Almost a year after the launch of the reform by Health Minister Christian Dubé, the first measures to improve access to services can be felt on the front line. The first-line access counter (GAP), specialized nurse practice clinics (IPS) and the increasing role of pharmacists are “helping” emergencies, according to medical associations. But to what extent? And do patients benefit from this?
The Quebec government has surpassed its goal: more than 507,000 Quebecers are now cared for collectively by groups of primary care physicians. If they have a health problem, these patients should contact the GAP hotline for advice. After evaluation, they are directed by a nurse at the counter to a doctor or “the right professional” to provide them with “the right care at the right time”.
Since May 21, the CAP has registered almost 600,000 requests, according to the Ministry of Health and Social Care (MSSS). “Increasingly, people’s reflex is not to go to the emergency room, but to call the GAP,” notes Dr. “It helps us,” he adds. dr Judy Morris, president of the Association of Emergency Physicians of Quebec, also claims to be “seeing results” in this area.
But the counter’s real effect on ER traffic remains unclear. dr Boucher reports that the average daily number of outpatients (by their own means and not by ambulance) was small low in early 2023 compared to the same period in 2019, a year before the pandemic. He states that there was no flu epidemic in January and February of this year (it occurred in November and December 2022), which usually entails visits to the emergency room.
“It’s still a success that there are slightly fewer patients compared to four years ago considering that people are [dans la population] are older and have more health problems,” says Dr. Boucher, who sits on the Quebec-established crisis unit to liberate the emergency rooms. According to him, the CAP makes it possible to avoid “a greater increase” in outpatients.
IPS clinics: limited impact
In Quebec, according to Dr. Boucher sends about 5,000 patients to the emergency room every day for a non-urgent problem.
The three IPS clinics launched in Montreal in December had a limited impact on this traffic. The IPS Clinic at the CIUSSS de l’Est-de-l’Île-de-Montréal has treated 793 patients since it opened on December 1st. For their part, the two IPS clinics of the CUSSS du Centre-Sud-de-l’Île-de-Montréal welcomed 398 between December 15 and March 13.
Health facilities explain that clinics are not fully utilized because not all fixed positions are occupied. NPs still do voluntary work there, working overtime or splitting their time between GP groups and clinics.
For their part, pharmacists have their hands full, according to Benoit Morin, president of the Quebec Association of Owner Pharmacists. “We have more clinical activity than before, there are more things we can do,” he says. At the same time, we are faced with a shortage of staff and the challenge of doing more with less. »
Their members also call on the population to “help” them become “more efficient” in order to better contribute to the Dubé reform. They suggest that patients call them 24 to 48 hours in advance to have their prescriptions refilled. You don’t have to queue at the counter. “There are pharmacists who don’t have time to treat chronic diseases because of the flow rate [de clients] is not organized,” says Benoit Morin.
Still, pharmacists could do more to clear the first line if “barriers were lifted,” he says. “In Ontario, for a woman with UTIs, the pharmacist may initiate antibiotic treatment based on the symptoms,” he gives as an example. In Quebec, the patient must have seen a doctor for this problem within the past five years.
Abandoned Patients?
Sylvie Tremblay, director general of the Provincial Regrouping of User Committees, thinks the measures proposed by Quebec make sense. However, she regrets that vulnerable patients are being forgotten in this reform. Seniors have to call GAP every time they need care (one issue per appointment, they say). “For people who are vulnerable or 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, as of February 28, just over 77,000 people aged 70 and over were registered with a group of primary care physicians. They made up 15% of the patients treated together.
Still, it’s a success that there are slightly fewer patients compared to four years ago, considering that people [dans la population] are older and have more health problems
GAP phone line outages are still happening, according to Sylvie Tremblay. Several testimonials collected by Le Devoir confirm this. Anne Michaud, 64, has contacted the CAP 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 was cut! ” She says. With severe abdominal pain, she went to the emergency room at the hospital in Gatineau, where she lives. The diagnosis came after a series of tests: gastric hyperacidity.
“I’m told that I’m being looked after by a clinic,” says Anne Michaud. Yes, but if I have to wait three hours on the phone, get hung up, call back and maybe wait another two and a half or three hours to get an appointment maybe ten days later, that’s not support, that! »
According to MSSS, on March 11, average cumulative response times from administrative officers and GAP nurses reached one hour. These do not account for calls that the patient abandoned before they could even speak to anyone. As of March 11, the queue drop-out rate was nearly 23% for administrative officers and 15.3% for nurses.
According to the MSSS, the GAPs are regularly monitored. A team will go on tour and make recommendations to improve their performance.