PRIMARY HEALTH CARE
Position The Nurses Association of New Brunswick (NANB) believes that a health care delivery system grounded in the principles of Primary Health Care (PHC) will provide all New Brunswickers access to universal, comprehensive, accessible, portable, publically administered healthcare that is efficient, effective and sustainable. Furthermore, NANB believes that registered nurses (RNs) and nurse practitioners (NPs) have a key role in collaborating with other stakeholders to develop, deliver and maintain such a system. Definition PHC and Primary Care Confusion exists between the care delivery models of PHC and Primary Care. The terms are often used interchangeably in the media, by government officials and health care providers. However, these two approaches to care differ in how they define health and in the conceptualization of the underlying source of the problem and the strategies to bring about solutions (CNA, 2012). PHC is defined as a health system which is composed of a core set of functional and structural elements that guarantee universal coverage that includes accessible healthcare for all individuals based on practical, scientifically sound, socially acceptable methods and technology that includes the client in all aspects of his/her care (WHO, 2008). Furthermore, in New Brunswick, the Premier’s Health Quality Council (2002) defined PHC as “individual and community focused healthcare that is integrated, accessible and sustainable”. PHC involves:
Education for the identification and prevention/control of prevailing health challenges; Proper food supplies and nutrition; adequate supply of safe water and basic sanitation; Maternal and child care, including family planning;
Immunization against the major infectious diseases; Prevention and control of locally endemic diseases; Appropriate treatment of common diseases using appropriate technology; Promotion of mental, emotional and spiritual health; and Provision of essential drugs.
(WHO, 2008) Primary care is generally thought of as being illness oriented with emphasis on medical diagnosis, treatment and follow‐up and is currently predominantly provided by family physicians and is but one of the elements necessary in a broader framework of primary health care services (Aggarwal & Hutchison, 2012; WHO, 2003). PHC and New Brunswick The current health care system in New Brunswick faces significant challenges. Statistics on the health status of New Brunswickers are overwhelming: seven in ten have been diagnosed with at least one chronic disease (Statistics Canada, 2005), more than one in every three New Brunswick children, ages two to seventeen, are considered overweight or obese and New Brunswick ranks second (16.2%) in Canadian’s provinces and territories (only behind Nova Scotia) with the percentage of its population over the age of sixty‐five (Human Resources and Skills Development, 2013). As a result, a health care system grounded in PHC has become a necessity for New Brunswick, however to date, there has been a disjointed application of PHC principles in the province. The New Brunswick government has been exploring the concept of PHC for almost a decade. The creation of the Primary Health Care Steering Committee (PHCSC) in 2005, with the mandate of improving access and the delivery of healthcare to New Brunswickers, resulted six years later in the release of a discussion paper, Improving Access and Delivery of Primary Health Care Services in New Brunswick. Informed by feedback given on this discussion paper and a PHC summit held with key stakeholders, the PHCSC developed and released the Primary Health Care Framework in August of 2012. Since this time, the New Brunswick government has chosen to focus PHC reform on the creation of Family Health Teams (FHT).
It is time the government made a firm commitment to PHC. New Brunswick is facing significant fiscal challenges; the current fee for service structure was developed in a time (1961) in which there was an abundance of resources. This is no longer the case and the way in which healthcare is funded and provided has to change to meet the needs of the population. Funding models must be considered that facilitate collaborative team approaches to care allowing individual health care professionals to work to their full scope of practice (CHSRF, 2012). Provincial legislation has changed and opened the door to new providers (such as NPs) and expanded scopes of practice for existing providers (such as pharmacists); however to date, optimizing the competencies of all health care professionals is not a reality. The province continues to fund an antiquated system. In order for a health care delivery system based on PHC to be efficient and effective, the government must make a commitment to full implementation and not choose pieces that can fit into the existing system. Difficult decisions need to be made; however the research has shown significant improvements in the health status of a population and cost efficiency when the principles of PHC and the determinants of health are considered in healthcare delivery (CNA, 2012; Raphael, 2004; Yong, Saunders & Olsen, 2010). Recommendations for Government Decisions about the governance, funding and delivery of health care services must focus on healthy public policy considerations and are responsive to the needs and expectations of individuals, communities, and populations (CNA, 2012). Health care elements must be integrated across the full continuum of care (provided by a collaborative team of health professionals and support staff), ensuring individuals, communities, and populations have timely access to the most appropriate health care provider— when, and where they need it. Public policy must focus on ensuring equity, social justice and access to the broader determinants of health.
NB’s PHC delivery model must build on the Government’s primary health care framework by creating a variety of PHC collaborative team delivery methods that meet the needs of the local community such as: Ontario’s Family Health Team, Saskatchewan’s Mobile Health bus, Ontario’s Nurse Practitioner (NP) lead clinics, and British Columbia’s RN led street health teams. Health service delivery models, interventions and practices are informed by multiple sources of evidence and validated best practices. Health record must be integrated across health systems and ideally the Electronic Health Record should be implemented in all PHC health care teams. Registered nurses and nurse practitioners1 must be utilized in PHC settings to their full scope of practice. Rigorous monitoring and evaluation processes must be in place to measure the impact of PHC teams and the quality and safety of the service, and inform continuous improvement. May 1993 Reviewed 1996, 2002, 2008, 2014
Nurse practitioners are autonomous health professionals with advanced education who provide essential health services grounded in professional, ethical and legal standards. They integrate their in‐depth knowledge of advanced nursing practice and theory, health management, health promotion and disease/injury prevention, and other relevant biomedical and psychosocial theories to provide comprehensive health services. Nurse practitioners work in collaboration with their clients and other health care providers in the provision of high quality patient‐centred care.
R EFERENCES Aggarwal, M., & Hutchison, B. (2012). Toward a primary care strategy for Canada. Canadian Foundation for Healthcare Improvement. Retrieved from http://www.cfhi‐fcass.ca/Libraries/Reports/Primary‐Care‐Strategy‐EN.sflb.ashx Canadian Nurses Association. (2012). Primary Healthcare: A New Approach to Health Care Reform. Ottawa: Author. Canadian Health Services Research Foundation. (2012). Interprofessional Collaborative Teams. Ottawa: Author Health Canada (2006). About PHC. Retrieved from http://www.hc‐sc.gc.ca/hcs‐ sss/prim/about‐apropos‐eng.php New Brunswick Premier's Health Quality Council (2002). Health Renewal. Fredericton: Author Raphael, D. (2004). Social Determinants of Health Canadian Perspectives. Toronto: Canadian Scholars’ Press Inc.Shields. M, Statistics Canada (2005). Population projections for Canada, provinces and territories 2005‐2031. Catalogue #91‐520‐X1E. World Health Organization. (2008). Primary Health Care in Action. Geneva:Author World Health Organization. (2003). Health Systems: Principled integrated care: In The World Health Report 2003 ‐ Shaping the Future (pp 105‐131). Geneva: Author. Volunteer Canada (2013) Volunteering and Older Adults Final Report. Report commissioned by Human Resources and Skills Development Canada. Ottawa: Author. Retrieved from: http://volunteer.ca/content/volunteering‐and‐older‐ adults‐final‐report. Yong PL, Saunders RS, Olsen LA, (2010). The Healthcare Imperative: Lowering Costs and Improving Outcomes: Workshop Series Summary. Institute of Medicine (US) Roundtable on Evidence‐Based Medicine, Washington (DC): National Academies Press.