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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.