At the heart of the reform presented on Tuesday by the Minister of Health, Christian Dubé, is the first line access counter (GAP). The goal: direct patients without a family doctor to various health services to prevent them from clogging up emergency rooms… and general practitioner offices. Miracle solution, or mirage? Experts speak out.
“A good efficient family doctor, in 2022, every patient who comes into his office says to him: “it’s going badly” […]. See your doctor again to be reassured, we don’t do that anymore, ”indicated this week at the Homework general practitioner Mathieu Brouillet.
The family doctor, who works in a family medicine group (GMF) in Pointe-au-Père, has been participating in the GAP du Bas-Saint-Laurent pilot project since its inception in 2020.
There, the head of the regional Department of General Medicine, Dr.r Éric Lavoie, has deployed a telephone counter service for orphan patients – without a family doctor and who require care. The GAP employs four clinical nurses and as many administrative assistants, who accompany these patients to the right medical services. In half of the cases, the orphans end their trajectory before a professional other than a doctor. And they would be delighted.
“Before, we had a few complaints from orphan patients a year,” says Dr.r The way. Since then, there have been zero complaints. »
A temporary solution…
Is the project, often cited as an example by Minister Dubé, a miracle solution for all that? Mylaine Breton, professor at the Faculty of Medicine and Health Sciences at the University of Sherbrooke, has studied the operation and effectiveness of access points in seven Canadian provinces. She regrets that the GAP is a “temporary response pending support”. “I think there is a gain, but we are not in continuity: after that, there will be no follow-up,” she says in an interview.
We troubleshoot, we provide service, [mais] even if we solve the problem, it ends on: do you want to be my doctor?
In the field, the Dr Brouillet also sees the GAP as a temporary solution, which sometimes places doctors in front of ethical dilemmas.
“What underlies the GAP is that the problem is in principle punctual and that it can be settled in one meeting”, he recalls. Yet the patients who end up in his office have conditions that are mostly complex — and chronic. “We help out, we provide service, [mais] even if we solve the problem, it ends on: do you want to be my doctor? says the general practitioner. I think it affects my colleagues, that it may cause distress. »
… but more relevant
Still, the GAP has the great advantage of “generating relevance”, underline the Drs Brouillet and Lavoie. Clearly, it makes it possible to send patients to the professionals who are best equipped to respond to their problems.
“It’s normal, in the head of a patient, to say to himself: I’m going to go to the emergency room or I’m going to see the doctor, he’s going to sort it out for me”, specifies the Dr The way. “It’s binary in the mind of a patient who is not initiated into the network. Except that the network itself is not binary at all,” he adds, listing the services in mental health, rehabilitation and psychology.
“In my opinion, the general practitioner should be used most often in complex cases, where there are several pathologies,” continues Dr.r Brouillet. “This is the richness of general practice: we put the heart, the kidneys and the liver together, and psychology often too. »
The GAP is part of this new multidisciplinary vision. This is a paradigm shift that will require an in-depth review of the organization of services, according to Mylaine Breton.
She points out that in Quebec, the “entry key” that gives access to FMGs and their professionals remains, for the time being, registration with a doctor. “We are the only province that does not allow direct registration for specialized nurse practitioners [IPS]. However, these professionals are just as capable of monitoring babies as family doctors. “The results are going to be comparable and sometimes better,” she says. The literature is quite eloquent [à ce sujet]. »
From the opening to the Dubé cabinet
Minister Dubé’s office says it is ready to allow IPSs to become gateways to FMGs in the same way as doctors. We “have to get out of the idea that everyone needs a family doctor,” he also argues.
At the end of the deployment of the GAP, the teams of Christian Dubé also hope to be able to redirect patients to community organizations. These could complement the services already provided by, among others, social workers. It would be a way of reaching vulnerable clienteles, underlines the minister’s entourage.
But it is still necessary that these vulnerable patients have recourse to the GAP. “We know that people who are socially and materially disadvantaged are under-represented on the lists [des divers guichets d’accès], says Mylaine Breton. It is extremely complex to navigate in this system, [par exemple] if you don’t speak French or English. At Cabinet Dubé, we recognize this blind spot. “We see the patients we have at the counter, but we don’t see those we don’t have,” says a source.