Borden Primary Health Centre Collaborative Practice

1. Borden Primary Health Centre Collaborative Practice Colleen Nesbitt, RN-NP, Borden Primary Health Centre Tessa Laubscher, MBChB, CCFP, Academic Family Medicine Saskatoon

2. Borden Primary Health Centre(BPHC) Located in Borden, 50km west of Saskatoon Under the jurisdiction of Saskatoon Health Region Provides services to residents of communities extending from Langham in the east to Maymont in the west. Majority of people regularly accessing the health centre are from Borden, Radisson and surrounding farms.

3. Borden Primary Health Centre Population in service area about 1800. Active patient charts in the clinic (people who see either NP or MD) about 310. Many people access other services (lab/X-ray, pharmacy, etc.) but have physicians in other communities.

5. Borden Health Care Team Nurse practitioner and clinic nurse Physicians Lab and X-ray technician Receptionist Pharmacist CPAS coordinator Physiotherapist Dietician Mental health worker Home care nurses Public health nurse SHR primary health services facilitator SHR primary health services nurse manager Our patients/clients NP/RN Mon – Fri no after hours MD 2 half days per week Lab 4 days per week Receptionist 3 half days Pharmacist 3 half days All other care providers once or twice a month, and additional phone contactNP/RN Mon – Fri no after hours MD 2 half days per week Lab 4 days per week Receptionist 3 half days Pharmacist 3 half days All other care providers once or twice a month, and additional phone contact

6. Collaborative practice at BPHC since 2004 Academic Family Medicine (AFM) contracted by SHR to provide MD services in May 2004. Dr Laubscher is the primary physician in the care team. Eight other AFM physicians, family medicine residents and medical students also involved. Physician clinics held two half days per week. AFM also provides support to NP and on-call services for patients.

7. Collaborative practice at BPHC since 2004 Initial challenges faced by the physicians: Learning the roles of the various practitioners Understanding the competencies of the NP and learning how to work collaboratively Itinerant clinics Dr TL familiar with working with advanced clinical nurses in northern Saskatchewan, but other doctors had to become familiar with the NP role, and comfortable with shared care. HAND OVER TO COLLEENDr TL familiar with working with advanced clinical nurses in northern Saskatchewan, but other doctors had to become familiar with the NP role, and comfortable with shared care. HAND OVER TO COLLEEN

8. Collaborative practice at BPHC since 2004 Initial challenges faced by the rest of the health team after AFM physicians joined: For the NP, learning to practice in an expanded role and work collaboratively. Working with family medicine residents and students. Introduction of new clinical tools and a different style of practice.

9. Borden Primary Health Care Team Goal: To enhance primary health care for the people accessing BPHC through clear, effective communication between all team members. Team meetings held every three months. Emphasize – health care not just medical care. Seldom have all members at team meetings and this sometimes limits program development. Emphasize – health care not just medical care. Seldom have all members at team meetings and this sometimes limits program development.

10. What does success look like for the Borden Primary Health Care Team? Team members understand their roles and work cooperatively. We have an increased client base for all our services. We do a good job at following our patients with chronic diseases. We engage in preventive health care. We see evidence of people taking responsibility for their own health, including lifestyle changes. Patients understand how to access our services. We have good attendance at educational events. We link successfully with other agencies and services. Generally I think all the team members and most of our patients would agree that we have achieved success in all of these domains over the past three years. HAND OVER TO TESSAGenerally I think all the team members and most of our patients would agree that we have achieved success in all of these domains over the past three years. HAND OVER TO TESSA

