of hospital. This relationship is not forged in walk-in clinics, in emergency departments or through specialist visits.
A number of international studies have shown the stronger the system of primary care in a region, state, or country, the better the population’s health outcomes. “We know that good primary care is better for the patient’s health but now we know that it is better use of our health care dollars too,” said Dr. William Cavers, a Victoria-based family physician and the co-chair of the committee that commissioned the research.
Hollander’s study is also being hailed by US physician and academic Dr. Barbara Starfield, one of the world’s leading experts on the link between family physicians and better health outcomes. “Although it might be hypothesized that the sickest individuals would benefit the most from frequent visits to specialists, this is not the case,” said Starfield. “Policy makers must realize that it is ongoing primary care, not specialist care, that has the most to offer in the care of ill individuals regardless of their age,” Starfield said.
In fact, Hollander’s study found that attachment to a family practice was the best predictor of the patient’s overall health care costs and was more related to costs than other variables such as age.
The paper is being hailed by doctors in Canada and BC because at the present time, a shortage of family physicians poses a serious challenge to health care systems in Canada and the US.
“This paper presents compelling evidence of the cost-effectiveness of comprehensive primary medical care for higher needs patients,” said Dr. Anne Doig, president of the Canadian Medical Association. “It is remarkable for the rigour and robustness of the analysis. This landmark study should stimulate the drive to ensure that every Canadian has a primary care physician. “
"This study shows that a well designed, collaboratively developed program between physicians and government that has been effectively implemented will work in an area otherwise fraught with setbacks," said Dr. Brian Brodie, president of the BC Medical Association. "In the past, many different programs and models have attempted to renew primary care - all with little results. These are results from a program designed for all family practitioners that provides better care to patients and saves the system money. This is the kind of program that makes being a family doctor a rewarding career choice because one can see the benefits every day."
Since 2002, in an unprecedented collaboration, the BC Ministry of Health and the BC Medical Association agreed to support family physicians in the province. The resulting General Practices Services Committee (GPSC) has the mandate to “find solutions to support and sustain full service family practice,” said Cavers. Some of the GPSC actions include: incentive payments that compensate doctors for the extra time, care and effort good full-service family practice entails; physician recruitment initiatives; funding for training modules for family physicians; and other financial and practical supports.
The Hollander study was an evaluation project of the GPSC to examine the basic question of whether or not full-service family practice was a wise investment of funds in British Columbia. “Our study would suggest that the more we support family doctors to provide good primary care to their patients, the lower the costs to the health care system overall,” said Hollander.
Copies of the full paper are available for free download at:
http://www.longwoods.com/product.php?productid=21050
-30-
Media Inquiries
For comments about the research aspects of the study please contact:
Dr. Marcus Hollander, President, Hollander Analytical Services Ltd., at marcus@hollanderanalytical.com
For comments about the policy and program implications of the study please contact:
Dr. William Cavers, Co-Chairperson, General Practice Services Committee, at wcavers@shaw.ca (for Canada)
Dr. Barbara Starfield, University Distinguished Professor, Johns Hopkins School of Public Health, at
410-955-3737 or at bstarfie@jhsph.edu (for the USA)
To speak to someone in person, for more information, or for assistance in contacting any of the above individuals, please call 250-389-0123.
Thursday, September 24, 2009
Wednesday, September 16, 2009
The Most Interesting Health Consultant In the World
A message from The Most Interesting Health Consultant In the World about universal health care in the United States and the truth about Canadian publicly funded health care.
Monday, September 14, 2009
Knowledge Translaton and Transfer. In teaching . . .
In teaching, you must simply work your pupil into such a state of interest in what you are going to teach him that every other object of attention is banished from his mind; then reveal it to him so impressively that he will remember the occasion to his dying day; and finally fill him with devouring curiosity to know what the next steps in connection with the subject are.
Source: James on Psychology and The Teaching Art
Source: James on Psychology and The Teaching Art
Monday, September 7, 2009
Knowledge Translation 1.0 (the work of William James)
Ever wonder what you audience is up to? William James writes (in 1892)
We have thus fields of consciousness,—that is the first general fact; and the second general fact is that the concrete fields are always complex. They contain sensations of our bodies and of the objects around us, memories of past experiences and thoughts of distant things, feelings of satisfaction and dissatisfaction, desires and aversions, and other emotional conditions, together with determinations of the will, in every variety of permutation and combination.
