Making Rural Primary Care Delivery Work: For Patients, For Providers, For Governments

Transcription

1 Making Rural Primary Care Delivery Work: For Patients, For Providers, For Governments

2 Geography is an Indicator of Health Roy Romanow 2002 Advanced Age Seasonal Work Low Income Low Education Few Support Services Isolation Lack of Affordable Housing

3 Rural Population in Canada Rural = 35% ( up 2% over 2006 census ) Urban = 65% 100% Iqualuit City (pop=6699) 23.2% 53.6% 51.7% 12.4% 19.4% 39.1% 31.9% 11.3% 19.6% 42.2% 38.9% 34.9% Statistics Canada 2011 Census

4 Rural Funding Of the Federal Governments Health Transition Fund: $150 million for 140 projects $14 million (just under 10%) was earmarked for 27 projects (just under 20%) with a rural and remote focus. Health Canada 2011

5 Accessing Health Services

6 The Fixable Problems. Focusing on acute care Funding a model of illness management Focusing on institutionalized care Funding physicians for primary care Funding pharmaceuticals as first line management of chronic disease Avoiding use of technology in primary care Under-funding homecare

7 Consider This

8 Nursing Stations: Not Just for the North

9 History of Nursing Stations in Canada

10 Modern Nursing Stations in Canada

11 Parry Sound Nursing Stations Hospital Nursing Stations

12 NP Nursing Station Model Buildings, Donations, In-kind Operations NP Station Funding, Grants

13 2013 RNAO Resolution: In Support of Nursing Stations WHEREAS: RN managed Nursing Stations have been a model of care in Ontario for 100 years, and Nurse Practitioner-managed Nursing Stations have been a model of care in Ontario for 35 years, serving 22,000 patients annually; and WHEREAS: funding to recruit and retain Nurse Practitioners and Registered Nurses in Nursing Stations has lagged behind other models of care; and WHEREAS: Nurse Practitioner and Registered Nurse-managed Nursing Stations have been shown to increase access to care for those in remote and rural parts of Ontario; THEREFORE BE IT RESOLVED THAT RNAO advocate for the sustainability of Nursing Stations as a viable model of care in Ontario, through increased funding for Nurse Practitioner and Registered Nurse positions.

14 Scope of Practice RN NP MD Specialist Diagnosis and Treatment Allied Health Care Providers

15 Top of Scope Family MD Primary Care Specialist

16 NP Nursing Station Model

17 Inter-Connected through Technology Nurse Practitioner Managed Nursing Station Specialists

18 Type of Care Provided 33% 25% 20% 22% Preventative Curative Diagnostic Supportive

19 Patient Acuity: ER/Nursing Stations ER Triage Score (7% Unknown) Percent Nursing Station Acuity Percent 1 - Resuscitation.02% 1 Life Threatening 0% 2 - Emergent 5% 2 - Emergent.09% 3 - Urgent 27% 3 - Urgent 2% 4 Semi-Urgent 53% 4 - Complicated 21% 5 Non-Urgent 7% 5 Episodic/Chronic 77% Total Patients seen in the WPSHC ER ,126 Total Patients seen in six Nursing Stations ,240

20 Hospital Usage by Postal Code Region by Postal Code Town of Parry Sound # NP s/md s 3 NP 15 MD s 2011 Census ER Visits ER visits/ year/ person Hospital Admissions 65+ years Re- Admissions Within 30 Days Georgian Bay 1 Part Time NP Seguin 1 NP Whitestone 1 NP (3 months no NP) Archipelago 1 NP Central West 1 NP McDougall No Health Care Providers

21 Conclusions Reduced: Wait times for primary care Visits to the ER Hospitalizations for chronic illness Increased Access to health care for rural seniors Opportunities to Age in Place Monitoring for compliance with treatments and health outcomes Collaboration with all health care providers Opportunities for health teaching and illness prevention Continuity of care and advocacy Understanding of patients living conditions and support system Compassion Accountability Rights and Responsibilities Excellence

22 Recommendations Change Family Doctor title to Primary Care Specialist to promote top-of-scope functioning. Enable Nurse Practitioners and RN s to work in their full scope of practice. Implement NP Managed Nursing Stations as a model of primary care delivery in rural areas throughout Canada for a collaborative, sustainable, and accessible, method of entering the health care system. Compassion Accountability Rights and Responsibilities Excellence

23 Questions Thank you! Donna Kearney, BScN, RN(EC), MHST West Parry Sound Health Centre Compassion Accountability Rights and Responsibilities Excellence