11. BPHC activities /achievements Improved delivery of care to people with diabetes – in-service for all team members; educational materials for patients; diabetes flow sheet; regular diabetic reviews. Health promotion in the community – heart healthy choices in local restaurant; shopping tour (healthy choices, food labels); diabetes expo at seniors centre. “Live well with chronic conditions” self-management workshop. 1 – expand on importance of in-service for non-medical team members – carol understands the importance of lab tests before DM reviews, lab facilitates this, NP able to renew meds if pt. can’t get to see MD, all use same flow sheets, pharmacist able to talk with NP and get Rx, etc if MD not present. This resulted in Borden having very complete data when the clinic joined the CDM collaborative in October 2006. 2 – dietician met with local restaurant public health nurses did shopping tour, good attendance, and resulted in local supermarket getting in some healthier foods. good attendance by people of all ages to diabetes expo, lot of school kids, CDA travelling show1 – expand on importance of in-service for non-medical team members – carol understands the importance of lab tests before DM reviews, lab facilitates this, NP able to renew meds if pt. can’t get to see MD, all use same flow sheets, pharmacist able to talk with NP and get Rx, etc if MD not present. This resulted in Borden having very complete data when the clinic joined the CDM collaborative in October 2006. 2 – dietician met with local restaurant public health nurses did shopping tour, good attendance, and resulted in local supermarket getting in some healthier foods. good attendance by people of all ages to diabetes expo, lot of school kids, CDA travelling show

12. BPHC activities /achievements Improved care for people living with COPD – NP is a COPD educator; spirometry; increased patient education by pharmacist and NP; community educational event in near future. Saskatchewan CDM Collaborative – October 2006. Once we had achieved improved and more coordinated care for people with DM, we decided to turn our attention to COPD, as the patient numbers are higher and it was apparent that many were not receiving optimal management.Once we had achieved improved and more coordinated care for people with DM, we decided to turn our attention to COPD, as the patient numbers are higher and it was apparent that many were not receiving optimal management.

13. BPHC – Advantages and Successes of Collaborative Care Co-location results in enhanced communication amongst clinical care providers and improved patient care. Physicians rely on the NP to provide follow-up, coordinate care with others in the team, monitor INRs, do routine prescription refills. The multi-disciplinary nature of the care team is important, especially for seniors and those with limited transportation. Give examples – first point: seniors reluctant to share social concerns, lack of finances, etc – having informal corridor conversations with other team members results in my being able to provide better care. This would not happen in we were not co-located and had a trusting working relationship. Second point – example – Andy Third point – PT able to go to patients homes, falls assessments, mobility aids, etc MHW to patient’s home if needed.Give examples – first point: seniors reluctant to share social concerns, lack of finances, etc – having informal corridor conversations with other team members results in my being able to provide better care. This would not happen in we were not co-located and had a trusting working relationship. Second point – example – Andy Third point – PT able to go to patients homes, falls assessments, mobility aids, etc MHW to patient’s home if needed.

14. BPHC – Advantages and Successes of Collaborative Care Many patients are taking responsibility for their own health care, and seek out different members of the team when needed. Improved patient care because of team work and ease of calling on one another in special circumstances. Give example for second point - KatieGive example for second point - Katie

15. BPHC – Challenges in Providing Optimal Collaborative Care General public’s lack of understanding of the role of the NP; many patients still want to see only a physician. NP worked in Local hospital for years as RN, and been difficult for community to accept her role as NP. Inadequate time for the clinical team to be involved in optimal interdisciplinary management of patients with complex conditions. Inadequate physician time in the community. Lack of an electronic medical record. Limited time for team to work on preventative health care and community development. HAND OVER TO COLLEENHAND OVER TO COLLEEN

16. BPHC – Client Experience Survey (2007) Response rate 54.2% 71% of respondents >50years old. 90-95% of respondents found the clinic staff welcoming, and felt respected by the physicians and nurses. 95% of respondents were happy with the service provided by the doctors; 53% rated it as excellent. 95% of respondents were happy with the service provided by the NP; 59% rated it as excellent. Other care providers not accessed as often, but the services of all practitioners were consistently rated as very good or excellent.

17. BPHC – Client Experience Survey (2007) Comments about strengths and weaknesses of services at BPHC: Most negative comments were related to inadequate physician hours, and limited hours of operation of health centre. Many positive comments were related to access to variety of services, quality of medical care, friendliness and knowledge of staff. Examples “patient-friendly staff -you are not just another file” “they work well together and it is good for us as it alleviates some of the care”

18. BPHC – Client Experience Survey (2007) Examples: “the doctors and support team are excellent and I feel very confident with the services provided” “it is nice we have Colleen to fill in on days when doctors are not in” “the health centre is community-centered and the staff very accommodating” “coming from Alberta I feel the health care services provided in Borden are excellent and played a large part in our decision to move to this area” HAND OVER TO TESSAHAND OVER TO TESSA

19. Any Questions?