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Jamie Milligan MD, CCFP

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  1. Jamie Milligan MD, CCFP The Mobility Clinic: A Primary Care Access Project

  2. Spinal Cord Injury in Ontario • Low incidence, high cost¹ • 10.4 to 83 per million per year • 1/3 tetraplegic, 50% complete lesion • Mean age = 33 years • Male/female = 3.8² • Frequent visits to family physicians, physiatrists³ • Verrier et al, Ontario Spinal Cord Informatics (2009) • Wyndaele and Wyndaele, Spinal Cord (2006) • Munce et al, Spinal Cord (2009)

  3. Physical Access Challenges • Office equipment • Inaccessible examination tables • No Hoyer lifts or other lifting devices • Immobile equipment (such as x-ray machines) • Office arrangements • Inaccessible washrooms • Narrow doorways, Small waiting and exam rooms • Small elevators, stairs • Exterior office barriers • Lack of accessible parking • Cost of parking

  4. Systemic Challenges • Lack of specific expertise about disability • Awareness and attitudes among primary health care professionals • Financial and time disincentives

  5. Mobility Clinic Project • Supported by ONF • In-kind contributions: • CFFM FHT • UW-Schlegel Research Institute for Aging • Research & Innovation site, Kitchener

  6. Mobility Clinic Project • Thirty months • Development phase: July-December, 2009 • Clinic start January, 2010

  7. Project Objectives • To improve care for patients with mobility issues by developing an inter-professional care Mobility Clinic • To increase mobility-impaired patient access to family physicians by developing team and individual expertise within CFFM FHT via the Mobility Clinic • To promote awareness of mobility issues to health care professionals within Waterloo Region through education. • To develop further clinical, education, and research projects involving patients with mobility issues.

  8. Development Phase • Team formation: • Project lead, Family physicians, Social workers, Nurses, Pharmacist, Admin, Researchers, Learners, Patients and families • Physical clinic • Skills development • Community partnerships

  9. Operational Phase • Start January, 2010 • Development of registry • Patients identified with Mobility challenges include • SCI • Non-traumatic neurologic disorders • Musculoskeletal disorders

  10. Operational Phase Anticipated Outcomes: • More patients with mobility issues will have access to primary care and be effectively assessed and managed • Health provider skills and capacities will be enhanced • Sustainability and knowledge transfer

  11. Enhanced Health Provider Skill • Professional development of Mobility Clinic team • Continuing Education to family physicians and other health care practitioners • Education of health care learners (Family Medicine residents, medical students, pharmacy students, social work interns) • clinic rotations • presentations • workshops