Wednesday, September 26, 2007

A Multi-Disciplinary Approach to Health Care

The following questions were put to me during the Provincial Election campaign by community health care professionals. My response follows.

Dear MPP candidate:

I am writing to all candidates in my riding to determine whether they support an important solution that will improve access and timeliness of health care in Ontario.

In particular, I would like to know whether you support regulatory, policy and legislative changes that will enable primary health care nurse practitioners across Ontario to fully utilize their knowledge and expertise to improve access to timely health care and reduce fragmentation and duplication of care.

Nurse practitioners provide primary health care to thousands of individuals and families in Ontario and are integral to completing the Second Stage of Medicare. Ten years ago Ontario led the way in implementing the NP role but has since fallen behind other provinces.

Earlier this year, the Primary Health Care Nurse Practitioner Integration Task Team reported to the Minister of Health and Long-Term Care on strategies to address barriers that limit NPs’ ability to provide timely, efficient, comprehensive care. I urge you to commit to implementing these recommendations.

Specifically, I would like to know whether you will commit to several key actions.

Removing barriers that restrict specialists from accepting referrals from nurse practitioners: Many women, for example, who need a referral to an obstetrician or gynaecologist, are required to first see a family physician in order for the specialist to bill the full fee for seeing the patient. The result is less timely care, increased costs for the health system, fragmentation of care and inconvenience for patients.

Removing barriers that limit NPs’ ability to prescribe and order tests and diagnostic procedures: NPs’ authority to prescribe is limited and listed in regulation. When new, more effective and cost-efficient drugs are introduced, it can take up to two years to add these drugs to the NPs’ list. NPs have the knowledge, skills and expertise to prescribe appropriately within the scope of their practice as primary health care providers.

Supporting a variety of strategies to recruit and retain NPs: NP salaries are no longer competitive within nursing in Ontario or across Canada. Government, together with nurse practitioner stakeholders, must support an independent salary review to address this issue. Changes are needed to government funding programs that will facilitate recruitment and retention of NPs through:

a) annual cost-of-living increases;
b) continued and expanded support of the Grow-Your-Own NP program; and
c) financial incentives for positions in rural, remote and under-serviced communities (e.g., moving costs, bonus payments, additional continuing education funding).

Remove barriers that limit effective inter-professional team practice: Current compensation models are structured to provide bonus payments to physician members of inter-professional primary care teams to recognize and reward illness prevention and health promotion activities such as immunizations and mammograms. Physicians are eligible for this compensation regardless of which member of the team - such as NPs or registered nurses - actually provided the care. This is disruptive to effective team development and marginalizes and devalues the contributions of other health care professionals to improving and sustaining the health of patients.

Develop, in collaboration with NP stakeholders, a public education program about NPs and their key role in primary health care: The healthcare system would benefit hugely from an enhanced understanding - by physicians, other health care providers and policy-makers, such as the LHINs - of the role of NPs in increasing access to care, reducing waiting lists, improving management of chronic diseases and implementing preventative health care programs.

Will you commit to these recommendations to support nurse practitioners and more timely access to health care in Ontario?

DearCommunity Member,

Thank you for taking time to contact me regarding this very important issue.

I am very proud of the long term approach that the Green Party of Ontario takes with respect to health care.

My own personal background includes serving on the board of my local community resource centre, the Overbrook-Forbes Community Resource Centre since 2001. I have taken a leave of absence during the election. I served as board President from 2002-2004 and Treasurer, 2004-2007. this organization is in the process of implementing a multi-disciplinary health component which should be open to the public on site by December, 2007.

Below are what I believe are some of the pertinent sections of our platform to your questions. For your reference, the full document can be found here:

The GPO’s health plan takes a broad approach to wellness, with an emphasis on healthy communities, healthy lifestyles and a healthy environment, not just health care. Reducing toxins in our environment, addressing the social determinants of health and encouraging healthy lifestyle choices are important components of the Green Party’s health plan.

The Green Party has a plan that will offer more choice, emphasize prevention and be accountable to the public.

To achieve these objectives, the Green Party of Ontario will:

Provide Ontarians in the lowest 75th percentile of income an additional health care allowance of $1,000 per person, phased in over five years at $200 per year, for purchase of prescription drugs and/or care from any practitioner mandated by the Regulated Health Professionals Act (RHPA) at an eventual cost of $9.75 billion by 2012. These professions include: physicians and surgeons, nurses, chiropractors, physiotherapists, naturopaths, audiologists, chiropodists, dental hygienists, dental technologists, denturists, dieticians, massage therapists, medical laboratory, midwives, occupational therapists, opticians, optometrists, respiratory therapists and dental surgeons.

Immediately increase the budget of the Ministry of Health Promotion, currently at 1%, to 2% of the Ministry of Health and Long-Term Care’s budget. Since most illnesses result from lifestyle choices, the GPO believes that health promotion is fiscally prudent and will lead to improved wellness. These funds would be used to place nurses in the school system to promote healthy lifestyles and to assist in identifying youth at risk of long-term health problems.

Increase the funding and effectiveness of primary and preventive health care by:
Creating a joint commission of stakeholders to explore best practices for implementation of preventive and primary health care by family doctors, with an emphasis on improved outcomes. This may include rewarding doctors who successfully assist their patients resolve risk factors such as obesity, smoking or uncontrolled high blood pressure.
Increasing support and incentives for multidisciplinary clinics and practices that team doctors with nurses, dieticians, psychologists, counsellors, physiotherapists etc. This is particularly important for taking a holistic approach to mental health, addiction and lifestyle counselling.

I am strongly supportive of proposals that promote a multi-disciplinary approach to health care. I view your proposals very favourably.

Thank you for taking the time to contact me.

Leonard Poole

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