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PHARM 120 Final > Primary Care > Flashcards

Primary Care Flashcards

1
Q

Differentiate between Primary Care and Primary Health Care.

A

Primary care:
the shorter term defines a narrower model of Family doctor type

Primary Health care:
- Holistic approach to health policy and services (social determinants of health)
- Contains prevention and health promotion

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2
Q

What are the core principles of Primary Health Care (4)

A
  1. Universal
  2. Equity
  3. Community Participation
  4. Intersectoral
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3
Q

What are the characteristics of Primary Health Care (6)

A
  1. First level of contact
  2. Close to where people live and work
  3. First step in a continuing care process
  4. Include the main health problems
  5. ***Include promotive, preventative, curative rehab services
  6. Accessible 24/7
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4
Q

What is physician supply associated with?

A

Means: # of physicians per 10,000

associated with better health outcomes, better lifestyle, lower costs

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5
Q

What is the percentage of Canadians that can get same or next day appointment. What about the opposite?

A

51% of Canadians can get same or next day app.
62% of Canadians reported not getting same or next day app.

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6
Q

When Canada was planning on reforming primary care to primary health care, what were the 3 issues?
IAM

A
  1. Introduction of patient enrolment
  2. Alternative payment plans
  3. Multidisciplinary teams
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7
Q

What will introduction of patient enrolment help in the reform?

A
  • it will formalize a relationship between the physician and the patient
  • it is voluntary for both parties
  • Requires dual commitment
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8
Q

What does traditional fee-for-service payment model mean?
What are its theoretical issues?

A
  • Physicians bill to OHIP
  • Payment made for each service
  • Physicians are independent and self-employed
  • Payment from MOHLTC is used to cover all clinic expenses

Issues
- Over care
- barriers to interprofessional

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9
Q

What does a capitation payment model mean?
What are its theoretical issues?

A
  • payment based on # of enrolled patients
  • It is adjusted for age and sex
  • Not adjusted for health status
  • Does not look at # of visits

Issues
- Can select only healthy patients

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10
Q

What are some incentives offered to MDs as an alternate payment plans

A
  • Rostering patient fees
  • Chronic disease management
  • Preventive care
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11
Q

What is the issue with salary APP

A

low productivity

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12
Q

What are the 5 family practice APP

A
  1. FFS with bonuses to enrolled patients
  2. Salaried model
  3. Blended capitation model
  4. Blended salary model
  5. Complement-based remuneration and incentives
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13
Q

What are the multidisciplinary teams (3) which also contain pharmacists

A

Community Health Centres CHC
Family Health Teams FHT
Nurse Practitioner Led Clinics NPLCs

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14
Q

What were the first primary health care organizations to be created that have transformed?
What were their payment model

A

Health service organization HSO
Primary care networks PCN

Capitation

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15
Q

What do Community Health Centres CHC focus on?
What are their payment models?
What is it funded by?

A
  • Focus on social determinants of health and health promotion
  • Physicians are employees and paid with a salary
  • Funded by LHINs (Ontario health) (Global budget)
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16
Q

What are Family health Networks replaced FHN?
What are their payment model?

A

Replaced PCN
Blended Capitation: capitation reimbursement + limited FFS and incentives
- Patients are enrolled to physicians

17
Q

What are Family Health Groups FHG?
What are their payment models?

A
  • Groups of at least 3 FPs/GPs
    Blended FFS: FFS payment + bonus & premium payments
  • Voluntary enrolment of patients
  • Move from FFS solo to group practice
18
Q

What is the payment model for Rural-Northern Physician Group?

A

Blended complement model: base remuneration (based on # of physicians)
5% shadow billing
1-7 physicians

19
Q

What are Family Health Organizations FHO?
What are their payment models?
What is it funded by?

A
  • 3+ physicians
  • MAINLY capitation model (but still a little blended)
  • Governance and Lead Physician
  • Difference between FHN and FHO is scope of included codes and capitation rate
20
Q

How does Comprehensive Care Model CCM work?
Payment model?

A
  • Solo physician
  • Blended FFS + CCP
21
Q

How do Family Health Teams FHT work?
What are their payment models?
What is it funded by?

A
  • Team practice
  • Independent, non-profit
  • Blended Salary
  • Has funding for other: executive director, allied health professionals, implementation of electronic medical records
22
Q

How do Nurse Practitioner-Led Clinics NPLC work?
What are their payment models?
What is it funded by?

A
  • Independent, non-profit
  • Team practice
  • Salary
  • Global budget
23
Q

Which 3 Primary Health Care organizations do not have patient enrolment

A
  • Community Health Centre CHC
  • Nurse Practitioner-Led Clinics NPLC
  • FFS
24
Q

How much percent of MDs are in an FFS model in 2015

A

25%

25
Q

Of the 93.3% of patients in 2022 that have a family doctor, how many can get same or next day with a primary care provider?

A

40.6%

26
Q

What are the pharmacists’ role in these primary health care organizations

A

Consultation services
Medication Management
Smoking cessation
Anti-coagulation management

27
Q

What are the theoretical benefits of Primary Care reform? (5)

A
  • Continuity of relationship
  • accountability for physicians
  • access with less emergency admission
  • productivity
  • quality of care
28
Q

Which organizations had the higher than expected ED visits? (3)

A

FHN (blended capitation) (large rural)
FHO (blended capitation)
FHT (blended salary) (large rural)

29
Q

Which organization had the highest health promotion but lowest efficiency (cost per patient)? why?

A

CHC
- CHC’s are usually for disadvantaged and sicker populations and they have substantially lower ED visit rates than expected

30
Q

Which model is the most attractive for future MDs

A

Family practice
Mostly Blended and blended capitation models

31
Q

What are the gaps in primary care. (4)

A
  • Access: wait times are high
  • Chronic disease management and prevention
  • Electronic medical records: only 50% used electronic
  • Accountability and performance
32
Q

What were the 4 issues from the Price-Baker report

A
  • Attach every one to regular PHC provider
  • Everyone can obtain interprofessional care
  • Integration of both PHC providers and other systems
  • After hours and on weekends
33
Q

What is the new proposal to strengthen patient-centered health care in Ontario

A

Give Ontario’s 14 local health integration networks (LHINS) an expanded role, including in primary care
- This would increase efficiency to direct more funding to patient care

34
Q

What is the current plan according to super agency Ontario health

A

Dissolving the 14 LHINS and merging them all to one- the interim 5 regions
- 1 coordinated team to focus on patients
- Improve navigation of patients and families
- Improve access to information system

35
Q

What occurred in the Ontario Physician Services Agreement

A

2015: 2 7% cuts for physicians
2022: 1% increase in each of the first 2 years of the agreement

36
Q

What % of ED visits are manageable by pharmacists with expanded scope

A

4.3%

PHARM 120 Final (4 decks)

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