Meeting Community Needs Through Integrated Care

1. Meeting Community Needs Through Integrated Care Donna Kearney, BScN, RN(EC), MHST Rosseau Nursing Station Nurse Practitioner - Manager

2. Rural Indicators of Health “Geography is an Indicator of Health” Roy Romanow 2002 Advanced Age Seasonal & Low Income Minimal Education Few Employment & Social Opportunities Few Support Services High Dependency

3. Age Demographics Ontario 2006 District of Parry Sound 2006

4. Rural versus Urban Parry Sound Town of Parry Sound 2006 Rural Parry Sound 2006

5. Primary Care Providers by Region

6. Nursing Stations: An Extension of the Hospital Hospital Nursing Stations

7. Nursing Stations - Model Buildings, Donations, In-kind NP Station Funding, Grants Operations

8. Scope of Practice RN NP MD Specialist Diagnosis and Treatment Allied Health Care Providers

9. Research: Purpose 1) To evaluate a model of primary health care delivery appropriate for rural populations. 2) To determine the scope and collaborative nature of NP practice in a rural nursing station setting.

10. Research: Purpose 3) To define the level of importance of hospital affiliation in reducing cost of care. 4) To show the impact on ER usage, hospital admissions, and wait times for primary health care.

11. Research: Process • 12 month data collection period (March 1, 2009 – February 28, 2010) • Used electronic reporting tool developed for the project to improve consistency and accuracy by all 6 nursing stations • Used hospital statistics for ER usage & acuity, admission, and re-admission rates

12. Research: Variables • Moose Deer Point nursing station decreased services from 5 days to 2 days per week due to lack of patients. • H1N1 Pandemic • NP vacation time, education time, and sick leaves not replaced consistently • One station dropped out of the study

13. Research Findings: Demographics Totals: 48% Adults (16-64), 44% Seniors (65+), 8% Children (0-15)

14. Patients Without a Family Doctor

15. New Patients

16. Type of Care Provided: Nursing Stations

17. Referral Rates from Nursing Stations Total Referral Rate = 11%, Consult Rate = 19%

18. Patient Volumes: Nursing Stations

19. Patient Volumes: ER/Nursing Stations

20. Patient Acuity: ER/Nursing Stations Triage/Acuity Level 4 & 5: 60% in ER 98% in Nursing Stations

21. ER Usage by Postal Code and Age

22. Hospital Admissions/Re-Admissions

23. Cost Analysis Cost Analysis information is not available for FHT’s or NP Led Clinics to date, therefore comparisons are not possible.

24. Conclusions • Reduced: • Wait times for primary care • Visits to the ER • Hospitalizations for chronic illness • Increased • Access to health care for rural seniors • Opportunities to ‘Age in Place’ • Monitoring for compliance with treatments and health outcomes • Collaboration with all health care providers • Opportunities for health teaching and illness prevention • Continuity of care and advocacy • Understanding of patients living conditions and support system

25. Recommendations: Local Level • Create permanent NP positions in the ER at WPSHC. • Provide after hours primary care services to residents in the Town of Parry Sound. • Relief funding is needed to replace NP’s at the nursing stations during absences. • Increase operating budgets of nursing stations to allow hiring of additional staff (RPN’s, NP’s), and to provide mentorship opportunities to prepare new NP’s to work full scope in rural nursing stations.

26. Recommendations: Provincial/National • Change FP title to ‘Primary Care Specialist’ to promote top-of-scope functioning of all health care providers. • Implement this model of primary care delivery in rural areas throughout Canada for a collaborative, sustainable, and accessible method of entering the health care system.

27. Questions – Thank you! Donna Kearney, BScN, RN(EC), MHST West Parry Sound Health Centre dkearney@wpshc.com