In most of our concrete states of consciousness all these different classes of ingredients are found simultaneously present to some degree, though the relative proportion they bear to one another is very shifting. One state will seem to be composed of hardly anything but sensations, another of hardly anything but memories, etc. But around the sensation, if one consider carefully, there will always be some fringe of thought or will, and around the memory some margin or penumbra of emotion or sensation.
In most of our fields of consciousness there is a core of sensation that is very pronounced. You, for example, now, although you are also thinking and feeling, are getting through your eyes sensations of my face and figure, and through your ears sensations of my voice. The sensations are the centre or focus, the thoughts and feelings the margin, of your actually present conscious field.
On the other hand, some object of thought, some distant image, may have become the focus of your mental attention even while I am speaking,—your mind, in short, may have wandered from the lecture; and, in that case, the sensations of my face and voice, although not absolutely vanishing from your conscious field, may have taken up there a very faint and marginal place.
Again, to take another sort of variation, some feeling connected with your own body may have passed from a marginal to a focal place, even while I speak.
We have thus fields of consciousness,—that is the first general fact; and the second general fact is that the concrete fields are always complex. They contain sensations of our bodies and of the objects around us, memories of past experiences and thoughts of distant things, feelings of satisfaction and dissatisfaction, desires and aversions, and other emotional conditions, together with determinations of the will, in every variety of permutation and combination.
In most of our concrete states of consciousness all these different classes of ingredients are found simultaneously present to some degree, though the relative proportion they bear to one another is very shifting. One state will seem to be composed of hardly anything but sensations, another of hardly anything but memories, etc. But around the sensation, if one consider carefully, there will always be some fringe of thought or will, and around the memory some margin or penumbra of emotion or sensation.
In most of our fields of consciousness there is a core of sensation that is very pronounced. You, for example, now, although you are also thinking and feeling, are getting through your eyes sensations of my face and figure, and through your ears sensations of my voice. The sensations are the centre or focus, the thoughts and feelings the margin, of your actually present conscious field.
On the other hand, some object of thought, some distant image, may have become the focus of your mental attention even while I am speaking,—your mind, in short, may have wandered from the lecture; and, in that case, the sensations of my face and voice, although not absolutely vanishing from your conscious field, may have taken up there a very faint and marginal place.
Again, to take another sort of variation, some feeling connected with your own body may have passed from a marginal to a focal place, even while I speak.
LHIN investing in wait time reduction strategies
Three London health care institutions are in line for significant funding to help reduce wait times and to start new programs and carry on with initiatives that have already proved successful.
That was the word from three London MPPs, Deb Matthews, Chris Bentley and Khalil Ramal, as well as representatives from the South West Local Health Integration Network (LHIN), Friday (Sept. 4).
"Our government is investing in community-based services to improve healthcare." said Ramal MPP, London-Fanshawe.
"The 18 initiatives that are receiving funding through the South West LHIN prove that partnerships and innovative initiatives are making a difference in freeing up emergency room beds and allowing seniors and other patients to stay in their homes," he said.
In total, Ontario is providing funding of $2.4 million to the Southwest region as part of its Urgent Priorities and Aging at Home initiatives. The funding includes:
*$310,517 to London Health Sciences Centre for three programs that will improve cancer surgery wait times, improve outcomes for hip and knee care and help long-term ventilation patients get back to their home communities.
*$950,161 to the Southwest Community Care Access Centre (CCAC) for a number of programs including enhanced overnight supports for medically fragile children and improvements to wound care management.
*$857,931 to St. Joseph's Health Care to extend the operation of its Transitional Care Unit Parkwood Hospital until October 2010 when more long term care beds will become operational.
"The transitional care unit is a more appropriate place for patients who no longer need acute care," said Elaine Gibson, vice president complex, specialty aging and rehabilitative care at St. Joseph's Health Care, London.
"It provides restorative care to help patients maximize their potential to be cared for in their own homes with support from the South West Community Care Access Centre, or in long-term care homes or supportive housing," she said.
That was the word from three London MPPs, Deb Matthews, Chris Bentley and Khalil Ramal, as well as representatives from the South West Local Health Integration Network (LHIN), Friday (Sept. 4).
"Our government is investing in community-based services to improve healthcare." said Ramal MPP, London-Fanshawe.
"The 18 initiatives that are receiving funding through the South West LHIN prove that partnerships and innovative initiatives are making a difference in freeing up emergency room beds and allowing seniors and other patients to stay in their homes," he said.
In total, Ontario is providing funding of $2.4 million to the Southwest region as part of its Urgent Priorities and Aging at Home initiatives. The funding includes:
*$310,517 to London Health Sciences Centre for three programs that will improve cancer surgery wait times, improve outcomes for hip and knee care and help long-term ventilation patients get back to their home communities.
