``Will chronic diseases get the best of my medical practice?`` - symposium conferences now on line!
According to work by demographer David Foot, professionals and managers in the health care system have about 10 years to find solutions to respond to the needs related to population aging and the resulting increase in chronic diseases.
However, we are far from the only ones grappling with this reality and many initiatives have already improved chronic disease management. As Québec Medical Association Executive Director Claudette Duclos states, behind all efficient models stands the leadership of family physicians supported by an interdisciplinary team, along with easier access to medical specialists, clinical information and technical support centres. Adequate information systems support well-defined clinical projects. But success lies primarily in the willingness to change ways of doing things and to adapt the organization and medical practices to the needs of patients.
In this spirit, the symposium Will chronic diseases get the best of my medical practice? could well become a lever for this change, the beginning of a broad movement where QMA members will most certainly be “doctors in action”.
There is no doubt that chronic diseases are affecting medical practices and the entire health care system. To illustrate, half the people in North America have one chronic disease, and over age 65, two out of three people suffer from two chronic diseases. In Québec, close to 3% of the population accounts for 50% of all patient days.
Dr. Jean-François Lajoie, QMA President, pointed out that in an effort to face this monumental challenge, the QMA had brought together representatives from the information and communications technologies (ICT) industry and representatives from the medical field at the symposium Will chronic diseases get the best of my medical practice? in order to arrive at a common vision of the current situation in the health care system, its anticipated development over the next 10 years, and the ICT requirements to be in a better position to link strategies and technology tools.
“The Canadian Medical Association’s Strategic Plan for IT,” by William Pascal
Health care costs have more than tripled over the last four years and will continue to rise as the population ages if nothing is done, said William Pascal, Chief Technology Officer at the Canadian Medical Association. Because the strategies deployed to date have not fully reached their objectives, they need to be revised, resulting in the need to create an interface to share patients’ medical information. Adopting an approach that allows professionals to participate actively would help to reduce consultation time and medication errors, which would in turn generate substantial savings while also facilitating chronic disease management through prevention and patient participation in monitoring the state of their health.
“The Hidden Side of the Health Commissioner’s Report,” by Robert Salois
Inform, assess, consult and recommend are four words that describe the daily routine of Mr. Robert Salois, Health and Welfare Commissioner. In his speech, he painted a portrait of the current situation in Québec and observed that “a performance analysis of our system suggests that solutions are organizational and lie in the tools we offer clinicians and in developing people’s capabilities.” He went on to say that our health care system has several shortcomings and recalled the importance of investing in programs to computerize the system and empower patients to get involved in their own care in order to free up primary care.
“ Cleveland Clinic Health Systems,” by Dr. Rami Boutros
Empowering patients to manage their own health by giving them access to their medical records and experts at all times is the Cleveland Clinic’s ultimate objective. With an enthusiastic presentation, Dr. Rami Boutros, head of clinical services, aroused keen interest in the audience by showing the positive spin-offs of the Cleveland Clinic’s way of doing things. The conference was very inspiring, provoking thought among participants on the possibilities of introducing the knowledge gained in OHIO into our own system.
“The Experience in British Columbia,” by Dr. Garey Mazowita
Dr. Garey Mazowita, a professor at the Faculty of Medicine at the University of British Columbia, enthusiastically presented a clinical organization model that allowed for optimal chronic disease management. He spoke about the General Practice Services Committee set up by the Ministry of Health, the British Columbia Medical Association and the British Columbia College of Family Physicians. The committee introduced programs to promote the practice of family medicine by responding to physicians’ desire to be compensated and valued for their true worth, by encouraging students to practise family medicine, and by promoting longitudinal care. Programs to meet the desire of physicians for training and practice support were also created, as well as Divisions made up of family physicians with practices converging in a given area. Today, more than 80% of family physicians are part of one of the Divisions. The electronic medical record, which has been introduced gradually since 2006, has been very successful, particularly among physicians with group practices (more than 90% of registered physicians who work in a group of six or more professionals have implemented computerized medical records).
In short, British Columbia’s experience as described by Dr. Garey Mazowita is very inspiring, both for the challenges presented by the integration of information technologies and for those related to chronic disease management.
