Monday, 3 June 2019

The future of primary care: "Build the plane while it flies"

Josep M. Picas

Recently, The King's Fund, based on a study by the National Centre for Social Research (BSA), reported a significant decline (7%) in the assessment of satisfaction with English primary care by its citizens. This is probably due to the difficulties of access, caused by the scarcity of resources and the increasing complexity of patients. We do not know this information in other countries and especially in Spain, but it would surely be very similar, since the problems are global.

Forbes has also recently published an interesting article by Robert Pearl, a surgeon and professor at Stanford University and former CEO of The Permanente Medical Group, in which he discusses the potential use of artificial intelligence in daily practice. The author is recognized for his writings on the need for disruption in primary care.

On a more general level, The Economist has also published an excellent special on artificial intelligence and the job of the future.

The evolution of health services and technological evolution lead to a global rethinking in the provision of services and specifically in primary care. We approach, a complex problem of multi-factor solutions. One of the solutions that seem most interesting to study is the collaboration with artificial intelligence: this helps us to improve quality in its various aspects for example, increasing its resolutive capacity and decreasing heterogeneity.

It’s true that the solution isn’t solved exclusively by technology and to face the issue we should start working with a vision of the future and not be burdened with the problems of the past. At this point, it’s of great interest to pay attention to the approach to primary care that makes the recognized Institute for Health Improvement (IHI) (remember: triple aim, Don Berwick ...).

As Jordi Varela commented in an article, Americans have discovered primary care; Surely that’s the case but, as another participant in this blog, J. M. Monguet, thinks, when they approach a topic they take it seriously and deepen it. Let's consider as an example, the titles of the sessions of the IHI conference held last year in San Diego (California).

The title of the congress is: The design of primary care for the integral care of the person

The subtitle: Join us in the transformation of primary care

The conference dealt with the following topics:

  • Patients and populations at high risk and high cost
  • Data utilization
  • Consolidate navigation through health services
  • Promote a strong organizational culture
  • Use best practices in attendance, based on teamwork
  • Address the professional burn-out of the care team
Associations (partnerships)
  • Involve patients
  • Foster relations between primary and specialized care
  • Obtain value in integrated organizations (ACO)
Payment policies
  • Manage health care in value-based environments
  • Guarantee financial support for care based on the healthcare team
  • Moving from payment for service to payment based on value

Finally, he recommends: "Attend the IHI Summit to learn the practical skills and tools you need to address these unique challenges and design the integral care of the person. Return with renewed joy and passion for your daily work."

This reflection serves as an incentive for the Spanish primary care to initiate an appropriate reflection. We are in a global world and different approaches can be useful; our contributions, based on our experience and knowledge, are also very necessary. In summary, the question is about "building the plane while it flies".

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