Telehealth: Enhancing the role of rheumatology nursing support
Contact:
Dr Jason Kur
jasonkur@shaw.ca
Presenter(s):
Dr Jason Kur | Rheumatologist
Artus Health Centre
Arwa Nemir | PhD Pharmacy
University of BC
Funder(s): Specialist Services Committee
COVID-19 precipitated a necessary and rapid shift from the traditional and predominant model of care delivery for rheumatology patients in BC. Adapting to change and to continue to provide care to their patients, rheumatologists adopted telehealth. Telehealth is also considered to be an effective medium for follow-up visits that do not require procedures and/or immediate physical examination. Thus, the discipline has now pivoted towards a hybrid model of in-person and virtual care. Prior to the COVID-19 pandemic, nurses played an essential role in the education and teaching of rheumatology patients. With the prompt switch to virtual platforms, nurses continue to offer similar support.
To gain a better understanding on the current and potential enhanced role of nurses in virtual rheumatology care, this study explored the attitudes and perceptions of patients and nurses regarding the expansion of telehealth nursing care. Conducted in January 2021, this qualitative study included virtual semi-structured interviews with six rheumatology patients from four Canadian provinces (i.e., Alberta, British Columbia, Ontario, and Saskatchewan) and one virtual focus group of six rheumatology nurses based in BC. Data analysis was iterative, occurring as interviews proceeded and used a thematic approach.
Most nurses reported using telehealth to provide patient care during the pandemic, with some nurses having in-person visits for first-time appointments, unstable patients, or administering injections. Nurses described their experience with telehealth as evolving and changing over time. Participating nurses perceived challenges during care provision via telehealth to include: attending to the mental health needs of patients, performing physical assessment, and managing time constraints, language barriers, and patients’ technology literacy. Patients were most comfortable with telehealth nursing support for responding to email questions, counselling virtually, reviewing laboratory results, and recommending in-person or allied health assessments. Patients were least comfortable with nurses altering advanced therapies or disease modifying drugs.
This study serves as a framework to support the improvement of rheumatology telehealth nursing in BC, and it establishes suggestions on the best ways to integrate virtual nursing care. Furthermore, activities that are suitable for nursing telehealth care in rheumatology practice are outlined, specifically those that are highly acceptable to rheumatology nurses and patients.
Developing an integrated virtual care network for family physicians in Burnaby
Contact:
Erica Corber | Director
Burnaby Division of Family Practice
Presenter(s):
Dr Birinder Narang | Family Physician
Burnaby Division of Family Practice
Georgia Bekiou | Executive Director
Burnaby Division on Family Practice
Erica Corber | Director
Burnaby Division of Family Practice
Funder(s): General Practice Services Committee
Technology is changing the landscape of primary health care. To stay relevant and support the sustainability of full scope family practices, the Burnaby Division of Family Practice (BDFP) is developing a physician-led virtual care network (VCN). The objectives are to give patients a better choice for accessing care, facilitate longitudinal care, funnel patients back to our practices through a “no wrong door” approach, improve clinic administrative efficiency, increase after-hours coverage, facilitate provider-to-provider communication, and bring physicians back to the community.
In the implementation phase and scheduled to go live in summer 2022, the emerging VCN will offer patients enhanced access to all participating family physicians in Burnaby through a web portal and centralized online booking system. The presentation will describe how the VCN advances the transformational vision of primary care and the journey the division took to find the optimal solution for delivering seamless and integrated virtual care to Burnaby residents.
On the path to whole person care: Integrating community resources with medical services
Contact:
Erica Corber | Director
Burnaby Division of Family Practice
Presenter(s):
Georgia Bekiou | Executive Director
Burnaby Division of Family Practice
Jeff Malmgren | Consultant
DSI
Funder(s): General Practice Services Committee
The Burnaby Primary Care Network (PCN) brings together community service providers, its family physicians and Fraser Health community services to collectively drive city-wide health and wellbeing. We are creating multiple linkages from family practices to community agencies so that patients’ experiences of health care teams not only include doctors or health authority providers, but also their community agency providers.
