Tag Archives: multimorbidity

Arlene Bierman is the Director of Center for Evidence and Practice Improvement (CEPI) at the United States Agency for Healthcare Research and Quality (AHRQ)

Rick Glazier is a Family Physician and Senior Scientist and Program Lead of Primary Care and Population Health at the Institute for Clinical Evaluative Sciences (ICES) in Toronto, Canada

 

Primary care is foundational to optimizing individual and population health. Health systems based upon primary care provide better access to care while improving health equity and outcomes and reducing costs. Effective models of primary care can greatly enhance the value of increasingly constrained health care spending. Despite large investments on primary care transformation in the US and Canada, primary care has yet to achieve its full promise in either country. Sharing successes and failures from attempts at innovation on both sides of the border can help each country accelerate improvement.

Despite very different health systems, primary care practices in both countries encounter remarkably similar challenges in delivering care. At the point of care, patients’ needs are similar and their experiences too often suboptimal. ...continue reading

Robyn Tamblyn is the Scientific Director of the Canadian Institutes of Health Research Institute of Health Services and Policy Research, and a Professor in the Departments of Medicine and  Epidemiology & Biostatistics in the Faculty of Medicine at McGill University, Canada

Andrew Bazemore is a practicing physician and the Director of the Robert Graham Center – Policy Studies in Family Medicine & Primary Care -  in Washington, DC

 

Yehuda Berg, an American author and spiritual leader, was probably talking about individual level transformation when he said “We need to realize that our path to transformation is through our mistakes. We're meant to make mistakes, recognize them, and move on to become unlimited.” But the statement has a lot of validity even applied to system level transformation.

Canada and the United States share the dubious honor of ranking near the top of OECD nations for total healthcare costs and near the bottom for health outcomes, whether measured in terms of individual health or health system performance. But it is through the recognition of these mistakes that both countries have embarked on a path toward transformation.

While differences between the two systems of health care delivery are frequently emphasized, we actually face some common challenges to primary care transformation ...continue reading

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bonnie-larsonBonnie Larson is Family Physician at Calgary Urban Project Society (CUPS) Health Centre

 

Recently I called the emergency department from my outreach clinic in an urban shelter.  Near the end of the day, the nurse mentioned that one of the clients staying there, a young aboriginal woman I will call Ms. Rain, was supposed to follow up on an abnormal lab result from a few days earlier.  As I looked the patient up on the ancient clinic laptop, I thought about the promise I had made to my daughter that morning to try to be home by suppertime.   I willed the computer to load the results a little faster so I could get home to my family.

Finally, several abnormal results, including an elevated D-Dimer, appeared.  ...continue reading

Domhnall_MacDomhnall MacAuley is a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK

 

We expect Nobel Prize winners to be high profile researchers of almost celebrity status, pioneering cutting edge science that changes the world at a stroke. And, then I heard that one of this year’s winners was William C Campbell, a fellow Irish man. I didn’t recognise the name, was unfamiliar with his work, and knew nothing of his background. But, as the media story broke, I learned more about him. He came from Ramelton, a small village in County Donegal, far from the bright lights and, like many Irish doctors, undertook his graduate work in the US. His research was in worms - not the type of glamorous cutting edge clinical science that features in glossy magazines but, from the messy world of vials and dishes and parasitic roundworms kept in the freezer.

“You must be kidding!” was his reaction, when telephoned with the news.

But, his findings did change the world. ...continue reading

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Domhnall_MacDomhnall MacAuley is a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK

 

Some sessions just stand out. Dee Mangin's stunning distinguished presentation of her research into whether iron deficiency without anaemia in infants affected their long term developmental outcomes. They had, incredibly, 100% recruitment with blood tests in infants, and they followed the kids meticulously for 6 years with validated outcomes for intellectual and psychomotor ability. There was no loss to follow up with only minimal data loss e.g. 5% missing blood data blood at age 6 years. Dee’s presentation kicked off a superb afternoon on Tuesday at NAPCRG 2015 of ground-breaking trials asking important clinical questions... Do steroids help in chronic cough? What's the effectiveness of maintenance SSRI (and what happens with antidepressant withdrawal)? It would be unfair to release any of these findings in a blog and we all look forward to publication of the papers. Suffices to say, they will be practice-changing. ...continue reading

Bruce Guthrie05_resizeBruce Guthrie is Professor of Primary Care Medicine at the University of Dundee in Scotland. He is a keynote speaker at this week's Society for Academic Primary Care annual conference in Oxford.

 

Multimorbidity is usually defined as present when people have two or more chronic conditions. It’s an idea that appeals to medical generalists because it makes clear that specialist care that only focuses on one of those conditions may sometimes be too narrow, particularly when someone has very many conditions or when the conditions they have are very different. Physical and mental health conditions are the exemplar of the latter, with many countries having separate services ...continue reading