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The changing roles of health professionals in primary care

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The changing roles of health professionals in primary care

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    1. The changing roles of health professionals in primary care Dr Melissa Cahill Doctors Grand Plaza Browns Plains

    2. As we were 4 patients an hour with up to two double bookings per hour. 15min appointment. 40 patients per day plus No nurse support. No systems. Half baked care - bandaid medicine – fix the acute problem and move on. Reception support – BPs, weights, ECGs, spiros and WTU.

    3. Road trip

    4. Nursey arrives Immunisations. Dressings BPs Weights Our diabetic patients started to have some structure to their care Management plans

    5. Collaboratives Self improvement. Outcomes. Systems. Delegate responsibilities to others. All the staff as a team

    6. Kieren

    7. Benefits Quality improved. Patient satisfaction increased Stress levels decreased

    8. Initial investment Time consuming. Setting up registers Doing PDSAs Looking at outcomes Developed our management plans Consultation templates. Nurse instruction sheet for management plans. Doctor’s meetings Set rules for our systems. Self management with our patients. Educate patients

    9. Drew

    10. My day now 1-5 management plan patients per day. 30mins with the nurse 30mins with the doctor. Do everything we possibly can e.g. health education, ECGs, ABIs, scripts, referrals, blood forms, driver forms, motivational interviewing, minor complaints Book every 3 months Book the next appointment at the last appointment Reminder phone call the day before

    11. The bonus More control over our timetable Working less hours per day Seeing less patients per day Feeling less demand Earning more money

    12. 10 years ago Patients would book for 15mins Still expect you to do everything Hadn’t seen for ages Didn’t know where we were up to with eye checks and urine results and bloods. Patch up care May not come for follow up Phone script that they forgot Squeeze them in for “emergency” Care patchy, disjointed, not very satisfying and exhausting.

    13. Evolution Chronic disease management plans TCAs DMMRs Mental health plans COPD clinics Annual health checks with pap smears for the women Annual health checks for men (when their wives talk them in to coming in) 45-49 yr health checks 40-49 yr old diabetic risk assessment. ATSI health checks from 15 yrs and up. 75yr old health check

    14. Further evolution 4 yr old health checks Newly developed autism assessment/screening with 18 month and 4yr old immunisations Fluvax clinics Nurse only immunisation appointments Depo nurse only appointments Regular assessments of chronic disease risk by using the Ausrisk tools, CV risk tables and PIKO-6 screening tool. Visiting review by a SPHN paid dietician for our diabetic patients. Visiting psychiatrist supplied by Logan Mental health. Access to SPHN lifestyle modification programs eg lighten up and living strong Developing stop smoking program

    15. For our regulars Not just about treating the common cold. So much more to offer.

    16. Your last doctor’s visit Effort to get there. Leave work early or pack up the kids Sit in the waiting room for ages. Want to be heard Want to be dealt with properly. Want to get your money’s worth

    17. Changes to health care in our practice Nurse - small financial investment but decreased stress levels and improved the quality of patient care ten fold. Developed systems – sense of tribe, come and visit us – we are happy to share Encourage self management - get them to decide upon what is important to fix in their health. Give a sense of control and ownership Changed from reactive to proactive – structure your day, target risk factors Work as a team – within the practice but also your favourite allied health.

    18. Changes to health care in our practice Motivational interviewing, be a health coach Patients have more complex needs and will require complex treatment. Developed the care calendar and blue folder Upskill in regards to chronic disease – Collaboratives are a must Support from our division – use the SPHN health directory on the website – www.sphn.org.au/community-organisations Negotiate those aspects of care that can be negotiated. Trained our patients No loss of income

    19. Care calendar and blue folder Filled in for each management plan patient Updated on receipt of letters from specialists and at time of management plan Care calendar tells what is happening when and what is due to be done at each visit Blue folder contains action plan as first sheet, care calendar, management plan, motivational interviewing sheet, allied health correspondence sheet, room for pathology results and requests, referrals, scripts, ECG, Spiro, ABI result, list of education topics and educational material

    20. Changes Chronic disease management - increasing importance, increasing percentage demand on our services. Need to adapt Takes a bit of time but it is not an insurmountable task.

    21. Jane’s mantra Pause Look around you Breathe that fresh air Survey a new vista Don’t just run down the other side Takes a bit of extra time out of your day In the end you will be refreshed and inspired and life will be better.

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