The PCN convened nine working groups as part of its grassroots governance structure. While continuing to inform and support another, the working groups focus on vulnerable populations and integrate social and medical services to target the social determinants of health. Focusing on families and individuals, from seniors to children, these working groups cover food security, social isolation, developmental disabilities, financial security, technology, and homelessness. Participating organizations include the City of Burnaby, school district, library, family physicians, Fraser Health, and over 40 community service agencies.
Examples of the outcomes of these collaborative efforts include: a food network that feeds close to 6,000 people a week; coordinated and responsive primary care services for the homeless population delivered through PCN resources, family doctors and Fraser Health that have never been available before; seniors fairs and distribution of free technology (e.g. cell phones and computers) to isolated seniors; DocTalks, an ongoing interactive webinar series that directly connects residents with family doctors around critical health and wellness issues.
How to stabilize the patient medical home in rural and remote BC
Contact:
Leanne Morgan | Executive Director
Rural and Remote Division of Family Practice
Presenter(s):
Dr Tracey Thorne | Division Co-Chair
Rural and Remote Division of Family Practice
Leanne Morgan | Executive Director
Rural and Remote Division of Family Practice
Catherine Coatta | Associate
Reichert and Associates
Funder(s): General Practice Services Committee
The Rural and Remote Division of Family Practice has heard from its members that there are challenges facing the stability of patient medical homes in rural and remote communities in BC. This lack of stability contributes to physician burnout and ultimately disrupts patient access to primary care. Challenges identified include recruiting and retaining physicians to rural and remote locations and communities. This research used a strengths-based approach to understand the rural physician perspective on what is attractive about rural practice and what has supported them to start and stay in rural family practice. It also explored challenges and barriers in the current system that detract from rural practice and identified opportunities to improve.
Research included 12 interviews with rural and remote family physicians, survey data from 26 rural and remote physician respondents, and 10 interviews with supportive services, including staff from divisions of family practice, health authorities, UBC CPD, Doctors of BC, and programs such as Health Match BC.
Lessons learned from the research can apply to anyone who is interested in supporting rural and remote family medicine. Recommendations range from increased community engagement, roles of divisions of family practice, and system-level changes that could improve the stability of rural and remote patient medical homes. Findings can also be applied to the development of primary care networks.
Empowering interdisciplinary healthcare teams in rural BC: A pilot
Contact:
Adrienne Peltonen | Project Manager
Rural Coordination Centre of BC
Presenter(s):
Dr Rahul Gupta | Family Physician
Rural Coordination Centre of BC
Dr Dana Hubler | Family Physician
Rural Coordination Centre of BC
Dr Anthon Meyer | Family Physician
Rural Coordination Centre of BC
Funder(s): Joint Standing Committee on Rural Issues
A literature review about team culture identified eight foundational elements for health care teams to provide high quality patient care, enhance patient safety, and experience more wellness and joy in their work. These elements informed the design of a new program, Quality Team Coaching for Rural BC (QTC4RBC), which piloted with 11 rural health care teams. Underpinning QTC4RBC is a coaching approach intended to support teams to draw on their own strengths, align with shared values, create solutions for local priorities, and to have the tools to continue to do this beyond the duration of the program.
Through QTC4RBC, teams participated in a virtual workshop on the elements and competencies of highly effective teams, which was followed by a series of up to four team coaching sessions. One-on-one coaching was available for an individual on the team in a leadership role, and teams could also access funding for further learning or to conduct a project.
Workshop participants completed a survey as part of a preliminary program evaluation. Early findings show that after the workshop, average competency ratings increased across all measured areas of highly effective teams. Most (89%) respondents reported having used strategies or tools from the program and 68% noticed differences in how their team works together.
