Georgina
Nurse Practitioner-Led Clinic
Cliniques dirigées par du personnel
infirmier praticien Georgina
The Georgina NPLC:
Part of the South Simcoe and Northern
York Region Health Link
Beth Cowper-Fung NP-PHC, BScN, MN
Clinic Director
January 24, 2013
Objectives
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Introduction to the NP role
The Georgina NPLC
Caring for seniors
Complex Case Load Management
Challenges
Advantages for and with Health Links
Primary Health Care Nurse Practitioners
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A nurse practitioner (NP) is a registered nurse with advanced
university education who provides personalized, quality health care to
patients.
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Education and certification process includes a 4 year undergraduate in
nursing, an average of 5 years clinical experience, a 2 year post
degree certificate program (many PHC-NPs are also Masters
Prepared), an additional registration exam into the RN Extended
Class
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We are registered and governed by the College of Nurses of Ontario
and are held to a higher standard and Quality Assurance process than
other nurses
Primary Health Care Nurse Practitioners
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Ontario nurse practitioners provide a full range of health care services
to individuals, families and communities
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NPs work in collaborative partnerships with physicians, Nurses,
Dieticians, Social Workers, Midwives, Mental health professionals,
Pharmacists and more.
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NP’s provide full primary care for all ages and can assess, diagnose
illness, order laboratory tests, order most diagnostic tests and write
prescriptions (non-federally regulated meds)
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If a clinical situation is beyond the knowledge, skill and experience of
the NP they have a collaborative relationship with a physician for
support
The Georgina NPLC: The Model of Care
Vision :Bridging the gap through collaborative care.
Nurse Practitioner-Led Clinics are a model
in which nurse practitioners are the lead
providers of primary health care and work
within an interdisciplinary health care team
to provide comprehensive, accessible, and
coordinated family health care services to
populations who did not previously have
access to a primary care provider.
The focus is to improve quality of care through enhanced health
promotion, disease prevention and chronic disease management, as well
as improve care co-ordination and navigation of the health care system at
the local level.
The Georgina NPLC: The Model of Care
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Patients registered to the clinic have access to:
• Primary Care Nurse Practitioners – all ages
• Sr. Social Worker (counsellor)
• Registered Dietitian
• Registered Practical Nurse (lab, foot care, spirometry)
• Pharmacist
• **New next month Ontario Telemedicine Network
Additional Services provided on site
• DEC from Southlake
• Ultrasound
• Counsellor (Catholic Community Services of York Region)
Georgina
Nurse Practitioner-Led Clinic
Southlake
Regional health
Centre
Pre and post
hospital care
York region
Public Health
Sexual health
outreach to local
high schools
Sunnybrook
Home for
Specialized Care
Primary health
care outreach,
Skills workshop
Cliniques dirigées par du personnel
infirmier praticien Georgina
Chippewas of
Georgina Island
Primary health
care outreach to
Georgina Island
health center
Georgina
Nurse
PractitionerLed Clinic
Sandgate
Women’s
Shelter
Primary health
care outreach,
Skills Workshop
Lakeview
Diagnostic
Cervices
On site Ultrasound
Sutton Youth
Multiservice
Centre
Primary health care
outreach
Catholic
Community
Services of York
Region
Shared space
within clinic
Diabetes
Education
Center Diabetes
management and
outreach
Caring for Seniors
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Our building has been a clinic for almost 50 years
When the clinic changed over to the GNPLC in July 2011
most of 800 patients previously cared for by a senior
physician stayed with the clinic and transferred care to an
NP. Many of these persons are over 65
Our average number of visits is 2.3 visits per quarter (9.2
visits per year)
Data restriction: Nightingale does not have extractable
data by age without much manual manipulation
Caring for Seniors
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NPs have longer appointment times that allow for seniors
to discuss their health concerns
The NPs focus on health promotion and disease
prevention supports patients in making healthy choices
There are several studies that identify NPs as having
excellent outcomes with chronic disease management and
patient satisfaction
The team based interdisciplinary model of care provides
an excellent environment for coordination of a care plan
Complex Case Load Management
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Many seniors have registered with the clinic who have not
been seen by a PCP in several years
They present with a list of concerns and unclear,
irretrievable histories
It takes several visits to address all of the chronic diseases
and begin to manage them effectively
Several seniors with mental health diagnoses that have
been poorly or not managed
Several female patients felt that after children they did not
need to be seen by a provider - multiple unmanaged
