Primary Health Care in NB through the citizens experience: Painting - - PowerPoint PPT Presentation

Primary Health Care in NB through the citizens’ experience: Painting the picture

October 20th, 2011

Objectives

• Context for NB Healthcare System
• Briefly review inputs (capacity to deliver clinical

care)

• Review outputs (products and services)
• Finally review outcomes
• Questions

The portion for Wellness is $7.02 million The portion for Long Term Care is $462.53 million

Total NB expenses = $7,727.8 (million)

Expenses for the New Brunswick Health System 2010 actual amounts (millions) % of total expenses Department of Wellness, Culture and Sport – Wellness portion* $7.02 0.09% Department of Health $2,585.00 33.45% Department of Social Development – Long Term Care* $462.53 5.99% Total – Health System $3,054.55 39.53%

Context Matters

"In order to get from what was to what will be, you must go through what is."

Anonymous

Inputs……………….……..Capacity

Source: ICIS

Source: CIHI

MRI and CTs New Brunswick Canada CT scanners/million population 21.9 14 MRI machines/million population 8.2 8.1

Source: (2010) CIHI

Information Technology

EMR Score EMR 7.8 % New Brunswick physicians use electronic records INSTEAD OF PAPER CHARTS to enter/retrieve clinical notes National Range: (1.9% 27.7%) National Average: 16.1%

Source: National Physician Survey 2010

There are four sectors of care which make up the Health Care System

5% for administrative expenses $ $ $ $ D C B

$177,318,900Prescription drug program Public Health Provincial Epidemiology $23,672,544 Communicable disease control (DH) immunization program surveillance inspection services health protection program (food, air, water) $27,261,581 Promotion of healthy lifestyles/healthy families early child intervention (ECI) 3.5 years old health clinic baby friendly initiatives healthy eating dental health healthy learners and school sexual health programs Injury / disease prevention initiatives Tobacco $84,861,300Ambulance Services Primary Health Care Chronic disease prevention and management $3,820,000 Telecare services $26,295,161Community Health Centres $10,089,775Health Centres $7,016,000Wellness, Sport and Operational Expenses $215,566,460Physician Costs $575,901,721Total

Outputs…

What do we know about the quality of services and performance...

Primary Health Care (PHC) Visits

50,000 100,000 150,000 200,000 250,000 300,000 350,000 400,000 450,000 500,000 PFD ER SPEC AHC ALT TC CHC AMB NP

PHC Visits in the Last 12 Months

by service area / health professional

62% 18% 12% 8%

PHC Visits: Model of care used most often when sick or need care

by service area / health professional

PFD AHC ER OTHER

81% 42% 40% 25% 21% 10% 7% 6% 5%

PFD: personal family doctor ER: emergency room SPEC: specialist AHC: after-hours clinic

• r walk-in clinic

ALT: alternative pracitioner TC: Tele-Care CHC: community health centre AMB: ambulance services NP: nurse practitioner

National Comparisons – Accessibility

Primary Health Care Indicator Canada New Brunswick Percent who have a personal family doctor 86% (CSE-PHC 2008) 93% (NBHC 2011) Percent who can get an appointment with their personal family doctor on the same day

• r next day

45% (Commonwealth Fund 2010) 30% (NBHC 2011) Personal family doctor has an after-hour arrangement when office is closed 31% (Commonwealth Fund 2007) 22% (NBHC 2011) Percent who used a health information telephone line in the past year 24% (Commonwealth Fund 2007) 10% (NBHC 2011)

National Comparisons – Emergency Room

Primary Health Care Indicator Canada New Brunswick Percent who visited a hospital emergency department in the past year 24% (CSE-PHC 2008) 42% (NBHC 2011) Percent who waited less than 4 hours in the hospital emergency department 73% (Commonwealth Fund 2007) 75% (NBHC 2011)

National Comparisons – Teams-Coordination

• f Care

Primary Health Care Indicator Canada New Brunswick Percent who have access to a primary health care team 39% (CSE-PHC 2008) 34% (NBHC 2011) Percent who reported that their personal family doctor “always or usually” helps them coordinate the care from other healthcare providers and places when they needed it 68% (Commonwealth Fund 2010) 59% (NBHC 2011)

Primary health care team is defined as : having a personal family doctor AND a nurse is regularly involved in health care OR a nurse practitioner is regularly involved in health care OR other health professionals work in the same office as the personal family doctor

National Comparisons – Timely Information

Primary Health Care Indicator Canada New Brunswick Percent who reported that, after staying

• vernight in the hospital, their personal

family doctor did not seem informed and up- to-date about the plan for follow-up care 23% (Commonwealth Fund 2007) 10% (NBHC 2011)

Tests are NOT available about 7.8% at the time of visit in NB

National Comparisons – Healthy Living

Primary Health Care Indicator Canada New Brunswick Self-rated health (% very good or excellent) 59% (CSE-PHC 2008) 53% (NBHC 2011) Percent of citizens with 1 or more chronic health conditions (among arthritis, cancer, COPD, diabetes, heart disease, high blood pressure, and mood disorders, including depression) 33% (CSE-PHC 2008) 49% (NBHC 2011)

National Comparisons - Preventative Care / Health Promotion

Primary Health Care Indicator Canada New Brunswick Percent of citizens with 3 or more chronic health conditions (among arthritis, cancer, COPD, diabetes, heart disease, high blood pressure, and mood disorders, including depression) who reported that they “rarely or never” talk with a doctor, nurse, or other health professional about things they could do to improve their health or prevent illness 40% (CSE-PHC 2008) 29% (NBHC 2011)

National Comparisons – Patient-Centered Care

Primary Health Care Indicator Canada New Brunswick Percent who reported that their personal family doctor had “always

