Ontario’s Science Table: “The healthcare system is falling down”
TORONTO – A finale shock: exiting the scene, the Covid-19 Science Advisory Table – set up to deal with the pandemic and dissolved in September – painted a gloomy picture of the state of health in Ontario. Unequal distribution of access to primary care throughout the province, lack of data and serious general communication problems, inability to contact family doctors, exhausted health personnel. A disaster, in short.
“There is a huge number of people who are unable to access primary care in Ontario, we have an exhausted workforce and we need to think differently about the care we will provide in the future,” says the lead author of the Table report, Dr. Danielle Martin, family physician and president of the Department of Family and Community Medicine at the University of Toronto.
According to the Table, a team-based approach to primary care would better respond to patient needs and help address the alarmingly high number of Ontario residents without a family doctor. That number currently stands at 1.8 million, while another 1.7 million Ontarians have a doctor aged 65 or over, and recent research shows that the first six months of the pandemic spurred a real exodus of family doctors.
“One of the biggest lessons we have learned is that people who have dealt with a team, rather than individual professionals, have had a better experience of caring during this pandemic,” said Dr. Martin.
Then, there is a problem with the problem: with so many procedures and surgeries canceled due to Covid-19, family doctors and nurses are bearing the added burden of returning “old” patients to the care they need.
According to Dr. Martin, therefore, the only way out is to create primary care “teams” that also include pharmacists, medical assistants, social workers and community health workers. “Otherwise it will be very difficult to get out of this pandemic in a way that does not cause the complete collapse of our emergency wards and our hospitals,” she stressed.
The other criticality highlighted by the Scientific Table is the lack of equity in access to care: people from rural communities and inner suburbs, new Canadians and marginalized people remained with low levels of primary care. But there are some community-led initiatives that should be replicated and expanded, Table said, citing the Black Creek Community Health Center in northwest Toronto as an example.
Primary care “teams” involved community “ambassadors” and set up vaccine clinics open in the evenings and weekends to accommodate essential workers. This led to a significant spread of the vaccine from 5.5% of the population in the area in April 2021 to 56.3% just one month later.
“Community leaders took the initiative and the health system for once followed what the leaders themselves had to say, listened to and took instructions from people who understood how to best reach their people,” said doctor Martin. “This system must become permanent if we are to continue to fill these equity gaps and provide better care for indigenous people, people of color and other racialized groups.”
Another problem is the communication and data analysis. “We have hundreds and thousands of independent professionals using electronic health records, but we have no way to securely access that data to conduct research or improve the quality of the health services we offer,” Dr. Martin pointed out. And this lack of integrated data “has compromised the response in the treatment of the pandemic.”
“This disjointed and incomplete data system means that health care executives cannot ‘measure’ what is being done, who is being cared for and the effectiveness of that care, thus making it difficult to identify gaps in care,” she notes.
Lastly, there is no way to easily communicate with family doctors in the province. “Even now, after two and a half years of the pandemic, there is no easy-to-access centralized list that government or public health officials can use to send a clear and unique message to the primary care sector,” said Dr. Martin. “It’s astounding.”
Dr Fahad Razak, scientific director of the Table, in turn stressed that “the burden of managing Covid-19 will increasingly fall on general practitioners. And this includes not only treating any new infections, but also of conditions such as long-Covid “.
Even if the pandemic was over, the real emergency seems to start now…