Canadian patients' preferences for walk-in clinics versus continuity of care

¶ … healthcare services in Canada i.e. continuity of care by family physicians and walk-in clinics. The paper explores the existing situation in the context and seeks to find a solution in the best possible manner to address existing and projected issues concerning seamless, effective, and economic service.

Key Message

According to Jones (2002), walk-in clinics are stand-alone (not part of any hospital system) health care facilities that accept clients without referrals or appointments. Walk-in clinics are especially popular in the United States, Canada and Australia. They started in the early 1970s in the U.S. as independent emergency facilities that helped to release the pressure from overwhelmed emergency departments and family doctors through the provision of non-referral / non-appointment care services. By the end of 1970s, walk-in clinics had spread throughout the U.S. and into the Canadian health care system. These emergency care provision facilities soon took up more primary care responsibilities and offered services vastly more than emergency-only facilities.

However, the main concerns that opponents of these types of facilities in Canada have is that, these centers lack continuity of care, overlapping services, low complexity, and competition for fees. For instance, it has GPs (General Practitioners) who have a gate-keeping role referring only those cases that they think family physicians cannot handle. Thus, whatever is learned here could be relevant to the existing as well as developing healthcare system, given the fact that Canadian citizen is ageing very fast. The country has had walk-in clinics for over two decades now (Jones, 2000). These walk-in clinics have been used in the provision of different interventions and treatments. Both proponents and opponents' perspectives will be examined in this paper.

Executive Summary

Introduction

The healthcare scenario in Canada faces issues on two main counts -- lack of a nationwide, unitary healthcare plan and policy (in that the states are empowered to devise and implement their own strategies, whereby there are many differences in healthcare laws as we move from state-to-state), and on the other hand, most individuals do not have family doctors that can take care of primary health issues and hence seek to defer their healthcare concerns, till the conditions become serious. Ironically, many individuals also seek expert care even for preventable and primary healthcare. These two issues combine to stress the healthcare scenario. It is here that Walk-in Clinics (WIC's) appear as attractive options. WIC's have less 'waiting-periods' than the conventional, public or private hospitals. However, they lack continuity of service, and uniformity in FFS (Fee-for-Service) structure.

Report

Unsurprisingly, Provincial governments are emphasizing the need of a family doctor for each family, especially when majority of residents are not seeking such services. However, it is not clear how they seek to achieve that without a policy or plan to either increase the number of family physicians or increasing the load on existing doctors.

A policy issue that arises in this context is that the fees physician receive for services offered allows them to choose and accept patients that suits "economic" rather than "healthcare" needs. Another important policy issue arises in the form of lack of uniform policy for health insurance, especially for those with citizenship status issues. A third concern is the fact that the 'baby boomers' group is soon reaching "aged" stage and would require continual care, towards which, urgent action seems to be lacking. The wait-in queues put stress on the patients as well as public and private hospital institutions. This may explain the proliferation of WIC's, at least to a measurable extent.

Action Plan - The Way Ahead

1) Area-wise distribution of primary healthcare, for improved access

2) Better coordination amongst the different healthcare institutions (private, public, community health centers and WIC's, family doctors, clinics and hospitals)

3) Health Education in social and community constructs towards preventative and long-term, longitudinal care (for the old, chronic, terminal and handicapped care).

4) Involving the NPs (Nursing Practitioners) and pharmacists into the healthcare structure to reduce the stress on the mainstream institutions and physicians.

5) Lastly, a unified, basic, transparent payment structure (both for the physicians and for the patients)

As understood from the challenges and situations (existing, evolving and projected), any 'instant' solution could prove detrimental in countering the issues of the healthcare industry. A long-term plan, targeting at least a couple of decades ahead with joint efforts of provincial as well as federal governments would help address concerns in healthcare to a large extent.

Recommendations

The endeavor of the provinces should be to track the "unattached" segment of the population, doctors, pharmacists and NPs. Bringing them and the services offered and received would help target the gaps and problems that need solutions- in the short- and long-term. Then ways and means could help prioritize and sufficiently address the issues involved. For example, access to Pharmanet can help locate the existing relationship and interaction between the patient and type of health provider. Further, such information can be used to tie up patient information with community and hospitals in the area.

It is in this context, that Technology can help the governments access and relay data securely, effectively and speedily. Such data can help explore possible solutions with the help of academic investigations.

