Nearly a year after the launch of the reform by the Minister of Health, Christian Dubé, measures aimed at improving access to front-line services are beginning to be felt on the ground. The first-line access counter (GAP), specialized nurse practitioner (IPS) clinics and the increased role of pharmacists “help” emergencies, according to medical associations. But to what extent ? And do the patients benefit from it?
The Quebec government has exceeded its objective: more than 507,000 Quebecers are now taken care of collectively by groups of family doctors. When they have a health problem, these patients should contact the GAP hotline for consultation. After evaluation, a nurse at the counter directs them to a doctor or “the right professional” in order to offer them the “right care at the right time”.
Since May 21, the GAP has registered nearly 600,000 requests, according to the Ministry of Health and Social Services (MSSS). “Increasingly, people’s reflex is not to go to the emergency room, but to call the GAP”, notes the Dr Gilbert Boucher, President of the Association of Emergency Medicine Specialists of Quebec. “It helps us,” he adds. The DD Judy Morris, president of the Association of Emergency Physicians of Quebec, also claims to “see results” on the ground.
But the real effect of the counter on emergency room traffic remains equivocal. The Dr Boucher reports that the average daily number of outpatients (coming by their own means and not by ambulance) has been slightly lower in early 2023 compared to the same period in 2019, a pre-pandemic year. He specifies that there was no wave of influenza in January and February this year (it occurred in November and December 2022), which usually generates visits to the emergency room.
“It’s still a success that there are a little fewer patients compared to four years ago, when you take into account the fact that people [dans la population] are older and that they have more health problems”, judge the Dr Boucher, who sits on the crisis unit set up by Quebec to unclog emergency rooms. According to him, the GAP makes it possible to avoid “a greater increase” in outpatients.
IPS clinics: limited impact
In Quebec, about 5,000 patients come to the emergency room every day for a non-urgent problem, according to Dr.r Butcher.
Launched in Montreal in December, the three IPS clinics have had a limited effect on this traffic. The IPS clinic of the CIUSSS de l’Est-de-l’Île-de-Montréal has seen 793 patients since it opened on 1er December. The two IPS clinics of the CIUSSS du Centre-Sud-de-l’Île-de-Montréal, for their part, welcomed 398 between December 15 and March 13.
Health facilities explain that clinics are not operating at full capacity, as not all permanent positions have yet been filled. NPs still work there on a voluntary basis, working overtime or dividing their time between family medicine groups and clinics.
Pharmacists, for their part, have their hands full, according to Benoit Morin, president of the Quebec Association of Owner Pharmacists. “We have more clinical activities than before, there are more things we can do,” he says. But at the same time, we are faced with a shortage of personnel and with the challenge of doing more with less. »
Its members are also asking the population to “help” them to be “more efficient” in order to better contribute to the Dubé reform. They suggest that patients contact them by phone 24 to 48 hours in advance to get their prescriptions refilled. They won’t have to line up at the counter. “There are pharmacists who don’t have time to manage chronic diseases because the flow rate [de clients] is not organized,” says Benoit Morin.
Despite everything, pharmacists could do more to unclog the first line if “barriers were lifted”, he thinks. “In Ontario, for a woman who has a UTI, the pharmacist can start antibiotic treatment based on the symptoms,” he cites as an example. In Quebec, the patient must have seen a doctor for this problem in the last five years.
Patients left behind?
Sylvie Tremblay, director general of the Provincial Regrouping of User Committees, believes that the measures put forward by Quebec are useful. But she regrets that vulnerable patients are forgotten in this reform. Seniors have to call the GAP each time they need care (one problem per appointment, they say). “For people who are vulnerable or who have multiple pathologies, you need a support mechanism, and we don’t have that,” she says.
According to the Régie de l’assurance maladie du Québec, just over 77,000 people aged 70 and over were registered with a group of family doctors as of February 28. They represented 15% of patients treated collectively.
It is nevertheless a success that there are slightly fewer patients compared to four years ago, when we take into account the fact that people [dans la population] are older and have more health problems
The GAP telephone line is still experiencing failures, according to Sylvie Tremblay. Several testimonies collected by The duty confirm it. Anne Michaud, 64, has contacted the GAP twice since February. She waited two and a half hours on the phone to get an appointment with a doctor for a refill. “The second time, I waited three hours and the line cut! ” she says. In the grip of intense pain in the abdomen, she went to the emergency room of the hospital in Gatineau, where she lives. The diagnosis fell after a battery of tests: problem of acidity in the stomach.
“I am told that I am taken care of by a clinic, says Anne Michaud. Yes, but if I have to wait three hours on the phone to be hung up on, call back and wait possibly another two and a half or three hours to get an appointment maybe ten days later, that’s is not support, that! »
According to the MSSS, the average cumulative response times of administrative officers and GAP nurses reached one hour on March 11. These do not take into account calls abandoned by the patient before he could even speak to someone. As of March 11, the abandonment rate was nearly 23% in the queue for administrative officers and 15.3% for that of nurses.
The GAPs are regularly monitored, according to the MSSS. A team will tour and make recommendations to improve their performance.