Primary Health Care in NB through the citizens experience: Painting - PowerPoint PPT Presentation

Primary Health Care in NB through the citizens’ experience: Painting the picture October 20 th , 2011

Objectives • Context for NB Healthcare System • Briefly review inputs (capacity to deliver clinical care) • Review outputs (products and services) • Finally review outcomes • Questions

2010 Expenses for the New actual % of total Brunswick Health amounts expenses System (millions) Department of Wellness, $7.02 0.09% Culture and Sport – Wellness portion* The portion for Department of Health $2,585.00 33.45% Wellness is Department of Social $462.53 5.99% $7.02 million Development – Long Term Care* Total – Health System $3,054.55 39.53% The portion for Long Term Care is $462.53 million Total NB expenses = $7,727.8 (million)

Context Matters "In order to get from what was to what will be, you must go through what is." Anonymous

Inputs……………….……..Capacity

Source: ICIS

Source: CIHI

MRI and CTs New Canada Brunswick CT scanners/million 21.9 14 population MRI machines/million 8.2 8.1 population Source: (2010) CIHI

Information Technology EMR Score EMR 7.8 % New Brunswick physicians use electronic records INSTEAD OF PAPER CHARTS to enter/retrieve clinical notes National Range: (1.9% 27.7%) National Average: 16.1% Source: National Physician Survey 2010

There are four sectors of care which make up the Health Care System C D $ B $ $ 5% for administrative expenses $

$177,318,900 Prescription drug program Public Health Provincial Epidemiology $23,672,544 Communicable disease control (DH) immunization program surveillance inspection services health protection program (food, air, water) $27,261,581 Promotion of healthy lifestyles/healthy families early child intervention (ECI) 3.5 years old health clinic baby friendly initiatives healthy eating dental health healthy learners and school sexual health programs Injury / disease prevention initiatives Tobacco $84,861,300 Ambulance Services Primary Health Care Chronic disease prevention and management $3,820,000 Telecare services $26,295,161 Community Health Centres $10,089,775 Health Centres $7,016,000 Wellness, Sport and Operational Expenses $215,566,460 Physician Costs $575,901,721 Total

Outputs… What do we know about the quality of services and performance...

Primary Health Care (PHC) Visits PHC Visits in the Last 12 Months PHC Visits: Model of care by service area / health professional used most often 500,000 when sick or need care by service area / health professional 450,000 400,000 350,000 8% 300,000 12% 250,000 PFD 200,000 AHC ER 150,000 18% OTHER 62% 100,000 50,000 0 PFD ER SPEC AHC ALT TC CHC AMB NP PFD: personal family doctor ALT: alternative pracitioner 81% 42% 40% 25% 21% 10% 7% 6% 5% ER: emergency room TC: Tele-Care SPEC: specialist CHC: community health centre AHC: after-hours clinic AMB: ambulance services or walk-in clinic NP: nurse practitioner

National Comparisons – Accessibility New Primary Health Care Indicator Canada Brunswick 86% 93% Percent who have a personal family doctor (CSE-PHC 2008) (NBHC 2011) Percent who can get an appointment with 45% 30% their personal family doctor on the same day (Commonwealth (NBHC 2011) or next day Fund 2010) 31% Personal family doctor has an after-hour 22% (Commonwealth arrangement when office is closed (NBHC 2011) Fund 2007) 24% Percent who used a health information 10% (Commonwealth telephone line in the past year (NBHC 2011) Fund 2007)

National Comparisons – Emergency Room New Primary Health Care Indicator Canada Brunswick Percent who visited a hospital 24% 42% emergency department in the (CSE-PHC 2008) (NBHC 2011) past year Percent who waited less than 4 73% 75% hours in the hospital emergency (Commonwealth (NBHC 2011) department Fund 2007)

National Comparisons – Teams-Coordination of Care Primary Health Care Indicator Canada New Brunswick Percent who have access to a 39% 34% primary health care team (CSE-PHC 2008) (NBHC 2011) Percent who reported that their personal family doctor “always or 68% 59% usually” helps them coordinate the (Commonwealth (NBHC 2011) care from other healthcare providers Fund 2010) and places when they needed it Primary health care team is defined as : having a personal family doctor AND a nurse is regularly involved in health care OR a nurse practitioner is regularly involved in health care OR other health professionals work in the same office as the personal family doctor

