Ontario needs a comprehensive strategy to boost the number of family doctors in the province and help those struggling to keep up with the increasing demands of providing care in the pandemic, according to a new brief by the recently disbanded Ontario COVID-19 Science Advisory Table.
Primary care clinicians are seeing a growing number of patients requiring COVID care, including those needing testing, treatments and vaccines, as well as those with long COVID, but with no additional resources or supports, the brief states.
In addition, primary care doctors are working through a backlog of patients who missed seeing their physician for routine care or had their care delayed during the pandemic, further straining their ability to meet the needs of all their patients.
“We have this catching up to do, but the COVID burden is not going to ease out here in the community,” said Dr. Danielle Martin, the brief’s lead author and chair of family and community medicine at the University of Toronto.
“We are not in a situation right now where we can confidently say that primary care in Ontario is ready and able to pick up the challenge of this next pandemic wave, while at the same time dealing with all of the backlog of chronic disease management and prevention and caring for elderly and more complex patients.
“It’s a heavy load, and we don’t have the right system for it.”
The lengthy brief — and the final one published by the science table — makes a case for investing in primary care, not only to ease the burden on physicians and improve patient care, but to help stabilize a health-care system floundering under years of pandemic strain.
“We cannot keep building more hospital beds and expecting a different result in the community,” said Martin, a family physician and executive vice-president and chief medical executive at Women’s College Hospital.
“It’s not to say that hospital beds aren’t important, but we can prevent people from going to hospital if we give them equitable access to high-quality primary care services.”
The science table chose to focus on primary care due to its critical role in the pandemic response and because there are “opportunities to improve the quality of care provided,” Dr. Fahad Razak, the table’s former scientific director, said in an email.
The science table and its working groups, which provided guidance to the government and public, were dissolved in early September, several months after moving from U of T’s Dalla Lana School of Public Health to Public Health Ontario. The provincial agency is recruiting members to a scaled-down table called the Ontario Public Health Emergencies Science Advisory Committee.
Razak, a general internist at Toronto’s St. Michael’s Hospital, said if the COVID landscape remains the same in Ontario “much of the burden of managing COVID going forward will fall on primary care physicians and outside of the hospital sector.”
This means family doctors will be managing acute infections, caring for those with long COVID, keeping patients up to date on their vaccines and prescribing treatments, including the oral antiviral Paxlovid, to eligible patients, he said.
“These significant COVID-related demands are on top of the already considerable workload on primary care physicians and the spill-out effects of three years of delayed and deferred surgeries and procedures,” Razak said.
It also makes the case that more needs to be done to recruit and retain primary care clinicians in the province. Figures released in September by the Ontario College of Family Physicians show that one in five Ontarians could be without a family doctor in the next three years, and the brief points to data showing that as of March 2020, nearly 1.8 million people in the province did not have or were only “loosely connected” to a primary care clinician.
Efforts are also needed to create and enhance infrastructure to support primary care. For example, there is no email list for primary care in Ontario that allows health system leaders to communicate with family doctors, Martin said.
“The evidence is very clear that people who have formal attachment to a family doctor or a primary care clinician did better in this pandemic — for COVID and non-COVID-related diagnoses,” she said. “It will not be possible to meet the primary care needs in Ontario with the number of (clinicians) we’ve got and the number of models we’ve got; we need to get creative.”
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