Workshop: “Implementing a New Practice Model”, moderated by Dr. Gerry Bédard
Chronic diseases were already affecting medical practice, said Dr. Gerry Bédard from the FMG in Lavaltrie-Lanoraie, pointing out that the situation was not likely to improve over the next few years due to an aging population, a growing number and complexity of chronic diseases, and a health care system that was becoming increasingly difficult to fund. With this in mind, the participants in the “Implementing a New Practice Model” workshop described the characteristics of an optimal health care organization that would carry us over the next 10 years, starting with a more detailed analysis of the needs of the population. At the heart of this change were stakeholders such as general practitioners and specialists, the Minister and the Health and Welfare Commissioner, but first there had to be a desire to change that was strongly anchored in a common vision. Finally, the participants drew up a list of a few conditions likely to facilitate change, namely appropriate compensation, knowledge transfer, investment in home care and the adapted integration of information and communications technologies into medical practice..
Workshop: “Learning to Manage Change”, moderated by Louise Beaudoin
Louise Beaudoin, an organizational psychologist and associate at Société Pierre-Boucher, summarized the “Learning to Manage Change” workshop that she moderated. She emphasized the importance of defining change in an inspiring, concrete way so that it is accepted. Workshop participants also highlighted the importance of carrying out an impact analysis in order to better define the actions to take and traps to avoid. Finally, besides preparing, measuring and following up on change, the conditions that fostered success in managing change hinged greatly on communication, clear messages, listening and feedback. In this respect, Louise Beaudoin suggested activities involving frequent but short communication.
Workshop: “Managing Evolving Patients, Understanding Their Requirements and Expectations, and Turning Them into Partners”, moderated by Stéphane Gendron
Stéphane Gendron, Vice-President of CROP, defined three major points that emerged from the discussions in the workshop he moderated: the importance of playing a larger role for patients, offering community-wide care, and reviewing the role of physicians. In fact, it may be beneficial to modify the paradigm and to encourage “access to health care” rather than “access to a physician”. Solutions ranged from how patients are received and heard, a partner approach, and sharing and circulating information and knowledge. In short, it was necessary to review our ways of doing things.
Call for candidates for the missions
For several years now, the team at the Québec Medical Association and many of its members have been interested in the problems resulting from the emergence of chronic diseases and the challenges this poses for the health care system and the medical profession.
With this in mind, Executive Director Claudette Duclos announced that the QMA, in collaboration with partners in the information and communications technologies industry, would be sponsoring a mission abroad in order to heighten knowledge about effective management programs capable of inspiring or even initiating winds of change here!
The two clinical environments selected are very different from each other. The first is a network of institutions in British Columbia, the Providence Health Care medical centre, that has proven its effectiveness in terms of chronic disease management. The second health care system is the Cleveland Clinic Health System in Ohio, which is known for its optimal use of information and communications technologies.
If you would like to learn more about the QMA’s fact-finding and observation missions, additional information is available at:
Speech by Dr. Yves Bolduc, Minister of Health and Social Services
The Minister of Health and Social Services, Dr. Yves Bolduc, described himself as a “100% digital guy”. While he was the first in his FMG to use only an electronic prescriber since 2004, he felt that Québec was now just as computerized as elsewhere. Moreover, while he believed that we have better tools to deal with the impacts of chronic diseases (drug insurance, physicians spread across the province, etc.) than in Ontario, for example, he admitted that our system was not perfect and that we had to revise our ways of doing things. “There is a problem of service accessibility and how easy it is to use services. However, it is not something that will be solved by more money, but rather by more management, and especially by more collaboration between professionals and between actors in the health care system. And by leadership from the Minister, agencies, institutions, federations and unions.” It was necessary to change our management methods and our practices, but there was an enormous amount of resistance to change. On the other hand, the current technology flow is irreversible and will force the adoption of new habits. “Family medicine groups, network clinics, computerization of the health care system: this train has arrived and will keep going, and people will have no choice but to get on it.” The Minister also believes that it may be necessary to make the change mandatory so that it works. Finally, Dr. Bolduc pointed out that it was important to be inspired by the technology and organizational innovations at the Cleveland Clinic, Mayo, Kaiser Permanente, or here at home, but that it was even more important to generalize innovation so that everyone could benefit.
To conclude the symposium, QMA Executive Director Claudette Duclos recalled that according to work by demographer David Foot, professionals and managers in the health care system have about 10 years to find solutions to respond to the needs related to population aging and the resulting increase in chronic diseases.
However, we are far from the only ones grappling with this reality and many initiatives have already improved chronic disease management. Behind all efficient models stands the leadership of family physicians supported by an interdisciplinary team, along with easier access to medical specialists, clinical information and technical support centres. Adequate information systems support well-defined clinical projects. But success lies primarily in the willingness to change ways of doing things and to adapt the organization and medical practices to the needs of patients.
Claudette Duclos expressed the desire that the symposium Will chronic diseases get the best of my medical practice? could become a lever for this change, the beginning of a broad movement where QMA members will most certainly be “doctors in action”.