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Is it my turn yet?

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It is no secret that we are (extremely) frustrated with long waiting times. Consecutive governments repeatedly promise to fix this problem but wait times only seem to grow longer.
As noted by the Fraser Institute: “excessively long wait times remain a defining characteristic of Canada’s health-care system, but this year (2016) is the longest we’ve ever seen and that should trouble all Canadians.” Bacchus Barua, senior economist at the Institute, continues, “long wait times aren’t simply minor inconveniences, they can result in increased suffering for patients, lost productivity at work, a decreased quality of life, and in the worst cases, disability or death.”
http://globalnews.ca/news/3083826/medical-wait-times-in-canada-are-longer-than-ever-hitting-20-weeks-in-2016-fraser-institute/

 

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The Canadian Institute of Health Information (CIHI) released a report based on The Commonwealth Fund’s 2016 international survey that highlighted this continued issue. According to the survey, Canada scored the poorest of all 11 countries surveyed when it came to access to specialists.  Fifty-six percent of Canadians wait longer than a month to see a specialist—as compared to the international average of 36 percent.

Dr. Josh Tepper, CEO of Health Quality Ontario, along with Vanessa Milne and Sachin Pendharkar, published “Four ways Canada can shorten wait times for specialists” at Healthydebate.ca.  Their prescription for success focuses on simple, achievable concepts:

 

1.Do virtual consults, not visits

Not every patient needs to see a specialist.  Often the family physician needs some guidance and a virtual consult system can help.

The Rapid Access to Consultative Expertise (RACE) is a phone based system available in parts of British Columbia. Family physicians call a central phone number during business hours on weekdays, and a specialist calls back within a couple of hours.

The success of RACE in B.C. inspired a similar program in Ontario, called The Champlain BASE e-Consult service. In this system, primary care providers complete a form that includes patient information and the medical question. Test results and images can be attached. The information is then sent to a specialist.

From 2010 to 2015, the BASE service was used in over 10,000 consultations in the Champlain region. The average wait time for a response from the specialist was two days.  Most impressively, in 40% of cases the patient did not need to see the specialist.

 

2.Add physician directories and e-referrals

Alberta currently offers paperless referrals through e-Referrals. The system includes referrals to Oncologists and Orthopedics.  Family doctors get an idea of wait times BEFORE submitting the referral and can chose a specific specialist.

 

3.Try pre-assessment in specialized clinics

Another approach is adding an assessment step in between the referral and the specialist.  This method has been successfully introduced for patients with severe low back pain (Interprofessional Spine Assessment and Education Clinics (ISAEC)).

Known as CareAxis in B.C., Saskatchewan, Ontario and Quebec, wait times are reduced by training physiotherapists to triage potential surgical candidates.

 

4.Switch to central intake

Pooled referral systems (aka central intakes) allow family doctors to select a specific specialist or the first-available.  Newfoundland, Ontario, Saskatchewan and Calgary all use this model.  Quebec’s model, CRDS, launched in the Fall of 2016, offers central intake for 9 specialties: Cardiology, ENT, Gastroenterology, General Pediatrics, Nephrology, Neurology, Ophthalmology, Orthopedics, and Urology.

Information can be found at:

Tél. : 514-762-CRDS (2737)
Téléc.: 514-732-5121
Courriel: crdsmontreal.ccsmtl@ssss.gouv.qc.ca

https://www.santemontreal.qc.ca/professionnels/medecins/crds-centre-de-repartition-des-demandes-de-services-montrealais/

So…can wait times be fixed?

All four models can help reduce wait times and simplify the process.  However, the authors caution, “Canada is notorious for being a land of pilot projects in health care, where good ideas aren’t scaled well. For systems like this, where getting buy-in from many professionals is crucial, that problem is especially important to overcome.”

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In Response to Dr.Goldman

Thank you Dr. Brian Goldman for supporting my profession.  I went to Mcgill University and studied dietetics and human nutrition which included  4 levels of stage.  It takes 3 and half years to complete this program and when you graduate you become an expert in the field of nutrition care.  I will admit that I did not feel like an expert until I had accumulated a certain amount of professional experience.  Currently, I work at GMF Kildare.  If you want to know what a GMF is click here.  I also work at CLSC Benny Farm.

Dietitians help patients with such a wide variety of issues.  I help the bulk of my patients with chronic disease state management for such illnesses as diabetes, high blood pressure, sub-optimal cholesterol and of course weight management.  Sometimes I see seniors that appear malnourished.  This can be very serious and requires a skilled intervention to prevent further complications.  I have colleagues who specialize in pediatric nutrition and prenatal care and others who are experts in tube feeding on surgical units in acute care.  Another colleague is a home care specialist and provides direct nutrition care in patients own living environment.  Some dietitians are even food service managers who run the acute care, rehab and long term care kitchens; ensuring that patients receive appropriate meals and snacks.

The first time I meet a new patient I will do an initial evaluation.  This can take about an hour. I will ask many health related and social questions to fully understand the client’s lifestyle habits.  This information will help make me the right assessment and give the appropriate intervention for that client.  It’s important to understand that each nutrition care intervention is individualized and created just for that person. This is what I am trained to do and how I am able to help people.  It is just  like doctors who are trained to ask the right questions, make the proper diagnosis and provide the right treatment for each patient they see.

There are so many variables that make up a person’s medical and social history.  Each person’s experience is going to determine what type of nutrition care they will need.  It’s very important to get a sense of what the patient is willing to change. As a professional dietitian, I must be able to work with where the patient is at, on any given day. I need to ask, are they ready to make a big change like reducing simple sugars or are they willing to try something a bit easier like add a glass of water to their daily intake?  Sometimes it takes many nutrition care follow ups before a client is even willing to think about changing a behavior.

I provide information concerning the management, of a disease or condition, but it is the patient’s responsibility to use the information to promote change. The patient always has the right to make the choice that works for them and sometimes that means not following dietary advice.  Not everybody is ready to work on their diet and lifestyle habits. Either way, I provide motivation and can coach clients wherever they may be on the behavioral change continuum.

Caryn Roll