Transcript Chronic Disease Prevention and Management (CDPM) Strategy

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
Access to care
Health promotion & disease prevention
Isolation
Communication
Coordination
Public demand
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




Full scope of practice
Highly integrated team environment
Holistic approach (not focused on tasks)
Health care encounters as opportunities (nonselective patient visits)
 Patient fully participates in care
 System development to support application of
clinical practice guidelines
 Fee for Service
Nursing Integration
Healthy Living
•Chronic disease
management
•Disease Prevention
•Health Promotion
Information
•More information
•Better Decisions
Individual/
Family/
Community
Team
•Other health care providers
•Limiting risk
•Building on strengths
Access
•Access to care
•Coordination
•Communication
•Navigation
Chronic Diseases








Diabetes
Hypertension
Asthma/ COPD
Cardiovascular Disease
Cancer
Mental Health
Dyslipidemia Counselling
Osteoarthritis
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
 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
 Canadian Nurses Protective Society
 Vicarious Liability
 Nurse works within scope of nursing practice
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
 Physicians are paid an established fee for
visits.
 Responsible for all overhead costs.
 Private business.
Bottom-line




Financially feasible
Enhanced care
Improved access
Improved work life satisfaction
Program Elements






Physician resource manual and recruitment
Nursing education program
Resource kit
Support for integration
Collaborative team days
Lecture series
Integration Support







Scheduling
Office efficiency
Space
Organization
Communication
Full scope practice
E-mail and phone support
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
 Monthly education event
 Goals
•
•
•
•
•
Networking
Continuing education
New physician engagement
Identification of issues
Information sharing
Program Evaluation (phase 1)
Components




Provider Survey
Service description survey
Project tracking form
Team survey
Program Evaluation (phase 1)
Key Outcomes:




Significantly enhanced access
Nurses practicing in expanded scope
Provider satisfaction
Enhanced screening and prevention
Patient Age Demographics
Age Demographics by Patient (n=837)
* 50.0%
40.0%
n=244
30.0%
n=195
20.0%
n=106
10.0%
n=108
n=87
n=58
n=39
0.0%
0 to 17
18 to 24
*Please note the Y-axis goes to 50%
25 to 39
40 to 49
50 to 64
65 and Over
Unknown
Type of Patient Care Demographics
Categories of Chronic Care
Chronic Care Categories (n=473*)
100.0%
90.0%
80.0%
70.0%
60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
0.0%
n=325
n=134
n=89
n=71
n=61
n=55
n=51
*Please note patients could receiv e multiple types of care
Ar
th
r
iti
an
ce
r
C
Lu
ng
Pa
in
ni
c
hr
o
C
M
s/
O
st
eo
p
or
o
si
s
ea
lth
en
ta
lH
et
es
ia
b
D
O
th
er
C
VD
n=21
Types of Services Provided
Total Services Provided (n=4,578)
* 50.0%
40.0%
30.0%
n=1341
n=1111
20.0%
n=683
n=600
n=355
10.0%
n=256
n=232
0.0%
Counselling/Education Vitals
Medication
* Please note the Y-axis only goes to 50%
Assessment
Referrals
Immunization
Treatment
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
 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
 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
 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
 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
 Enhanced care
 Improved access
 Improved work-life situation
 Team approach
 Increased capacity
Program Evaluation (phase 2)
Spring, 2009
 Chart audit
 Patient satisfaction survey
Integration support is key!





Mentorship
Practice support
Networking with peers
Ongoing education
Specific to primary care context (providers as
experts!)










Developed in consultation
with…
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
 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