cartoon-winter-freezingI am at the North American Primary Care Association meeting in Ottawa, Canada tonight. The presentations, posters, and plenary sessions are very impressive. Following are some random observations from the presentations I have seen thus far:

1) We need to work a lot harder to get the patients perspective. The group from Sherbrooke presented a marvelous presentation on the importance of truly including the patients perspective in care delivery. Physicians want may one thing but patients need at lot of other things. The Sherbrooke folks grouped physicians and patients and worked to achieve concordance on priorities. In the end, the doctors were “forced” to agree that access when patients want, when patients want, will be important to achieve patient buy-in for any type of health system. Defining that in a manner that is workable is our next challenge.

2) We need to listen less to insurance companies and more to doctors to improve rural care. Insurance companies have been defining “quality” using a limited set of metrics. The Colorado group interviewed rural docs and rural patients and discovered that rural patients and rural doctors don’t need sophisticated communication systems. They have the telephone and random encounters in the  Walmart to keep each other posted on progress. The complex rules of the Patient Centered Medical Home may be overkill in close knit communities.

3) You can’t fatten a cow by measuring it every day. Rick Glazier presented his observations and measurements regarding the efforts made by the Provence of Ontario in primary care transformation. Although a lot of effort was made to improve primary care delivery, the efforts were not accompanied by incentive structure improvement. Consequently, care delivery did not improve as much as anticipated. On the other hand, the increased attention in primary care was associated with a marked increase in interest in primary care.

I am looking forward to the rest of the meeting. I am struck by how similar our problems are to those of my colleagues in other countries. I am also struck by how our problems in Alabama often mirror those elsewhere in America. Lastly, I am looking forward to learning more pithy Canadian expressions.

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