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Addressing Problems in Accessing Primary Health Care in Nova Scotia

There is strong acceptance that primary care is the "foundation" of the healthcare system. Evidence also shows that those who are attached to a primary care provider or clinic have better outcomes, especially those with chronic conditions that require ongoing and lifelong planning [1].When the components of primary care are analyzed in relation to improved outcomes and satisfaction, continuity of care is identified as a key element [2]. Continuity of care allows providers and patients and families to get to know each other, develop trust, and evolve strategies for ongoing care.
 
There is much discussion about ensuring all Nova Scotians can access a family physician in a primary care setting. Incentives to attach patients to a practice would seem to be the solution. However, if practices become too large, timely access becomes difficult. 
 
Achieving timely access to good primary care requires a balance among two key components [3]. The first of these is finding a primary care provider or clinic that will to provide care for you on an ongoing basis. The second is ensuring that the primary care provider or clinic has adequate resources to meet their commitments to care. It is important to balance these two components; attending to one without consideration of the other results in limited or delayed access and increased stress for providers.
 
Ensuring an adequate supply of family physicians and other primary care providers requires a health human resource plan that ensures that the content of health care provider training programs reflects the human resource needs identified for an adequate primary care endeavor [4]
 
In Nova Scotia, the principles of the CFPC Patient's Medical Home have been incorporated into a Health Home [5]. This model includes evidence-based estimates of appropriate practice sizes based on the number of family physicians and other primary care professionals. The Health Home is the primary care center of an expanded primary health care approach that includes integrated chronic disease management and health promotion, prevention and wellness. It is also embedded in a context that assesses community needs with a population health approach and ensures that the primary care center team is responsive and adaptive to the community's needs.

The metrics for team size and composition proposed in this Nova Scotia model are based on some local analysis and consideration of the evidence. Individual communities and geographic regions have varying health care needs, so the team development will require a quality improvement approach. This approach allows the adjustment of team capacity to better match local needs. It may identify additional or different health professionals for the team or may lead to a variety of specific community strategies for local health issues and challenges. Ongoing evaluation can direct continuing development of the team. In some cases, the Health Home primary care team would need to be shared among a cluster of communities to ensure sustainability and adequate flexibility for the providers in meeting their needs for professional development time, vacation, and participation in ongoing planning.

Nova Scotia has begun the establishment of primary care collaborative inter-professional teams organized in a Health Home shaped by community and community cluster health needs. It has identified critical numbers of providers to assure sustainability and reasonable quality of work life. Community based training of family physicians, nurse practitioners and family practice nurses has been increased over recent years and should be shaped by ongoing health human resource strategies and plans. Ongoing research would allow others to learn from Nova Scotia's experience. The Health Home approach, combined with a commitment to responding to community needs, could provide equitable primary care to all Nova Scotians.

By David Gass, MD, FCFP
Interim Department Head
Dalhousie University Department of Family Medicine


Bibliography
 
1. Starfield B, S. L. (2005). Contribution of Primary Care to Health Systems and Health. The Milbank Quarterly, 457-502.
 
2. Guthrie B, S. J. (2008). Continuity of care matters. BMJ, 337:a867.
 
3. Holland, M. (n.d.). Personal communnication.
 
4. Nova Scotia Department of Health and Wellness. (2020, January 11). Shaping our Physician Workforce. Retrieved from
https://novascotia.ca/dhw/ShapingPhysicianWorkforce/
 
5. Nova Scotia Health Authority. (2017). Strengthening the Primary Health Care System in Nova Scotia. Retrieved from
http://www.nshealth.ca/sites/nshealth.ca/files/phc_evidence_synthesis_april_2017_final_updated.pdf

 

New Ethics Afer Hours - Podcast

White Coat Black Art


Seniors Tell Dr. Brian Goldman What It’s Really Like to Live in Long-Term Care (Encore)

In this episode of White Coat Black Art, Dr. Brian Goldman talks to Sharon Cooke and Devora Greenspon about what it is like to live in a long-term care setting, how they experienced the transition from living independently to now living in a care facility, and how this has influenced them. 

Read our discussion guide with review questions!

Read more on this podcast review!

Get to Know NSHEN!

Three Questions for NSHEN...

Meet Christy Simpson, Ethics Collaborations Coordinator and Head and Associate Professor, Dept of Bioethics, Dalhousie University

1. What do you most enjoy about working with NSHEN? 


What I enjoy most about working with NSHEN is meeting people from across the province who are dedicated to providing the best care possible for patients, whatever their role is. This care includes identifying and addressing ethics issues, both clinical and organizational.

2. What is your favourite resource on the NSHEN website?

While I like all of the resources on the NSHEN website, my current favourite is are the plain language definitions of health ethics terms. It’s already come in handy for discussing difficult issues with folks and ensuring that we are all on the “same page” in our understanding of what we are talking about. And if there are suggestions for other terms in health ethics that should be included, please let us know!


3. What's good?

I understand “good” in ethics to be about trying to determine what is the most right or best possible approach to difficult situations where the values we hold (individually or collectively) may be in tension with each other.

Fireside Chat Video Series

New interview available!

Judy Aymar, Social Worker (retired) with experience in Long Term Care and Acute Care discusses the ethical issues of moving into a long term care facility and living at risk.

New Featured Article Summary

 

Poverty – Not a Justification for Banning Physician-Assisted Death

by Lindsey M. Freeman, Susannah L. Rose, and Stuart J. Youngner, The Hastings Center Report, 2018

Abstract

Many critics of the legalization of physician-assisted death oppose it in part because they fear it will further disadvantage those who are already economically disadvantaged. This argument points to a serious problem of how economic considerations can influence medical decisions, but in the context of PAD, the concern is not borne out. 

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Bioethics Book Club

 

Lots of good titles for those cozy winter nights!


No fee to borrow and return envelopes provided!

Recent titles of interest:

 

Diagnosis: Truths and Tales by Annemarie Jutel

Clinical Ethics on Film (hardcover) A Guide for Medical Educators by Sara M. Rosenthal

The Power of Kindness: Why Empathy Is Essential in Everyday Life by Brian Goldman

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Moral Resilience: Transforming Moral Suffering in Healthcare Paperback by Cynda Hylton Rushton


If you are interested in borrowing one of these titles or another book we have avaialble in our LIBRARY please email the NSHEN Adminstrator
 
NSHEN Case Database & Resources

Plain Language Definitions – Ethics Health Care Terms

Straightforward Definitions of Terms in Health Ethics

Talking about values and principles in health care ethics can be confusing, especially if some of the words are unfamiliar.  NSHEN created a plain language definitions document which have short definitions to help make it clearer what some of the words that we use in ethics work mean.

Click on the link below to download the file.

NSHEN Plain Language Definitions -Ethics Health Care Terms

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