| Nurse Practitioner-Led Clinics. An Idea that can change everything. |
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So much has happened since Marilyn Butcher and I were given the opportunity to develop and open Canada's first NP-led Clinic that we often don't have an opportunity to sit back and reflect upon the impact of the Clinic. For that reason, I'm particularly excited about this new Blog site. We will be posting the thoughts of not only the Clinic Board members and Staff, but also of community members who have been touched in some way by this model of primary health care. Now...to the interesting part. I'm thrilled to introduce Gisèle Guénard our first Guest and first Blogger.
Roberta Heale, President of the Board of Directors, Sudbury District Nurse Practitioner Clinics
There are those who fear change, and those who will remain uninformed about the fact that NP-led clinics are an effective and key part of the solution to our access to care problem, within the reach of many communities, and need to be supported. This is a model where the NP can practice her or his full scope of skills, and emerge as a major player in the transformation of our health care system. When Marilyn Butcher and Roberta Heale, the NPs who spearheaded the first clinic (now operating in Sudbury Ontario, and caring for 2000 patients who did not previously have access to a ‘family doctor’ – yes I said 2000…) first approached me with their idea, the hair stood up on the back of my neck. I thought – here it is … An Idea that can change everything. You see, my Mother, in her late eighties, frail, wheelchair-bound and blind, with a major heart block to boot, lost her family doctor. He died, and so I and my two daughters were in the same boat. I am a Registered Nurse and was a busy nursing professor at the time. The three of us were young and healthy, but I knew what our doctor’s death meant for my elderly Mum. With no primary care, she was now at higher risk of becoming ill, and ending up ‘ALC’ or worse. Our community was already in a doctor shortage, and though I tried, no physician would ‘take her’ – she was ‘too heavy’. At 90 pounds soaking wet, what this meant was ‘too many health problems’. Stunned, I was relieved when a francophone community clinic, which had NPs, agreed to take her. These kind and gentle NPs, and occasionally the like-minded physician, looked after her for a time, until the day came when she required full-time care in a long-term care facility. Without those NPs, I would have had to cart my helpless, blind, ‘never wanted to be a bother to anyone’ Mum, from walk-in clinic to walk-in clinic, or to overcrowded Emergency department, to face a new doctor every time, for all her prescription renewals, and every new health problem she would eventually face. Those NPs gave her back her dignity, care, and most of all, hope. Five years later, I was finally ‘adopted’ by a very caring physician. My daughter and baby grandson are now patients of an NP, and have never had complex health issues requiring a family physician as yet. Through a complex pregnancy, my daughter was followed by an obstetrician, as any other patient would be. So - what if you have something more serious and need a doctor? The collaborating physicians of the Sudbury District Nurse Practitioner Clinics (SDNPC) are there when any of the 2,000 current patients need their advanced skills. The same collaborations will be in place at the clinic’s 2nd site when it opens in the fall of this year, 2009. Approximately 4500 patients will eventually be cared for by these two sites. That is 4,500 out of the 30,000 currently without primary care in our community – nothing to sneeze at. Many of the NP’s patients are people with serious chronic illness, multiple conditions, injuries, mental health and physical ailments of all types. They are people like you and I, of all ages – babies, new mothers, people with diabetes, sexually transmitted disease and other infections, people needing family planning, cancer care, end-of-life care and diagnostic exams of all types. Their NP can order the xRay, the ultrasound, the blood tests, the prescriptions, and refer you to the physician or specialist you need, when you need her or him. The list of ‘what they are allowed to do’ is a long and growing one, enabling the physicians who work with them to focus on more complex and critical cases. The NP-MD collaboration is a key element of the model. Nurse Practitioners have been providing care under the ‘Extended Class’ category ( see http://www.cno.org ) for many, many years. Theirs is a tried and proven scope of practice expansion, which is already part of successful, sustainable health care here and in other countries. Canada is now leading further primary care reform, with this NP-led model. The forward-thinking planners in Ontario’s Ministry of Health and Long Term Care (MOHLTC) are to be commended for launching this patient-centered initiative. 25 NP clinics are planned for Ontario, where well over 500,000 people do not have access to primary care. With the capacity to carry a patient load of 800 patients in an NP-led setting, even if each of these new clinics had only 3 NPs, the orphan patient issue in Ontario would virtually be eliminated in short order. The logic goes on. NPs are also a cost-effective solution to primary care, and their full-tilt team approach combined with the ‘nursing care’ model is proving to be highly satisfactory to the patients at the Sudbury clinic. They love it! Ontario’s new NP clinics will be staffed by seasoned, experienced NPs, as well as newer graduates, just as would be seen in all fields of practice. My family members have had care from new and experienced doctors and NPs, all with excellent results. The MOHLTC is including physicians as part of the NP clinic model, and many physicians are looking to team up with the clinics already. As a multi-disciplinary group, NP clinics can enroll and provide high-quality comprehensive care for many more patients than a physician in a stand-alone clinic, or an NP working for a physician could possibly do safely. The opportunity to help patients learn to manage their own health in a much more successful way is greater by far. Physicians in communities where NP clinics will be opened can look forward to a new partner in caring for the people of their area. They may seek to join the new teams as collaborating physicians, or look to re-opening their rosters to new patients, or perhaps re-entering the field of in-patient care, where the need is becoming critical. Many hospitals, who can ill-afford it, are forced to pay out of global budgets for hospitalist physician programs, due to a dearth of physicians willing or able to do in-patient hospital care. NPs always have a collaborating physician to work with when required, enabling patients to access more specialized care if needed. Though many physicians do not have hospital privileges, the NP-MD team approach here ensures patients have access to specialists, who can initiate hospital in-patient care when needed, should the clinic physician not have hospital privileges. Similar issues are at play in communities where Family Health Teams (FHT) are now operating. FHT’s are another positive initiative in the province of Ontario, and are developing with many physicians bringing their existing practices within the FHT model, and some taking on new patients. Newly graduating physicians are gravitating en masse to team models. At the announcement for the 2nd clinic in Lively, Ontario, I listened to several guest speakers, and was struck by the non-partisan statements I heard from everyone. At times, there was not a dry eye in the house. Even the politicians focused on the wisdom of this decision by the MOHLTC, as well as the undeniable health benefits coming to this under-serviced community and its most vulnerable residents. The standing-room only crowd, largely seniors - many of whom had been orphan patients for years, was clinging to every word – in the hope … the hope – that finally, someone would be there for care for them, to help them stay or get healthy again. My work is positive change, and I know this is a new day in Ontario - a new day for the people of Canada. An audacious vision for positive change, held by two Nurse Practitioners, who knew it could be, has become a reality. Another key piece of the health care puzzle has been found – it fits, and this, truly, is One Major Positive Change.
3.26 Copyright (C) 2008 Compojoom.com / Copyright (C) 2007 Alain Georgette / Copyright (C) 2006 Frantisek Hliva. All rights reserved." |
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