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?