Sustaining quality care through rural health networks: Innovations in BC
Contact:
Dr Jude Kornelsen | Associate Professor
Department of Family Practice, UBC
jude.kornelsen@familymed.ubc.ca
Presenter(s):
Dr Jude Kornelsen | Associate Professor
Department of Family Practice, UBC
Dr Nancy Humber | Enhanced Surgical Skills Physician, Network Co-Lead
Rural Coordination Centre of BC
Tom Skinner | Senior Project Coordinator
Rural Coordination Centre of BC
Funder(s): Joint Standing Committee on Rural Issues
Historically, the sustainability of rural health services has been challenged due to issues that arise from low population density and isolation. Challenges include difficulty recruiting and retaining care providers, lack of immediate support from specialists, patient transport, limited access to diagnostics, and lack of other infrastructure. This has led to both a cascade of service reductions and, in response, a concerted effort to stabilize such services. Across Canada, BC is leading system responses to address rural health care challenges, including the strategic prioritization of rural health care at a systems-level through establishing the Joint Standing Committee on Rural Issues and the subsequent resources to support rural health care providers. Many of these evidence-based innovations appreciate the importance of networks of health care delivery, specifically across vast geographies. Through regional planning and support, core services can be maintained and enhanced to ensure access to quality care for rural residents.
The workshop will consider the foundations to sustainable rural health sites as part of a network of services from the perspective of the core services of general surgery, emergency, obstetrics, and anesthesia applied to stratified levels of care (specialist-led and generalist (ESS)-led).
Activities that support small volume hospitals and networks of services can be found through learning of the Rural Surgical Network as well as previous and ongoing research and evaluation. Quality activities that support small volumes health sites will be described in three sessions:
- Case studies of local community-led quality activities across rural BC.
- Comprehensive evaluation including considering health outcomes within the context of low procedural volume, process measures, patient-reported outcomes and cost-effectiveness.
- Maximizing virtual connectivity as a key component of sustainability through virtual simulation and coaching and Real-Time Virtual Support.
Innovating to reduce unattachment in a time of primary care crisis
Contact:
Mona Mattei | Project Manager
Kootenay Boundary Division of Family Practice
Presenter(s):
Mona Mattei | Project Manager
Kootenay Boundary Division of Family Practice
Erin Fazzino | Primary Care Network Manager
Interior Health Authority
Tanya Peever | Nurse Practitioner
KB Health Online Clinic
Funder(s): General Practice Services Committee
The worst care possible is the care a patient doesn’t receive.
In BC, primary care is facing a dual crisis in recruitment of providers and an increasing number of unattached patients. The Kootenay Boundary (KB) primary care network (PCN) initiative faces an uphill battle for attachment with a decreasing number of providers in our rural communities. Patients are being diverted to emergency departments or online services with siloed care. To ensure equitable access for rural patients designed for their needs, the KB PCN (Interior Health, KB Division of Family Practice, patients and Indigenous partners), is piloting a virtual attachment clinic – KB Health Online.
This innovative approach to primary care is a local solution to the growing virtual care landscape. The clinic is a unique partnership governed by the KB PCN and is operated by the newly formed Prima Health Co-operative, a clinical arm of the KB Division. Providing a staged approach to permanent attachment, KB Health collaborates with the local urgent primary care centre, walk-in clinics, emergency departments and the Health Connect Registry.
KB Health is a hub for unattached patients to connect with culturally safe, team-based care with nurse practitioners, social workers, and registered nurses. The clinic provides temporary, comprehensive care to patients with complex care needs, and then supports these patients through accelerated attachment to existing primary care clinics when the patient agrees they are ready.
The KB Health Online team provides a blend of in-person and virtual appointments with plans for outreach clinics to meet vulnerable patients where they are most comfortable.
The use of the virtually enabled electronic medical records create patient empowerment with information transparency and active engagement. The support of a virtual care coordinator makes the clinic accessible to all patients by providing direct patient support, working with community resources to link patients with volunteers, and identify access to locations for patients whose internet or digital literacy is limited.
Patients’ outcomes will improve as the team focuses on providing wrap-around care tailored to the patients’ needs. Most importantly, patients will receive care in their home communities in a variety of ways.
Structured multi-organizational mortality reviews yield actionable insight for trauma system improvement
Contact:
Dr David Evans | Medical Director, Research and Analytics Unit
Trauma Services BC, Provincial Health Services Authority
Presenter(s):
Dr David Evans | Medical Director, Research and Analytics Unit
Trauma Services BC, Provincial Health Services Authority
Jo Ann Hnatiuk | Lead, Clinical Initiatives and Programs
Trauma Services BC, Provincial Health Services Authority
Gezer Recep | Provincial Lead, Data, Evaluation, and Analytics
Trauma Services BC, Provincial Health Services Authority
Funder(s): TBC
Modern health system performance improvement strategies are largely predicated on the reporting and quantitative assessment of large amounts of data from complex and costly data collection efforts that often yield limited actionable insight for the effort invested. In contradistinction, clinical case reviews offer an underused but highly productive and cost-efficient method of qualitatively exploring processes and outcomes from a whole-system perspective.
