Primary Care Panorama
A 360 Degree Look at Primary Care
2015 Quality Forum
Dr. Bill Cavers- President, Doctors of BC
Dr. Brenda Hefford- ED,Practice Support and Quality, Doctors of BC
Shana Ooms, Director, Primary Health Care,Ministry of Health
Petra Pardy- ED Primary Care, Fraser Health
Evidence for benefits of Primary Care:
“… helps prevent illness and death, regardless of whether
the care is characterized by supply of primary care
physicians, a relationship with a source of primary care,
or the receipt of important features of primary care…
associated with a more equitable distribution of health in
populations.” - Barbara Starfield (2005)
“…available evidence confirms improved population
health outcomes and equity, more appropriate
utilization of services, user satisfaction and lower costs
in health systems with a strong primary care
orientation.”
Atun R (2004) What are the advantages and disadvantages of
restructuring a health care system to be more focused on primary care
services? Copenhagen, WHO Regional Office for Europe
Primary Health Care Charter
“Family physicians are the
cornerstone of Primary
Health Care.
They are part of a
broader community
network and professional
team…”
General Practice Services Committee
(GPSC)
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•
•
Ministry of Health Services + Doctors of BC
Operational rather than structural solutions
Input from Health Authorities
•
Responsible for:
- Care incentives (fee codes)
- Practice Support Program (PSP)
- Divisions of Family Practice
- A GP for Me
“Finding solutions to support and sustain full service
family practice in British Columbia”
www.gpscbc.ca
Triple Aim
Improved Health
of the Population
Population Health
Improved Experiences
for Patients and
Providers
More Sustainable
Health Care System
Experience of Care
Per Capita Cost
www.gpscbc.ca
Family Practice Incentive Program
•
Chronic Disease Management (CDM)
•
Conferencing fees
•
Complex Care Initiative
•
Maternity Network Initiative
•
Mental Health Initiative
www.gpscbc.ca
Evidence from BC
“…the more higher-care-needs
patients were attached to a primary
care practice, the lower the costs
were for the overall health care
system (for the total of medical
services, hospital services, and
drugs).
The majority of the cost reductions
stemmed from decreases in the
costs of hospital services.”
- Marcus Hollander
Healthcare Quarterly, Vol 12 no 4, 2009
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Practice Support Program
Learning modules:
•
Advanced Access/Office Efficiency, Group Medical Visits, Practice
Self-Assessment
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•
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Adult Mental Health
Child and Youth Mental Health
Chronic Disease Management
End of Life
Advanced Care Planning
Shared Care - COPD/Heart Failure
Practice Coaching
Shared Care Committee
•
•
Formed in 2006 (PMA)
Mandate to provide funding and project support to family
physicians and specialist physicians to improve the flow of patient
care from primary to specialist services.
•
Works closely with the other collaborative committees; the GPSC
and SSC
•
has helped more than 2,500 family physicians and 240 specialist
physicians to work together on over 240 projects across BC.
www.sharedcarebc.ca
Shared Care Committee
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Partners in Care (PIC)
Transitions in Care (TIC)
Polypharmacy
Rapid Access to Psychiatry
Teledermatology
Youth Transitions
Child and Youth Mental Health Collaborative (CYMHC)
www.sharedcarebc.ca
Divisions of Family Practice Doctors
was founded to:
of BC
•
•
Improve patient care
Increase family physicians’ influence on
MoH
Ministry of Health
PMA
Physician Master
Agreement
health care delivery and policy
•
Provide professional satisfaction for
physicians
GPSC
General Practice
Services Committee
DoFP
www.divisionsbc.ca
Divisions of Family
Practice
Local Divisions of Family Practice are community-based groups
of family physicians working together to achieve common
health care goals.
Results
A new way of working together
GP
MoH
Doctors of BC
GP
GP
Doctors
of BC
Health
Authority
Health Authorities
GP
GP
GP



Municipalities
Community Groups
Non-profit Societies
Divisions
Divisions of Family Practice Growth
2009 to current
40
Existing Divisions
New Divisions
33
35
30
30
25
22
34
34
1
3
8
20
30
33
2012
2013
15
22
10
17
5
5
5
2009
2010
0
2011
2014
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Promoting Clinical Integration Through
Collaborative Services Committees
Chilliwack Primary Care
Seniors Clinic
Home Health Integration in
White Rock-South Surrey
Residential Care Program in
South Okanagan Similkameen
Attachment Initiative:
Three prototype communities
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A province-wide initiative funded jointly by
Doctors of BC and the Government of BC to
strengthen the primary care system
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Goals of A GP for Me
•
Enable patients who want a family
physician to find one
•
Strengthen and support the family doctor
- patient continuous relationship, including
better support for vulnerable patients
•
Increase capacity of the primary health
care system
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Multi-pronged approach
1. Physician practice level incentive fees
2. Community patient attachment strategies
through Divisions of Family Practice
3. Integration, alignment, and leveraging of
existing health authority, ministry, joint clinical
committees, and partner initiatives, programs and
policies
4. Patient and public engagement and education
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Practice Level - attachment incentives
Four new family physician fees.
