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IERHA
Primary Health
Care Survey Kaitlin K. Adey MD Candidate of 2016
Faculty of Medicine
University of Manitoba
About Myself
Lifelong resident of Eastern Manitoba
3rd year medical student
Disclaimer: This presentation uses data
gathered in the past TWO summers.
The Project: Background
Interlake-Eastern RHA recently complied
data regarding service gaps in primary
health care.
Their focus:
Beausejour & Area
Pine Falls & Area
2013 IERHA Service Gaps Current Service Status Service Goals
Avg. 7-21 day wait for appt. 24-48 hour access
9am to 5pm clinic service Extended service hours
15,000 clients unattached Every person attached to MD/NP
Program based service Collaborative practice
Physician care emphasis Diverse Provider mix
Paper processes New technologies (EMR)
* Based on entire IERHA region
Current IERHA Services Con’t
Current Service Status Service Goals
Community voice via board Active grass-roots network
Provider leads care Self-managed care
Illness/injury focus Wellness and Prevention
Central planning of services Tailoring services to local population health needs
Presence of service gaps Outreach to underserved
* Based on entire IERHA region
So what is the solution?
Primary Care Networks
Promises to bridge and abolish gaps in silo-
style care.
Definition: “A formalized, collaborative
partnership between one or more RHAs,
independent primary care practices, and
other PCN partners who share the goal of
providing high-quality primary care services to
a defined PCN population.”
Manitoba Health
The ultimate goal of PCN development is
to assist PHC teams in providing the right
care, at the right time, by the right
provider in the right place.
Input Required
Interlake-Eastern RHA recognizes that staff
and community consultations which
describe barriers and/or factors that
demonstrate readiness for change are
crucial in project progression and success
Input Collection
The value of the project approach is that
the people closest to the care and clients
are providing the project inputs.
Paul Barnard Primary Care Manager
Pine Falls Health Complex
Input Collection Con’t
Access to an external facilitator was
deemed critical as it was felt that they
may receive more open and honest
opinion.
This is where I come in!
Input Collection Con’t
Data collected and anonymously
collated in a report to be presented to
the Vice President, Primary Health Care,
IERHA.
And to you!
Part A: PHC Staff Feedback
All available PHC staff in Beausejour and
Pine Falls Primary Health Care Centres
were interviewed (~80%).
MD, RNs, Mental Health, admin staff
Questions Current role in PHC delivery
Describe what you envision as a "successful"
collaborative care model
What are some barriers in developing such a model?
How might these barriers be overcome?
If you had lead accountability for steering this PHC
transition how would you plan, manage and measure
progress using current or otherwise feasible resources?
If, in the coming year, you had to make one change
towards collaborative care in your workplace, what
would it be and how would you implement it?
Results
40 page formal report
Results: Common Themes
1) Role confusion regarding nurse
practitioners despite campaigns to increase
awareness.
Fluidity and individuality in nurse
practitioner roles and scope of practice
Better defining the role of a nurse
practitioner region wide or allowing for
individuality and defining the role of each
practitioner specifically would assist in
abating confusion.
Results: Common Themes
2) Need for better team relationships and
functioning and increasing role clarity in
better providing comprehensive PHC
Results: Common Themes
3) Team meetings along with more basic
levels of communication, such as handouts,
were suggested in bridging communication
gaps in silo-style practices.
3 Take-Away Points: Part A
Fostering a stronger “team” may mitigate issues in other areas such as role clarity and better coordinating patient care
Team meetings were deemed to be essential in building a stronger team but need to be efficiently led by a team leader/management
Core resource crises must be addressed before a team can be expected to spend time and energy bettering its internal functioning
Part B: Client Feedback
Eight clients were recruited by various staff in
the Pine Falls Primary Health Care Centre.
The Beausejour Clinic was unable to
participate.
No formal interview questions were utilized in
building three “Client Stories”.
All clients ranked nine services areas.
The Quiz:
3 RHA staff polled:
1. Increase physician retention
2. Respectful environment
3. Decrease wait time in the clinic
Quantitative Summary Scores
How would you rank your primary health
care team in the following areas:
(1 = Very Poor, 5 = Excellent)
Respectful Communication - 3.4
How well does your PHC team (including
administrative staff) make you feel respected,
comfortable, and heard as a primary health
care client?
Timely Access - 3.4
Continuity of care - 2.3
How well does your PHC team retain its team
members allowing you to build long lasting
health care related relationships?
Team Based Care – 2.3
How well do your PHC providers work as a
team in coordinating your care?
Client Centred Care - 2.6
How well does your PHC team work with you
in developing care plans that suit you as an
individual?
Ex: Discussing your daily routine to find a medication that suits your busy life.
Comprehensive Care
How well do the PHC services offered match
and address your specific needs? – 3.3
Comprehensive Care
How well do the PHC services offered
match the specific needs of your
community? – 3.2
Self-managed Care – 2.3
How well do your PHC providers support and
recommend self-management in achieving
your best possible health?
Health Education – 2.6
How well do your PHC providers educate you
about your specific illnesses, medications,
general health care needs, and preventative
measures to ensure that you achieve the
best possible health?
Navigating your way through
the health care system – 2.3
How well does your PHC team educate you
about, and help you access, other services
that may benefit your health including other
PHC services, specialist physician services,
ancillary health care services such as
occupational therapy, medical device
services, etc.
Client Suggestion Summary (1):
1. Increase physician retention by selecting physicians who will enjoy the culture and activities available in Pine Falls. Increase the involvement of the municipal and town government in recruiting physicians.
2. Ensure physicians are familiar and comfortable with the breadth of practice in rural medicine or include specific training as to how they should proceed in such a way that the client is still able to receive proper medical care.
3. With such a large population of patients experiencing poor health, there is need for an increase in physical space and care providers who could focus on patient education especially regarding self-management.
Client Suggestion Summary (2): 4. Increase team-based care especially through
scheduling rotating appointments where the client may see all care providers beneficial to them. This would decrease travel time and inconvenience and act as a platform to easily incorporate more services such as counseling. Including a primary care nurse to act as a key educator may be of great benefit.
5. Organize more support groups and group teaching sessions to best utilize resources. Sessions should be held on a regular basis to ensure that clients are able to attend.
6. Increase the presence of elders and traditional First Nation medicine while working parallel to current western medicine.
Client Suggestion Summary (3):
7. Utilize nurse practitioners on reserves and in smaller communities to reduce travel costs and inconvenience to patients. Nurse practitioners, as salaried staff, are better able to take time to educate patients.
8. All acknowledged that if a client is not proactive in requesting care and services, they may be overlooked by care providers that do not ask anything beyond their presenting complaint. Thus, clients should be encouraged to bring a friend or family member to their appointments to act as a patient advocate.
Take-Away Points: Part B
A much larger sample size is needed to
produce more meaningful results.
Clients want increased education and
guidance in accessing PHC services.
Our patients are aware of shortcomings in
teamwork in PHC.
With great appreciation:
Staff of Beausejour Primary Health Care Centre
Staff of Pine Falls Primary Health Care Centre
Doreen Fey (IERHA)
Paul Barnard (IERHA)
Debbie Veil (IERHA)
Wayne Heide (ORNH)
Kevin Beresford (MB Health)
Drs Papetti, Bruneau, Chapnick, Poliquin, Csupak, Governo, Stearns, Kinsley, Anozie, and Lisa Kroeker (NP)
Questions?