• r usually” given them enough

time to discuss their feelings, fears and concerns about their health 81% (CSE-PHC 2008) 76% (NBHC 2011) Percent who reported that their personal family doctor had “always

• r usually” involved them in

decisions about their health care 71% (CSE-PHC 2008) 74% (NBHC 2011)

Technical Quality of Clinical Care

Screening tests or measurements (among citizens with a self-reported diagnosis for diabetes, heart disease, stroke or high blood pressure) Team No Team NB Blood pressure measurement in the last 12 months 94.6%* 92.5% 93.3 Cholesterol measurement in the last 12 months 80.6% 79.9% 79.8 Body weight measurement in the last 12 months 69.3%* 61.2% 64.3 Blood sugar measurement in the last 12 months 78.8% 75.7% 76.6 *statistically different comparing team and no team

Outcomes

Increased Knowledge about health and healthcare among the population

Team No Team NB Understanding information about chronic conditions Citizens know what their medications do (% strongly agree) 46.6% 46.1% 46.7% Citizens know how to prevent further problems with their health condition (% strongly agree) 39.1% 37.2% 38.1% Citizens are confident that they can control and manage their health condition (% very confident) 43.7%* 38.1% 40.1% Navigation How easy or difficult it is for citizens to know where to go when they need healthcare (% 8, 9 or 10 where 0 is very difficult and 10 is very easy) 79.3%* Range from 68.1-84.4% 76.9% 76.6%

Chronic Disease prevalence rates in NB and Canada (self-reported)

Accessibility-providing timely services

Zone Range Averages

• 1. Percent who can get an appointment

with their personal family doctor on the same day or next day (NBHC PHC 2011) (14-65%) NB 30.3% Can 45% 2.Contact with dental professionals in the last 12 months 2008 CCHS (47.4- 56.7%) NB 54.7% Can 64.8% 3.Household spending on prescription drugs (percentage spending greater than 3% after tax income)(2008) NB 9.1% Can 7.6%

Appropriateness-relevant and evidence - based

Zone Range Averages

1. Pap test within the last 3 years (2007-2008) (70.7-87%) NB 80.9% Can 85%

• 2. Breastfeeding initiation (2010)

(79-87.8) NB 80% Can 87.2%

• 3. Colorectal cancer screening

( 29-52%) NB 39.8% Can 51.3%

• 4. Measurement for body weight in the

past 12 months (CSE-2008 & NBHC PHC 2011) (55.5-78.9%) NB 70% Can 74%

Effectiveness-doing what is required to achieve the best possible results

Zone Range Averages

• 1. Reported that they have been diagnosed with

high blood pressure (2010 CCHS) (18.4- 29.7%) NB 22% Can 17%

• 2. % Diabetes Patients NOT in Control (greater

than 7%) (2006) 62% 50%

• 3. Age standardized rate Ambulatory Care

Sensitive Conditions ( 2009 ) (345-752) NB 489/ 100,000 Can302/ 100,000

• 4. Adults 65 years and up who have received the

flu shot in the last year (%, 2009) (52-80%) NB 60.9% Can 66.5%

Efficiency-making the best use of the resources

Zone Range Averages

1. ER % Triage codes 4&5 (Hospital Services 2010) (52-79.8%) NB 65.8% Can (45%)

Safety

Zone Range Averages

1.Citizens who experienced an error or harm in community (excludes hospital stay) (NBHC PHC 2011) (1.2-6.7) NB 3.4%

• 2. Age standardized injury hospitalization

rate (2009 CIHI) (433-931) NB 587/ 100,000 Can517/ 100,000

• 3. Percent of population who know what

each of their prescribed meds do (% strongly agree) (NBHC PHC 2011) (25.7-56.1%) NB 46.7%

Equity

• 1. Access to family doctor

Women, citizens living in a rural area, those who prefer French as their language of service, older New Brunswickers and non-Aboriginals have more access to family doctor. There was no significant difference by education level or income.

• 2. Quality rating of overall services

Men, older New Brunswickers, citizens with a lower income, those with a lower education level, and those who prefer French as their language of service are more satisfied with their experiences with overall health care services. There was no significant difference by urban/rural area and for Aboriginals.

Reasons why patients are admitted to the hospital (2009-2010)

Rank Description of the main intervention

Comparison with 2005-2006

1 Live births Not recorded 2 Chronic obstructive pulmonary disease (1) 3 Myocardial Infarction (10) 4 Other medical care (Palliative care, admission for chemotherapy) (2) 5 Chest or throat pains (3) 6 Heart failure (9) 7 Perineal laceration during childbirth (8) 8 Pneumonia (5) 9 Care demanding rehabilitation (7) 10 Convalescence Not recorded

Source: Rapport annuel du Ministère de la Santé du Nouveau-Brunswick pour l’exercice se terminant le 31 mars 2010

(Reasons related to primary health / chronic conditions)

20 40 60 80 100 120 140

See their health as being very good or excellent See their mental health as being very good or excellent Pain or soreness that prevents activities (physical

• r emiotional)

Life expectancy Infant with below average birthweight Infant mortality premature death from hearth and stroke premature death from cancer premature death from breathing disease premature death from injuries premature death - suicide / self inflicted

Population Health Outcomes

NB Canada

Overall Grade

D

Conclusion

• We have to match the needs of the citizens and

performance on the quality of services being delivered to appreciate the story and to effectively change our programs and policies.

• We must also look at the outputs and their effects on

hospital care to recognize their impact.

• There needs to be accountability and benchmarking

to have an influence on sustainability and improvements to the system.

Questions?

Michelina Mancuso Directrice exécutive de l’évaluation du rendement Michelina.Mancuso@csnb.ca 1.877.225.2521 www.csnb.ca