*$950,161 to the Southwest Community Care Access Centre (CCAC) for a number of programs including enhanced overnight supports for medically fragile children and improvements to wound care management.
*$857,931 to St. Joseph's Health Care to extend the operation of its Transitional Care Unit Parkwood Hospital until October 2010 when more long term care beds will become operational.
"The transitional care unit is a more appropriate place for patients who no longer need acute care," said Elaine Gibson, vice president complex, specialty aging and rehabilitative care at St. Joseph's Health Care, London.
"It provides restorative care to help patients maximize their potential to be cared for in their own homes with support from the South West Community Care Access Centre, or in long-term care homes or supportive housing," she said.
Friday, September 4, 2009
We Americans have chosen to leave 47 million of our citizens . . . . . .WITHOUT HEALTH COVERAGE.
| We Americans have chosen to leave 47 million of our citizens . . . . . .WITHOUT HEALTH COVERAGE. |  | Spotlight Universal Healthcare Message to Americans from Canadian Doctors & Healthcare Experts Canadian Doctors for Medicare hosted a celebration of Medicare in Canada. The speakers included Roy Romanow, former Saskatchewan Premier and Commissioner on Health Care in Canada; Steven Lewis, a trusted health policy advisor to Premiers and Ministers; Linda Silas, the head of Canada's nurses unions and several physicians. They tell Americans that Canadian universal healthcare works and encourage Americans to implement a single payer universal healthcare systems. So here it is: Universal Health Care Message to Americans From Canadian Doctors & Health Care Experts. |
Thursday, September 3, 2009
Final Issue of Nursing BC
A sign of the times
This issue marks the end of Nursing BC. I have had the privilege of editing this publication for 24 of the 41 years it has been in existence, first as RNABC News and then as Nursing BC.
Throughout those years, I have also had the privilege of talking to hundreds of nurses from all parts of the province and beyond – some who wanted to submit articles to the magazine, others who had an issue about something we published, and many who wanted to connect with a nurse who was featured in one of our stories. Overall, it’s been a great ride.
The reasons for ceasing publication of Nursing BC are not motivated by economics, as some believe. Rather, they have more to do with communicating more effectively with you about the regulatory issues that affect your practice as a nurse in B.C. If you have been a long-time reader of Nursing BC, you likely noticed that the content of the publication has changed significantly in recent years. There have been fewer articles about nurses and their practice and more emphasis on Standards of Practice, registration requirements, legislative changes that impact nursing practice and other regulatory matters. This has been necessitated in order to meet the requirements of the provincial legislation that created CRNBC as a regulatory college. Unlike the former RNABC, CRNBC is not an association.
In June, most of you received our first e-mail newsletter. Some of you thought it was informative and useful; others said they would never read it and preferred to read the printed version of Nursing BC. Those of you for whom CRNBC does not have an e-mail address may not have seen this newsletter unless you opened it from the CRNBC website.
The e-mail newsletter is now one of CRNBC’s official methods of notifying you of important regulatory information. It will be e-mailed to you 6-8 times a year. If you do not have an e-mail address or choose not to provide one to CRNBC, you can still find the information on the CRNBC website. CRNBC is currently redesigning its website to make it more user friendly and useful to you. We will let you know when the redesigned website is ready.
I would like to take this opportunity to thank all of the nurses who submitted letters and articles to Nursing BC over the years (sorry we weren’t able to publish all the articles) as well as to CRNBC staff members who vetted and wrote articles for the magazine. Finally, thanks to all the nurses and employers who let us tell their stories.
Bruce Wells
Editor
READ CRNBC’S NEW E-NEWSLETTER ONLINE
Have you read our new e-mail newsletter? If not, you can find it on our website at www.crnbc.ca It’s one of our official methods of notifying you about important regulatory information that impacts your nursing practice.
Do we have your current e-mail address?
To receive the e-newsletter, we need your current e-mail address. You can update your e-mail address by going to the Contact Us section of the CRNBC website www.crnbc.ca and clicking Change Your Address.
If you do not have an e-mail address, please refer to the CRNBC website regularly for registration information and other information that may impact your nursing practice.
This issue marks the end of Nursing BC. I have had the privilege of editing this publication for 24 of the 41 years it has been in existence, first as RNABC News and then as Nursing BC.
