One year of the Dubé reform: what progress?
![One year of reform Dubé form: what progress? /></p>
<p> Photo: Jacques Nadeau archives Le Devoir “Increasingly, the reflex of people is not to go to the emergency room, but to call the GAP,” notes Dr. Gilbert Boucher, president of the Association of Emergency Medicine Specialists of Quebec. </p>
<p>Almost a year after Health Minister Christian Dubé kicked off the reform, measures to improve access to frontline services are beginning to be felt on the ground. The frontline access point (GAP), specialized nurse practitioner (IPS) clinics and the increased role of pharmacists are “helping” emergency rooms, according to medical associations. But to what extent ? And are patients benefiting from it?</p>
<p>The Quebec government has exceeded its objective: more than 507,000 Quebecers are now collectively cared for by groups of family doctors. When they have a health problem, these patients should contact the GAP hotline for consultation. After assessment, a counter nurse refers them to a doctor or “the right professional” to provide them with the “right care at the right time”.</p>
<p>Since May 21, the GAP has registered nearly 600,000 requests, according to the Ministry of Health and Social Services (MSSS). “Increasingly, people's reflex is not to go to the emergency room, but to call the GAP,” says Dr. Gilbert Boucher, president of the Association of Emergency Medicine Specialists of Quebec. . “It helps us,” he adds. Dr. Judy Morris, president of the Quebec Association of Emergency Physicians, also says she is “seeing results” in the field.</p>
<p>But the real effect of the counter on emergency room traffic remains ambiguous. Dr Boucher reports that the average daily number of outpatients (coming by their own means and not by ambulance) was slightly <b> </b> lower at the start of 2023 compared to the same period in 2019, a year pre-pandemic. He specifies that there was no wave of influenza in January and February this year (it occurred in November and December 2022), which usually generates visits to the emergency room.</p>
<p>“It's still a success that there are a little less patients compared to four years ago, when you take into account that the people [in the population] are older and they have more health problems, “says Dr. Boucher, who sits on the crisis unit set up by Quebec to unclog the emergency room. According to him, the GAP makes it possible to avoid “a greater increase” in outpatients.</p>
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IPS clinics: limited impact
In Quebec, About 5,000 patients come to the emergency room every day with a non-urgent problem, according to Dr. Boucher.
Launched in Montreal in December, the three IPS clinics have a limited effect on this traffic. The IPS clinic at the CIUSSS de l'Est-de-l'Île-de-Montréal has seen 793 patients since it opened on December 1. The two IPS clinics of the CIUSSS du Centre-Sud-de-l’Île-de-Montréal, for their part, welcomed 398 between December 15 and March 13.
Health facilities explain that clinics are not operating at full capacity, as not all permanent positions have yet been filled. SNPs still work there on a voluntary basis, working overtime or dividing their time between family medicine groups and clinics.
Pharmacists, for their part, have their hands full, according to Benoit Morin, president of the Quebec Association of Owner Pharmacists. “We have more clinical activities than before, there are more things we can do,” he said. But at the same time, we are caught with a shortage of personnel and with the challenge of doing more with less. »
![A year of the Dubé reform: what progress? /></p>
<p> Photo: Michaël Monnier Le Devoir archives Pharmacists must “do more with less,” according to Benoît Morin, president of the Quebec Association of Proprietary Pharmacists. </p>
<p>Its members are also asking the population to “help” them to be “more efficient” to better contribute to the Dubé reform. They suggest that patients contact them by phone 24 to 48 hours in advance to get their prescriptions refilled. They won't have to line up at the counter. “There are pharmacists who don't have time to do chronic disease management because the flow [of clients] isn't organized,” says Benoit Morin.</p>
<p>Still, pharmacists could do more to unclog the front line if “barriers were removed”, he thinks. “In Ontario, for a woman who has a UTI, the pharmacist can start antibiotic treatment based on the symptoms,” he cites as an example. In Quebec, the patient must have seen a doctor for this problem in the last five years.</p>
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Any patients left behind?
Sylvie Tremblay, director general of the Provincial Regrouping of User Committees, believes that the measures put forward by Quebec are useful. But she regrets that vulnerable patients are forgotten in this reform. Seniors have to call the GAP every time they need care (one problem per appointment, they say). “For people who are vulnerable or who have multiple pathologies, you need a support mechanism, and we don't have that,” she says.
According to the Régie de l'assurance maladie du Québec, just over 77,000 people aged 70 and over were registered with a group of family doctors as of February 28. They represented 15% of patients treated collectively.
It is nevertheless a success that there are slightly fewer patients compared to four years ago, when we consider take into account that people [in the population] are older and have more health problems
— Dr. Gilbert Boucher
The GAP telephone line is still experiencing failures, according to Sylvie Tremblay. Several testimonies collected by Le Devoirconfirm it. Anne Michaud, 64, has contacted the GAP twice since February. She waited two and a half hours on the phone to get an appointment with a doctor for a medication refill. “The second time, I waited three hours and the line cut! ” she says. In the grip of intense pain in the abdomen, she went to the emergency room of the hospital in Gatineau, where she lives. The diagnosis fell after a battery of tests: problem of acidity in the stomach.
“I am told that I am being taken care of by a clinic, says Anne Michaud. Yes, but if I have to wait three hours on the phone to be hung up on, call back and wait maybe another two and a half or three hours to get an appointment maybe ten days later, that's is not care, that!
According to the MSSS, the average cumulative response time of administrative officers and GAP nurses reached one hour on March 11. These do not take into account calls abandoned by the patient before he could even speak to someone. As of March 11, the drop-out rate was nearly 23% in the administrative agent queue and 15.3% for the nurse queue.
GAPs are subject to regular follow-ups, according to the MSSS. A team will tour and make recommendations to improve their performance.
