BY NORM TOLLINSKY
Local health integration networks (LHINs) across Ontario have begun hiring lead primary care physicians to help family doctors with chronic disease management.
“That’s where the focus will be for the next decade,” said Dr. Ian Cowan, a North Bay family physician and North East LHIN board member. “It’s all about trying to prevent people from getting sick as opposed to treating them after the fact.”
The LHINs have no authority over primary care and can’t tell family health teams, nurse practitioners or family doctors what to do, but primary care is “where we’re going to get the most bang for our buck” as far as chronic disease management is concerned, said Cowan.
“Now, we’ll have a physician who can go and talk to family health teams in Powassan, Timmins or Sudbury, show them the epidemiological data and say, ‘Here’s what we’d really like you to focus on.’ We all know that hospital beds are tight and everything’s costing more, but if we can prevent some of the complications from chronic illness, we can go a long way toward making the system more efficient.”
Chronic disease management was also in the spotlight at a LHIN-sponsored forum in Sudbury October 14th that brought together close to 100 primary care providers from across the region to share best practices.
“There has been a lot of work done in various corners of the LHIN,” said Cowan. “Timmins, for example, has been a leader in diabetes management and Sault Ste. Marie has been instrumental in kidney disease prevention.”
By bringing all of these people together in one room, primary care providers from across the LHIN can learn from each other, said Cowan. “Instead of reinventing the wheel, they can borrow the Timmins model or the Sault Ste. Marie model. I don’t think any one of us knows about all of the programs that are available, so this was a really good way of networking.”
The chronic diseases in the province’s crosshairs are diabetes, congestive heart failure, chronic obstructive pulmonary disease and chronic kidney disease. Obesity is another priority.
“If diabetics can control their sugar levels, cholesterol and blood pressure, and protect their kidneys through the use of medication, we can prevent or delay a lot of complications,” said Cowan. “If chronic disease patients don’t get blind because of their diabetes or if they don’t need a new kidney or dialysis, it’s going to be a benefit to them and to the system.”
Primary care providers don’t have to be part of family health teams to implement chronic disease management programs, said Cowan.
“I practise with a group of family doctors. What we did was we got together and hired a nurse who does a lot of the chronic disease management teaching and follow-up, so small groups of family physicians can start these programs, borrow resources that others have developed and get right into chronic disease management without having to spend a lot of time or money.”
There is no instant gratification in working with patients to control their chronic diseases, acknowledged Cowan. “With chronic disease management, you’re looking at years or decades of interaction with a patient to try to prevent them from having a heart attack, blindness or kidney disease. The patient will never thank you for the heart attack he never had…but if nothing happens, that’s good.”
Hospitals are also focusing on chronic disease management even though it’s not their role, said Cowan. They’re doing so out of necessity to keep chronic disease patients from clogging up their ERs and taking up hospital beds.
“But it’s not a hospital’s responsibility to make sure diabetics are controlling their sugars. That’s really the responsibility of the patient’s primary care provider.”
The Ministry of Health and Long-Term Care’s new diabetes registry will be a big help, said Cowan.
“All family doctors in Ontario now have lists of their diabetics and detailed information on when they had their last OHIP-funded eye exam, when they had their last cholesterol check and when they had their last hemoglobin AIC.”
Armed with this information, family doctors will be able to see at a glance which of their patients need to be more closely managed and how they compare with their colleagues across the province.