In alignment with Trauma Services BC’s (TSBC) mission to optimize performance of the provincial trauma system, the TSBC Performance Improvement and Patient Safety Committee developed and implemented a structured mortality case review process that convenes key agencies and stakeholders in consensual protected discussion around trauma-associated deaths where system-level learnings are probable. This collective initiative is supported by privacy and data-sharing agreements of involved organizations and by their quality assurance programs.
A consolidating strategy promoting structured reviews for injury-associated deaths recorded in any hospital facility participating in the trauma system underpins the provincial review process. Selected cases from local and regional reviews are screened for consideration of provincial review. Approved cases are prioritized for data abstraction by the BC Trauma Registry and a chronology of the case is produced. This is provided to an assigned Case Review Lead (CRL) who then gathers all documentation to curate a complete and accurate account of the case. The abstracted data, clinical notes, reports, and other relevant information is organized and stored on a custom-built module of the BC Patient Safety Learning System platform which enables protected information sharing across agencies under Section 51 of the BC Evidence Act. A Case Review Group of relevant stakeholders from involved organizations is assembled by the CRL. Usually included are (1) clinical and administrative representatives from involved sites and health regions, (2) BCEHS paramedics, advisors, and patient transport leads, and (3) any additional required expertise.
A facilitated deliberation targeting pre-identified issues is held to produce objective statements of fact and related recommendations for system-level process improvement. De-identified recommendations are forwarded to the TSBC Council for consideration and endorsement.
Four provincial mortality reviews were completed in the first year of this initiative. These yielded 20 case-specific recommendations distilled into eight summative provincially relevant recommendations adopted for action by TSBC. Substantive improvements to BC trauma system processes are anticipated. This rigorous quality assurance program demonstrates the power of well-structured multiagency clinical case review to identify and action opportunities for valuable system-level improvement in the processes of care for major trauma patients.
Worse than waiting for Godot: Improving adult ADHD services
Contact:
Cynthia Bukett | Project Manager, Healthcare Initiatives
North Shore Division of Family Practice
Presenter(s):
Dr Elisabeth Baerg Hall | Psychiatrist
Vancouver Coastal Health Authority
Dr Betty Tang | Psychiatrist
Vancouver Coastal Health Authority
Dr Dean Brown | Family Physician
North Shore Division of Family Practice
Funder(s): Shared Care Committee
The only dedicated adult attention deficit hyperactivity disorder (ADHD) clinic in the Canadian public health system, the VCH Adult ADHD Clinic, has seen exponential increases in referrals year-over-year since opening in 2016. Patients are languishing on waitlists for longer than a year. Many of these patients are young people in need of diagnosis, skills development, and medication to thrive during their formative years. Review of clinic waitlist cases revealed an opportunity to support family physicians to provide primary care for many of these patients, preventing further functional impairment secondary to ADHD. Sub-optimally treated and untreated ADHD is associated with significant medical and psychiatric comorbidity including poor management of chronic diseases (e.g., diabetes), anxiety, depression, substance use, motor vehicle accidents, and incomplete schooling. Patient voices identified that the ability to access treatment faster in primary care would be of great benefit.
This project aims to increase primary care clinicians’ (PCPs) capacity to identify and manage uncomplicated ADHD in the primary care setting, such as patients with a childhood diagnosis, or uncomplicated presentation of ADHD.
Developed together with PCPs, a new educational series helps PCPs identify patients at high risk for ADHD impairment in adulthood, to conduct quality diagnostic evaluations, and to undergo both medical and psychological treatment of adult ADHD. Additionally, the series offers PCPs case-based individual and group review sessions to enhance practical and applied learning.
The series focuses on a practical, evidence-based approach that can readily be undertaken in a busy primary care clinic. To date, four education sessions have been completed and PCPs have already identified increased confidence and capacity in treating adult ADHD. This simple intervention presents a model for spread to other primary care settings and provincially within the adult mental health substance use network.
