In the midst of the turmoil in primary care, doctors are developing some innovative approaches with the support of Divisions of Family Practice to ease their burden and better support their patients.
One example is in the Central Okanagan, where doctors and nurses work together in a total of 18 family practices, and that number is growing all the time. The result is that patients, particularly those with complex conditions, get the time and attention they need while physicians can focus on those who require immediate care. In some cases it means the clinics have been able to expand their practices and take on more patients.
Dr Janet Evans at CGB Medical Clinic is one of the doctors who pioneered having a nurse-in-practice approach under a model created with the Division of Family Practice four years ago. Her clinic was recently able to attach close to 400 new patients, something she says would not have happened without their nurse, Heidi Howay, an RN with certification in orthopedics, neurology, diabetes, and gerontology. She supports four doctors at the clinic, including Dr Evans.
“Heidi’s presence releases time for us that allows us to provide direct patient care, and also helps to ease the pressure that contributes to burnout,” says Dr Evans. She does note that it’s a big change to work in a team environment, and requires an approach based on trust and communication. “At the beginning, when building the team, trust, and psychological safety, shadowing is essential.”
“Doctors have to be willing to have a nurse join them and shadow them, to learn how they practice. It’s so important in building that communication and trust,” agrees Heidi.
Other clinics in the Okanagan are also embracing the benefits of a team-based approach. At HealthWise Family Practice in Kelowna, Drs Andre Hugo and John Dawson work closely with nurse co-ordinator Rebecca Klassen. Among her responsibilities, Rebecca helps patients with chronic disease navigate the health care system, helping to co-ordinate their care and access the services available. She draws on other members of the allied health care team in the community including clinical social workers, Indigenous health coordinators, dieticians, occupational therapists, pharmacists and others.
Navigating the maze of services outside of the practice is a huge support and time saver for doctors. “If I need something, I can ask Rebecca,” says Dr Hugo. “She has the medical knowledge to access the appropriate resource and will come back with that information.”
Having the additional team support allows doctors to make the most of their resources, time, and capacity, and work on quality improvement and practice enhancements.
“We are further ramping up her training to see more patients in person for Pap tests, diabetic foot exams, allergy and vitamin B shots,” says Dr Hugo. He notes that “having a second clinical eye has also been useful to assess patient needs and triage appointments.”
“It’s been a very fluid role, initially starting with care coordination and referrals within primary care and Interior Health,” Rebecca explains. “It’s built up to supporting a group of patients who require more time.”
Small time savers across all patients are adding up. Dr Hugo explains that Pap tests, for example, include a questionnaire and 20-minute appointment so by delegating this task, he can see other patients. A patient who needs an unexpected assessment can be seen without concerns about impacting the schedule for other patients.
The cumulative time savings have created enough capacity for the practice to take on six new patients a month; opportunities that are expected to grow.
Even that process is more efficient. “Rebecca does the intake, and populates the EMR with their history. We review this history together, establish a bit of a treatment approach, and then I see them,” says Dr Hugo.
“I’m really seeing the benefits for both patient well-being and care,” agrees Dr Hugo. “I wouldn’t go back.”
Dr Evans also agrees. “We are not just doctors,” she says. “We’re a team within a community.”
For more information, read this article with practical tips on integrating nurses into primary care teams.