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Nursing in Your Family Practice Initiative: Primary Health Care – Capital District Health Authority, NS. 2009 NANB Annual General Meeting Fredricton, June, 2009. Patsy Smith MN, RN Consultant on behalf of Primary Health Care, CDHA. The Challenge. Growing chronic care needs

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Nursing in your family practice initiative primary health care capital district health authority ns

Nursing in Your Family Practice Initiative: Primary Health Care – Capital District Health Authority, NS

2009 NANB Annual General Meeting

Fredricton, June, 2009

Patsy Smith MN, RN Consultant on behalf of Primary Health Care, CDHA


The challenge
The Challenge

  • Growing chronic care needs

  • Access to care

  • Health promotion & disease prevention

  • Isolation

  • Communication

  • Coordination

  • Public demand


The capital health program
The Capital Health Program

A program of supports for family physicians and family practice nurses working in fee for service practices in Nova Scotia

  • Funded by Primary Health Care, Capital Health with support from industry partners

  • Launched in March, 2007

  • 4 program intakes (Last: 4th April, 2009)

  • 41teams


The model
The Model

Full scope of practice

Highly integrated team environment

Holistic approach (not focused on tasks)

Health care encounters as opportunities (non-selective patient visits)

Patient fully participates in care

System development to support application of clinical practice guidelines

Fee for Service


Nursing integration
Nursing Integration

Healthy Living

  • Chronic disease

    management

  • Disease Prevention

  • Health Promotion

Information

  • More information

  • Better Decisions

Individual/

Family/

Community

Access

  • Access to care

  • Coordination

  • Communication

  • Navigation

Team

  • Other health care providers

  • Limiting risk

  • Building on strengths


Chronic diseases
Chronic Diseases

  • Diabetes

  • Hypertension

  • Asthma/ COPD

  • Cardiovascular Disease

  • Cancer

  • Mental Health

  • Dyslipidemia Counselling

  • Osteoarthritis


Health promotion and disease prevention
Health promotion and disease prevention

  • Risk factor assessment (e.g.metabolic syndrome)

  • Well Baby Visits

  • Well Women Visits

  • Perinatal

  • Immunizations

  • Family History

  • Healthy Eating

  • Medication Management

  • Physical Activity

  • Screening (B/W, Mammograms, bone density, cancer screening)

  • Community Programming


Access and coordination
Access and Coordination

  • Multiple Specialists

  • Communication (linking primary and tertiary care)

  • Complex Health Problems

  • Long term care/ elderly care

  • Follow-up

  • Telephone Triage

  • Other Care Providers (Public Health, Community Groups, students)


Liability
liability

  • Canadian Nurses Protective Society

  • Vicarious Liability

  • Nurse works within scope of nursing practice


Business case
Business Case

  • Fee for Service

  • No “upfront” funding requirement

  • Increase number of patient visits each hour (2-3)

  • Physician must interact with patient in order to bill

  • Additional revenue generated covers expenses associated with integrating a nurse

    * Nurse must be working to full scope of practice and providing care for complex or time intensive patients.


Fee for service
Fee-for-service

  • Physicians are paid an established fee for visits.

  • Responsible for all overhead costs.

  • Private business.


Bottom line
Bottom-line

  • Financially feasible

  • Enhanced care

  • Improved access

  • Improved work life satisfaction


Program elements
Program Elements

  • Physician resource manual and recruitment

  • Nursing education program

  • Resource kit

  • Support for integration

  • Collaborative team days

  • Lecture series


Integration support
Integration Support

  • Scheduling

  • Office efficiency

  • Space

  • Organization

  • Communication

  • Full scope practice

  • E-mail and phone support


Collaborative team development
Collaborative Team Development

  • Three team events: Diabetes, COPD, CV

  • Network participating practices

  • Primary Care providers as experts

  • Focus on:

