Ontario Doctors Still Struggle with Care Coordination

A recent report from Health Quality Ontario contained some worrying insights. Chief among them: many of the province’s primary care physicians struggle with care coordination. How can this be?

In recent years, policymakers have placed major emphasis on helping patients navigate the health care system. They’ve recognized the role care coordination plays in patient-centred care.

Unfortunately, change takes time. And practitioners have a lot on their plates.

It’s true that many primary care doctors play a foundational role in improving care coordination—by establishing Health Links, for example. That said, not all practitioners have the in-office resources to ensure patients move smoothly through the health care system.

Unfortunately, poorly-coordinated care can have real consequences. The population is aging, and the number of patients with complex conditions is on the rise. Now, more than ever, care coordination is critical.

In home care, care coordinators and case managers have the potential to be a major resource for family doctors. But how well are these professionals working together to ensure smooth care delivery for patients?

In this post, we’ll look closer at care coordination in primary care—and how professional relationships might improve it.

Primary care & care coordination: a crucial pairing

The value of care coordination carried out by primary care practitioners can’t be overstated. Every patients needs a go-to practitioner—someone they can discuss all of their health-related concerns with.

Family doctors do so much more than just perform annual checkups. And the concerns they hear go far beyond bad colds and earaches. Through primary care, patients are connected to any number of outside resources—specialists, mental health practitioners, community and social supports.

Family doctors listen. They connect patients to the right professionals and organizations based on what they hear. But that’s only half the battle.

New information must be integrated into the care that a patient receives. Patients need to be made aware of changes in their health, and how they might be impacted.

But what does this mean for primary care physicians and their day-to-day work? Do these practitioners need to follow up with other providers for every test result, every diagnosis, and every set of recommended lifestyle changes?

There are various models of primary care operating in Ontario. Some physicians have a bigger staff at their disposal than others. But care coordination poses challenges in even the best of circumstances. When practitioners take on this responsibility in an environment where they have little support, additional pressure can result.

According to one study, 78% of physicians report experiencing burnout. And it’s not hard to imagine why. This is especially true in primary care, where the scope of responsibility is so large.

That said, care coordination is absolutely essential to patient-centred care. And the role of primary care is key.

Consider this. The Ontario Primary Care Council has stated that care coordination is “best led by a patient’s primary care organization throughout his or her lifetime.”

But what about coordination in other parts of the health care system? How does it factor in outside of the family doctor’s office?

The home care disconnect

Care coordination is necessary anytime a patients needs to see a specialist or provider other than her primary care doctor. Timely communication is important in these instances.

But what about patients who receive care at home and in the community? According to Health Quality Ontario’s recent report, only 29% of Ontario doctors say that they (or someone in their practice) regularly communicate with their patients’ home care providers or case managers.

This gap matters. Often, patients who are cared for in the community have a number of chronic conditions. They may have an entire network of professionals devoted to their care.

If you work in home care, you know what this can mean. You’re constantly aware of the threat of communication breakdown. The geographic distance between patient homes and provider offices can make sharing information a real challenge.

Scheduling alone can cause problems. But above and beyond that, providers must be vigilant to ensure that caregivers have access to and are working with the most up-to-date health information—and that they’re recording any changes that might impact the care delivered by other providers.

During home visits, nurses and personal support workers (PSWs) collect vital information. They see firsthand how patients are doing and (in many cases) take vitals and other health-related measurements. They provide basic care.

Other caregivers in the patient’s circle of care need to know what they’ve observed and what they’ve done. So do home care coordinators and case managers. And hopefully, primary care physicians will know, too.

From the physical therapist to the social worker, every professional who cares for a patient at home has valuable information for that patient’s family doctor. Home care coordinators should have immediate access to this information, which should make sharing possible.

And yet, regular communication with care coordinators only takes place with 29% of doctors in primary care offices. In Saskatchewan, that number is 62 per cent. Clearly, improvement is possible.

Better together

There’s no denying it: coordinating care is a difficult task. And the consequences of not getting it right are significant.

According to Health Quality Ontario, 25% of family doctors in the province say that in the previous month, tests and procedures had to be repeated because results couldn’t be located.

These inefficiencies aren’t good. If delays are having such a significant impact on patients in general, what problems are they causing in home care? After all, when care is delivered in patient homes, there’s no shortage of opportunities for miscommunications.

How can primary care doctors improve care coordination for their patients who receive home care? Given the time demanded of physicians and their often limited in-office resources, it’s a tough question to answer.

It seems natural that family doctors and home care coordinators would connect. But often, there are obstacles in the way. And they’re not just structural. Sometimes it comes down to attitudes.

For doctors who do a lot of their own coordination without sufficient support, following up with yet another provider may seem daunting. Time is precious—especially for those with a very large scope of responsibility.

There’s also confusion among many doctors about what care coordinators do. As time goes on, the value of the role will become clearer. And it goes with our saying that the value is significant.

Consider Health Links. In Health Links, care coordinators and case managers are dedicated entirely to engaging with people who have significant coordination needs—and ensuring that those needs are met. In order to fulfill patient needs, home care coordinators need patient medical histories from primary care practitioners. But doctors need help from care coordinators, too.

Who better to answer questions pertaining to a coordinated care plan than the person who created it with the patient? Who better to provide detailed information about recent changes in the patient’s condition?

In most cases, home care coordinators and case managers see patients far more often than family physicians. For this reason, the information they collect can be extremely useful.

Take the following example, which we used in a previous post. Say a care coordinator visits a patient at home three times a week, collecting his blood sugar levels.

The patient’s family doctor doesn’t see him nearly as often as the coordinator. By reviewing the coordinators information, the physician can see trends she never otherwise would have.

The potential for better care coordination

Primary care practitioners are well positioned to coordinate care. Very often, they’re the entry point into the health care system when patients face new health challenges.

In home care, care delivery is ensured by a separate system of coordination. It’s not always a system that primary care physicians understand. Care coordinators can help by opening the lines of communication and (when relevant) educating family doctors about what they do.

What these two groups have in common is the best interest of patients. To ensure the highest quality of care, family doctors and home care coordinators must work together. Moving forward, sharing information will be key.

Feature image courtesy of Hamza Butt

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