What are Family Health Teams

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What are Family Health Teams?
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Components/ key elements of PCR

• Service to a defined population (rostering)
• Increased health promotion and disease prevention
• Expanded access to 24/7 Care (THAS)
• Multidisciplinary teams
• Enhanced Information Technology
• Non fee-for-service physician payment

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In Addition

• Physicians working more in groups
• Vertical integration
• Focus on Chronic Disease Management
• Prevention and Lifestyle Management
• Reaching Targets and meeting Guidelines
• Empowering Patients

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• 110 MDs
• 247,000 patients

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Paradigm Shift in Primary Care

• Family Doctor Micro Management
• Vs
• Family Doctor Macro Management

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Is Micro Management Successful?

• Are Canadians Reaching Targets?
• Are Canadians Medication Compliant?
• Are Canadians Hospitalized Due to complications
  of Drug Drug Interactions?

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ExampleHypertension Management
Hypertensive patients who are treated and BP
controlled
Hypertensive patients who are treated but BP
uncontrolled
Diabetic patients who are treated and BP
controlled
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(9)
21
43
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Patients who are aware but remain untreated and
BP uncontrolled
Hypertensive patients who are unaware
Joffres et al. Am J Hyper 2001141099 1105
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The ChallengeManaging Dyslipidemia
44 of Canadians 18-74 y have hypercholesterolemia
, yet 86 are not treated controlled
MacLean et al. Can J Cardiol 1999 Kirkland et
al. CMAJ 1999 Pearson. AJC 2000.
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Medication Use In Different Medical Disorders
(3-12 months)
100
90
80
70
Compliance Rates
60
50
40
30
Diseases
Cramer JA, Mattson RH, Prevey ML, Scheyer RD,
Ouellette VL. JAMA, 1989.
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Effect of Initial Drug Choice on Persistence
(Canada)
100
9
0
CCB
8
0
7
0
ACEI
6
0
Beta-blocker
5
0
Persistence rate ()
Diuretic
4
0
3
0
2
0
1
0
0
0
1
2
3
4
5
Years
n 22 000
Cumulative antihypertensive therapy persistence
rates. () per class of drug.
Caro et al. CMAJ 1999.
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Adherence to Cholesterol-Lowering Medication
100
90
80
70
60
50
Proportion remaining on medication ()
40
30
20
10
0
0
30
100
200
300
400
500
600
700
800
900
Days from starting medication
Saskatchewan Prescription Drug Plan Data. New
users. May 1991-August 1993.
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Evolving Problem

• Increasing population trends are pushing
  unexpected communities into classification as
  underserved areas. (i.e. Burlington, ON)
• Decreasing pool of Family MDs.
• Limited consult time per patient.
• Increasing incidence of undiagnosed and
  sub-optimally treated conditions.

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Increasing Burden on Health Care
Decreasing pool of Family MDs
Increasing population
Increasing Strain on Health Care System

Family MD time with each patient limited
Increasing incidence of undiagnosed disease and
under treated patients
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AN INTEGRATION MODELROLE OF THE PHARMACIST IN
FAMILY HEALTH TEAMS
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MEDICATION COSTS - THE OPPORTUNITY

• 72 of adverse events experienced by patients
  after hospital discharge are medication related
• 25 of Hospital Admissions for gt50 years of age
  are because of medication problems
• Preventable drug-related morbidity estimated to
  cost over 11 billion per year
• Accounts for 20 of hospital admissions 32
  billion in hospital care (2001) 6.4 billion

CMAJ 2004 170(3) 347 Arch of Intern Med 1990
150 841-845 Seamless care. Canadian Pharmacists
Association 2003 chapter 213-17
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PHARMACISTS SERVICES
Drug therapy can cure disease, reduce or
eliminate symptoms of a disease, slow disease
progression or prevent a disease
To achieve maximum benefits, medications must be
prescribed and used appropriately
The system is fragmented. Consequently
pharmacists are inappropriately used in the
health care system. Valuable pharmacist services
have not been implemented.

• Estimated economic cost of non-adherence in
  Canada - 7 to 9 billion yearly
• Economic benefits of Pharmacists Services
• ROI 16-17

Seamless care. Canadian Pharmacists Association
2003 chapter 213-17
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MEDICATION THERAPY PATIENT POINTS OF CONTACT
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PHARMACISTS ACCESSIBILITY

• gt 10,000 licensed pharmacists in Ontario

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PHARMACISTS ROLES
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ACCESSIBILITY

• Patient-centric care
• Ease of access through shared care
• Pharmacy in every community
• Extended hours of operation
• No wait lists
• Medication expert in the community

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SUSTAINABILITY COST EFFECTIVENESS

• Leverage existing resources
• Build on existing infrastructure
• Availability and accessibility of appropriate
  services
• Reimbursement only when services rendered

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The Solution

• Physician Pharmacist Collaboration
• Utilizing the
• Passport to Health Program

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Passport to Health

• The Hamilton Family Health Team will be
  implementing the program in September 06. Year
  one will see 10 physicians working with 10
  pharmacists managing 5 patients collaboratively.
  This will be expanded in year two and three
• Other FHTs in North Bay, Stratford, Midland and
  Paris are interested in participating and are
  looking to us for information and direction.

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Next Steps

• PTHAS (Passport to Health Adherance Study)
• Adherance study comparing PTH intervention vs
  standard care
• Protocol in progress
• McMaster Population Health Research Institute

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• Comments
• Questions?
• The End!

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Passport to HealthManaging Your Health
Information
Family MD
Passport to Health
Patient
Pharmacist
Richard Tytus, B.Sc.Phm., MD. Iris Krawchenko,
B.Sc.Phm., R.Ph.