Abstract
Background: The primary health care system is under stress in Ontario, Canada. There is a shortage of primary health care providers such that pregnant women and newborn babes are not able to access primary care. Parents of newborns and pregnant women are turning to the emergency room for care. This situation prompted a group of clinic managers and health care providers in Kingston, Ontario to seek solutions to this issue.
Our common motivation was that access to health care in early childhood is critical for setting up children for later success. Thus, we added two care pathways to ensure that all newborn babes would receive ongoing care. This initiatives were based on a solid understanding and educational outreach to the community of family physicians about the importance of primary care in childhood for ACE’s (Adverse Childhood Experiences) prevention and reducing the risk of chronic disease referencing evidence by the DOHAD (Developmental Origins of Health and Disease) studies.
Approach: A group was created with Kingston Community Health Center (KCHC) (a community based primary health care clinic), Queens University Department of Pediatrics and School of Nursing and the local public health unit. Through the 2 meetings, we established a plan of action for free office space and funding for providers and admin staff. This rapid solution oriented process reflected the common value that prenatal and well baby care is essential. In particular, one member of the group had not had access to prenatal care until late in the pregnancy and she was able to offer insight into the significant distress this can cause.
Results: A care pathway was developed where unattached newborns identified at birth were referred to a community based clinic for well baby visits until 18 months of age.
A second care pathway was created where KCHC took on identifying pregnant women who did not have attachment to primary care. These women were then “attached” to family physicians in the area. The newborns of these women would go on to be attached for ongoing care with the family physician provider. This has been successful over the past 2 years with over 600 women identified and attached to primary care.
Implications:
- In this scenario, debating possible options with both clinical and administrative expertise present rapidly led to the successful care pathway that was developed 2 years ago and still continues today ensuring that no child is left behind.
2.Evidence based rationale for services and programming can quickly bring multiple stakeholders together working on a health care issue. In this situation, taking the time to educate the stakeholders of the importance of health care during pregnancy and early childhood motivated attachment to primary care.
3.The current stressors in the health care system in Canada, demand that there is a process for development of care pathways for priority populations. Similar to LMIC settings, Canada is now struggling with health care personnel shortages as well as budgetary restrictions such that alternatives to the current care model must be considered.