Conclusion

Canadian Healthcare has existing and projected concerns. Policy concern arise from the decentralized healthcare industry. The institutional facilities have long wait-in-queues that allow the sustenance of 'walk-in' healthcare facilities. Also, adding to the issue is the reluctance or inability to access 'family doctor' construct. A third issue is the inability of industry to take cognizant and critical services the NPs and Pharmacists can provide.

Coordinating the services and efforts of all contributing factors could well be the sustainable solution Canadian Healthcare industry seeks. The means to interlink all the stakeholders is present in the form of information and communication technology. All efforts must be made to deploy this tool effectively to address the existing problems in addition to making policy adjustments to improve access and continuity through community education and creating more doctors.

Introduction

The majority of Canadians would first seek the services of family physicians if they were in any situation that required medical attention. However, quite a huge percentage of Canadians (especially in the last three decades) rely on the country's emergency departments and its stand-alone walk-in clinics. In addition, author Mertl (2015) argues that quite a significant population (15%) of Canadians does not have family physicians. And he gives two reasons for this: First, many young people feel healthy and don't see the need to have a family / personal doctor; second, a number of Canadians have not been able to find for themselves a family physician that would care for them the way they want them to. Another factor that has caused this shift in healthcare preference (from Family doctors to Walk-in facilities) is long waiting times for the patients at hospitals.

Figures released by Statistics Canada back Mertl's figures, they show that approximately 33% of Canadian men aged between twenty and thirty-four are not affiliated / latched in any way to any physician. The figures are different in different provinces around Canada. For instance, only 6% and 7.5% of New Brunswickers and Ontarians respectively do not have family doctors, the percentage of people without family doctors in Quebec is twenty-five. The situation is worse in Nunavut where approximately 82% of the people do not have a primary physician (Mertl, 2015).

Of late, many of the Canadians with no family doctors constantly troop into hospital emergency rooms even for infections that were not threatening. For instance, just in the last fall, the Canadian Institute for Health Information, reported that over 1.4 million Canadians went to hospital emergency departments for ailments such as sore throats that should have been treated in alternative facilities. In the recent years, more and more Canadians are visiting health care facilities to get healthcare services. The result is an overstressed medicare facility (institutionalized), leading to proliferation and sustenance of walk-in clinics. The large number of walk-in Clinics has queered the Canadian healthcare system qualitatively.

Further, the provincial nature of Canadian healthcare system, without an overall, common Federal cover gives rise to disparities, from state to state. However, generally, the fact that physicians do not have to declare what kind of service they have makes it difficult to know how many walk-in clinics are there in Canada. The British Columbia's College Professional Standard is one of the toughest standards to adhere to in the whole of Canada concerning the description of the relationship between walk-in clinic services and patients. Other provincial colleges such as Alberta, New Brunswick, Saskatechwan have also come up with policies for walk-in clinics on care standards. In Ontario, the situation is different, the policy is that patients do not identify with a family doctor but go to the same multi-doctor, urgent care, or walk-in clinic then it is assumed that they are getting primary care at that facility. However, the country's Medical Association has no position on the issue (Ontario's Action Plan For Health Care n.d.).

The Ontario policy that physicians are responsible for offering all their patients longitudinal care, encompassing all the regular health checks raised a lot of concern among stakeholders. This prompted the provincial college's registrar to respond; she did so by explaining that the new policy was a combination of several other policies that were already in use. Moreover, that the policy does not mean that a single visit to a clinic is sufficient to lock the facility as the visitor's primary care provider. However, for reference purposes, it is assumed that such a facility would be providing the visitor or patient with long-term care.

One might have to wait for a few minutes at the reception, but he or she will have his or her sore throat or runny nose checked in a few minutes (Mertl, 2015). That is not the problem, in fact, in that way one can see how useful such walk-in clinics are. However, at what point should a regular visitor to such walk-in clinics be forced to register as a patient? Now that these facilities are handling almost the same healthcare duties as hospitals, should they be regulated in the same way?

Report

One of the biggest healthcare headlines in 2012 was the declaration by the Ministry of Health in B.C. (British Columbia). that everyone would have a family doctor by 2015. This was a big headline because millions of Canadians do not have the services of family doctors and if a provincial government can make evidence-based plans to tackle that problem in only three years with very little cost, then such a declaration would definitely be a noteworthy event (Picard, 2012). However, a closer look at the press release by the Ministry of Health reveals what the minister really promised. He said that every resident of the province who is looking for a family doctor, would have one. This reveals the situation underlying the current problem. The problem is not that Canada has a shortage of doctors. The problem is that most of the people without a physician are not specifically seeking one. Thus, the solution is not simply training or hiring more physicians.

