A System of Health Care Delivery

J.M. Daniel was Nursing Administrator, Mount Sinai Hospital, Toronto.

Dr. Frederick Glaser, the primary contributor to these three volumes, is Head of Psychiatry at the Clinical Institute of the Addiction Research Foundation (ARF) in Toronto; he is also Professor of Psychiatry at the University of Toronto. The ARF has a worldwide reputation for excellence in all aspects of addiction, the result of a strong commitment to education and research. It is this initiative that helped create the Core Shell Treatment System Project at the Institute.

Dr. Glaser and nine associates have given comprehensive documentation of the results of this multi-phase pilot project, which was aimed at resolving the question: what is the best way to deliver health care services to clients with addiction diseases? The delivery model the authors tested is described as a two-component “core-shell” system. The core and shell relate, but they are different structurally and functionally. When entering the system, the client is matched through careful assessment in the “core,” with the appropriate treatment options in the “shell.”

Volume I describes the implications of the system, the medical and educational components, and a computerized information system.

The second volume describes primary care and assessment. The focus of primary care is on illness prevention and health maintenance, as opposed to secondary care, which has a more curative focus. Assessment, a crucial step in the treatment process, is the activity that identifies the addictive disease and describes the population entering the system. This aids the planning of future directions and places the client in the most suitable treatment program.

The third volume deals with the selection and matching of patients with appropriate services, and follow-up and evaluation of the treatment program in relation to patient outcomes.

The systems approach to health care delivery is not new, but the authors have developed some innovative ideas that could be considered for any delivery system.

The trilogy has been organized so that all information on a particular subject is found under one heading. This facilitates reference to a specific area of interest without having to skim large portions of text.

Dr. Glaser admits that no definitive answers are provided regarding the optimal methods for health care delivery, and neither he nor his associates present “a proven method of procedure”; but they have succeeded in meeting their stated objective of providing a contribution toward resolving some current problems in health care delivery. To this end, the three volumes give a very sound overview for those who are responsible for the planning and delivery of health care in any field.