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Dr. Rita McCracken, MD, PhD (she/her) Profile picture
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Sep 20 • 6 tweets • 3 min read
How do we fix healthcare?

A @CBCnewsbc spoiler 🧵
1/
❤️‍🩹🩺⬆️⬆️ FED & PROV 💰💰 in PRIMARY CARE

=Directly fund buildings + operations + non-MD staff

= "global funding" to CHC's-no more grant hustling to pay for community health needs

=transparent evaluation & QI

#bcpoli
2/
❤️‍🩹🩺 SHIFT MD PAYMENT TO MODELS THAT INCENTIVIZE HIGH-QUALITY, LONGITUDINAL CARE

= e.g. capitation (lump sum pay based on # and complexity of patients in a practice)

≠ fee for service - it incentivizes VOLUME
3/
❤️‍🩹🩺 INTEGRATE PRIMARY CARE w MENTAL HEALTH & SOCIAL SERVICES

💥income disparity, racism, colonialism, etc have serious deleterious effects on health

💥addressing these "social" determinants of health in primary care is essential (ref: @BCACHC)
canada.ca/en/public-heal…
4/
Imagine if we started designing health system solutions with a "seven generation horizon"

Everyone living in Canada deserves access to
❤️‍🩹high quality
❤️‍🩹comprehensive
❤️‍🩹team-based
❤️‍🩹longitudinal
PRIMARY CARE

Let's go back to the basics and make #BetterMedicare.
5/
To all my exhausted MD and RN and other healthcare colleagues.

What a wild ride this last 2.5 years has been, right?

Everyone working hard, caring so much, and bumping up against a system that is stretched to its limit.
6/
❤️‍🩹Patients need access and better services

But

❤️‍🩹🩺Providers also need better... a system where you can be a healthcare HUMAN, not a HERO, and get the job done.

• • •

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More from @DrRitaMc

Dr. Rita McCracken, MD, PhD (she/her) Profile picture
Aug 31
🧵 1/5
Will "time modifiers"
added to family doctors fees
help more people in BC
access primary care?

🩺❤️‍🩹Probably not

2006-14, BC spent a BILLION $$ (!!)
with incentive fees family doctors for work that typically takes more time (e.g. mental health)

#bcpoli #primarycare
2/5
 The new fees were "on top" of the usual "fee-for-service"

The stated aim:
💥to encourage family doctors to return to a traditional model of "full-service family practice"💥

And acknowledged that some work was taking doctors MORE TIME⌚️
@globeandmail
theglobeandmail.com/opinion/was-bc…
3/5
 The result?😢

-family doctors got paid more
-family doctors saw fewer patients

⁉️But maybe patient outcomes like hospitalizations improved, she types hopefully (see next tweet...)

ref: longwoods.com/content/23782/…
Read 5 tweets
Dr. Rita McCracken, MD, PhD (she/her) Profile picture
Aug 31
1/5
 Today is International Overdose Day

Education is important

Whether it's
understanding how to use naloxone students.ubc.ca/health/health-…
or
proper language when speaking about substance use
fnha.ca/Documents/FNHA…

there is a lot of learning to do.

#IOAD2022 @BCCSU @CHEOSNews
2/5
 Our REDONNA team has been working on educating prescribers in BC about sparing opioid analgesics for noncancer pain among opioid-naïve patients.
@ShawnaNarayan @ircoopy @JanKlimas @Drug_Evidence
ti.ubc.ca/2021/11/24/web…
3/5
 200 participants (FPs, NPs, Nurses, and community members) attended an educational webinar focused on opioid sparing practices and the (lack of) evidence for opioid analgesics to treat noncancer pain.
You can read more here: doi.org/10.1093/fampra… (3/5)
Read 5 tweets
Dr. Rita McCracken, MD, PhD (she/her) Profile picture
Aug 31
The REDONNA study doi.org/10.1016/j.cct.…
began from the motivation for improved & safer opioid prescribing in primary care

We aimed to educate MDs about their OWN prescribing practices using audit & feedback letters developed by the @Drug_Evidence @JanKlimas @ShawnaNarayan 1/4
They received information about the number of new opioid initiations & how they compared to the average physician. They were provided information on the (lack) of effectiveness on pain for opioid naïve patients through an educational webinar: doi.org/10.1093/fampra… (2/3)
From this study, we hope to support the uptake of quality prescribing practices that are equity-oriented and evidence-based to help patients experience less pain. (3/4)
Read 4 tweets
Dr. Rita McCracken, MD, PhD (she/her) Profile picture
Aug 25
1/ Why I am worried about these emergency funds and why I think they probably won't help improve primary care access, a thread #bcpoli #PrimaryCare
2/ 💯Primary care is in a terrible state in BC (has been worsening for 20 years), and this money might "stem the bleeding" but it won't remedy the sharp objects causing the bleeding🩸🩸🩸
3/ Imagine public education in the same state, a million kids don't have a school to go to and teachers quitting everywhere because they are burnt out, and the cost of running their own school is unsustainable
Read 19 tweets
Dr. Rita McCracken, MD, PhD (she/her) Profile picture
Aug 12
🤔
How much time should a primary care doctor
SEE a patient (direct)
v.
THINK/MANAGE a patient's care (indirect)

This recent paper looked at all the EXPECTED work of primary care providers w large #'s of patients

@BCFamilyDoctors @DoctorsOfBC @JournalGIM
link.springer.com/article/10.100…
🐘 US Study

US & 🇨🇦 primary care recommendations are similar (NOT same, but similar)

Doctor-only care = 26.7 hours/day to provide "recommended" care (IMPOSSIBLE)

In a team-based environment (few in 🇨🇦) doctors need to work = 9.3h/day (Still a v. long day)

#primarycare #bcpoli Image
INDIRECT care in

doctor only model = 3.2 hours/d
= 12% of the IMPOSSIBLE day

team model = 2.6h/d
=28% of the very long day

INDIRECT CARE=
notes written
labs reviewed
forms filled
care coordinated
emails read
etc

HOW MANY PRIMARY CARE MODELS CONSIDER THIS WORK?
#primarycare
Read 6 tweets
Dr. Rita McCracken, MD, PhD (she/her) Profile picture
Aug 5
The #FamilyDoctorShortage
Can we fix it with more walk-in clinics?

A 🧵 about access hours
for (episodic) primary care in BC
based on our recent pre-print paper

#Cdnhealth #primarycare #bcpoli #tweetorial
@ircoopy @LindsayKHedden @UBCISU @sarah_fletch

medrxiv.org/content/10.110…
1⃣ What's the difference
between seeing a family doctor at a walk-in clinic
versus
a "regular" family doctor's office?

There are two typical kinds of "relationships" people have with a family doctor - EPISODIC + LONGITUDINAL #Cdnhealth #primarycare
A LONGITUDINAL relationship
with a doctor, NP, clinic,
ie you get to know each other

Research has shown that LONGITUDINAL primary care
improves the health of a community +
reduces overall costs of the system.

🪄Magic, right? #Cdnhealth #primarycare
pubmed.ncbi.nlm.nih.gov/16202000/
Read 20 tweets

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