1. Comm Community Based Group Family Practice in a Fee For Service (FFS) Model John Hadley OD. MD. CCFP.

2. St. Paul Family Medical Practice Structure z5 family physicians (3 female, 2 male, age 30-40 yrs.) z8 staff including 2 1/2 RN’s

3. Services Provided by SPFMC zOffice based care, Hospital based care, Obstetrical care, Palliative Care (Hospital and home), Nursing home care, Mental Health Counseling. Cambridge Cancer Clinic. zFor our patients we provide Hospital Rounds 365 days per year

4. Services Provided by SPFMC (cont’d) zMembers of group provide administrative services at the hospital, including chief of department of family medicine, Medical Director of the Brant Community Cancer Clinic, membership on quality assurance committee, perinatal morbidity/mortality committee, obstetrical quality assurance committee, library committee, BGH palliative care committee.

5. Services Provided by SPFMC (cont’d) zPart of a larger call group (17 members to cover after hours, weekends) z3 members of group have provided care in the Brant County Health Unit sexual health clinic zVON medical director

6. Patient Demographics zMixed urban/rural zRepresentative of community re: socioeconomic, age and sex zPalliative zObstetrics zNursing home

7. Interactions with Public Health Department zImmunization programmes zInfectious diseases (T.B., HIV, STDs) zHealthy Babies, Healthy Children Programme zLactation support zSexual Health Clinic

8. Provision of Clinical Preventive Maneuvers zPreventive Care is an important part of Family Medicine zMany important determinants of health are largely beyond the scope of clinical intervention (socioeconomic factors, lifestyle decisions, pollution etc.)

9. Preventive Care Challenges zCompeting priorities (underserviced areas) z“System” Barriers zCommunity partners’ pressures (Public Health, CCAC cutbacks. zInappropriate use of physician time.

10. Practice in an Underserviced Area zThere are up to 10,000 people without a family physician in Brant (pop. 126,000) zBGH admits 2-10 patients daily who have no Family Physician (F.P.) zHRCC is asking us to assume care of Brant cancer patients who have no F.P. zWe are daily asked to take on new patients by colleagues, patients, friends.

11. Ethical Dilemma z“Optimal care for a limited number of patients” vs. “Providing some care for a larger number of patients”. yWho is your commitment to: xYour present patient population or the community at large? xAre you getting the biggest “bang for your buck”?

12. Ethical Dilemma zHence in underserviced areas, preventive care can take a back seat to more acute medical needs

13. “System” Road Blocks to Preventive Care zFFS system does not support the infrastructure to allow FFS physicians to optimize preventive care services. (E.g. Hire the most appropriate/cost effective staff to provide these services, install and maintain databases which will allow for outcome measures and recall systems etc.)

14. “System” Road Blocks to Preventive Care (cont’d) zThe Ontario Fee Schedule does not reflect support for preventive services.

15. Community Partners’ Pressures zCommunity services are facing shrinking resources. zThis often results in difficulties such as communication problems due to limited hours, voice mail, manpower limitations. zPrograms are cut back.

16. Inefficient Use of MD Time zSuboptimal public education regarding management of minor illnesses (e.g. colds, flu) zInordinate time spent negotiating the healthcare system (e.g.. arranging specialist consultation, accessing test results)

17. Optimizing Interaction with Public Health to Improve Preventive Health Care

18. Present Strengths zThe human connection (MOH attending department of family practice meetings) zPeriodic letters outlining health unit programmes/changes etc.

19. The Future zWE ALL WANT TO IMPROVE THE HEALTH OF PATIENTS zIt is often difficult to judge the effectiveness of preventive interventions zWe need good quality data, and need to be able to measure in some concrete way an intervention’s effectiveness.

20. Information Technology zThis calls for I.T., electronic medical records and databases. zCollection of good quality data at local and regional levels zAllows for easy production of recall lists

21. Health Unit’s Role zUtilizing and supporting data capture in family practices, the Public Health Unit/Health Council could use their epidemiological expertise to provide more analysis/outcome measures at a local level in a timely manner. zThis provides the Family Physician needed feedback and validates the utility of the intervention.

22. Community Based Group Family Practice in a Fee For Service (FFS) Model John Hadley OD. MD. CCFP.