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Niagara needs to double down on primary care

Posted Apr 5th, 2024

This is an opinion column by Niagara Health President and Chief Executive Officer, Lynn Guerriero and ED physician at the Marotta Family Hospital in St. Catharines, Dr. Ryan Chadwick published in the St. Catharines Standard.

According to the Ontario College of Family Physicians, by 2026, an estimated four million Ontarians will be without a family doctor. Currently, 2.3 million individuals are navigating the complexities of their health without a primary care provider, and the strain on hospitals is palpable. 

The primary care crisis is about more than the physician shortage; it has also driven a change in the role of the family doctor. In the not-too-distant past, family doctors worked in hospitals. They were on wards, in Emergency Departments (EDs) and delivering babies. With this came relationships with hospital specialists, surgeons and internists. Urgent help for a patient was a phone call, or hallway chat, away. But, with the ever-expanding office load, many family doctors have reluctantly given up their hospital roles, and with them these relationships.

The consequences impact patient care. Patients who once relied on their family doctors for urgent interventions are often now directed to crowded EDs for care. Our EDs are seeing sicker patients, patients who have no family doctor to provide post-discharge care, and patients who need regular, community-based services which the hospital is not equipped to provide. 

The critical role of the family physician cannot be overstated when it comes to the care of those with chronic conditions. Niagara has the third-highest older adult population in Canada and our residents have higher rates of chronic conditions such as diabetes, arthritis, asthma, COPD and heart disease than the provincial average. Evidence shows that patients with chronic conditions have better outcomes when they are managed by primary care providers in the community. For example, unmanaged diabetes can lead to heart attack, stroke and limb amputations.

Better patient outcomes is at the heart of why Niagara Health embraces the need for collaboration between hospitals and community physicians. Niagara’s family doctors and Niagara Health have been working together to manage patients and avoid unnecessary ED visits and hospital admissions. Central to these efforts is SCOPE – Seamless Care Optimizing the Patient Experience – a program that pairs a hospital nurse navigator with outpatient doctors to help them connect with hospital specialists, urgent diagnostics and community health partners.  

NH has also taken the lead in creating outpatient urgent management clinics, such as the Iron Infusion Day Hospital, which accepts patients referred from physicians without the necessity of a specialist appointment, lessening the burden of access for family doctors and enhancing patient access to timely care.

NH is also in the final phases of creating a new leadership position – Chief of Primary Care. This role will be central to ensuring seamless collaboration with community primary care. It’s another signal of the importance NH places on the critical partnership between hospitals and community primary care providers. 

In order to see positive, long-term change in the health care system, we have to double down on what we know is the best primary care, and that is comprehensive, team-based care. Health teams bring together physicians and other health care professionals to offer patients a wide range of health services under one roof, including evening and weekend hours. The Ontario government recently announced a big boost in funding for these teams, including more than $2 million for Niagara.

Team-based care helps achieve the best outcomes for our patients by keeping people well, making sure patients have access to a primary health care provider when they are sick, and helping manage patients who have more complex issues and may be frequent visitors to hospitals. 

We have to be bold when we think of primary care and that means making sure, from a policy perspective, every Ontarian has access to comprehensive, team-based care. We must acknowledge primary care is at the heart of patient care and make practicing primary care more attractive for doctors.  

Niagara Health System