In numbers, about four million Canadians do not have a family doctor. However, Statistics Canada argues that over 54% of the people in this group are not actually looking for one (Picard, 2012).The rest who are looking for a physician and have not found one have cited three main reasons:

Their doctor recently retired or moved;

The physicians in their areas are not registering any new patients; and That there are no doctors offering care services in the areas where they live.

However, the majority of individuals who apparently cannot find a doctor, said that they have access to community health centers, walk-in clinics and hospital emergency departments (Picard, 2012). While emergency departments and walk-in clinics are not the best ways to deliver primary care, the situation is that only less than 350,000 Canadians have no place to go to when in need of care. Thus, the situation is not as dire as is perceived. This is in fact a very good position for a country of more than thirty million individuals and this provides a much different reality from the often cited four million Canadians. However, back to what the B.C. Health Ministry promised. Apart from what the ministry promised, it is crucial to look into what it didn't exactly say (Picard, 2012). The ministry did not say that it was going to recruit more physicians neither did it say that the existing physicians were going to have to take more patients under their care. In fact, the ministry emphasised the opposite, that its new policy did not mean any physician would have to work for more hours or that they would have to increase the patients they take in. So it is interesting to ask, in which way is the province going to provide family doctors to those who are looking for one without forcing doctors to increase their patient numbers or to do more work?

Issues causing Policy Concern

Family Doctors:

For the past few years, the number of physicians in Canada on government payroll has been increasing. For instance, in 2012, Canada had at least seventy-five thousand doctors working and the federal government was paying them approximately 22 billion dollars for their services. The number of physicians per every hundred thousand people has also been increasing, and as of 2012, the figure was 214 doctors for every 100,000 Canadians (Andreatta, 2013). According to Andreatta (2013) number of doctors is expected to rise significantly as Canadian medical schools continue to graduate record numbers of doctors, and more physicians from abroad relocate their services here. The growth in number of doctors was highest in rural provinces, having highest shortages. For instance, statistics show that in the last five years, the number of doctors in rural provinces has risen over five times faster than the national population growth. However, according to the researchers at Statistics Canada, the growth has not matched the rural population i.e. despite the percentage of people in rural Canada standing at 18%; only 8.5% of Canadian doctors serve this population.

For the majority of people in rural Canada, getting a family physician is a choice and not a must. The majority of these individuals have their needs met at walk-in clinics. However, quite a significant proportion of the 4.4 million Canadians in rural areas reported that they do not have a place to get continuing care. According to Professor Tom Noseworthy (as cited by Andreatta (2013), the problem is not really shortage of doctors but their distribution. Furthermore, the professor argues that the kind of training received in Canadian medical schools is not well-matched with the current market needs -- And that this has led to an undersupply of family physicians in the country.

In a recent study published in the Canadian Family Physician, the journal interviewed 18 residents of Ontario who had recently lost their family doctor. The study established that most of these individuals were frustrated in their search for a new doctor. One of the interviewees stated that he felt like he was applying for work and that he knew that he could have problems finding a doctor if a person's care needs are too many or with regards to the burden one was going to add to a practice (Milne, et.al, 2014). Various medical colleges around the country have reported receiving complaints about clinics not accepting patients and only picking those with the least problems, despite these colleges having standards and policies against such practices. Such issues have brought about heated discussions on the common introductory meeting, with some wondering whether it is opportunity for physicians to screen potentially time-consuming patients or for them to present their services and to look whether the patient could benefit from it. It is also known that new healthcare funding models will likely be favoring pick-and-choose like the old ones did. Thus, it is important to investigate how deep does this issue run? And, what can be done to turn the tide?

Physician payment models in Ontario are part of the problem. Capitation, which was introduced in the last few years, has become quite popular. More than four thousand of Ontario's family doctors are already on this payment model, which reimburses physicians based on the number of patients they treat per year and not per visit (Milne, et.al, 2014). In the conventional payment model, the doctors were paid for service. According to Mark Dermer, a family physician in Ottawa, fee-for-service did not provide much incentive for physicians to cherry-pick as the new model of pay does. Under the new model, the pay is only adjusted based on the gender and age of the patient but not how severe his or her illness is. This means that doctors would be paid the same amount of money for a 50-year-old patient who came to their facilities once a year as for a one who came to their facility every month of the year. Doctor Dermer concludes that the new system is flawed, since it provides doctors with the incentive to cherry pick.

