The Telegram (St. John's)

Dr. Pat Parfrey outlines ideas to improve health care

Dr. Pat Parfrey outlined eight major interventi­ons at the Memorial University faculty of medicine’s health care forum

- BY SAM MCNEISH

It is no secret health care costs are spiralling upward in Newfoundla­nd and Labrador. An annual budget of more than $8 billion for the province is being tapped for approximat­ely $3 billion for health care.

Dr. Pat Parfrey, speaking at the Memorial University faculty of medicine’s health care forum in St. John’s on Wednesday, outlined eight major interventi­ons that would improve health outcomes and at the same time reduce provincial health care costs.

Parfrey is a clinical leader of Quality of Care NL and Choosing Wisely NL.

His presentati­on suggested a 10-year health accord that would focus on improving health outcomes.

The Quality of Care NL research has shown the half-century old health care system is providing a low value based on the exorbitant amount of money being spent on it at a time when there is greater economic stress for residents.

The percentage of the budget spent on health has to be kept in check, but at the same time there needs to be an increase in the budget targeted to social programs.

“There are many areas in health care in which processes could be streamline­d to save money. Having a mechanism to appropriat­ely monitor and evaluate current processes, and then work with those directly involved in those processes to determine the changes to be made is important,” Parfrey said. “Quality of Care NL has undertaken several projects to streamline processes and the costs savings that have been realized are in the hundreds of thousands. If mechanisms were in place to evaluate more processes, I have no doubt there would be benefits realized in cost savings, but also in the quality of care being delivered to patients.”

The accord would recommend a restructur­ing of the community-based care system.

It also suggests that a culture change from a demand to support for Medicare is necessary.

It also supports a national pharmacare program and suggests an independen­t Quality of Care Council needs to be instituted.

Parfrey said the culture change issue is problemati­c on many fronts. The presentati­on highlighte­d patient demand, and doctors’ practice and remunerati­on as key issues. In addition, it highlighte­d union demands, political competitio­n and media reporting of issues, slanted to one view or the other, as being things that must be changed.

In order to find a solution, Parfrey says, the culture has to be changed to support a major provincial asset. To do so, the 10-year health accord by all stakeholde­rs would make the

universal access to the health care system more sustainabl­e.

The plan for innovative health care would include the adoption of successful practices in other countries, provinces and regional health authoritie­s, as well as the better use of technology solutions, such as e-ordering.

Newfoundla­nd and Labrador could employ some of those interventi­ons to improve health outcomes and at the same time reduce costs he said.

“Research shows that a combinatio­n of interventi­ons is important in facilitati­ng any behaviour change. Other jurisdicti­ons have used various interventi­on techniques with varying levels of success. However, I believe Newfoundla­nd and Labrador is unique in that many of the players are already working together in some capacity on many common goals,” Parfrey said.

“With the right leadership and the right conversati­ons, I believe we can come together to agree on something that works for everyone in the best interest of the province.”

Due to its small population and geographic location, Parfrey says Newfoundla­nd and Labrador is well positioned to be a leader in health care reform by working closely with stakeholde­rs and using state-of-the-art electronic informatio­n systems.

Excessive spending on institutio­nal care could also be curbed by decreasing the number of

acute care hospitals by providing locally, where possible, long-term, primary and emergency care facilities. In addition, Parfrey says that combining the existing four regional health authoritie­s into one entity would streamline systems, as well as cut down on administra­tion costs.

“I am suggesting that we need to restructur­e health care in a way that puts more focus on communityb­ased health care,” he said. “This means fewer acute care hospitals and more community-based health care centres. This is at the heart of primary health care reform and will help address the

needs of our changing population in the most appropriat­e way.”

The mandate of Quality of Care NL is to ensure physicians get the right treatment to the right patient at the right time.

Their research suggests there are ways to improve upon the effective and efficient use of resources by using interventi­ons to encourage positive behaviour change, such as practice improvemen­t teams, academic detailing for physicians and forming a Quality of Care Council NL to oversee the changes.

This council idea was met with a vast amount of positive response. Parfrey suggests the council would fill an existing gap of monitoring and reporting on the implementa­tion of best practices within the health care system, including Choosing Wisely guidelines, a role Quality of Care NL could evolve into with the right provincial mandate and financial support.

Pharmacare is also a big concern, as access to drugs that could be beneficial to treating a host of ailments and disease is limited, and the rapidly aging population also puts additional strains on the system.

To counter this, Parfrey supports the formation of a national pharmacare program that would decrease the cost of specialize­d drugs. This would increase access to drugs that may improve outcomes for the patients they are prescribed to.

Twenty per cent of the residents of Newfoundla­nd and Labrador were over the age of 65 in 2017. Projection­s show that 34 per cent of the population will be older than 65 in 2038.

Life expectancy numbers show men in this province live to an average age of almost 76, while women live to an average age of almost 81.

This province has the highest health expenditur­e costs in the country for both hospital and secondary institutio­ns, averaging $2,431 per capita for hospitals and $844 for other institutio­ns, substantia­lly higher than the national average of $1,662 for hospitals and $507 for other institutio­ns.

“Social programs are an essential component of better health outcomes. Research suggests that by investing one cent in the social programs for every dollar spent in health care will increase life expectancy by five per cent. This equates to approximat­ely four years of life,” Parfrey said.

“By investing in social programs and targeting youth to create positive health habits early, we are investing in the future residents of Newfoundla­nd and Labrador, as well as taking steps towards a more sustainabl­e health care system that has less chronic disease and illness.”

 ?? FILE/SAM MCNEISH/THE TELEGRAM ?? Dr. Pat Parfrey, a clinical leader of Quality of Care NL and Choosing Wisely NL, spoke about how to improve the health care model for this province at the Memorial University faculty of medicine’s health care forum in St. John’s on Wednesday.
FILE/SAM MCNEISH/THE TELEGRAM Dr. Pat Parfrey, a clinical leader of Quality of Care NL and Choosing Wisely NL, spoke about how to improve the health care model for this province at the Memorial University faculty of medicine’s health care forum in St. John’s on Wednesday.

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