Primary Care Toolkit for Family Physicians
The College of Family Physicians of Canada
The advent of new approaches to healthcare, including chronic disease management and preventative care, as well as the increasing development and use of clinical practice guidelines for a broad variety of health conditions, have served as opportunities and evidence for interdisciplinary collaboration in primary care. Further evidence may be seen in academic models of delivering primary care and in clinical care settings such as long-term or complex continuing care institutions where trans- and inter-disciplinary models of education and service are being successfully implemented. However, it is well recognized that interdisciplinary collaboration (or team-based care) is not new. Family physicians frequently participate in collaborative care as they undertake their education and training in the hospital or community. And the valued professional relationships that have existed for years between family physicians and family practice nurses are examples of collaborative care in practice.
Interdisciplinary collaboration in providing care at the primary care level of our health system in Canada has been embraced by most governments and health authorities as the most important development in primary healthcare. It is considered to be one of the key elements to the success of primary care renewal and as such, has been supported by most governments and health authorities with millions of dollars allocated to developing and educating interdisciplinary primary care teams and providers. While the evidence to support this approach by governments has remained somewhat lacking, an increasing focus on interdisciplinary collaboration has nevertheless been pursued, somewhat justifiably, as an answer to what ails the primary care system, i.e.; the health human resource challenges and the changing expectations and preferences of a younger health system workforce. The importance of interdisciplinary collaboration is no less relevant for family physicians than it is for other healthcare providers who are interested in seeing an increased focus on interdisciplinary collaboration. However, it is an issue about which there remains a fair degree of uncertainty amongst family physicians in Canada.
While governments and health authorities may promote and encourage movement towards the establishment of interdisciplinary collaborative teams, family physicians should and will continue to play a key role in the coordination of patient care to ensure continuity and comprehensiveness. These are essential features of the scope of practice in family medicine and as such, are the responsibility of family physicians. Likewise, although there has been much discussion about access to patient information, the family physician should remain the custodian of the medical record, electronic or paper-based. An important driver behind issues of coordination, stewardship and ownership is the fact that patients choose to join primary care models most often because of their relationship with their family physician, not the team. It is therefore essential that this personal relationship be preserved for patient satisfaction and good healthcare.