Why some Canadians do not have doctor challenges

As mentioned before there are a myriad of factors, why some Canadians are not attached to a family physician, including: lack of planning; increase in population through immigration and closure of practices. However, it must be said that patients can get regular health care even as they remain unattached to a family physician. This is exactly the case for those who regularly visit walk-in clinics. In Canada, much like in the United States and Australia, walk-in clinics provide care without appointments (Crooks, et.al, 2012). In other words, anyone can simply walk-in a get the care they need. While some of these clinics might allow their visitors to ask for specific doctors, most of them do not do so.This is owing to the fact that the walk-in clinic model is anchored on lack of interpersonal continuity. Walk-in clinics are built on convenience and the majority of their visitors are patients who do have family doctors but have care needs that they believe exceeds the capacity of their family physicians. However, a significant number of patients do not have family physicians and so get their regular care from walk-in clinics. The benefits of having a family doctor are known. For instance, one of the main benefits is the fact that a continuous medical record will be maintained by the family physician and it is these records, kept by knowledgeable doctors that are utilized for referrals. The situation is different in walk-in clinics where the physician does not maintain such records (Crooks, et.al, 2012).

Most individuals have also reported only going to walk-in clinics when signs or symptoms appear worse or when it becomes obvious to them that they are facing a new illness and never for preventative needs (Crooks, et.al, 2012). This means that many walk-in patients wait until diseases get to a crisis point before seeking the care they need. This has left many patients visiting emergency facilities many more times, than they would like to. As mentioned before, quite a significant percentage of walk-in patients experience the problem of not having continuous medical records. Even though some have acknowledged that their transitions to different clinics and/or to different areas contributed to the situation, many have agreed that having a family physician could help in the compilation of their medical records (Crooks, et.al, 2012). Lack of medical records means that the burden is on the patient to remember key clinical data such as prescriptions, dates and clinical procedures, which would mean that the patient will not get the same quality of care as one with a regular doctor.

The Walk-in clinic

For quite some time now, walk-in clinics have existed side-by-side with conventional family doctor practices. When walk-in clinics first arrived, they proved to be a popular alternative because they offered more convenience than the conventional practices. For instance, the Canadian Mental Health Association in York Region, and South Simcoe mobile program that offers mental health, sexual and medical health care services for the youth is a fine example of a walk-in type service that offers convenience to its target population (Persico, 2015). The program involves a bus that has an NP, a peer support specialist and a youth counselor who provide medical care, counseling and a myriad of other services to the youth near the places where they live or hang out.

For the longest time now, many individuals have had concerns with walk-in clinics. For instance, public health policies regulate and control family doctors and their practices, but any form of policies does not regulate walk-in clinics. Many provincial governments and even the national government have largely ignored walk-in clinics in their efforts at improving access to primary healthcare. Not many studies have been done into walk-in clinics and the kind of services they provide, thus much is not known about them. The majority of walk-in clinics have the fee-for-service model and the doctors in such facilities often operate without the help of health care professionals from other disciplines. According to many health care experts, walk-in clinics duplicate primary care services and that this in turn increases the cost of care as citizens seek care from different providers in a haphazard manner. Yet, one cannot ignore the convenience brought about by walk-in clinics, particularly for individuals who do not have, cannot see their family physicians or do have access to one (Andeatta, 2012).

Waiting Times

At present, Walk-in Clinics provide the best alternative to an impatient population that seeks urgent attention for the most basic, common symptoms that could have been addressed by the family doctor. However, long waiting times at such clinics have veered the patients away from such facilities. Objectively, the proliferation of Walk-in Clinics can be seen as a response to waiting times, which in turn is caused by patients seeking attention for common afflictions. In this way, the popularity, or at least preference for illnesses towards Walk-in Clinics has encouraged such stand-alone facilities to attend to more than what they were originally meant to attend (Medical wait times up to 3 times longer in Canada-CBC.ca / Health, 2014).

