Manitoba panelists make recommendations addressing issues in primary care

It’s been the hot topic in Manitoba for quite some time: the health care crisis. To help address the primary care aspect of it, a panel of people from across Manitoba, representing different demographics, gathered to help create a report with 37 recommendations.

The report, Manitoba Priorities Panel on Primary Care: New perspectives and possibilities for the future of primary care in Canada, breaks down the list of recommendations into six categories, including:

1. Increasing the number of health care professionals
2. Ensuring holistic, person-centred care
3. Addressing sociological factors impacting health like racisim
4. Caring for Indigenous peoples
5. Fostering connectivity and transparency
6. Informing and engaging the public

Dr. Alan Katz, the Manitoba co-lead for the initiative led by OurCare, said, “Primary care is as it is in most places in Canada, a series of individual doctors’ offices and clinics. They really don’t communicate outside of themselves, and they’re left out of the bigger health care system — which is the hospitals where all the money is spent — and we’re left to struggle in the trenches in isolation.”

He said the panel members recognized the importance of an integrated primary care system for the benefit of patients.

Sandra Epp, one of 30 panelists bringing the perspective of a mom, patient and daughter caring for her elderly parents, said the group “tried to provide recommendations that were achievable as opposed to a pie in the sky.”

She said high on the priority list was implementing primary care teams and moving away from a “one-part-per-visit type of service.”

“A primary care team might include a nurse practitioner and social health worker or mental health worker, and they all work together to serve the needs of the patient (from) a holistic view,” she said.

Epp said there was a consensus that the primary system neglects that “our bodies are systems” with pieces that interact with one another. “If you’re looking at one specific point, then you could be missing the larger picture,” she said.

Katz said primary-based care necessitates team-based care.

Another recommendation Epp said was critical to the group was connected care, so that records are electronically available to different care providers and accessible to the patient. “We could potentially correct or add to them.”

Katz said one way to tighten this up would be through plastic health care cards, rather than paper.

“That provides the opportunity for both loading information onto the card, or using the card as a way of accessing information,” he said, adding that electronic medical records are already existent in Manitoba but isn’t integrated or able to transfer between sites.

“We have a long way to go in that respect,” he said.

Among the loudest priorities Epp said was providing care to Indigenous communities. “Regardless of what (the panel’s) demographics were, we all recognize that that is a huge priority. We need to take care of those communities much better than we are right now.”

Katz said research he has done shows Indigenous people die 10 to 15 years earlier than non-Indigenous people regardless of their health condition. “There are a whole series of factors that goes into that,” he said, but the bottom line is “because of social circumstances and colonization, Indigenous folks have significant health risks and poor outcomes.”

One way to heal this wound, Katz said, is through giving health care providers appropriate cultural training. He said the panelists also brainstormed that a ministry of Indigenous health was needed–separate from existing ministries of health.

He also noted newcomers often struggle in Manitoba’s primary care system.

“People who come to Manitoba from different counties often come with a very different understanding of how health care works,” he said. As an example, he explained that Ukrainians have often seen specialists for what Manitoba treats at the primary care level. They’re left “not knowing where to go and feeling neglected when they weren’t immediately seeing a specialist for their problem,” he said.

Personally, one of Epp’s priorities was staffing up the system. For she and her children, “A lot of our mental health damage was incurred as a result of extended wait times. Not (having) enough care providers available, not enough specialized care available, waiting for a year to get help for an issue that was traumatic right now,” were all problematic, she said.

Education also could have saved her a lot of time and pain, Epp said. With two elderly parents needing care and not knowing what resources were available to them, she said, “We kind of fumbled our way through the system, and it was quite challenging.”

Over her time with the panel, she said she learned about patient advocates, which would have been a huge help to her.

“It wasn’t until my father had an experience that landed him in the hospital and we talked to resources saying ‘look, we’re really struggling here,’ that we were referred to home care.

“Had we had more understanding about home care from the primary care perspective, we might not have needed that acute care visit,” she said.

Katz added to this, saying, “We need a strong primary care system to support emergency rooms and keep people out of hospital.” Without that, he said the larger health care system is falling apart.

He said the panelists also recommended having a health ombudsman so those not getting the care they feel they need have a place to go.

Epp said during the process of establishing the panel’s priorities, it helped to hear from front-line workers, which Katz said served as guest speakers during a “30-hour immersion in trying to understand what primary care is, and how best to deliver it, and all the challenges around it.”

He said a question-and-answer session was a part of the exposure.

“The biggest revelation for me was meeting with care providers and hearing the struggles, and the pain, that they go through, and realizing that we’re a team. It’s not us versus them. It’s us with them working together to make things better,” Epp said.

She said she was able to see how front-line workers want to do better but are shackled when it comes to money and resources.

“They can’t do any better and they’re doing the best they can,” she said. “If we work together and we get the funding, we can make a significant difference.”

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