Access to care more important for your health than seeing the same doctor, says researcher

Being able to access health care early is more important for patients' health than always seeing the same doctor, says a health researcher.

Scott Robertson is part of a research team at Stanford University looking at providers of high quality health care with low annual spending costs.

He was also born and raised in Yellowknife, where he worked as a registered nurse at Stanton Hospital and in communities throughout the N.W.T. and Nunavut. 

He spoke with Northbeat's Randy Henderson on Friday. This interview has been edited and condensed.

How did you determine that having access to care when you need it matters much more than seeing the same doctor or nurse every time?

We looked at high value health care systems across the U.S., places that were providing above-average care — the top 25 per cent on quality measures but also in the bottom 25 per cent on cost — and that's a very hard thing to do. So we investigated a number of these places across the U.S. to say 'what is it exactly that you're doing that's different than everyone else?'

We took our findings and one of the conclusions we came to is that this team approach to care — having access to a member of the care team — was much more important than always seeing the same physician or nurse practitioner.

How do you know it works?

The high value health care systems gave us great examples of how this works. When people required access to care they could call into the practice, and these were anywhere from very small, one or two provider practices, to very large, 25 or 50 physicians/nurse practitioner practices.

Getting people in early to see someone when they had an issue — and that could have been providing the care over the phone or working them into the schedule — made a huge difference.

And we know this because of the data we were able to analyze from these practices that their patients did better on average than other practices that we compared them to.

Can you give me an example, through a patient's eyes, under this system you're describing, and how it's benefited them?

One really great example we saw was with diabetes care. If someone had a high blood sugar level at home, they took their reading, they would call into the practice and they would be put through to the diabetes educator who would work with the person over the phone, using practice guidelines, to try different things. Maybe they would have to adjust their medications, or do other assessments, and if they could do that and keep them from having to come into the office, that was great.

But if they determined that it wasn't appropriate, they couldn't manage this over the phone, they would find a way for them to see one of the nurses, the nurse practitioner or one of the physicians in the office and then bring them in. It was determining who could provide that level of care first, using them to their maximum skill, whether it was a nurse a medical assistant or a physician and them bringing them quickly to the right level of care.

How does a system like this lower health care costs?

What you're doing is you're using everyone to their maximum skill level, everyone from the receptionist at the front desk who's answering the call, who instead of just making your appointment is getting basic information that would trigger them to say, 'I think you need to talk to the nurse today because of the symptoms that you're calling in about.'

[They're] giving people the ability to really work to their full scope, their full practice, in order to provide that care so that everything isn't always going to the doctor, going to the specialist. Because along the way you have other members of the care team that are able to provide that care, without always having to use that resource of the physician.

So this translates into fewer doctor visits, fewer emergency room visits as well?

How this came out in our data was that people ended up in the emergency department and ended up being hospitalized less, and those are very expensive things to do.

So it's not that doctors don't matter, it's that your single doctor doesn't matter. It's more important to have access to someone on the care team than always seeing that same person.

Of course relationships are important, we want to encourage that but you don't want to design your entire health care system to fall apart and your entire care to fall apart, if you can't see that one person.

There are some people out there who may take a skeptical approach that you're just trying to save costs.

It's not about rationing care, it's about providing the right care to people and this is something that came across very clearly in our research findings.

When they were ordering diagnostics like X-rays and lab, they weren't just ordering everything they could for you because they could, they were being thoughtful. 'We need to do this test because it will help us make this decision, and we don't want to do this test because it doesn't matter what this test shows, it wouldn't change our care.'

And there are many examples and this is pretty well known in the research that people get a lot of care that they don't need. One example would be for low back pain. Thousands of Canadians get an X-ray for low back pain every year and there's almost never a reason to do that that helps a clinician make a decision. So it's not about rationing care, it's about providing the right care.

Can a system like this work north of 60?

Absolutely and we have all the pieces in place here. We've got great people, very dedicated clinicians, nurses, nurse practitioners all across the North and the work that is underway to bring a territorial health focus is a really great idea.

Within that they're trying to make sure that there's more consistency in who you see and my recommendation from my research is to say that's a good idea but make sure that you design it in a way that you can maximize the use of everyone on your team so that people can have early access to care when they need it.