The answer to everything wrong in health care

TOP Alberta has released a beautiful infographic Evidence Summary: The Benefits of Continuity in Primary Care, and the document also serves as an overview of the 112 publications they reviewed.

It speaks for itself. Maybe the title of this post is a bit grandiose, but as a shameful hypocrite [I have very little continuity in my clinical practice, something I'm working to remedy] I cannot underscore how important this idea is.

Every physician, nurse, administrator (yes, you!), health policy person, and their uncle needs to not only know this but act on it. Continuity is what we need.

It's not a fad. It's something that we used to have. And it has slowly been eroded, without too many people noticing, as we kept focussing on the newest technology and the latest pharmaceuticals as if they would solve everything.

In BC, the essential nature of continuity has been recognized particularly with the work of Marcus Hollander and was implemented in the GP for Me/Attachment Initiative. Unfortunately (some might dispute this), changing physician incentives to try to encourage more attachment hasn't made much of a difference for patients. So while we know that we need continuity, we don't know how to 'make' the system or the providers do it.

It's a perfect storm for patients: Can't find a GP, or if you can it's hard to build a relationship with them because they are so busy/unavailable/don't have enough time to spend with you; the GP doesn't know all the details of your care as pharmacists/naturopaths and others expand their scope and don't communicate with the GP; the medical records at the hospital or from the specialist in the other city don't link with those of the GP so no one knows what is going on; when a referral or requisition is sent, there is no confirmation that is was received so it might be that you are just waiting, or it might be that it has been lost and you will never hear back about the appointment; when a home care support worker or nurse comes, it is a different person each day and they don't know you or your needs, and they aren't allowed to do the things you need help with most.

Health care really is about caring for people, and how can we do this when we do not build robust and lasting relationships?

The review did not cover provider satisfaction but personally and in BC studies so far, physician satisfaction is improved by continuity with patients. However, this is not how most young graduates are practicing; Yet another great reason that we need to look more into this.

Is it too good to be true? Before we rush ahead and try to force the "magic pill" of continuity, we need to know more about why it's being eroded, and if we can save it, then how?



Quality Forum: Choosing Wisely by Jessica Otte on Prezi

10 minutes: That's how much time I had to tell the audience at the BC Quality Forum about the Choosing Wisely Canada campaign.

10 minutes may be the schedule duration of a routine patient visit with their GP. That's a short amount of time! In this short time it is hard to have a fulsome discussion with a patient about their condition, review their history, check in with their goals, and plan a strategy of treatment. It's even harder when the patient has 3 things they want to discuss!

10 minutes is not enough time to change the world - unless you do it a little bit at a time! That's why the take-away from my talk was simple:

If you feel you may need more, check out the slides on Prezi.

If you want to see other talks or articles I've done, go to the Media/Talks section.


Transfusion Medicine for Physicians

Did you know that there is an online, CME-Accredited course regarding the use of blood products?

In the area of transfusions, Less is often more!

Emergency and Family physicians, hospitalists, internists, residents and surgeons could all benefit from learning the when, why, and hows of transfusion.


See the PDF Flyer or go to the website to learn more and register!


Overall Learning Objectives:
After participation in this course, the learner will:

1. Appropriately interpret clinical signs and symptoms of reduced oxygen carrying capacity and utilize hemoglobin concentration to determine need for RBC transfusion.
2. Be confident their RBC transfusion ordering practice is up to date and reflects current literature.
3. Apply the appropriate elements of informed consent for transfusion.
4. Appreciate the indirect relationship of common coagulation tests to bleeding risk and the role of frozen plasma transfusion.
5. Recognize and respond appropriately to adverse transfusion events or reactions.
6. Know where to seek further advice on transfusion management.