Flu vaccines are available starting Oct. 25th, free of charge. Please check out our Facebook page for more details./ Le vaccin contre la grippe sera disponible à partir du 25 oct. sans frais. Veuillez consulter notre page Facebook pour plus d'information.

Médecine de proximité

prox

“The goal of proximity medicine is to keep as many services as possible within people’s reach.”

Dr. Marie-Dominique Beaulieu, former President of the College of Family Physicians of Canada, presented a compelling vision for Family Medicine at the Dr. Ian McWhinney Lecture last September. Entitled “The perils and the promise of proximity,” Dr. Bealieu issues a sincere wake-up call to family doctors, to move “beyond our current understanding of patient-centered care into the realm of partnerships with patients, wherever they are in their lives or communities.”

 

“Medicine is coming up against a wall.”

Proximity medicine is not simply geographic access – it is a medical approach “that can take into consideration individuals in their entirety and in their complexity, support them in their journey, and place them at the heart of the health care system.” Dr. Beaulieu laments that “technological developments are distancing us from the knowledge, skills, and know-how we need to cope with the challenges facing us.”

The Four Challenges:
1. action on the social determinants of health;
2. timely access to care;
3. care transitions and service integration; and
4. overdiagnosis and overtreatment—our practice of maximally intrusive medicine.

1. Social determinants of health
“We are not all born equal”
Family physicians need to take specific actions aimed at social determinants and by adopting non-stigmatizing practices. This can be accomplished by applying for income supplements, advocating for change in our communities, supporting resources and fostering social participation. Most importantly, ensuring all services are accessible to all our patients, regardless of their sociodemographic characteristics.
2. Accessibility
“We have built fortified castles around our clinics”
Dr. Beaulieu notes that to many, “the concept of service quality referred primarily to whether practices conformed to guidelines rather than to comprehensiveness, timely access, or continuity of care.” To the contrary, timely access to care is not a luxury, but a necessity – or as she writes, “one of the pillars of the patient’s Medical Home.”
3. Care transitions
“The hospital is part of the community and needs to build bridges with services and professionals outside its walls… How do we persuade hospitals to be part of the proximity medicine community?”
“Fragmentation of care is a scourge, one of the primary causes of gaps in care and medical errors.” Care transitions, whether from home to hospital or hospital to home, need to be seamless.
4. Overdiagnosis and overtreatment: “maximally disruptive medicine.”
“Being a patient has become a full-time job”
Dr. Beaulieu laments that over-testing and over-diagnosis have plunged medicine and society into “a vortex from which we cannot extract ourselves without a drastic change in culture.”
“We offer people increasingly complex treatment plans. We interfere with their work, their leisure, and their lives overall. “
The cure: parsimonious medicine not personalized medicine. Evidence-based approaches that propose interventions that offer real differences for patients. “We need a medicine that truly involves patients as full partners in their own diagnoses and care, which is what proximity medicine is all about. We need darn good clinicians.”  Medicine based on “sound clinical judgment…medicine that tolerates uncertainty.”

In the end, I agree with Dr. Josh Tepper, CEO and President of Health Quality Ontario:

 

JTepper

Can Fam Physician. 2016 Dec; 62(12): 964–968.

Learning from Effective Primary Care Teams

forblog

Santé Kildare was selected to participate in the University of Toronto Department of Family and Community Medicine Quality Improvement “teaming” project in 2016.  High functioning primary care teams were chosen across Canada with the goal of developing a blueprint and action plan to guide primary care teams to function effectively. The ultimate outcome leading to improved health of populations, improved and patient and provider experiences and improved value.  Santé Kildare was the only clinic studied from Quebec.

Launched in late 2014, the Quality Improvement (QI) Program set out to answer the question: What makes primary care teams effective or high-functioning?

“The evolution of health care provision in the community is moving from a single primary care provider (usually a family physician) providing health care patient by patient in a reactive context, to an organizational one – a primary care team proactively meeting the needs of a defined population. Teaming – a verb – refers to the collective actions or processes associated with a primary health care team performing optimally”.

In April 2016, the environmental scan for the teaming project was completed with case studies of nominated, high-functioning primary care teams. The case studies, representing teams from Alberta, Ontario and Quebec, marked the last element of the scan that included a robust literature review and a series of expert interviews.

Last Fall, the Quality Improvement (QI) Program published themes that were identified as attributes of high-functioning teams.  They include:

  1. A practice environment where members of an interprofessional team work in close proximity (co-location)
  2. Effective use of electronic medical records (EMRs)
  3. A focus on patient experience
  4. An effective communication culture
  5. Leadership
  6. Right skill mix
  7. A combination of clarity and flexibility around roles
  8. Ensuring that all team members work to their full scope of practice
  9. Professional development
  10. Collaboration with external partners and agencies

It was pleasure for Santé Kildare to participate in this project.  The full report can be found here.

Groupe de médecine de famille (GMF) et Super-cliniques (GMF-Réseau): Quelle est la différence?

Groupe de médecine de famille (GMF)
Un groupe de médecine de famille (GMF) est un regroupement de médecins de famille qui travaillent en étroite collaboration avec d’autres professionnels de la santé. Cette organisation du travail permet à la clientèle d’avoir plus facilement accès à des soins médicaux.
Chaque médecin s’occupe de ses propres patients, qui sont inscrits auprès de lui, mais tous les médecins membres du GMF ont accès à l’ensemble des dossiers médicaux. Ainsi, une personne qui se présente pour une consultation sans rendez-vous peut être vue par un autre médecin que le sien. Au besoin, elle peut aussi rencontrer une infirmière ou un autre professionnel de la santé du GMF pour différents suivis.
Ce travail en groupe permet :

• d’assurer un meilleur suivi de l’état de santé et du dossier médical des patients;
• d’améliorer la qualité des soins médicaux;
• d’améliorer l’accès aux soins médicaux.

Super-cliniques (GMF-Réseau)
Une super-clinique (GMF-Réseau) est un GMF avec une offre de service de première ligne accrue pour les besoins semi-urgents et les besoins urgents simples.
En plus des services offerts dans les GMF, les super-cliniques doivent :
• offrir des consultations aux patients n’ayant pas de médecin de famille ou étant inscrits dans un autre GMF;
• être ouvertes 7 jours sur 7 et 12 heures par jour;
• permettre la prise d’un rendez-vous le jour même, jusqu’à 3 heures avant la fermeture;
• donner accès à un centre de prélèvements public;
• donner accès à un laboratoire d’imagerie médicale;
• faciliter l’accès aux services spécialisés.
Les services disponibles dans les super-cliniques permettent aux usagers qui ont une condition non prioritaire d’éviter de se présenter à l’urgence d’un centre hospitalier et d’y subir une attente prolongée. Il s’agit de services accessibles rapidement pour les besoins de première ligne.
http://sante.gouv.qc.ca/systeme-sante-en-bref/groupe-de-medecine-de-famille-gmf/