Things could certainly be better in the Canadian health care system. Dr. Terrence Montague's pivotal book traces how our health care system got to where it is today and provides a process for making it better. The prescription is simple: make patients the focus of the health care system. By making incremental improvements to close the gap between usual care and optimal care, large populations at risk will be better able to cope with the strain. Pateinst First reflects one physician's personal journey from the traditional and individual patient orientation of medicine to a broader vision of achieving the best health care for the most people at the best cost. Dr. Montague urges that our health care system adopt the principles of Patient Health Management, in particular community-based partnerships that aim at closing the care gap by putting patients first and measuring and dealing with the root causes, which are: less than optimal access; the diagnosis process; and prescription administration and compliance.
Replete with case studies, populaiton-based evidence and first-person testimonials by practitioners, patients and policy makers, Patients First provides a compelling prescription for the future of Canada's health care system.
Table of Contents
Foreword by Mark Poznansky, President, Robarts Research Institute. by Ross Tsuyuki, BSc (Pharm), MSC, PharmD, Director, The Epidemiology Coordinating and Research Centre (EPICORE), University of Alberta. Acknowledgements. Introduction. Part 1: The Theory. Chapter 1: How We Got to Where We Are. Chapter 2: Defining Quality of Care. Chapter 3: The Care Gap and Its Causes. Chapter 4: The Prescribing Gap. Chapter 5: The Compliance, Concordance and Adherence Gaps: Challenges and Opportunities. Chapter 6: Access, Health and the Economy: Can We Afford Access Gaps? Chapter 7: The Care Gap Gorilla: Bigger Gaps for Older Patients. Part 2: The Practice--Patient Health Management (PHM). Chapter 8: Background and Rationale of Patient Health Management. Chapter 9: Learning Experiences: The Epidemiology Coordinating and Research Centre (EPICORE), the Heart Function Clinic and the Clinical Quality Improvement Network (CQIN). Chapter 10: A Pivotal Experience: Improving Cardiovascular Outcomes in Nova Scotia (ICONS). Chapter 11: Other Experiences in Patient Health Management. Part 3: What Have We Learned So Far? Chapter 12: What Works: The Action Plan. Chapter 13: What Doesna t Work? Part 4: Vision for the future. Chapter 14: The Strategic Alternatives. Chapter 15: Skate to Where the Puck Will Be: Wayne Gretzkya s Strategic Plan. Appendices Appendix A: Guiding Principles for Public/Private Partnerships: Disease Management and Outcomes Research Appendix B: Patient Management Template, Heart Function Clinic, circa 1994. Appendix C: CQIN Mission, Goals and Objectives. Appendix D: Representative CQIN Partnership/Governance Structure for the Project Entitled: Mortality risk and patterns of practice in 4,606 acute care patients with congestive heart failure. The relative importance of age, sex and medical therapy. Appendix E: Physician Order Sheet for Management of Patients with Heart Attack from a Representative CQIN Hospital, Circa 1992--1996. Appendix F: ICONS Members and Affiliations. Appendix G: ICONS CARE Map: Management of Anticoagulation in Atrial Fibrillation. Appendix H: ICONS Care Map: Management of Heart Failure. Appendix I: ICONS Standardized Discharge Order Sheet. Appendix J: ICONS Provider Newsletter. Appendix K: ROCQ Project Outline. Appendix L: CURATE Treatment Algorithm for Osteoarthritis Patients. Appendix M: Examples of Diabetes Hamilton Newsletters. Bibliography. Index.
Born in Saint John, New Brunswick, Dr. Terrence Montague graduated from Dalhousie University with a doctorate in Medicine. He is one of Canada's pre--eminent experts in disease management and health outcome research. Dr. Montague is currently vice president of Patient Health at Merck Frosst Canada, one of the country's leading research--based pharmaceutical companies. Prior to joining Merck, Dr. Montague was Professor of Medicine and Director of Cardiology at the University of Alberta. He has occupied a number of academic positions at the University of Alberta, the University of British Columbia and Dalhousie University, and served on the editorial boards of the Canadian Journal of Cardiology, the American Journal of Noninvasive Cardiology, Chest, and HealthCare Papers. He has published more than 300 academic papers and presentations. Dr. Montague served with the Canadian Forces Medical Services in various roles in the Regular and Primary Reserve army in Canada and overseas, retiring with the rank of Lieutenant Colonel. Currently, Dr. Montague is a fellow of the American College of Chest Physicians, the American College of Cardiology, the American Heart Association, the Royal College of Physicians and Surgeons of Canada, and, a member for life of the Royal Canadian Regiment Association.