Technology (including EMR) is an important enabler as we strive to improve patient care and reduce waste within the healthcare system. However, if isolated from policy, legislation and compensation, EMRs alone cannot solve the problem of limited access to care. 'A GP for Me' is a joint program between the Government of BC and the BC Medical Association, created through the General Practice Services Committee (GPSC) which has been put in place to assist approximately 176,000 patients who cannot find a family doctor.
A February 23rd article in the Vancouver Sun provides further details on the $132 Million program. One of the stand out features is the designation of funding for telephone consultations with patients in order to more efficiently manage care without needing to bring that patient into the office for a face-to-face consultation in order to be compensated. (Until now this was the only way a fee-for-service physician could be paid to manage a patient unless they were covered under a different program e.g. chronic disease). What this equates to is up to 500 telephone consultations with patients per year at $15 per consultation (with critera that will need to be followed). However, it is an important recognition of the capability to manage patients effectively using the most basic form of telemedicine, the telephone.
I believe that there is one element of this strategy that has not been addressed. After a number of years of working as a part-time family physician in a walk-in clinic, I am convinced that convenience will continue to win over quality 9 times out of 10. What I mean by this is that even with a family physician, unless there is a mechanism to link a patient to a doctor or practice and place some accountability on patients to attend their 'new' family physician for the majority of care, we will not really solve this problem. Granted, the +/-176,000 patients may find a family physician, but if patterns of access to healthcare do not change, their new family physician will be utilized just like the 'old' family physicians and become the repository for copies of lab results ordered by walk-in clinics, visits to Emergency Departments and requests from 3rd parties for documents or from lawyers for medical legal reports.
Don't get me wrong. I believe this is an excellent step in the right direction. My only concern is that people do not change their behaviour patterns very easily. I believe that patients will continue to attend any walk-in clinic that is convenient for the majority of their episodic care. With all of the additional primary care capacity being created within the healthcare system, effective utilization is a necessity.
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