Thread by @DrRitaMc

How do family doctors organize themselves to deliver #BCPrimaryCare?

Seems like a simple ? right... ?

Our @MaapStudy #MAAPBC team is identifying clinics that provide community-based primary care/family medicine.

And we want to group them into types of clinics. 1/x

We started out using the @cpsbc_ca list of all GP's in the areas of interest (all @VCHhealthcare regions).

We identified (by phoning & googling) only those GP's who provide community-based primary care (excluded those people who e.g.just work in hospitals, or are retired) 2/x

We also used yellow pages, medimaps, google to find listings for "family doctor" or "medical clinic" etc.

Now we have a list of all the clinics that provide community-based primary care in the @VCHhealthcare regions (which we are happy to share!)

@SetarehBani

3/x

Then we sent the clinics a voluntary MAAP-BC Clinic Survey, takes 10-15 minutes to complete & is best done by a front desk person, rather than a doctor....to give us a more accurate picture of what patients are experiencing about how care is organized at their clinic.

4/x

From the returned surveys and the process of making the clinic list, we started to see types of clinics emerging (process still underway)

There were 1)EXCLUDED clinics, ones that first appeared to be primary care, but ONLY do e.g."facial rejuvenation" or "executive fitness"

5/x

Then 2) RESTRICTED clinics, where primary care is delivered, but has an admission criteria, e.g. being under age 25, or having HIV, or you need to pay a private surcharge to "be a member/patient".

6/x

Then, 3) WALK IN ONLY clinics, are for urgent same day issues, you need to "walk in" to get an appointment, you see whoever is there and there is no intentional service design to facilitate CONTINUITY OF CARE. These clinics typically see 50 patients/doctor shift.

7/x

Then 4) SOLO GP clinics are pretty easy to identify, where there was ONE GP at a single address. These tend to be practices that have been around a long time, and have many patients attached to them.

8/x

The last easy to identify type is 5) A GROUP PRACTICE, where more than one family doctor +/- other health professionals practice at the same address, share a phone number(s) and doctors see each others patients if their usual GP is not available in a timely way.

9/x

But we found another type of primary care clinics, the 6) "HARD TO DEFINE", and not really fitting into the definitions above. If it's hard for us, we can imagine that it might be hard for patients, and health policy people (@DougBlackie @adriandix @DarcyJudy @mackenhusen )

10/x

The "HARD TO DEFINE" clinic type has >1 GP at the same address:
but...they may have separate:
-phone #'s,
-front desk staff
-rules about seeing each other's patients for emergencies
-medical records

Are they really SOLO GP's sharing space, or a diff.kind of GROUP PRACTICE?

11/x

Raises some questions for @MaapStudy ...
-Is it reasonable to expect a certain amount of homogeneity in types of practices?
-Does lack of homogeneity affect patient experience? Policy development?
-Can some types of practices adapt to change better than others? How do you tell?

Stay tuned to our observations, ruminations and conclusions re #BCPrimaryCare at maap-bc.ca and thanks to our AMAZING team:
@SetarehBani @Kasra_Ha @LindsayKHedden @DrAliMokhtari & the volunteers with out whom NONE of this data would have been collected.

Very keen to have your comments and ideas about this work!
DM, retweet, comment, email, etc!!
Thanks
13/13