START – Support Tapping Alumni as a Resource Today
Contact:
Dr Alex Hoechsmann | PQI Physician Advisor
Island Health Authority/Physician Quality Improvement
Presenter(s):
Dr Alex Hoechsmann | PQI Physician Advisor
Island Health Authority/Physician Quality Improvement
Jennie Aitken | PQI Manager
Island Health Authority/Physician Quality Improvement
Julia Porter | PQI Coordinator
Island Health Authority/Physician Quality Improvement
Funder(s): Specialist Services Committee
At Island Health, Physician Quality Improvement (PQI) alumni are a group of regional medical staff trained in systems thinking and quality improvement (QI) and represent a range of clinical services across 28 specialties. In 2020, an alumni strategy was co- designed to support PQI alumni to promote a QI culture and improve the health system after graduation by continuing to develop and use their QI skills.
Primary drivers identified to support alumni were:
- A community of experts to enable opportunities for collaboration on complex QI-related issues and to facilitate connections with local and wider QI communities.
- Advanced skills development through regular learning and leadership opportunities and support for graduate projects.
- Alignment and advocacy for QI across our health system to support alumni integration in Island Health structures and their participation in strategic projects.
In many health regions, medical staff trained in QI are an underutilized resource that can benefit their health organizations in managing larger, system-wide problems. The Island Health PQI alumni recognize their potential to apply a QI lens to complex organizational issues with a deep understanding of the local context. Through regular engagement events, alumni collaborate and contribute to improving the health system. Event highlights include:
- During the first waves of the COVID-19 pandemic, a large number of changes were made in a very short period of time. To provide relevant feedback to administration, an appreciative inquiry framework was chosen for PQI alumni. The framework enabled the group to identify future oriented solutions by focusing on the strengths, rather than deficits of a situation. (Pandemic PDSA, August 2020)
- Disney Method used to identify areas for improvement in the physician on-call system and identify key factors involved in a physician’s decision to attend in person. (Good Call, June 2021)
Wildfire emergency response prompts collaborative planning
Contact:
Chelsea Brooks | Practice Development Lead
Thompson Region Division of Family Practice
Presenter(s):
Chelsea Brooks | Practice Development Lead
Thompson Region Division of Family Practice
Rhonda Eden | Network Lead
Thompson Division of Family Practice
Dr Graham Dodd | Physician Lead
Thompson Division of Family Practice
Funder(s): General Practice Services Committee and Shared Care Committee
The 2021 wildfires and floods posed unique and immediate challenges for primary care providers in the Thompson Region. The Thompson Region Division of Family Practice (TRDFP) mobilized support to practices, enabling them to provide longitudinal patient care through the wildfire crisis.
This situation, along with the learnings from the TRDFP’s response to the COVID-19 pandemic, continues into an existing emergency management project, which includes two main bodies of work:
- Practice preparedness and continuity resources: The TRDFP collaborated with the Kootenay Boundary Division of Family Practice to develop an Emergency Management Guidebook for Health Care Clinics and an accompanying Emergency Management Workbook for Health Care Clinics. The resources enable practices to create their own evacuation, shelter in place, and incident recovery plans, as well as provide templates to practice, review, and debrief. The resources are now being shared with family physicians, nurse practitioners, and clinic staff to complete with support from the TRDFP.
- Incident Command (IC): IC is an emergency response system that standardizes roles, responsibilities, and procedures. The TRDFP was invited to sit at the Interior Health’s IC table during COVID-19, which was invaluable in collaborating to ensure equitable, safe, and accessible care for patients and providers throughout the region. At that time the TRDFP did not have a formal structure to support emergency response and has since developed an IC to support members, which was utilized for the wildfires. TRDFP IC worked closely with the Interior Health West’s IC to fill primary health care gaps in the local wildfire response. This included support for long-term care physicians as patients were moved from affected areas and working to ensure physicians displaced from their community had a place to continue practicing in an alternate location.
