Collaborative Care: ‘Health homes’ on the rise; could alleviate Nova Scotia’s doctor shortage

via The Chronicle Herald

The province likes to use the term “collaborative care” when addressing the future of Nova Scotia’s health care system.

Thousands of residents without a family physician are being told that these health clinics — called “health homes” by the Nova Scotia Health Authority — are the answer. There, physicians, nurses, social workers and other health professionals work as a team to provide care.

The basics of the term are clear, but what exactly does this kind of care entail for both the team and the patients?

Witnessing collaborative care

The Chronicle Herald visited a collaborative health clinic at the Community Wellness Centre in Spryfield to find out.

A round-table meeting was held in mid-September with two family physicians and a nurse, while the on-site psychologist and dietitian joined by phone.

At this location, there are a mix of full- and part-time staff that includes 10 family doctors, two family practice nurses, and eight other health professionals with expertise in mental health, clinic aid and internal medicine.

There are also 14 student residents, as it’s a training centre for Dalhousie Family Medicine.

For this team of professionals, “collaborative” begins with huddles.

Twice a day, they gather in a meeting room and go through the list of patients coming into the clinic.

Potential treatment options are suggested by anyone who can share their expertise.

Dr. Jennie Leverman said it’s important to support patients and match them with the most appropriate person who can provide that care.

Registered nurse Tammy Roode jumps in and assists wherever needed, which can include making referrals, and planning and co-ordinating care.

“It’s certainly non-hierarchal. We communicate very well across all the other disciplines because we all primarily have that same goal,” she said.

It also helps diagnose what psychologist Angela Cooper called “mind-body issues.”

“Emotions trigger just as many problems as a physical disorder,” she said via speaker phone.

She said doctors can get to the root of the problem by asking simple questions, like if someone is going through emotional stress.

Connected healthcare

When Cooper worked as a psychologist in England, she rarely consulted with a patient’s physician. “You miss so much by not having that connection,” she said.

But now, she notices that being part of a collaborative team cuts down on waiting times.

Dietitian Anne Riley agreed. “If I was just working in my own little bubble . . . it would be hard to get a fully, complete background of the person,” she said.

If a patient is looking to get the best head-to-toe care, then having a rainbow of health professionals at their disposal can’t be a bad thing.

That’s if the clinic is accepting new patients.

When this question is posed to the team at the Community Wellness Centre, the three professionals all looked at one another before responding.

“Our practice is currently closed to new patients,” said Roode.

The health authority says the clinic has about 4,200 patients.

“Currently we are flush,” said Leverman, adding that they took on many new patients about two years ago.

“We can adequately take care of the people that we have. We don’t have a lot of extra time to provide care for new patients.”

They will periodically review the number of patients they have, and if they think they can see more patients, then they will, at least temporarily.

New system meets an ongoing problem

This full patient load seems to be a rising trend across the board, and it coincides with another recent buzz phrase: “Doctor shortage.”

In September, health authority CEO Janet Knox said it still would be five years until every Nova Scotian had a doctor.

The health authority estimates about 10 per cent of the province’s population—roughly 100,000 people—is still without a doctor.

Their goal is to set up a fully functioning “health home” in every community across the province.

But for collaborative clinics in places like Chester or Sydney, recruiting doctors is not an easy task.

And if and when doctors are recruited, the funding for these clinics is not uniform.

Some are funded through the province’s “alternative funding” program that sends one lump sum for operations, while other’s have a move collaborative funding set-up.

The Spryfield clinic, for example, is funded by the Department of Health and Wellness, the Nova Scotia Health Authority and Dalhousie Family Medicine.

Most funding for physicians is provided through the Nova Scotia health ministry.

Funding for clerical staff and clinic infrastructure come from the health authority, while administrations and operations are paid by Dalhousie Family Medicine.

This team approach for funding creates unique care models, like the clinic’s service to marginalized communities such as Rockingstone Heights School.

Collaborative care a different experience for patients

But if soon-to-be patients are used to the traditional family medicine setup, and like to see the same physician repeatedly — they won’t get that here.

“It wouldn’t be your standard, one-on-one patient visit with your doctor every time,” Leverman said.

And Dr. Mandi Irwin said the patients know this going in.

It’s part of their new patient package.

“If that doesn’t work for a patient, if they don’t feel comfortable with that, then maybe they wouldn’t be patients here,” she said.

They all add that there are efforts taken to keep patients with the same doctor or resident.

It’s a unique setup, that both patients and staff benefit from.

“I always feel like I’m a part of the team,” said Roode.

“Except when (Dr. Irwin])is mean to me.”

Thedoctor breaks down in laughter. “Stop,” she says as everyone else in the room follows suit.

This teasing camaraderie continued throughout the meeting.

It’s a group-think mindset, one that is most obvious when they are faced with tricky questions.

They look at one another for feedback when asked if there are any challenges in their work environment before Leverman said, “It’s pretty good.”

But the one unavoidable downside to a team approach is that decisions are made collectively.

“You can’t direct, individually, something that you may want to change,” explained Leverman.

“Which is mostly a good thing, but you don’t have quite as much independence with that obviously as you would if you were out at a small group practice.”

When talking about their dream collaborative care clinic, they all mentioned physio and blood lab services as attractive additions.

But reality is treating them pretty good in the meantime.

“As family doctors, there are a lot of opportunities to work a lot of different places,” Irwin said.

“And certainly if we’ve chosen to work here it’s because we like it.”

Original publish date: Oct. 9, 2016

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