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‘We need to do better’ - Dr. Peter Zalan

Let me begin with a story. Betty is 60, and was admitted to hospital Dec. 3, 2011. She was on drugs that suppressed her immune system to treat her neurological disease. As a consequence, she developed multiple infections.
Let me begin with a story. Betty is 60, and was admitted to hospital Dec. 3, 2011. She was on drugs that suppressed her immune system to treat her neurological disease. As a consequence, she developed multiple infections. She was discharged home last week on multiple medications. She has no family doctor. Her family wonders how she is going to manage.

Let me tell you about an 82-year-old gentleman who woke up with a rash all over his body. He called his family doctor, who was unavailable. His friend drove him to the walk-in clinic. It was very busy, as was the next clinic. He gave up and went home.
These are not uncommon tales.

The 2010 Report on Ontario’s Health Care System noted that 730,000 adults were without a family doctor. Only 53 per cent of Ontarians can see their doctor on the same day or next day when sick — this standing is the worst among 11 countries surveyed.

We need to do better. The recently-published Drummond report makes this point emphatically.

Let me tell you a story of what was and is done elsewhere.

Ms. N was a 77-year-old retiree. She lived alone in an apartment. She had a history of high blood pressure, chronic obstructive lung disease, a below-knee amputation and back pain.

Despite having a lower-leg prosthesis, she did not walk and was thus unable to shop, do housekeeping, drive or use public transportation. She required assistance with food preparation, medication management and bathing. She took nine prescribed medications.

During the previous two years, Ms. N was admitted to hospitals several times for respiratory infections and for three surgical procedures for her skin wounds, after which she spent many months receiving wound care and rehabilitation as an inpatient.

Ms. N is typical of folks in our community who are older and living with multiple chronic health conditions. Good family physicians are often overwhelmed by the many needs for care in this population.

Right now, there is no comprehensive care for patients with complex needs who have multiple chronic conditions and a variety of health care professionals providing their care.

Some of our most complex patients coming out of hospital go to walk-in clinics to renew their medications. Care can be further undermined by limited available assistance from families and friends.

Let me describe a U.S. model called PACE. Participants are transported by vans from their homes to the adult day centre several times each week for education, social activities, meals and exercise. Physicians and a variety of health care professionals provide the health care.

Ms. N’s assessment of her care: The centre has nice hot lunches, coffee, tea and snacks. The doctors are patient. They have the time, and they give you the care you need. Nobody rushes you through.

We also have music, drawing, singing, exercise and meditation. We are blessed to have all this. They got my prosthesis to fit so it’s comfortable. It’s no problem now. I love coming here. The nurses, the doctor, the physical therapists, everybody who works here — we are just one big family.

Her PACE doctor’s report: She’s had zero hospitalizations since I’ve known her. At the first sign of trouble with lung infection or skin breakdown, we see her in clinic and start treatment right away. She continues to live independently, exercising three times each week.

She walks without assistance, performs most of her activities of daily living independently and receives assistance only with shopping, transportation, heavy chores and bathing.

A PACE model of care is operational in Edmonton.

Dr. Peter Zalan is president of the medical staff at Health Sciences North. His monthly column tackles issues in health care from a local perspective.

Posted by Vivian Scinto

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