How do you enhance residential care for seniors when your physician population is already stretched to capacity? It’s a question the Abbotsford medical community struggled with for several years before the introduction of the residential care initiative. While funding was needed to make residential care improvements happen, Abbotsford ’s biggest challenge was finding enough family doctors to take on the cause in the face of other critical care needs.
“In 2007, local physicians came together to explore how we could improve both hospital and residential care,” says Dr Alf Chafe, Residential Care Medical Coordinator for the Abbotsford Division of Family Practice. “With the Abbotsford Regional Hospital and Cancer Care Centre about to open, it made sense to focus on hospital care for our first program.”
The formation of the Abbotsford Division of Family Practice in 2009 provided the right opportunity to revisit plans to support stronger residential care for seniors. Fueled by a continued desire to tackle residential care, Abbotsford physicians were approved for funding to develop a residential care program in 2011.
Charting a Course for Improved Care
When developing the program plan, Abbotsford physicians set concrete goals: 10% reductions in emergency department transfers, polypharmacy and acute care admissions from fall-related injuries. As well, the team sought a 10% increase in the number of patients discharged from hospital.
“We knew our program needed to be well-organized,” says Dr Chafe. “Despite recruitment efforts, our community was still low on physicians and we were having trouble finding people who could take on the role of medical directors at residential facilities, particularly when someone retired.”
Before Abbotsford’s residential care program was introduced, some family doctors were managing patient care entirely by fax. In several cases, physicians had never met their patients.
“We were committed to doing better than that,” says Dr Chafe. As the Division’s Project Lead, he reached out to physicians with a passion for residential care. Together, they created a rota, scheduling each of the 10 to 14 participating family doctors for shifts at the region’s 12 care homes and to provide 24/7 call for all the facilities. Larger facilities were slated for more frequent shifts to ensure all patients received sufficient on-site support. The service agreement funding compensated physicians, beyond the fee-for-service system, for the time they were taking away from their clinical office.
Achieving Positive Trends in Care
With scheduled visits at each facility, staff knows when a physician will be on site and patients can be seen. There is also more proactive care taking place, as physicians connect with other residents once they have seen patients in need of treatment.
The new system has improved continuity of care with family physicians on the rota routinely agreeing to become Most Responsible Physician for new residents in need of a primary care physician. The program has also achieved each of its goals: polypharmacy, hospital transfer and admissions are all down, while the number of patients released from hospital after a stay is on the rise.
Building on the successes achieved in the first year, by 2012 Abbotsford’s program expanded to include making suture kits available to all facilities so physicians can provide a broader spectrum of onsite care. Doctors also worked with the facilities and the Fraser Health Authority to increase the facilities’ capacity by making it possible for patients to receive intramuscular antibiotics without needing to go into acute care.
“We’ve reduced overall antibiotic use,” explains Dr Chafe. “But for patients who would otherwise need to go to elsewhere for intravenous treatment, being able to offer an intramuscular option right in the care facility is much less taxing on them. Overall, we’re really pleased with the progress we’re making in improving care for our seniors in residential facilities.”
The GPSC’s residential care initiative is designed to enable physicians to develop local solutions to improve care of patients in residential care services. Since 2011, the initiative was prototyped by five divisions of family practice: Abbotsford, Chilliwack, Prince George, South Okanagan Similkameen, and White Rock-South Surrey. Building on the significant learnings of the prototype communities, in 2015, the GPSC committed up to $12m annually to expand the initiative to residential care patients in more than 90 communities across BC.