The first wave of COVID-19 focused Ontario’s collective attention on hospitals, critical care beds and ventilators. With case counts rising and Ontario now in its second wave, pandemic leaders within government must broaden that focus to face a double challenge: How to respond to rising case rates while also continuing other important care for Ontarians.
Regardless of what happens with COVID-19, other illnesses continue their relentless march. Ask anyone and many will share stories of late diagnosis, delayed treatment, avoidable outcomes and suffering faced by people, families and caregivers.
The hospital-centric approach in the first wave made sense. The second wave, however, needs a more thoughtful approach. The majority of care happens in the community. Family doctors alone provide two-thirds of all healthcare visits, not to mention the care done by other community-based physicians including specialists, those providing diagnostic services and other health professionals.
For our next wave and beyond, Ontario’s leaders need to immediately engage primary care physicians. Research shows that people with a family doctor benefit from timely cancer screening, fewer hospitalizations and emergency visits and live longer. Primary care is the heart of a high-functioning healthcare system and family doctors have continued to tirelessly care for Ontarians throughout the pandemic.
Consider a typical morning at your family doctor’s office. A 91-year-old living alone, with a history of lung disease, heart failure, atrial fibrillation, advanced kidney disease, calls in with worsening shortness of breath and fatigue. New parents call in worried about their newborn’s poor feeding. A 17-year-old student with severe social anxiety asks for help. And that’s just the first half-hour.
When decision-makers prioritize primary care, they are supporting safe, high-quality, holistic and compassionate care for Ontarians.
A few family doctors have helped shape Ontario’s pandemic strategy. However, front-line family physicians want to see a more meaningful partnership. We need to ensure that any plan that can move us forward – whether around a vaccine strategy, pandemic communication or support for non-COVID care – works effectively in the real world of your doctor’s office.
With this in mind, our prescription for Ontario’s pandemic leaders is simple: engage us, invest in us and lean on us.
First, engage family physicians in planning and rollout. Consider flu vaccination in Ontario. Family practices can identify priority groups for immunization including children, older adults and people with complex health conditions. In a year when widespread vaccination is critical, imagine the success story from meaningfully engaging family doctors to vaccinate everyone through coordinated primary care hubs. The flu vaccine may be important today but our plan for the COVID-19 vaccine will be critical in the months ahead.
Second, invest in us. In the first wave, community practices had to fend for themselves; clinics were left to source their own life-saving personal protective equipment. Even before the pandemic, Ontario’s health policy neglected much of primary care –the majority of Ontarians are excluded from interprofessional primary care teams. Approximately 1 million Ontarians do not have a family doctor or primary care professional. Imagine if every Ontarian had a team of experts to manage and coordinate his or her care, to promote health throughout and beyond COVID-19.
Third, lean on us. Primary care professionals hold trusted relationships with the people, families and caregivers in our communities. The pandemic is an opportunity to lean on the province’s 9,000 comprehensive family physicians to help socialize physical distancing, universal masking and other public health measures. Ontario’s family doctors are ready to support a provincial communications strategy that relies on key local primary care experts and influencers to convey a unified, science-based and compassionate message at a time when misinformation is deadly.
The second wave is a critical juncture. It is an opportunity for creative and courageous decisions in how we care for Ontarians. Most care happens in the community and primary care is central to an efficient, effective and equitable health system as well as its COVID-19 response.
Ontario’s doctors urge our pandemic leaders within government to engage with, invest in and lean on the province’s primary care professionals. Through the coming waves of the pandemic, the health of Ontarians depends on it.
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I am a veterinarian serving on the Board of a local city health centre and fully agree with this article. Despite the importance of hospitals in delivering health care much preventive and therapeutic activity would be better moved “upstream” to local physicians and physician teams. This is especially true in combatting CoVid-19
I always believed that primary care physicians have a strong role in “prevention” of medical disorders. I am wondering why nobody is talking about common sense strategies to educate people about immune system strengthening – you know make sure they have adequate nutrition and vitamin intake, check their vitamin D status, encourage supplementation with vitamin D and zinc? This should be the prime time for doctor’s to call in the vulnerable for full system health exams and make sure that any gaps are met. Why is nobody talking about these factors publicly? The message the media is sending is “COVID will kill you, wear a mask”, we know how to manage this disease. People have been getting ARDS from influenza and other respiratory infections in the past. One of the best strategies right now, aside from hand hygiene, would be to educate people how to maximize their physical potential. How to strengthen their immune system. Is anyone in primary care even concerned that there are people who have been out of work for months? how are they supposed to afford nutritious foods and vitamin supplements? Does primary care not concern itself with nutrition and general well being?
Thank you Dr Alam and Dr Nowak for explaining the role that primary care Physicians can and will play in the second wave of COVID-19. Engagement with, investment in, and reliable service from primary care will make a difference in this next wave. This requires a conscious change in the approach of Ontario’s leaders.
Very well said Drs.Alam and Nowak!
We are well served to find the balance between resourcing primary and tertiary care. We would be wise to also seek the balance between maintaining capacity in the healthcare system and protecting our economic and social well-being, both key determinants of health.
Exactly. This is what our healthcare leaders should analyze and act. In the mean time, what about the role of other healthcare professionals? How can we apply these strategies with other frontline workers? These are the interesting topics to debate. The top priority should be to deliver efficient health care even during the pandemic. Well said Dr. Alam and Dr. Nowak. Hope to read more from you in the future.
I strongly support the position in this article. Primary care is truly the core of our ‘system’ and it must be acknowledged that they must play a much more prominent role in strategies regarding the coronavirus going forward.