East Kootenay physician professional resiliency workshops
Contact:
Jacqui Van Zyl | Program Manager
East Kootenay Division of Family Practice
Presenter(s):
Dr Tyla Charbonneau | Registered Psychologist
Alpine Pathways Psychology
Dr Ron Nash | Family Physician
East Kootenay Division of Family Practice
Jacqui Van Zyl | Program Manager
East Kootenay Division of Family Practice
Funder(s): General Practice Services Committee and Shared Care Committee
The East Kootenay Division of Family Practice (EKDFP) recognizes the value of creating supporting networks for family physicians. EKDRP partnered with Dr Tyla Charbonneau, Registered Psychologist, to offer a program that supported physicians in their personal lives and helped them provide excellent primary care across the East Kootenay region.
The workshops aimed to build relationships between physicians, provide a common language for symptoms of professional fatigue, and to share tools and resources to navigate the ongoing challenges physicians face in healthcare particularly through vicarious trauma and compassion fatigue.
Groups of 10 -11 physicians met via Zoom to work through the Forward Facing® Professional Resilience: Prevention and Resolution of Burnout, Toxic Stress and Compassion Fatigue Program developed by Dr Eric Gentry. The workshops were facilitated by Dr Tyla Charbonneau and Dr Ron Nash. Workshops were accredited through UBC CPD. Thirty-two family physicians and specialist physicians from the East Kootenay region participated in the virtual Professional Resiliency Workshop series.
The value of the Professional Resiliency Workshops is quickly seen through physicians sharing how beneficial it was to talk to other physicians about compassion fatigue and finding the common humanity; feedback related to the use of self-regulation skills and calming of the autonomic nervous system in both their personal and professional lives; and the use of perceptual maturation to find new perspectives in approaching daily work and life.
As the division enters its fourth series, it is excited about what has been achieved through the workshops and look forward to sharing its success (and failures) during this session.
Real-Time Virtual Support: Digitally enhanced collaborative care in rural BC
Contact:
Katrina Bepple | Manager, Partnerships and Engagement
Rural Coordination Centre of BC
Presenter(s):
Dr Brydon Blacklaws | Physician Co-Lead, RUDi, RTVS
Rural Coordination Centre of BC
Dr Dana Hubler | Family Physician
Rural Coordination Centre of BC
Katrina Bepple | Manager, Partnerships and Engagement
Rural Coordination Centre of BC
Funder(s): Joint Standing Committee on Rural Issues
Real-Time Virtual Support (RTVS) pathways enhance health equity in rural, remote, and First Nations communities across BC by connecting rural healthcare providers to peer-to-peer support from virtual physicians through video or telephone conferencing.
Rural providers have historically worked in isolation, both geographic and professional, with fewer resources and supports than urban providers. The need for low barrier access to collegial, peer-to-peer support has been well established. The COVID-19 pandemic acted as a catalyst, enabling a group of partners to rapidly launch RTVS in April 2020.
RTVS emerged from the Rural, Remote and First Nations Virtual Health and Wellness Collaborative, which brings the perspectives of policy makers, system administrators, providers, academia (including researchers, learners and educators), citizens and linked sectors (industry and non-profit organizations).
RTVS addresses the need to provide on-demand support to rural providers, emboldens learners to explore rural practice, builds capacity in community through simulations, helps alleviate burnout, and enables timely delivery of culturally safe, patient-centered care to rural patients closer to home. This session will explore these benefits and the importance of RTVS remaining nimble and responsive to community needs in order to minimize and eliminate inequities in access to quality health care in rural, remote, and First Nations communities across BC.
The 24/7 instant access RTVS pathways are for Emergency (RUDi), Maternity (MaBAL) and Pediatric (CHARLiE) support. There are also seven additional pathways that provide quick reply access to specialist care that might not otherwise be available rurally. Since RTVS began operations in April 2020, it has served providers in over 109 rural communities in BC. At the core of this work is continued relationship building, compassion, and ingenuity all aimed at improving patient outcomes and improved patient and provider experience.
Rural Personal Health Records Project: A Community Affair
Contact:
Jess Rothenburger | rPHR Project Manager
Rural Coordination Centre of BC
Presenter(s):
Dr Anthon Meyer | rPHR Project Co-Sponsor
Rural Coordination Centre of BC
Jess Rothenburger | rPHR Project Manager
Rural Coordination Centre of BC
Funder(s): Joint Standing Committee on Rural Issues
The rural Personal Health Record (rPHR) is envisioned as a holistic and integrated electronic health system for rural persons and for those who support them. rPHR enables access to a person’s health information so that they can manage their health and wellness.