Throughout those years, I have also had the privilege of talking to hundreds of nurses from all parts of the province and beyond – some who wanted to submit articles to the magazine, others who had an issue about something we published, and many who wanted to connect with a nurse who was featured in one of our stories. Overall, it’s been a great ride.
The reasons for ceasing publication of Nursing BC are not motivated by economics, as some believe. Rather, they have more to do with communicating more effectively with you about the regulatory issues that affect your practice as a nurse in B.C. If you have been a long-time reader of Nursing BC, you likely noticed that the content of the publication has changed significantly in recent years. There have been fewer articles about nurses and their practice and more emphasis on Standards of Practice, registration requirements, legislative changes that impact nursing practice and other regulatory matters. This has been necessitated in order to meet the requirements of the provincial legislation that created CRNBC as a regulatory college. Unlike the former RNABC, CRNBC is not an association.
In June, most of you received our first e-mail newsletter. Some of you thought it was informative and useful; others said they would never read it and preferred to read the printed version of Nursing BC. Those of you for whom CRNBC does not have an e-mail address may not have seen this newsletter unless you opened it from the CRNBC website.
The e-mail newsletter is now one of CRNBC’s official methods of notifying you of important regulatory information. It will be e-mailed to you 6-8 times a year. If you do not have an e-mail address or choose not to provide one to CRNBC, you can still find the information on the CRNBC website. CRNBC is currently redesigning its website to make it more user friendly and useful to you. We will let you know when the redesigned website is ready.
I would like to take this opportunity to thank all of the nurses who submitted letters and articles to Nursing BC over the years (sorry we weren’t able to publish all the articles) as well as to CRNBC staff members who vetted and wrote articles for the magazine. Finally, thanks to all the nurses and employers who let us tell their stories.
Bruce Wells
Editor
READ CRNBC’S NEW E-NEWSLETTER ONLINE
Have you read our new e-mail newsletter? If not, you can find it on our website at www.crnbc.ca It’s one of our official methods of notifying you about important regulatory information that impacts your nursing practice.
Do we have your current e-mail address?
To receive the e-newsletter, we need your current e-mail address. You can update your e-mail address by going to the Contact Us section of the CRNBC website www.crnbc.ca and clicking Change Your Address.
If you do not have an e-mail address, please refer to the CRNBC website regularly for registration information and other information that may impact your nursing practice.
Monday, August 31, 2009
Universal Healthcare Message to Americans from Canadian Doctors & Healthcare Experts
Spotlight
Universal Healthcare Message to Americans from Canadian Doctors & Healthcare Experts. go to: http://www.longwoods.com
Canadian Doctors for Medicare hosted a celebration of Medicare in Canada. The speakers included Roy Romanow, former Saskatchewan Premier and Commissioner on Health Care in Canada; Steven Lewis, a trusted health policy advisor to Premiers and Ministers; Linda Silas, the head of Canada's nurses unions and several physicians. They tell Americans that Canadian universal healthcare works and encourage Americans to implement a single payer universal healthcare systems.
Universal Healthcare Message to Americans from Canadian Doctors & Healthcare Experts. go to: http://www.longwoods.com
Canadian Doctors for Medicare hosted a celebration of Medicare in Canada. The speakers included Roy Romanow, former Saskatchewan Premier and Commissioner on Health Care in Canada; Steven Lewis, a trusted health policy advisor to Premiers and Ministers; Linda Silas, the head of Canada's nurses unions and several physicians. They tell Americans that Canadian universal healthcare works and encourage Americans to implement a single payer universal healthcare systems.
Monday, August 24, 2009
5 Myths About Health Care Around the World
From the Washington Post:
By T.R. Reid | Sunday, August 23, 2009
As Americans search for the cure to what ails our health-care system, we've overlooked an invaluable source of ideas and solutions: the rest of the world. All the other industrialized democracies have faced problems like ours, yet they've found ways to cover everybody -- and still spend far less than we do.
I've traveled the world from Oslo to Osaka to see how other developed democracies provide health care. Instead of dismissing these models as "socialist," we could adapt their solutions to fix our problems. To do that, we first have to dispel a few myths about health care abroad:
1. It's all socialized medicine out there.
Not so. ….
2. Overseas, care is rationed through limited choices or long lines.
Generally, no.
3. Foreign health-care systems are inefficient, bloated bureaucracies.
Much less so than here.
4. Cost controls stifle innovation.
False.
5. Health insurance has to be cruel.
Not really.
This fragmentation is another reason that we spend more than anybody else and still leave millions without coverage. All the other developed countries have settled on one model for health-care delivery and finance; we've blended them all into a costly, confusing bureaucratic mess.
