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Chronic Disease Prevention and Management CDPM Strategy Capital

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Chronic Disease Prevention and Management CDPM Strategy Capital Powered By Docstoc
					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 (non-
  selective 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              Information
         management
     •Disease Prevention             •More information
      •Health Promotion               •Better Decisions
                        Individual/
                          Family/
                        Community
                                      Access
             Team                   •Access to care
    •Other health care providers     •Coordination
            •Limiting risk         •Communication
       •Building on strengths         •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                       n=108
                                                       n=87
                                                                                          n=58
 10.0%
                               n=39


   0.0%
              0 to 17       18 to 24      25 to 39   40 to 49   50 to 64   65 and Over   Unknown
*Please note the Y-axis goes to 50%
Type of Patient Care Demographics
                                               Categories of Chronic Care



                                         Chronic Care Categories (n=473*)

 100.0%
  90.0%
  80.0%
  70.0%        n=325
  60.0%
  50.0%
  40.0%
  30.0%                       n=134
                                               n=89             n=71                n=61          n=55     n=51
  20.0%
  10.0%                                                                                                               n=21
   0.0%
            VD




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*Please note patients could receiv e multiple types of care
                                     Types of Services Provided



                                        Total Services Provided (n=4,578)

* 50.0%


 40.0%

              n=1341
 30.0%
                            n=1111

 20.0%
                                            n=683        n=600
 10.0%                                                               n=355        n=256
                                                                                               n=232

   0.0%
       Counselling/Education Vitals       Medication   Assessment   Referrals   Immunization   Treatment
* Please note the Y-axis only goes to 50%
                       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
       shannon.ryan@cdha.nshealth.ca
 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