Analyzing Canadian S Choice for Walk in Clinic Visits or Continuity of Care by Family Doctors … Research Paper
Pages: 18 (7314 words) | Style: APA | Sources: 8
¶ … healthcare services in Canada i.e. continuity of care by family physicians and walk-in clinics. The paper explores the existing situation in the context and seeks to find a solution in the best possible manner to address existing and projected issues concerning seamless, effective, and economic service.
According to Jones (2002), walk-in clinics are stand-alone (not part of any hospital system) health care facilities that accept clients without referrals or appointments. Walk-in clinics are especially popular in the United States, Canada and Australia. They started in the early 1970s in the U.S. as independent emergency facilities that helped to release the pressure from overwhelmed emergency departments and family doctors through the provision of non-referral / non-appointment care services. By the end of 1970s, walk-in clinics had spread throughout the U.S. and into the Canadian health care system. These emergency care provision facilities soon took up more primary care responsibilities and offered services vastly more than emergency-only facilities.
However, the main concerns that opponents of these types of facilities in Canada have is that, these centers lack continuity of care, overlapping services, low complexity, and competition for fees. For instance, it has GPs (General Practitioners) who have a gate-keeping role referring only those cases that they think family physicians cannot handle. Thus, whatever is learned here could be relevant to the existing as well as developing healthcare system, given the fact that Canadian citizen is ageing very fast. The country has had walk-in clinics for over two decades now (Jones, 2000). These walk-in clinics have been used in the provision of different interventions and treatments. Both proponents and opponents' perspectives will be examined in this paper.
The healthcare scenario in Canada faces issues on two main counts -- lack of a nationwide, unitary healthcare plan and policy (in that the states are empowered to devise and implement their own strategies, whereby there are many differences in healthcare laws as we move from state-to-state), and on the other hand, most individuals do not have family doctors that can take care of primary health issues and hence seek to defer their healthcare concerns, till the conditions become serious. Ironically, many individuals also seek expert care even for preventable and primary healthcare. These two issues combine to stress the healthcare scenario. It is here that Walk-in Clinics (WIC's) appear as attractive options. WIC's have less 'waiting-periods' than the conventional, public or private hospitals. However, they lack continuity of service, and uniformity in FFS (Fee-for-Service) structure.
Unsurprisingly, Provincial governments are emphasizing the need of a family doctor for each family, especially when majority of residents are not seeking such services. However, it is not clear how they seek to achieve that without a policy or plan to either increase the number of family physicians or increasing the load on existing doctors.
A policy issue that arises in this context is that the fees physician receive for services offered allows them to choose and accept patients that suits "economic" rather than "healthcare" needs. Another important policy issue arises in the form of lack of uniform policy for health insurance, especially for those with citizenship status issues. A third concern is the fact that the 'baby boomers' group is soon reaching "aged" stage and would require continual care, towards which, urgent action seems to be lacking. The wait-in queues put stress on the patients as well as public and private hospital institutions. This may explain the proliferation of WIC's, at least to a measurable extent.
Action Plan - The Way Ahead
1) Area-wise distribution of primary healthcare, for improved access
2) Better coordination amongst the different healthcare institutions (private, public, community health centers and WIC's, family doctors, clinics and hospitals)
3) Health Education in social and community constructs towards preventative and long-term, longitudinal care (for the old, chronic, terminal and handicapped care).
4) Involving the NPs (Nursing Practitioners) and pharmacists into the healthcare structure to reduce the stress on the mainstream institutions and physicians.
5) Lastly, a unified, basic, transparent payment structure (both for the physicians and for the patients)
As understood from the challenges and situations (existing, evolving and projected), any 'instant' solution could prove detrimental in countering the issues of the healthcare industry. A long-term plan, targeting at least a couple of decades ahead with joint efforts of provincial as well as federal governments would help address concerns in healthcare to a large extent.
The endeavor of the provinces should be to track the "unattached" segment of the population, doctors, pharmacists and NPs. Bringing them and the services offered and received would help target the gaps and problems that need solutions- in the short- and long-term. Then ways and means could help prioritize and sufficiently address the issues involved. For example, access to Pharmanet can help locate the existing relationship and interaction between the patient and type of health provider. Further, such information can be used to tie up patient information with community and hospitals in the area.
It is in this context, that Technology can help the governments access and relay data securely, effectively and speedily. Such data can help explore possible solutions with the help of academic investigations.
Canadian Healthcare has existing and projected concerns. Policy concern arise from the decentralized healthcare industry. The institutional facilities have long wait-in-queues that allow the sustenance of 'walk-in' healthcare facilities. Also, adding to the issue is the reluctance or inability to access 'family doctor' construct. A third issue is the inability of industry to take cognizant and critical services the NPs and Pharmacists can provide.
Coordinating the services and efforts of all contributing factors could well be the sustainable solution Canadian Healthcare industry seeks. The means to interlink all the stakeholders is present in the form of information and communication technology. All efforts must be made to deploy this tool effectively to address the existing problems in addition to making policy adjustments to improve access and continuity through community education and creating more doctors.
The majority of Canadians would first seek the services of family physicians if they were in any situation that required medical attention. However, quite a huge percentage of Canadians (especially in the last three decades) rely on the country's emergency departments and its stand-alone walk-in clinics. In addition, author Mertl (2015) argues that quite a significant population (15%) of Canadians does not have family physicians. And he gives two reasons for this: First, many young people feel healthy and don't see the need to have a family / personal doctor; second, a number of Canadians have not been able to find for themselves a family physician that would care for them the way they want them to. Another factor that has caused this shift in healthcare preference (from Family doctors to Walk-in facilities) is long waiting times for the patients at hospitals.
Figures released by Statistics Canada back Mertl's figures, they show that approximately 33% of Canadian men aged between twenty and thirty-four are not affiliated / latched in any way to any physician. The figures are different in different provinces around Canada. For instance, only 6% and 7.5% of New Brunswickers and Ontarians respectively do not have family doctors, the percentage of people without family doctors in Quebec is twenty-five. The situation is worse in Nunavut where approximately 82% of the people do not have a primary physician (Mertl, 2015).
Of late, many of the Canadians with no family doctors constantly troop into hospital emergency rooms even for infections that were not threatening. For instance, just in the last fall, the Canadian Institute for Health Information, reported that over 1.4 million Canadians went to hospital emergency departments for ailments such as sore throats that should have been treated in alternative facilities. In the recent years, more and more Canadians are visiting health care facilities to get healthcare services. The result is an overstressed medicare facility (institutionalized), leading to proliferation and sustenance of walk-in clinics. The large number of walk-in Clinics has queered the Canadian healthcare system qualitatively.
Further, the provincial nature of Canadian healthcare system, without an overall, common Federal cover gives rise to disparities, from state to state. However, generally, the fact that physicians do not have to declare what kind of service they have makes it difficult to know how many walk-in clinics are there in Canada. The British Columbia's College Professional Standard is one of the toughest standards to adhere to in the whole of Canada concerning the description of the relationship between walk-in clinic services and patients. Other provincial colleges such as Alberta, New Brunswick, Saskatechwan have also come up with policies for walk-in clinics on care standards. In Ontario, the situation is different, the policy is that patients do not identify with a family doctor but go to the same multi-doctor, urgent care, or walk-in clinic then it is assumed that they are getting primary care at that facility. However, the country's Medical Association has no position on the issue (Ontario's Action Plan For Health Care… [END OF PREVIEW]
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