Long waiting times not only affects quality of healthcare but also causes economic loss to both, the patient as well as the industry. According to 'Wait time alliance' a dedicated group looking into the issues and suggesting measures for improvement, long waiting times have cost Canadian economy about 16.9 billion dollars in 2014 (in spite of measures taken by provinces to improve the situation). The estimated loss due to decreased productivity caused by waiting time for patients in 2007 was 14.8 billion dollars. These figures are a conservative estimate as only a few contributing ailments have been encompassed in the study.(Medical wait times up to 3 times longer in Canada-CBC.ca / Health, 2014)

Ontario's Action Plan

Our population age is transforming. We are now living longer and baby boomers are getting the age where they shall require additional health care. Similar to the way our education system reacted many years ago to the baby boom, the current health care system should now get ready for the demographic change that shall be twice as much the number of seniors existing in Ontario in the next twenty years. It is obvious that the older we get, the more we rely on our health care system. The expense of care for a senior is thrice as much that of an average individual. If we actually did not alter anything, maintained the age-specific costs at where they currently are, and used them on the population of 2030, health expenses would rise by 24 billion dollars, which is 50% higher than today from altering demographics only. Scarce resources shall force us to pick carefully amid health priorities so that we are capable of best serving patients as the system is altered to enhance the quality of care. Health care money should be shared amid hospitals, doctors, drugs, palliative care, and home care together with other services. Resources invested in this way simply imply that there is actually minimal funding present to cater for the needs in a different area (Ontario's Action Plan For Health Care).

The Plan should be to confront the challenge to minimize childhood obesity aggressively by 20% in the next five years. Achievement at this particular front shall require corporation, so they intend to organize a board of supporters, non-profit organizations, health care managers, as well as industry to come up with the strategy that meets targets. This particular board shall report back by Fall 2012. The objective is for each Ontarian to have a family health care provider and to offer more patients more convenient and quicker access to this care (Ontario's Action Plan For Health Care). Most of the times, it is those patients that require family health care the most, who cannot easily access the care they need, and only become part of the system after their condition becomes very serious. It is for this reason that plan shall be increasing access to house calls from health care experts. In consultation with health care experts such as nurses, doctors, together with other providers of health care, it shall broaden focus on quality enhancement to family health care, and make sure that every family health care provider is trained to incorporate the most recent evidence-based care into their practice. It shall speed up the move to patient-based payment, as the patients make their way through the health care system. Financing of the tiny, rural hospitals shall continue to be uniquely treated, providing for the lower volumes of patients. Total patient care change shall be successful only if our financing models are a depiction of our priorities. The inclination is to shift to a patient-oriented system and move away from a provider-oriented system; the manner in which to finance our providers should also change. The providers ought to be rewarded for guaranteeing improved patient outcomes and funding should come after the patient. It is for this reason that The Plan shall speed up the move to patient-based payment (Ontario's Action Plan For Health Care).

In order to meet these goals to the Plan requires the support of the whole system. In the health care system of tomorrow, there exists no room for personal interest, just the patients' best interest (Ontario's Action Plan For Health Care). A lot of work needs be carried out; however, as of today there is building on the improvement by the combined efforts and the readiness from across the division to adopt a patient-based system. We are quite lucky to have examples to refer to, from across the province whereby these alterations are already implemented and are enhancing the quality of life for Ontarians.

The Cost Implication & Implication of stakeholder

The policy options this study proposes principally, is the aggregation of resources that already exist. That involves negligible, if any cost. The only adjustments needed are in the form of defining the role each component needs to perform, the limitations and responsibilities. On the part of the government, it needs to streamline the fees-for-service structure and ensure efficient and transparent execution. The technological resources needed to encompass all sectors in healthcare are already in place, acting as conduits or coordinator amongst the institutions. They only need to extend the facilities to enlist the others (Pharmacists, NPs, WIC and family doctors). Comment by GL: If we use existing resources properly, we won't need to invest further money to bring about the changes, right-You wanted it under this heading ... so there it is ... how could that be confusing?

Following such initiative, the data obtained could help decide nationwide requirements in coming times while attending to existing, urgent issues. The projection is that such a measure could help provide solution for two decades, followed by wide-ranging reforms in education, community and lifestyle changes would be assessed and need to be implemented. Hence, at this point, the cost implications are negligible

Health Quality Ontario (HQO) then assists to translate the proof into solid tools and directions that health care providers in the health system, with the inclusion of family health providers, could actually put into practice for the general gain of the patients. As the mandate of Health Quality Ontario continues to increase, the Ministry of Health and Long-term Care, Ontario professes intent to ensure that it has the instruments and skill needed to fulfill this important function. The appropriate care also implies that care is offered by the suitable healthcare expert (Ontario's Action Plan For Health Care). They state that, they have taken the necessary steps to increase the scope of practice of several health care experts, for instance pharmacists and nurse practitioners, so that they are contributing their full potential to the gain of the patients. Further, that, as we progress, we shall continue to establish means of fully maximizing the potential of the variety of health care experts. It implies patients having quicker access to the care that they actually need. They go on to add that they could achieve this through continuing to employ technological improvements that permit patients to obtain care faster, particularly in rural and northern communities.