National Comparisons – Timely Information Primary Health Care Indicator Canada New Brunswick Percent who reported that, after staying 23% overnight in the hospital, their personal 10% (Commonwealth family doctor did not seem informed and up- (NBHC 2011) Fund 2007) to-date about the plan for follow-up care Tests are NOT available about 7.8% at the time of visit in NB

National Comparisons – Healthy Living New Primary Health Care Indicator Canada Brunswick Self-rated health (% very good or 59% 53% excellent) (CSE-PHC 2008) (NBHC 2011) Percent of citizens with 1 or more chronic health conditions (among arthritis, cancer, COPD, diabetes, 33% 49% heart disease, high blood pressure, (CSE-PHC 2008) (NBHC 2011) and mood disorders, including depression)

National Comparisons - Preventative Care / Health Promotion New Primary Health Care Indicator Canada Brunswick Percent of citizens with 3 or more chronic health conditions (among arthritis, cancer, COPD, diabetes, heart disease, high blood pressure, and mood disorders, including 40% 29% depression) who reported that they (CSE-PHC 2008) (NBHC 2011) “rarely or never” talk with a doctor, nurse, or other health professional about things they could do to improve their health or prevent illness

National Comparisons – Patient-Centered Care Primary Health Care Indicator Canada New Brunswick Percent who reported that their personal family doctor had “always 81% 76% or usually” given them enough (CSE-PHC 2008) (NBHC 2011) time to discuss their feelings, fears and concerns about their health Percent who reported that their personal family doctor had “always 71% 74% or usually” involved them in (CSE-PHC 2008) (NBHC 2011) decisions about their health care

Technical Quality of Clinical Care Screening tests or measurements ( among citizens with a self-reported diagnosis for diabetes, heart disease, stroke or high blood pressure ) Team No NB Team Blood pressure measurement in the last 12 months 94.6%* 92.5% 93.3 Cholesterol measurement in the last 12 months 80.6% 79.9% 79.8 Body weight measurement in the last 12 months 69.3%* 61.2% 64.3 Blood sugar measurement in the last 12 months 78.8% 75.7% 76.6 *statistically different comparing team and no team

Outcomes

Increased Knowledge about health and healthcare among the population Team No NB Team Understanding information about chronic conditions Citizens know what their medications do (% strongly agree) 46.6% 46.1% 46.7% Citizens know how to prevent further problems with their 39.1% 37.2% 38.1% health condition (% strongly agree) Citizens are confident that they can control and manage 43.7%* 38.1% 40.1% their health condition (% very confident) Navigation How easy or difficult it is for citizens to know where to go 79.3%* 76.9% when they need healthcare (% 8, 9 or 10 where 0 is very Range from 76.6% difficult and 10 is very easy) 68.1-84.4%

Chronic Disease prevalence rates in NB and Canada (self-reported)

Accessibility-providing timely services Zone Averages Range 1. Percent who can get an appointment with their personal family doctor on the NB 30.3% same day or next day (NBHC PHC 2011) (14-65%) Can 45% 2.Contact with dental professionals in the (47.4- NB 54.7% last 12 months 2008 CCHS 56.7%) Can 64.8% 3.Household spending on prescription NB 9.1% drugs (percentage spending greater than Can 7.6% 3% after tax income)(2008)

Appropriateness-relevant and evidence - based Zone Range Averages 1. Pap test within the last 3 years NB 80.9% (2007-2008) (70.7-87%) Can 85% 2. Breastfeeding initiation (2010) NB 80% (79-87.8) Can 87.2% 3. Colorectal cancer screening NB 39.8% ( 29-52%) Can 51.3% 4. Measurement for body weight in the NB 70% past 12 months (CSE-2008 & NBHC PHC (55.5-78.9%) Can 74% 2011)

Effectiveness-doing what is required to achieve the best possible results Zone Range Averages 1. Reported that they have been diagnosed with (18.4- NB 22% high blood pressure (2010 CCHS) 29.7%) Can 17% 2. % Diabetes Patients NOT in Control (greater 62% 50% than 7%) (2006) 3. Age standardized rate Ambulatory Care NB 489/ Sensitive Conditions ( 2009 ) 100,000 (345-752) Can302/ 100,000 4. A dults 65 years and up who have received the NB 60.9% flu shot in the last year (%, 2009) (52-80%) Can 66.5%

Efficiency-making the best use of the resources Zone Range Averages 1. ER % Triage codes 4&5 (Hospital Services 2010) NB 65.8% (52-79.8%) Can (45%)