The Minister of Health, Christian Dubé, was unable to respect his commitment to offer as of Thursday better access to health care for orphan patients in all regions of Quebec, an objective which he has instead postponed until the summer. next by presenting it on Tuesday as a “revolution”.
Asked about this, the Ministry of Health and Social Services (MSSS) acknowledged that Minister Dubé had to review his timetable for the deployment of the front-line access counter (GAP), inspired by a model launched in Bas-Saint-Laurent. “In November 2021, the minister effectively announced the deployment of GAPs on March 31,” agrees spokesperson Marie-Claude Lacasse in an exchange with The duty.
When he presented his reform of the health system on Tuesday, the Minister welcomed his desire to extend accessibility to this counter in the coming months, which makes it possible to direct patients without a family doctor to the right professionals. “By the end of the summer, more of the majority of Quebecers who are currently without a family doctor — who are currently called orphan patients — will be able to go through the GAP. This is the revolution that we are making in health, ”launched the elected official. He described this promise as “enormous”.
At the ministry, Mr.me Lacasse says the deadline was postponed at the request of the professionals in the field. “The arrival of the fifth wave of the pandemic required a lot of energy from clinicians and establishments, and the latter made a request to the MSSS to allow additional time,” she writes.
From now on, the ministry is therefore committed to ensuring that “all first-line access counters [soient] deployed on 1er june and [aient] started their activities” at that time. The “service offer” of these GAPs must be “completed on 1er September,” the spokesperson added. As of March 30, the GAPs were deployed in 7 out of 22 territories and offered their services to “approximately 50% of the clients registered with the access counter to a family doctor”.
Quick fix or fix?
The model that Minister Dubé wishes to extend to all of Quebec was set up in Bas-Saint-Laurent at the beginning of 2020, under the aegis of the head of the Regional Department of General Medicine, Dr.r Eric Lavoie. Is this a miracle solution or a temporary cure? In the region, opinions differ.
“It remains a troubleshooting system that we are about to perpetuate. That, that scares me a little, ”said the Homework the Dr Mathieu Brouillet. The family doctor, who works within the Family Medicine Group (GMF) du Fleuve, in Pointe-au-Père, has been participating in the pilot project launched in Bas-Saint-Laurent since its very beginning.
There, the GAP employs four clinical nurses and as many administrative assistants who accompany patients without a family doctor to the right medical services. At the heart of the project, there is this observation: 50% of calls from orphan patients can be directed to health professionals other than doctors and up to 95% of users are satisfied with the support they receive. , welcomes the Dr The way.
The Dr Brouillet is far from denying the positive effects that the GAP could have, especially in regions where large sections of the population have access to a family doctor. “In a region where almost everyone is registered [auprès d’un médecin], we see 25-year-olds with eczema, and there, things are going well: they are prescribed their cream, it takes ten minutes and it’s settled, he illustrates. But for chronic problems, it’s ethically difficult. »
In Bas-Saint-Laurent, the requests are “so well sorted by the nurses that what happens in the doctor’s office are complicated cases,” he says. “Me, I have the gentleman who has Parkinson’s and I will not solve his problem by [un rendez-vous]. The right attitude to have in his case is to register him “so that he has a family doctor, underlines the Dr Brouillet. This type of situation creates “unease”, an “ethical dilemma”, because doctors have to treat, on an ad hoc basis, health problems that nevertheless persist.
Then, “even if we solve the problem, it ends with “do you want to be my doctor?” laments the one who has 20 years of practice. “I think it affects my colleagues. »
At the Federation of General Practitioners of Quebec, the president, Marc-André Amyot, notes that the case of Dr Brouillet “is not isolated”. “Yes, it creates a bit of a conflict of values,” he told the Homework. But, despite its imperfections, the GAP remains an interesting solution to explore, in his opinion. “Is it better not to have a service or to have a service that is not ideal? ask the Dr Amyot. Of course, in an ideal world, everyone would have a family doctor. »
Good for all of Quebec?
Clinical nurse Stéphanie Fournier-Bernier, who has been supporting patients in Bas-Saint-Laurent through the GAP since 2020, believes that the model would benefit from being extended to all of Quebec, as the government. “I think people should have access to a medical consultation service. It’s nonsense for a person to wait six hours in the emergency room for a prescription refill,” she said in an interview.
In her practice, she accompanies patients to ensure “that at the end, there is an appointment”. In the vast majority of cases, patients who are not referred to a family doctor obtain an appointment with a medical specialist — with whom they already have an active follow-up — or with a pharmacist. The latter are “very good allies”, notes Mme Fournier-Bernier.
Under the leadership of the former Minister of Health, Danielle McCann, pharmacists obtained in March 2020 the right to practice new activities, such as the prescription of drugs. And at GAP, “one in six calls are for medication,” said Dr.r Lavoie during his visit to the National Assembly in February.
His project, which also aimed to “generate relevance” by directing patients to family doctors who really needed follow-up with them, could be expanded, in his opinion. “The more doctors you need, the more you have to manage your relevance,” he says. And “the more people you have who don’t know the network, the more there are advantages in supporting them in the services”.