illnesses (breast cancer, pelvic masses)
Challenges
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Patients present with multiple concerns on each visit –
managing expectations and time
Polypharmacy with specialists and from ED visits
Referrals to specialists can take up to a year depending on
the specialty
Lack of secondary specialist reports (if a specialist
transfers to another specialist the reports are often not
forwarded to the Primary Care Provider)
Lack of electronic data transfer from our local hospital
(we are working together on this goal) or from specialist
offices (still on fax service) and often do not inform the
clinic of appointments
Advantages with Health Links
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Coordinated, efficient, timely access to hospital reports
Faster access to specialists (hopefully also electronic) and
their consultation notes in a timely fashion
Care plan information sharing with the local hospital so
that pre admission status is available for the hospital and
post d/c information and instructions are available for
primary care
Improved data collection – NP data is invisible at this
time
Consistent data collection to provide for analysis and care
plan modification as demonstrated by the findings
Thank You
• For your Time and Attention
Resources
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Nurse Practitioners’ Association of Ontario
www.npao.org
College of Nurses of Ontario www.cno.org (look for
Extended Class Present and Future)
Canadian Nurse Practitioner Initiative www.cnpi.ca or
through CNA website
Health Regulatory Professions Advisory Council
www.hprac.org
Visit our web site at : www.gnplc.ca
Nurse Practitioners – Government Reviews/Reports
Federal
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Romanow Report (2002) –Theresa Agnew spoke for NPAO; members encouraged to present
Kirby Report (2002) – Linda Jones presented; NPAO submission;
CNPI Initiative (2003-2006) – NPAO members actively involved
Provincial
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Report to the MOHLTC on the Review of the Scope of Practice for RN(EC)s – HPRAC; Pam Pogue
presented and members actively participated
Report of the Task Team on PHC Integration – co-chaired by Dr. Alba DiCenso and Dr. Sue Matthews
(2008); Theresa Agnew committee member; members chaired/participated in working groups and members
participated
Report on the Integration of PHC Nurse Practitioners in Ontario (aka IBM Report) – co-chaired by Dr.
Alba DiCenso and Nursing Secretariat (2004); Theresa Agnew and Sharon Goodwin represented NPAO;
members participated
Panel on Health Professional Human Resources (aka George Report) - Sharon Goodwin appointed to
Steering Committee (2001)
Nursing Task Force Report (1999) and JPNC Progress Report (2001)
Health Services Restructuring Committee, Primary Care Strategy (1999)
Report of the Fact Finder on Physician Resources in Ontario (aka McKendry Report) (1999)
NDP government Nurse Practitioner Initiative - Utilization of Nurse Practitioners in Ontario (1993); The
Clinical Nurse Specialist, Clinical Nurse Specialist/Nurse Practitioner and Other Titled Nurse in Ontario
(1994), Assessment of the Need for Nurse Practitioners in Ontario (1994)
Additional References Supporting NP Care for Chronic Disease Management
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Horrocks,S. Anderson E, Salisbury,C. Systematic review of whether nurse practitioners working
in primary care provide can provide equivalent care to doctors. BMJ. 2002 Apr 6: 324(7341):
819-923.
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Laurant, M, Reeves, D, Hermens R, Braspenning J, Grol, R, Sibbald, B Substitution of doctors by
nurses in primary care (Review). Cochrane database of systematic reviews (online) 2009; art no.
cd001271 DOI: 10.1002/14651858.cd001271.pub 2(4): 1-40.
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Lenz, ER, Mundinger, MO, Kane, RL, Hopkins, Lin, SX Primary care outcomes in patients treated
by nurse practitioners or physicians: two year follow-up. Med Care Res Rev 2004 Sept, 61 (3)
332-351
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Lenz ER, Mundinger MO, Hopkins, SC, Lin, SX, Smolowitz, JL. Diabetes care processes and
outcomes in patients treated by nurse practitioners or physicians. The Diabetes Educator. 2002:
28 (4) 590-598.
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Litaker D, Mion, LC, Planavsky, L, Kippes, C, Mehta N, Frolikis, J. Physician-Nurse Practitioner
teams in chronic disease management: The impact of costs, clinical effectiveness, and patients’
perception of care. Journal of Interprofessional Care 2003; 17(3) 223-237
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Murchie, P Campbell NC, Ritchie,LD, Simpson, JA and Thain, J. Secondary prevention clincs for
coronary heart disease: Four year follow-up of a randomized controlled trial in primary care
British Medical Journal, 2003: 326 (7380) 84-87.
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Mundinger, MO, Kane, RL, Lenz ER, Totten, AM, Tsai W-Y, Cleary, PD et al, Primary care
outcomes in patients treated by nurse practitioners or physicians: A randomized trial. JAMA
2000: 283(1) 59-68.
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Newhouse RP, Stanik-Hutt, J, White, KM, Johantgen,M, Bass EB, Zangaro, G et al. Advanced
practice nurse outcomes 1990-2008: a systematic review. Nurs Econ 2011 Sept; 29(5): 230-250.