The fees are for:
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•
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Attaching unattached patients with complex
health needs;
Managing the care of frail patients;
Providing patient care over the telephone for all
patients;
Conducting conferences with other health care
providers for all patients.
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Practice level results to date*
3,101 family physicians have ‘signed-up’ to participate in A
GP for Me locally via their Division of Family Practice.
• 75% of full service family physicians.
More than 415,000 patients have received attachment
related services
$31.0 million has been paid for these services
*Based on services from April 1, 2013 to
December 31, 2014, paid to December 31, 2014
Community supports:
Local divisions of family practice
$40 million over three years to:
•
Engage and assess: community and patient needs,
local family doctor needs, strengths and gaps in
local primary care resources
•
Develop and implement community plans for
improving local primary care capacity, including
finding doctors for patients who want one
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Principles and Funding Parameters
1. Contribution to A GP for me Goals
2. Patient Centred
3. Accountable
4. Quality Improvement Oriented
5. Locally based and community developed
6. Collaborative
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Principles and Funding Parameters
7. Aligned with regional and provincial
strategies and initiatives
8. Contribute to integration
9. Comprehensive (promoting generalism and
full scope of practice)
10. Sustainable
• www.divisionsbc.ca; http://agpforme.ca/;
www.gpscbc.ca/attachment-initiative
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Key Community Strategies
•
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Physician retention and recruitment
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Inter-professional team based care
Practice Efficiency and Clinical Improvement
Supports
Public Education and Health Promotion
Attachment mechanism
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Community level results to date
Divisions' Participation in Attachment - Jan 2015
25
20
20
15
10
10
5
3
1
0
Not Interested
Assessment and Planning
Phase
Implementation Phase
Sustainability Phase
Planning and
Assessment
Expenditure as of
December 2014
$10,746,231
Implementation
$7,832,000
Total
$18,578,231
Integrate and Navigate Primary and
Community Care - Supporting Frail Seniors
1. Creation of meaningful
connections between
clients’ GPs and case
managers.
2. The expansion of the care
management team to
include a Surveillance Nurse
(SN) and a client services
assistant (CSA) .
3. Incorporation of the CARE
Management approach
into daily practice by Case
Managers and the SN
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Progress to Date
1.
Integration Achievements 2010 2014
# HH Offices with Surveillance Nurse
Implemented
Completed Potential
12
12
2.
# HH Offices with Client Services Assistant
Implemented
12
12
3.
# Divisions of Family Practice connected to
HH offices
10
10
4.
# GPs engaged across all communities
405
405
5.
# Home Health Long Term clients impacted
-
10,015
6.
# Clients with the Surveillance Nurse
-
2,500
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Impact of the Surveillance Nurse
on Client Outcomes
 Clients with the Surveillance Nurse (SN) are
3.2 times more likely to survive in the
community than clients not with the SN.
 Clients who are with the SN and who are
contacted more frequently by the SN,
survive for longer in the community.
 A CARE Management approach appears to
delay death or transition to AL /RC.
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Survival In the Community
(SN vs non-SN clients, N=590)
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Survival In the Community
(Total N= 954)
Clients who were seen more
frequently by SN
( who had 3 or more RVs n=546)
Clients who were seen less
frequently by SN
( who had 1 or 2 RVs n=408)
Days between initial call from SN to any
adverse event (AL, RC or Death)
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Added Value & Impact
1. Case Manager – GP Connections:
“This is the missing link..” Surrey Case Manager
“I met (Case Manager) last week. It was one of the
most productive 20 minutes I’ve spent in medicine.
She had a list of my patients on her books. We
decided on the best way to contact each other
quickly…(This initiative) is a wonderful positive
example of the new relationship between MOH, BCMA
& HA’s. When something is so right for your patients,
it’s obvious” Dr. Ralph Jones (Chilliwack Family
Physician / President, SGP)
“Very efficient use of my time, a no-brainer.”
Dr. Robert Hepburn, Surrey Family Physician
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Success Factors
Relationships
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Doctor/ patient
Members of the health care team
GPs and specialists, multi-disciplinary providers, system
planners, administrators, community
Patients and families, as partners
Orca Pod
Pacific Coast, British Columbia
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Success factors
Shared Perspectives
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Shared vision
Common ground
Flexibility, adaptable
Bottom-up
Stimulating for all
“
It is not the answer
that enlightens,
but the question.
Eugene Ionesco Decouvertes
”
British Columbia
Coastal Rain Forest
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Success Factors
Courage
•
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Unfamiliar territory
Letting go of old
ways
Okay to fail and
learn
Trust in the process
Open to new
possibilities
Annual Polar Bear Swim,
Pacific Coast, British Columbia
Photo: Mark Klotz, Vancouver, BC
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West Coast Trail,
Vancouver Island, British Columbia
“
If you want to travel fast,
travel alone.
If you want to travel far,
travel together.
”
Section 3
Section Title goes here
Thank you!
An initiative of the GPSC, funded by Doctors of BC and the Government of BC
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