A key pillar of New Brunswick’s attempt to expand access to primary care is the establishment of collaborative care clinics, but the province’s previous attempts at the care model leave some feeling uneasy about the current iteration’s prospects of success.
The current president of the New Brunswick Medical Society (NBMS), Dr. Paula Keating, has first-hand experience in a collaborative care setting, having participated in a pilot project that began 14 years ago.
“We thought, ‘Oh, this is going to take off,” and everybody liked it,” she said.
Collaborative care clinics, or the patient medical home model, involve a system of care that groups together physicians, nurses and other allied health practitioners with central administration support. The idea is to ensure that a visit is tailored to get a patient the appropriate level of care for their needs, freeing up doctors or nurse practitioners to take on more acute cases. Patients belong to one clinic, which can then provide appointments with the type of practitioner best suited for their visit.
A government news release from 2012 trumpets the Miramichi Family Health Team as a way to “provide better access, shorter wait times and improved health outcomes by managing chronic disease and improving care co-ordination.”
By that point, the clinic, which included six physicians, two nurses and a clinical care co-ordinator, was home to about 9,000 patients. A working group report in 2011 recommended the model be expanded provincewide and according to another government news release, the program was expanded to Oromocto in January 2013.
But Keating says after a few years the Miramichi team lost its funding and the participating physicians, herself included, went back to being solo practitioners.
“We were back to our fee-for-service practices, with no care co-ordinator, so the physicians are continuing to oversee the administrative staff and scheduling,” she said.
“Certainly access, I think, decreased a little bit.”
The government has pegged collaborative care clinics as its main strategy to meet its primary care goals, which are ensuring that all New Brunswickers have access to a provider within five business days. It has also looked to fill in the gaps for the 84,000 people without either a family doctor or nurse practitioner with its NB Health Link clinics.
The province’s attempts to move to a collaborative care model even predate the pilot project that Keating was part of at the beginning of the last decade. In January 2003, a framework for Community Health Centres (CHC) was tabled with the legislature, which described something quite similar to what is once again being proposed.
“CHCs are designed to improve access to Primary Health Care services and help focus efforts on population health promotion, chronic disease management, and the prevention of illness and injury through strengthening interdisciplinary teamwork and partnering with communities,” reads the framework, which arose out of a special legislative committee.
The document was recently found by the Green Party caucus in the legislative library, a moment that health critic Megan Mitton says underscores the challenges in health care reform in the province.
“Unfortunately it is all too often the case where there is good work done to create a report, chart a path forward and then government after government leaves it on the shelf and doesn’t implement what is needed,” she said.
“Reading through it there’s certainly a sense of déjà vu or Groundhog Day, unfortunately, where it’s just the same thing over and over again.”
The provincial government has earmarked $20 million to establish collaborative care practices in this year’s budget, a sum that could see around 30 clinics open or be shifted to fit that model. Horizon is looking to open three new clinics in Fredericton, Sackville and Sussex and says it will look to convert a number of CHCs into something closer to their original conception in the 2003 framework.
Vitalité is also seeing some success as eight new teams have accepted more than 11,000 patients.
Health Minister Bruce Fitch, who has already announced he isn’t running in this fall’s election, says he hopes that pushing the move to the care model may be one of his final achievements. As for why this attempt will be more successful, Fitch says the focus on administrative support will make the program extremely attractive for physicians.
“Putting the resources behind those collaborative practices, I think people will realize that that is the pathway forward,” he said.
Keating says the problem has never been with the desire of physicians and other practitioners to work in a collaborative setting, adding that the message hasn’t seemed to get through from professionals to policymakers for years.
The NBMS and the New Brunswick Nurses Union asked the government to spend $70 million on collaborative care in this year’s budget and push forward with 50 new clinics this year. Keating hopes that this third attempt to move to the model is more successful than the last two.
“I think we need to go all-in on this and the benefits are many,” she said.
“Think about the benefit, widespread across the province, how many people we can get off that patient connect list and into those family-based primary care teams.”
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