The recommendations to improve chronic disease management are reasonable, but the province will have to decide where the funding will go, says president of the local primary care network.
The Alberta Auditor General released a report on chronic disease management last week, which found chronic disease management care and services across the province are fragmented.
No one entity – Alberta Health, Alberta Health Services (AHS) or primary care networks (PCNs) – have taken responsibility to ensure the current structure is working or those resources are being used well.
The Department of Health and AHS do not have a process to identify individuals with chronic disease or determine the demand for services in the province, stated the report. Much of the work is thus left to PCNs and individual physicians.
The report recommends that Alberta Health and AHS set expectations for chronic disease management services within one year. The goal is to integrate and co-ordinate services between physicians, PCNs and Family Care Clinics within the next two to three years.
“I think the recommendations they have are pretty reasonable, their timelines are certainly aggressive,” says Dr. Darryl LaBuick, president of the St. Albert and Sturgeon PCN.
The Department of Health and AHS need to work with PCNs and family physicians to determine what is feasible. Working in isolation will not go very far, says LaBuick.
“Alberta Health has to figure out how fragmented they want to make primary care in the community,” he said.
“We’ve gone through this whole circuitous demonstration of developing Family Care Clinics and trying to keep PCNs going. If the government is committed to working on primary care in communities then they really have to commit the appropriate resources around it instead of lip service.”
Family Care Clinics were introduced in 2012 under former premier Alison Redford. They have met with criticism, as some say the clinics are a duplication of services already available through PCNs, and there is no proof they work.
Another issue identified by the report was the need to determine size and composition of health-care teams.
The department’s analysis found that health-care teams function effectively when five or more family physicians practice in a group with three or more care team providers per physician.
“That would be a very luxurious model. The cost of that is just formidable,” remarks LaBuick.
With size and composition of care teams varying from PCN to PCN, funding typically allows a ratio of one-quarter to one-third of an allied health care professional to one physician, he says.
“Even if we were to obtain a ratio of one nurse or pharmacist or mental health (professional) to one family physician, that would be really good. We do not have the funding within the system to even support that ratio.”
Other recommendations stated in the report include: more wide-spread use of care plans, better use of health care information (electronic medical records) between health-care providers and patients and more consistent chronic diseases management services within PCNs.
In 2012-2013, there were more than 735,000 Albertans known to the Department of Health to have one or more chronic diseases including hypertension, diabetes, chronic obstructive pulmonary disease and coronary artery disease. Publicly funded health care services cost more than $4.5 billion for those patients that year.