This interactive session will share how a community engagement approach (including a community design lab) formed the basis for the first implementation of an rPHR in Valemount, BC. Discussions will include critical elements of a rPHR and the engagement strategy that ensured communities drove the rPHR development process. The session will also discuss the importance of engaging with health care providers to help ensure that a rPHR enhances the provision of care in terms of workflow, communication, confidentiality and data safety and security.
Cultural Cedar brushing and smudging
Thelma Stogan & Arthur Stogan
Musqueam elders will be offering cedar brushing and smudging services at the breaks. This is an opportunity to care for your spirit, brush negative energy away and ground yourselves as you do important work in healthcare.
Raising Resilient Kids Pilot: Something borrowed and something new
Contact:
Christine Tomori
Presenter(s):
Dr. Joanna Cheek, MD, FRCPC
Dr. Fiona Petigara, MD
We applaud innovation, but do we really need to start from scratch every time? CBT Skills Group Provincial Spread project co-leads discuss how they’ve used their successful infrastructure of CBT Skills Group to boost the success of an unrelated pilot project, Raising Resilient Kids. By borrowing the innovative processes and structures from past successes, we don’t need to re-create the wheel every time to create something new.
CBT Skills Group Provincial Spread: what is helping & what we’re learning
Contact:
Christine Tomori
Presenter(s):
Dr. Erin Burrell, MD, FRCPC
Dr. Joanna Cheek, MD, FRCPC
We’ve heard about the 7 spreadly sins of what not to do when spreading a program. But what should we do instead? In this presentation, the CBT Skills group outlines their learnings — the Ten Spread Tenets — of how they’ve successfully navigated the system from pilot program to provincial spread.
CHANGE BC Worshop
Contact:
Colleen Enns | Executive Director
Pacific Northwest Division of Family Practice
Presenter(s):
Dr. Greg Linton
Dr. Onuora Odoh
Dr. Robert Boushel
Colleen Enns
Tamara Stephens.
Engage in an energetic discussion with CHANGE BC to learn more about this award-winning partnership focused program, developed to collaboratively strengthen primary care network supports for patients living with Metabolic Syndrome and Type 2 Diabetes.
A QI project to decrease the proportion of clients disengaged from care at Hope to Health (H2H)
Contact:
Dr Cole Stanley | Family Physician and QI Lead
Hope to Health Research and Innovation Clinic
Presenter(s):
Dr Cole Stanley |Family Physician and QI Lead
Hope to Health Research and Innovation Clinic
Introduction
H2H serves a marginalized and vulnerable population, where there is a high burden of mental health and substance use problems, and disparities in social determinants of health. Engagement and retention in primary care is difficult for this group, with high percentages of clients becoming disengaged and subsequently “lost to care”. Longitudinal primary care can improve client wellbeing and reduce acute healthcare costs, but engagement is often the missing prerequisite. We aimed to decrease our proportion of disengaged clients from ~45% to less than 10% over a 12 month period by February 2022.
Methods
Our primary outcome measure was obtained by implementing a “disengagement score” field in our EMR. This is used by the team to flag any clients who are disengaging from care, usually at the time of a missed appointment or review of clients not seen in the past three months. We used the proportion of clients not seen in the past three months as a balancing measure, aiming to keep this close to 0%. Following successful PDSA cycles, we implemented the following: 1) protected time for the team to focus on re-engaging clients with a standard template; 2) a checklist for mandatory items to cover at client intake; 3) peer-led text appointment reminders; 4) regular review of clients not seen in past three months; and 5) a custom EMR Dashboard for our QI measures and re-engagement efforts.
Results
Between March and August 2021, we decreased our proportion of disengaged clients from 42% to 15%, and this reduction has been sustained. We have also sustained the proportion of clients seen in the past three months at around 90% for the duration of the project.
ConclusionsWe used a QI approach to substantially reduce client disengagement and maintain close primary care follow-up for our marginalized and vulnerable population.