Rick Glazier is Senior Scientist at the Institute for Clinical Evaluative Sciences, Family Physician and Scientist at St. Michael’s Hospital, and Professor of Family and Community Medicine at the University of Toronto. He is currently serving as President of the North American Primary Care Research Group (NAPCRG)
I see patients in a setting where there is an inter-professional team, electronic medical records, patient reminders for cancer screening, physician payment through capitation plus incentives, and after-hours coverage. These changes have all occurred in the past few years and they have been very costly to the provincial health system.
Most primary care settings in the developed world have undergone similar changes, or want to have them. Like my setting, very few places are able to say whether these changes have made patient care better, improved health, or reduced costs. Sure, we all know of success stories: a plan that has reduced emergency department visits; a group that has improved immunization coverage. But are these successes sustained over time and when they are successful do they spread elsewhere? The evidence from somewhere else, produced about a decade ago, suggest that these types of changes produce better health and better equity at lower costs. But what about right now, where I practice? Sadly, not much is known.
We live in a world that has started to recognize the promise of primary care ...continue reading