Collaborative care

By Carolyn Sloan

Spectator

NovaNewsNow.com



The creation of the Family Practice wing at the Annapolis Community Health Centre in 2005 has allowed for greater collaboration between health professionals and an overall better quality of service, say the practice’s diverse team of physicians, nurses, and office staff.

Now that they are all under the same roof, the practice has engaged staff throughout the centre in offering several programs and services that address the needs of their patients, often on a case-by-case basis.

Based on a progressive vision and collaborative approach to wellness, these programs and services require additional resources and place a greater demand on the practice as a whole. However, as forward-looking initiatives, these offerings consider prevention and management of disease as providing benefits in the long term, far outweighing the initial cost.

“We’re very thankful [to be at the health centre],” says nurse practitioner Jacinta Harvey. “Now that we’ve settled down… we can do programs to give back to the community and hopefully improve the way we are doing things here.”



WELL WOMEN INIATIVES

It’s the kind of approach that has made the Annapolis Family Practice a leader in the province as the only office that sends reminders to patients who are overdue for a Pap test. Toward this aim, the primary care facility has spent the past two years reviewing the charts of its female patients in an effort to identify women who are under-screened.

With several thousand female patients, this initiative is ongoing and relies on the efforts of physicians and nurses as well as office staff, who have the task of organizing the information, sending out reminders, and issuing letters to patients with their test results.

Patients who receive a reminder from the practice are invited to come in for regular Pap clinics, now being offered at the office on a monthly basis by the nurse practitioner and physician Caroline Hancock. These clinics are also open to women who do not have a family doctor or who do not feel comfortable receiving the test from a male physician.

“[Pap tests are] the sort of thing that people will tend to put off,” Harvey explains, adding that approximately 60 per cent of Nova Scotians are under-screened. “We want people that haven’t had a Pap test…who need to get this done.”

While the practice has received positive feedback from patients who appreciate getting the reminders, the next step is to do an evaluation of the service to demonstrate its effectiveness. With support from Cancer Care Nova Scotia through its Cervical Cancer Prevention Program, staff are hoping that this initiative will be adopted by other practices around the province in an effort to decrease the incidence of cervical cancer throughout Nova Scotia.



DIABETES MANAGEMENT

In addition to the Pap test initiative, the practice has also been compiling a list of patients with a diabetic or pre-diabetic diagnosis to ensure that these clients are scheduling regular follow-up appointments with their physician and have been getting the necessary blood work done. About once a month, members of the family practice team meet with the health centre’s diabetic educator Nancy Price to determine the best way to look after these patients on a case-by-case basis.

The practice has also announced the development of a multi-disciplinary education program for diabetics with high blood pressure. While still in the process of obtaining funding, the program is another collaborative effort and forward-thinking initiative, which in this case, focuses on chronic disease management.