Recommendations:

Four wide implications of our findings regarding health policy and planning appear most obvious. Firstly, it would be important to come to a better understanding of the unattached expectations of patients when it comes to having a regular family doctor, so as to establish if 'they are actually sensible, and if they are not, if this might play a role in their failure in getting attachment. Secondly, the participants evidently preferred a 'traditional/conventional' model of being signed up by one family doctor with whom they could develop a permanent trusting relationship. In the meantime, latest Canadian health reforms have come up with collaborative practice models (Crooks, et.al, 2012). Thoughts should be given on how the benefits of such a style of practice are expressed to the unattached patients so that the kind of practices they may be signed up for are in line with expectations they hold. Thirdly, the function of the physician choice in the enlisting of new patients should be carefully analyzed, as was the case in Ontario, to establish whether this is leading to the continuous unattachment of particular patient populations. Fourth, serious thought should be given to the position that walk-in clinics should occupy in ongoing chronic illness management. In case health care administrators see these clinics as having a significant position in such management then measures should be put in place to allow doctors found in these particular clinics to carry out things like routine testing. The Attachment Initiative program in BC is still at its initial stages.The program is striving to have communities establish community-based solutions to the issue of patient unattachment. Several directions for the Attachment Initiative surface from this particular analysis (Crooks, et.al, 2012). First and foremost, it could be quite important to develop a means of tracking the unsuccessful attempts of the patients in getting enlisted so as to identify and hence respond to trends. Comment by GL: One can very well use non-attachment here ... In the literature such terms are used to profess continuity of meaning and sense with "unattached" Many words that do not appear in the dictionary, but are used to convey certain sense are known as "coining"

In addition, the College insists that walk-in clinics offer after-hours coverage and also have access to PharmaNet so that they get to know the prescriptions the patients are using. The College discovered mistakes with 46 doctors who had flawed prescribing practices (Fayerman, 2015). Sehmer mentioned that he was familiar with cases where patients are hurried to an emergency room and the hospital does not know where to send reports because patients claim that they do not have a regular doctor even though they have been regularly visiting the same walk-in clinic. In accordance to doctors of BC, medical organizations do not keep records of the number of patients that use walk-in clinics; however, more than 200,000 B.C. residents are in pursuit of a family doctor.

According to Rick Glazier, despite the ongoing reforms to enhance access to primary healthcare services, there shall always be a need from patients for rapid access to care for the minor but serious problems. A Canadian analysis has reported that even amidst emergency department attendees triaged as non-urgent, seven percent were admitted to hospital (Vertesi 2004). On the contrary, an analysis wherein patients with grievances, which could be deferred to the following-day care were randomized to next-day care saw no negative effects on patient safety on the deferred group. There are actually reasons to follow the secure diversion of non-urgent patients to primary care from the emergency department, in relation to care continuity, services duplication and costs (Howard, et.al, 2008).

The discussion gives rise to the possible solution -- 'connect', if ensured between different sectors of healthcare components (WICs, family doctor clinics, NPs and pharmacists with institutionalized sector) would be a seamless and cost-effective means of analyzing and to certain extent, ameliorating the concerns facing the healthcare industry.

Conclusion

Canadian Healthcare has existing and projected concerns. Policy concern arise from the decentralized healthcare industry. The institutional facilities have long wait-in-queues that allow the sustenance of 'walk-in' healthcare facilities. Also, adding to the issue is the reluctance or inability to access 'family doctor' construct. A third issue is the inability of industry to take cognizant and critical services the NPs and Pharmacists can provide. WICs, pharmacists, nursing professionals and family doctors should be the objectively brought under the same cover of technology that bind the community, public and private hospitals. The aim here is to seek 'continuity' of care. Effectively, it means that the provinces 'add' up all resources at hand currently and help improve the situation. The only care needed is that the roles should be clearly defined, based on level of competence.

Coordinating the services and efforts of all contributing factors could well be the sustainable solution Canadian Healthcare industry seeks. The means to interlink all the stakeholders is present in the form of information and communication technology. All efforts must be made to deploy this tool effectively to address the existing problems in addition to making policy adjustments to improve access and continuity through community education and creating more doctors.