A Vision for Canada: Family Practice:
The Patient’s Medical Home

Introduction

Executive Summary

The history of health care in Canada is linked to the vital role played by family practice and our nation’s family physicians. As we deliberate the future of our health care system it is essential that we contemplate the place that will be assumed by family physicians and their practices. The vision of family practices serving as Patients’ Medical Homes is intended for the consideration of all who are concerned about the health of Canadians and the health care provided for them. This includes not only family physicians, nurses, and the health professionals and staff who work with them in their practices but also a broad range of other stakeholders in governments, medical schools, and other health care organizations whose responsibilities and commitments intersect with those delivering family practice services.

Most important, this vision is intended for the people of Canada, over 30 million of whom are currently cared for by family physicians in urban and rural family practices throughout the nation, as well as the four to five million who do not yet have family physicians1,2.

In October 2009, the College of Family Physicians of Canada (CFPC) presented its discussion paper Patient-Centred Primary Care in Canada: Bring it on Home3. It described the pillars of a model of family practice focused on meeting patient needs.* Feedback from a broad cross-section of stakeholders including family physicians, other health professionals and their associations, governments, and the public provided important perspectives that are now incorporated into this vision paper describing family practices throughout Canada serving as Patients’ Medical Homes.

*A personal family physician for each patient, team-based care, timely access to appointments in the practice and for referrals, comprehensive continuous care, electronic records, system supports, ongoing evaluation, and quality improvement programs.

A Vision for Canada

While there are some shared elements with other international medical home models, this is a made-in-Canada vision—one that embraces Canadian values of equity, fairness, and access to care for all people. It builds upon the strengths our nation has long embraced in family practice and primary care. It hopes to add to several initiatives that have already begun across Canada, such as Alberta’s Primary Care Networks, which have embraced “the concept of the patient-centred medical home as a strong starting point”4(p26); Ontario’s Family Health Teams, which Rosser notes are already achieving significantly positive outcomes for 2.5 to 3 million people in Ontario and are probably the “largest experiment of the patientcentred medical home anywhere in North America”5; and Quebec’s Family Medicine Groups, which have been found to have a “positive impact on the accessibility, coordination, and comprehensiveness of care and patient knowledge.”6(p265)

To achieve the objectives and goals of a patient-centred health care system anchored by family practices serving as Patient’s Medical Homes in all communities throughout the country, it is imperative that we sustain and enhance the support for primary care and family practice that has been initiated across Canada over the last decade.

Unfortunately, recent studies have indicated that compared with people in other developed nations, Canadians today are less satisfied with their access to and quality of care7 and there are now worse health outcomes in Canada for several significant medical conditions.8 The vision of the Patient’s Medical Home is to see the levels of satisfaction and the health outcomes of Canada’s population once again ranked among the world’s best.

  1. Walker J, Harris/Decima. Poll: Nine in ten Canadians have a family doctor. 2009. Available at: http://www.harrisdecima.ca/sites/default/files/releases/061909E.pdf . Accessed August 18, 2011.
  2. Statistics Canada. Canada’s population estimates. The Daily. 2010. Available at: http://www.statcan.gc.ca/dailyquotidien/100628/dq100628a-eng.htm . Accessed August 18, 2011.
  3. The College of Family Physicians of Canada. Discussion Paper: Patient-Centred Primary Care in Canada: Bring iton Home. Mississauga, ON: The College of Family Physicians of Canada; 2009. Available at: http://www.cfpc.ca/uploadedFiles/Resources/Resource. Accessed August 18,2011.
  4. The Alberta Medical Association. Patients first: Our vision for primary and chronic care. Alberta Doctors’ Digest. 2011;36(1):25-27.
  5. The Canadian Press. Ont. doctor explains Family Health Teams experience. CTV News. 2011. Available at: http://www.ctv.ca/CTVNews/CanadaAM. Accessed August 12, 2011.
  6. Hutchison B, Levesque J-F, Strumpf E, Coyle N. Primary health care in Canada: systems in motion. Milbank Q. 2011;89(2):256-288.
  7. Davis K, Schoen C, Stremikis K. Mirror, Mirror on the Wall: How the Performance of the U.S. Health Care System Compares Internationally, 2010 Update. The Commonwealth Fund; 2010.
  8. The Conference Board of Canada. How Canada Performs: Health. Health Performance: Health Outcomes. 2011. Available at: http://www.conferenceboard.ca/HCP/Details/Health.aspx.
    Accessed August 18, 2011.