    • Communication

    • Role clarification and collaboration in practice

    • Best practices

    • Clinical challenges

    • Electronic records


Lecture series
Lecture Series

  • Monthly education event

  • Goals

    • Networking

    • Continuing education

    • New physician engagement

    • Identification of issues

    • Information sharing


Program evaluation phase 1 components
Program Evaluation (phase 1)Components

  • Provider Survey

  • Service description survey

  • Project tracking form

  • Team survey


Program evaluation phase 1
Program Evaluation (phase 1)

Key Outcomes:

  • Significantly enhanced access

  • Nurses practicing in expanded scope

  • Provider satisfaction

  • Enhanced screening and prevention






Access
Access

  • Practices accepting new patients

    Pre: 20% indicated yes

    Post: 70% indicated yes

  • Impact on wait times to book a regular appointment

    70% indicated wait times have decreased

    30% indicated wait times remain the same

  • Absorbed patients from a practice who is downsizing or closing

    60% indicated yes


Patients hour
Patients/hour

  • On average, practices were able to schedule approx. 2 additional patients each hour – This translates to an increase in capacity of ~ 40%

  • Able to accommodate more urgent care patients

  • Reduces wait times for appointments

  • Should reduce ER visits and walk-in visits


Increasing capacity
Increasing Capacity

  • Diabetes education and insulin starts

  • Procedures: 24 hour BP monitoring, ABI, minor procedures, IUDs, cervical screening.

  • Coordinating “specialist” visits

  • Advancing the threshold for patient referral

  • Electronic records

  • Research

  • Student mentorship


Decreasing demand
Decreasing Demand

  • Health promotion, screening and immunization

  • Risk factors (Smoking, nutrition, activity, stress, sexual health)

  • Early detection and intervention (HTN, DM2, COPD, Cardiac disease)

  • Aggressive chronic disease management (achieving targets, action plans, CPG)

  • Education and enhancing self management skills


Facilitating referral
Facilitating Referral

  • Decreased wait time to see family practice team

  • More timely referral

  • Increased awareness of community resources and how to access

  • Enhanced information to assist in triaging referrals


I believe patient care has improved, more services can be offered on-site and I am more content with my job. (Physician Survey Response)


It really has enhanced the quality of care to my patients overall. The establishment of this new collaborative approach after 17 years of solo general practice is quite an achievement in itself and this to the credit of the program. (Physician Survey Response)


Benefits
Benefits overall. The establishment of this new collaborative approach after 17 years of solo general practice is quite an achievement in itself and this to the credit of the program.

Enhanced care

Improved access

Improved work-life situation

Team approach

Increased capacity


Program evaluation phase 2
Program Evaluation (phase 2) overall. The establishment of this new collaborative approach after 17 years of solo general practice is quite an achievement in itself and this to the credit of the program.

Spring, 2009

  • Chart audit

  • Patient satisfaction survey


Integration support is key
Integration support is key! overall. The establishment of this new collaborative approach after 17 years of solo general practice is quite an achievement in itself and this to the credit of the program.

  • Mentorship

  • Practice support

  • Networking with peers

  • Ongoing education

  • Specific to primary care context (providers as experts!)


Developed in consultation with
Developed in consultation with… overall. The establishment of this new collaborative approach after 17 years of solo general practice is quite an achievement in itself and this to the credit of the program.

  • Doctor’s Nova Scotia

  • College of Registered Nurses of Nova Scotia

  • NS Medical Services Insurance program

  • Department of Health Section of Primary Health Care

  • CDHA

  • IWK

  • Community Health Board

  • Provincial Programs

  • Physicians and Family Practice Nurses (locally and nationally)

  • Dalhousie University School of Nursing


Thank you
Thank-you overall. The establishment of this new collaborative approach after 17 years of solo general practice is quite an achievement in itself and this to the credit of the program.

  • Shannon Ryan, Manager PHC, Principal investigator [email protected]

  • Lynn Edwards, Director PHC

  • Lisa Blackwood, Project Manager, PHC

  • Stephanie Health, Research Power Inc.

  • Dr. Jeffrey Colp, Family Physician

  • RN professional development centre

  • Primary health care team, Capital Health


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