Which, in turn, punctures the most persistent myth of all: that America has "the finest health care" in the world. We don't. In terms of results, almost all advanced countries have better national health statistics than the United States does. In terms of finance, we force 700,000 Americans into bankruptcy each year because of medical bills. In France, the number of medical bankruptcies is zero. Britain: zero. Japan: zero. Germany: zero.
Given our remarkable medical assets -- the best-educated doctors and nurses, the most advanced hospitals, world-class research -- the United States could be, and should be, the best in the world. To get there, though, we have to be willing to learn some lessons about health-care administration from the other industrialized democracies.
T.R. Reid, a former Washington Post reporter, is the author of "The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care," to be published Monday.
To read the whole column click below (or click the title).
By T.R. Reid | Sunday, August 23, 2009
As Americans search for the cure to what ails our health-care system, we've overlooked an invaluable source of ideas and solutions: the rest of the world. All the other industrialized democracies have faced problems like ours, yet they've found ways to cover everybody -- and still spend far less than we do.
I've traveled the world from Oslo to Osaka to see how other developed democracies provide health care. Instead of dismissing these models as "socialist," we could adapt their solutions to fix our problems. To do that, we first have to dispel a few myths about health care abroad:
1. It's all socialized medicine out there.
Not so. ….
2. Overseas, care is rationed through limited choices or long lines.
Generally, no.
3. Foreign health-care systems are inefficient, bloated bureaucracies.
Much less so than here.
4. Cost controls stifle innovation.
False.
5. Health insurance has to be cruel.
Not really.
This fragmentation is another reason that we spend more than anybody else and still leave millions without coverage. All the other developed countries have settled on one model for health-care delivery and finance; we've blended them all into a costly, confusing bureaucratic mess.
Which, in turn, punctures the most persistent myth of all: that America has "the finest health care" in the world. We don't. In terms of results, almost all advanced countries have better national health statistics than the United States does. In terms of finance, we force 700,000 Americans into bankruptcy each year because of medical bills. In France, the number of medical bankruptcies is zero. Britain: zero. Japan: zero. Germany: zero.
Given our remarkable medical assets -- the best-educated doctors and nurses, the most advanced hospitals, world-class research -- the United States could be, and should be, the best in the world. To get there, though, we have to be willing to learn some lessons about health-care administration from the other industrialized democracies.
T.R. Reid, a former Washington Post reporter, is the author of "The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care," to be published Monday.
To read the whole column click below (or click the title).
Tuesday, August 11, 2009
Canadian government will soon place an order for 50.4 million doses of the influenza A (H1N1) vaccine.
Canadian public health officials announced recently that the Canadian government will soon place an order for 50.4 million doses of the influenza A (H1N1) vaccine.
The officials, Leona Aglukkaq, Canada’s Minister of Health, and David Butler-Jones, Canada’s Chief Public Health Officer, said they expect the vaccine will be available in time for the winter influenza season.
“The government of Canada will ensure sufficient H1N1 vaccine is available to immunize every Canadian who needs and wants protection from the H1N1 virus,” Aglukkaq said in a press release. “We are pleased to have worked together with provinces and territories in implementing a coordinated, pan-Canadian response to all elements of the H1N1 outbreak, including decisions around vaccines.”
“We are confident the 50.4 million vaccine doses we plan to purchase will be sufficient to meet the needs of every Canadian likely to need and want protection,” said Butler-Jones.
Aglukkaq and Butler-Jones also said that although the delivery of immunization typically falls under the jurisdiction of Canadian provincial and territorial governments, the federal Canadian government is making an exception in this case and plans to cover 60% of the costs.
The officials, Leona Aglukkaq, Canada’s Minister of Health, and David Butler-Jones, Canada’s Chief Public Health Officer, said they expect the vaccine will be available in time for the winter influenza season.
“The government of Canada will ensure sufficient H1N1 vaccine is available to immunize every Canadian who needs and wants protection from the H1N1 virus,” Aglukkaq said in a press release. “We are pleased to have worked together with provinces and territories in implementing a coordinated, pan-Canadian response to all elements of the H1N1 outbreak, including decisions around vaccines.”
“We are confident the 50.4 million vaccine doses we plan to purchase will be sufficient to meet the needs of every Canadian likely to need and want protection,” said Butler-Jones.
Aglukkaq and Butler-Jones also said that although the delivery of immunization typically falls under the jurisdiction of Canadian provincial and territorial governments, the federal Canadian government is making an exception in this case and plans to cover 60% of the costs.
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