"Did you have trouble making ends meet at the end of the month?"
It's a simple question, but a powerful one for doctors who want to truly understand their patients' health.
That's according to Brian Match, executive director of the Kalyna Country Primary Care Network, which serves a largely rural area east of Edmonton.
In 2019, doctors and nurses with the network started asking patients about their financial circumstances — and they learned a lot in the process, according to Match. For example, he said, think of a patient whose diabetes just isn't stabilizing over time.
"If you're only able to put food on the table one meal per day, that can really have an effect in regards to your diabetes," said Match.
Knowing a patient is struggling financially means a doctor might not just prescribe insulin and lifestyle changes, but recommend community resources a patient may not have known about.
Doctors may also be less likely to prescribe a pricey medication and more understanding if a patient misses an appointment to pick up a shift at work, Match said.
"If you don't ask the question, then you don't really know what's going on," he said.
Pilot project drives change
Doctors and nurses in Kalyna Country — and two other Alberta primary care networks — started to ask that question through a pilot project called Reducing the Impact of Financial Strain.
The project was partly inspired by the work of national physicians' groups, including The College of Family Physicians of Canada, to encourage screening patients for financial strain and prescribing tax returns.
Tax returns are required to access different kinds of income support, according to Dr. Karla Gustafson, a medical officer of health for the Calgary Zone of Alberta Health Services (AHS), which worked on the pilot project alongside the Alberta Medical Association.
"It's really foundational to understand those circumstances that people are in, to understand their health and be able to improve it," said Gustafson.
Through the pilot project, Gustafson said primary care providers were able to take concrete steps to assess the impact of financial strain for individual patients. They also built connections with community groups that could offer resources to ease that strain.
'My doctor understands'
For Lethbridge resident Sandra Campbell, it makes a world of difference to have a family doctor who understands her financial situation.
Campbell injured her spine in 2010 and lost the use of her right arm when a later surgery didn't go as planned. Campbell, who previously worked in human resources, was left unable to work and with a very different budget.
"My doctor, she understands," said Campbell, who worked with AHS on the pilot project as a volunteer advisor.
Campbell explained that because of her ongoing health challenges, she often has to visit her doctor to fill out insurance paperwork. That typically costs a flat fee, but Campbell said her doctor will reduce her rate or won't charge her at all.
"I am so grateful to have that kind of support from her," said Campbell.
Financial screening now 'the way we do business'
Going forward, Campbell encourages more healthcare providers to "look at the whole person" and consider factors that affect a patient's health beyond what they see in the exam room.
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That's the plan at AHS, Gustafson said. While the initial pilot project has ended, she said the health authority is looking for ways to implement what they learned more broadly.
In Kalyna Country, Match said screening for financial strain is now a permanent part of the way his care network operates.
"It's the way we do business," said Match.