02/21/2013 12:18 EST | Updated 04/23/2013 05:12 EDT

Why Chronic Health Care Is the Challenge of Our Century

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Radiologist checking X-Ray of lungs.

Health care in Ontario today has tremendous strengths, none greater than the dedicated and highly trained nurses, doctors, pharmacists, home care workers and other professionals who devote their lives to delivering care. But at the same time, we face important challenges.

For the past decade, the Liberal government has tried to sustain our health care system by increasing spending six to eight per cent every year, far in excess of the economic growth that lets us pay for it. And despite all of the spending, we do not consistently get the results Ontario families expect and deserve. The Liberals' philosophy of health care has been "more of the same." But now they've run out of money -- so it's turned into less of the same.

This is why the Ontario PCs released our latest discussion paper, "Paths to Prosperity: A Healthier Ontario." It's the 10th in a series and proposes bold ideas to create a 21st-century model of care that is proactive and based on chronic disease management, health promotion and prevention.

Early in the 20th century, we achieved the biggest improvements in outcomes like life expectancy, mainly by managing infectious disease through clean water, better sanitation and advances in the health system, like vaccinations and antibiotics.

By the middle of the 20th century the biggest challenges were changing. As people lived longer we needed hospitals and more advanced acute care to manage the heart attacks, cancer, and other conditions that became the most important frontiers of health care.

Now, the biggest challenge facing our health care system is changing again. More and more people today are living with two, three, four or more chronic conditions, like heart disease and diabetes and chronic kidney disease. And just as we couldn't deal with acute conditions through cleaner water, we can't manage chronic disease with more acute hospital care. As a result, we need to build a system that treats chronic disease as the leading health care challenge of our time, not as an afterthought in a system designed around acute care.

Currently, the medical profession is mainly set up around diseases -- one doctor to deal with kidney disease and another to deal with diabetes. Even clinical trials typically screen out patients with multiple conditions.

This means that we often have very little evidence about what works for the patients who are the most intensive users of health care. A Healthier Ontario proposes to create one or more centres of excellence to develop new, integrated, evidence-based approaches to care that are tailored specifically to the needs of people with multiple chronic diseases.

We also know that the best care is provided close to home -- through community clinics and home care. Regrettably, people with complex chronic conditions frequently end up in acute care hospitals. Waiting in an emergency room is not only inconvenient and disruptive for these patients, but it is also expensive for the system. By providing community and home-based care options to help patients with complex chronic conditions live better at home, we can reduce the cost and the strain that unnecessary acute hospital visits put on our system.

Lastly, since care is often fragmented, patients with complex conditions often do not have a comprehensive care plan that covers all of the different specialists and all of the different sources of care they access. We must support health professionals to work together to develop integrated care plans for patients that need to see multiple doctors and use multiple sources of care. And for patients with the highest needs, we must provide a dedicated care navigator -- most often a nurse -- who can actively coordinate the plan. This will ensure that a patient doesn't get the same test three times, and that she isn't scheduled for physiotherapy at the same time as she is supposed to be getting an x-ray across town.

We cannot say today that our health care system is the best in the world -- but it can be -- and it starts by building an integrated system that treats a person with as many as three chronic conditions - diabetes, Alzheimer's and heart disease - like one patient, not three.

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