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Autumn 2007 | Vol 11 No 1

Q & A

Common questions about family health teams

By Astrid Van Den Broek

In Ontario, they’re touted as the solution to many of the painful issues facing the health care system – extensive wait times, family doctor shortages, lack of consistent care. This solution is family health teams (FHT), a concept introduced in 2005 by Ontario’s liberal government, in which a range of health care providers – from dietitians to social workers to doctors – link up to serve a community. CrossCurrents interviewed Dr. Nick Kates, director of programs for Ontario’s first and largest FHT, the Hamilton Family Health Team, and lead for the Quality Management Collaborative, the provincial agency set up to oversee the FHT initiative, to find out more about FHTs and their promise for the future.

What are family health teams?
FHTs are part of the government transformation of health care. They’re a model that will hopefully develop a new paradigm for the way health care is delivered in Ontario. They are group practices involving a range of health professionals offering effective team health care with a strong emphasis on chronic disease management, health promotion, prevention and self-management support through 24/7 coverage.

Each FHT determines exactly which providers best meet their needs, but most have included family physicians and nurses or nurse practitioners. Many have included mental health workers, dietitians, pharmacists, health educators or individuals with specialized expertise in specific programs that they’re interested in developing, such as an asthma educator or a children’s health worker.

What are the benefits of family health teams?
Family health teams have the capacity to identify populations and manage individuals with chronic diseases more effectively. Instead of relying on a single provider to know all the resources and offer all the treatments – and that was almost invariably the family physician – you now have various people who bring different expertise like a mental health worker or a dietitian. Other professionals may be able to assist with assessments or managing some of the problems seen routinely in primary care. For example, nurse practitioners can see cases that would otherwise be seen by the family physician, freeing up the family physician to deliver other kinds of care. And because of the extra resources, it’s easier to link with community programs, and it’s easier to develop programs within a single family health team because you’re not relying on just one or two health individuals.

This means services aren’t being duplicated, and at the same time, this set-up increases the number of individuals who can access primary health care. We’re also going to see that older physicians who might have otherwise retired may find this to be a more satisfying way to practise and may thus practise a lot longer than they would otherwise.

What is the current state of the rollout of family health teams  in Ontario?
All the FHTs – there are 150 funded in three waves – have now had their operating budgets and business plans approved and are in the process of setting up programs. Within our FHT, we’ve been operational for over a year. We’re setting up a number of pilot programs within the FHT. Within the pilot programs we’re looking at is a chronic disease management program for depression, which we’re calling a program for the enhancement of care for individuals. This is based around identifying a population, being able to monitor them, not only during the acute phase of an episode, but after treatment has been completed. And as far as recruiting professionals to work within the FHT, this is a completely new style of practice for most practitioners working in primary care, so it involves some training and preparation for individuals as well.

What feedback have you received from clients about this new model?
In our program, patients report very high levels of satisfaction. They like getting mental health care in a family physician’s office – it’s non-stigmatizing and it’s accessible and usually must faster than a referral to a clinic. As far as formal evaluations, we intend to start them before the end of the year. We’re already collecting relevant data toward an internal evaluation.

What have been the challenges to rolling out family health teams?
One difficulty has been with IT because a lot of the systems that have been used don’t have registry capability and there’s great variation between the systems. There are 19 different systems that have been approved to distribute products for registering clients in Ontario, so that’s one area where there have been a lot of bumps.

The second challenge has been around team development. The family health team model is new to health professionals. We’re recognizing that there’s more to team development than funding and hiring a group of skilled health professionals. We need opportunities to meet as a team, not just around tasks, but to build the social aspect of the working relationship. There are also changes in the roles of individuals, particularly family physicians. They don’t have to be doing everything they’ve been doing for the past 20 or 30 years because some of those responsibilities are now handled by other people on the team.

What is your vision for family health teams in the future?
I hope that family health teams will continue to expand, regardless of the outcome of the next provincial election. We need to evaluate what we’re doing and look at what is and isn’t working. We’re also seeing more physicians wanting to join existing family health teams. If this model can demonstrate the kind of outcomes we anticipate, then more people – both care providers and consumers – will want to work in or be served by this model.

For more information about family health teams, visit www.health.gov.on.ca/transformation/fht/fht_mn.html