Fixing primary care? Help people help themselves and others
Dr. Trevor Hancock
16 July 2019
In two previous columns I suggested a more thoughtful approach to fixing the primary care crisis would be to reduce the need and demand for care in the first place. Reducing the need for care means reducing the burden of disease within society. This requires both a government and society-wide provincial population health strategy and a much stronger commitment to public health and clinical prevention within the health care system.
The second main component is a comprehensive self-care strategy, an important way to reduce unnecessary or inappropriate demand for care by those who are sick. Any front-line health care worker will tell you that a significant number of people seeking care have minor and self-limiting conditions or chronic diseases that they could largely manage themselves, with some knowledge and support. Others do not have a medical problem so much as a social problem and may just need companionship, support and something to do.
Family physicians have old adages that tell an important story: Most minor problems will get better on their own, you only need to provide reassurance and apply the ‘tincture of time’. Indeed, in previous times, families and their neighbours knew about self-care and generally did a pretty good job of looking after minor ailments and injuries. But there is knowledge and skill involved in knowing what can and what cannot be managed without seeking care. However, in professionalising all care we have effectively de-skilled people, so they have to seek care.
The good news is that BC does have the 8-1-1 program, HealthLinkBC. This phone-line and online service (https://www.healthlinkbc.ca/) has nurses and navigators available 24/7 to help with non-emergency health concerns. The former provide health and treatment advice, while the latter help find health information or health services. The program also has dietitians and exercise professionals (available M-F, 9 – 5) and pharmacists (available 5pm to 9am every night).
There is also a Chronic Disease Self-management Program, provided by Self-Management BC (https://www.selfmanagementbc.ca) to “help people with chronic conditions to manage daily challenges and maintain an active and healthier life”; more than half the group programs in 2016 were for chronic pain self-management. The program provides both community-based group programs (in 2016 they were provided in 89 percent of BC communities with a population over 3,000) and online group programs, as well as a Health Coach phone support system for those needing extra support.
For those that have a social problem, especially related to loneliness, isolation, and similar problems, the answer is likely to be what the UK’s National Health Service calls ‘social prescribing’. People are referred to social agencies, community groups and others who can help link them to the connections and support they need. BC does not have a social prescribing program, although earlier this year the Ministry of Health contracted with the United Way of the Lower Mainland to develop over the next three years “up to 48 demonstration projects in communities in all regions of BC, based on innovative and promising program models”. One of the three program streams includes social prescribing, “for seniors at risk of frailty, to increase social support, physical activity and good nutrition”.
But a comprehensive approach to self-care is much more than managing minor ailments and injuries or helping people manage their chronic diseases, important though those are. It begins with having the knowledge and skills to keep yourself and your family healthy and safe, and that includes working with your community, local organisations and local government to make your community more healthy.
Self-care also includes having training in first aid, including CPR and trauma management, to manage emergencies until the first responders arrive. The final aspect of self-care is helping people prepare for the end of life by supporting them in preparing living wills or advance directives and in having the necessary conversations with family, care providers and friends so their wishes are known and can be respected
Here in BC we have made a start, but we need a comprehensive self-care strategy if we are to take the pressure off primary care by reducing unnecessary and inappropriate demand for care. This must include investing in teaching self-care in schools and the community, as well as increasing community-based supports.
© Trevor Hancock, 2019