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Why primary health care reform might stick this time!

April 10, 2019
By: 
Amit Gupta
Student - Public Health Policy and Microbiology
University of British Columbia

Across Canada, “Shoppers Drug Mart Presents…Medical Cannabis: The future is now”.

In holding conferences outlining the place for medical cannabis within patient treatment plans, Shoppers hopes to provide physicians with “practical insights...to learn how medical cannabis can be appropriately used for patients”. Even still, cannabis is already legal for recreational use.

Since nothing precludes Canadians from purchasing the drug for whatever purpose they choose, why do patients continue to designate their usage as a medical necessity?

Dr. Marcel Bonn-Miller, of the Center for Substance Abuse and Treatment finds that though cannabis has been shown as efficacious for a narrow range of chronic health conditions, medical cannabis users perceive the drug as beneficial for conditions beyond those indicated in prescribing guidelines. Furthermore, researchers from De Paul University outline that medical cannabis users use cannabis once they have exhausted allopathic prescription drug therapy; finding quicker action, longer lasting effects and better symptom management.

“‘I was taking 180 Vicodins a month for pain and I became hooked on them. And now I don’t take any pain [medications] whatsoever’” – 62-year-old male patient with rheumatoid arthritis, spinal cord disease, PTSD

When patients find themselves unsatisfied with uniquely allopathic care, they begin to independently make direct interventions in their healthcare. In the case of medical cannabis, physicians are still uninformed about prescribing guidelines and without access to specialized individuals, patients make unguided decisions to use the drug as treatment for health conditions that have not been adequately researched. The need to encourage access to a greater range of primary healthcare personnel is integral to allowing patients to make informed decisions about their healthcare.

According to the World Health Organization (WHO), primary health care is broadly about “caring for people, rather than simply treating specific diseases or conditions”; actors of the system are responsible for preventative services in addition to services managing chronic conditions. Yet, there is seemingly a lack of connectivity between different providers of care. Healthcare actors work in isolation of one another with little to no communication in developing holistic care plans that incorporate methods of care beyond the physician.

Medical cannabis is only one example of a public outcry for more comprehensive primary healthcare options for Canadians. Sick of the physician-centric approach to care, dictated by health legislation, patients want to access options that incorporate more compressive forms of healing in collaboration with allopathic care to provide optimal health outcomes.

The need for collaboration between health providers has been assessed by the WHO over 50 years of inquiry. The overwhelming conclusion highlights a reduction total patient complications, length of hospital stays, clinical error rates and even mortality rates.

While the notion of collaborative care guided by several practitioners at the community level may seem farfetched, organizations based in this principle are progressively appearing throughout the country. Localized especially in the CLSC program of Quebec, the government funded community health centers provide sites of centralized care upheld by physicians, nurses, nutritionists, dentists and psychologists.

Despite decades of existence, the centers struggle with overturning established institutions that attempt to maintain status quo in the practice of medicine.

Historically, collaborative practice has been viewed as unpractical to implement in community practice. Researchers from the School of Social Work at Laval University cite “ignorance of services provided by other [practitioners]” as a major barrier to establishing a “satisfying collaborative relationship” between professionals. New practices in the universities responsible for educating the practitioners are attempting to alleviate the ignorance between actors.

The University of British Columbia has recently implemented a form of learning for students in healthcare disciplines outlined as “interprofessional education”; whereby, students of different health schools follow grouped training in complex areas of healthcare such as ethics, ehealth and Indigenous cultural awareness. Interprofessional education provides students with the tools for effectively working in collaborative practice.

The role of physicians has continuously evolved with the evolution of healthcare itself. Nevertheless, assuming care from physicians as the only access to treatment becomes ignorant when contrasted with the other specialized actors within the healthcare system. In removing the barrier of ignorance, reforming primary healthcare to reflect a model of collaborative practice no longer seems like an unpractical ideal.