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G6 Navigation Through the Health System:  The Aboriginal Patients Journey - V. Stewart, A. Snow and J. Morgan
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G6 Navigation Through the Health System: The Aboriginal Patients Journey - V. Stewart, A. Snow and J. Morgan


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  • Welcome song by Agnes
  • Jenny: This session will capture the navigation of the health system from an Aboriginal Patients perspective. The session will provide the stories of patients journey’s from both the rural and urban viewpoint. In addition there will be discussion of programs, practices and strategic priorities implemented to enhance the Aboriginal Patients health and wellness journey.
  • Agnes to speak to introduce the topic of the Aboriginal Patient experience. Speak of her experience as a patient, what she has heard from her visits to Aboriginal communities About the importance of how the first person you see treats you and how that shapes the experience. Talk about access and gaps as she has heard them. Talk about understanding the many Nations in BC (205?). (52 in the North)Then talk about her role and how she works to improve access/care etc. Talk about the APL program as an imporant part of this.
  • Victoria: Also need to have our Aboriginal Health program and APL pamphlets there
  • Jenny on specifics of what the APL does. APN Program has been in VCH going onto 4 years now. Last year, was deemed a permanent program, after 3 years of a pilot project.
  • Jenny
  • Jenny on this gathering in Vancouver. A few points of shared concerns patients are experiencing?Annual conference. Each HA has its own APL. Each person can find out about their APLs
  • Questions: Treat you with respect and dignityEnough say about treatmentNurses and doctors did not talk in front of you as if you werent there
  • Initial referral came from the Prince George Regional Cancer Care Unit social worker, to the Vancouver Coastal Health Aboriginal Patient Navigator Program. Actions of the APN: received all the details of the patients travel arrangements, spoke to the patient travel clerk who was coordinating their flight and accommodations, confirmed time/location of medical appointments, met P1 and his wife at the Cancer Lodge in Vancouver, and accompanied them to his medical appointments that week. There were 5 appointments within a one week time frame.
  • P1 is still in Vancouver, Awaiting transfering him to the Fort St John’s hospital. The community home care nurse has been liaising with the APN on the discharge planning, and the APN will ensure to liaise with the Aboriginal Patient Liaison in the Ft St John’s hospital, to ensure continuity of care and support. Ongoing challenges: within the discharge planning, patient will require ongoing medical monitoring for post-op care, along with additional travel at a later date for cancer care treatment.
  • P2 was previously hospitalized in the Kamloops Royal Inland Hospital under similar circumstances.
  • Victoria
  • Victoria
  • Victoria
  • Agnes
  • Agnes
  • Agnes
  • Jenny
  • Agnes
  • Victoria
  • Victoria
  • Victoria:Strengthen the APL program:-APL Provincial initiative-Training-Community of Practice-Teleconference-APL and supervisor joint approachOngoing survey in field nowAdditional questions addedDiscussing data at AHICsAPLs planning approach to addressHSAs and DOC letter/1 pager
  • Agnes: open to questions
  • Transcript

    • 1. Quality Forum 2012Engage. Inspire. Lead. March 9, 2012 Four Seasons Hotel Vancouver, BC
    • 2. Navigation through the Health System: The Aboriginal Patients Journey Presenters:• Agnes Snow, Regional Director, Aboriginal Health Northern Health• Victoria Stewart, Lead, Aboriginal Health Engagement and Integration Northern Health• Jenny Morgan, Aboriginal Patient Navigator, Aboriginal Health Strategies Initiatives, Vancouver Coastal Health
    • 3. What we will cover• Aboriginal Patient Experience• Services in place to support this• Next Steps
    • 4. Navigation through the Health System: The Aboriginal Patients Journey• Aboriginal Patient Liaison Program
    • 5. Navigation through the Health System: The Aboriginal Patients JourneyJune McMullen Lillian LewisUniversity Hospital of Northern BC, Prince George Dze L Kant Friendship Centre, SmithersPhone: 250-565-2364 Phone: 250-847-5211 lillianr8lewis@msn.comAngie Combs Lyndsey RheaHazelton GR Baker Memorial Hospital, QuesnelPhone: 250-842-5211 Phone: 250-985-5812 Lyndsey.Rhea@northernhealth.caMelodie Johnson Bev LambertMills Memorial Hospital, Terrace Fort St. John/North PeacePhone: 250-638-4085 Phone: 250-262-5351 Bev.Lambert@northernhealth.caKen Solonas Yvonne TupperLakes District Hospital, Burns Lake Chetwynd/South PeacePhone: 250-692-2400 Cell: 250-692-6589 Phone: 250-788-7224 Cell: Yvonne.Tupper@northernhealth.caMary Wesley The role of the Aboriginal Patient Liaison is toPrince Rupert Regional HospitalPhone: 250-622-6520 facilitate Aboriginal peoples access to health care services that are culturally and linguistically appropriate and to increase the quality of care – Aboriginal patient experience.
    • 6. Navigation through the Health System: The Aboriginal Patients Journey• Aboriginal Patient Navigator ProgramAs a personal guide, the APN is there to helpthe Aboriginal patient and family with theirhealth care journey.A navigator acts as abridge between thepatient, communityand health care system
    • 7. Navigation through the Health System: The Aboriginal Patients Journey Dion Thevarge APN Team Leader and Aboriginal Patient Navigator• T: 604-875-5600 x 63292• E: Judy Mitchell Aboriginal Patient Navigator• T: 604-875-5600 x 63299• E: Jenny Morgan Aboriginal Patient Navigator• T: 604-875-5600 x 63290• E:
    • 8. Navigation through the Health System: The Aboriginal Patients JourneyAnnual Aboriginal Patient Liaison/Navigator Conference, Vancouver, November 2011
    • 9. Respect for patient preferences
    • 10. What else did we learn that was different about the perception of aboriginal respondents? Arrow represents statistically significant differences, at the 95 % confidence level, from your current score. Your current score is: higher or lower
    • 11. Aboriginal Results Inpatient Survey-Aboriginal Results Inpatient Survey – 2008 – Physical Comfort (pain control) - Individual Questions2008- Physical Comfort (pain control) Arrow represents statistically significant differences, at the 95 % confidence level, from your current score. Your current score is: higher or lower
    • 12. Aboriginal In Patient Survey Results - 2008There are five additional questions within the survey that alsoshowed statistically significant different (lower) results foraboriginal respondents in 2008 (although improved since 2005): NHA Respondents Non Aboriginal Question (Dimension or Theme) 2005 Score 2008 Score 2008 NHA Availability of Dr (Access to Care) 77.6% 77.7% 85.3% Knew who to call w/ questions (Continuity and Transition) 73.0% 76.2% 85.1% Dr/Nurse did not explain/say things differently (Coordination of Care) 67.4% 66.0% 74.6% Wait to go to room was not unnecessarily long (Coordination of Care) 71.9% 70.4% 79.6% Explained reason for wait in going to room (Information & Education) 85.9% 81.2% 88.0% Wanted more involvement in decisions (Additional Question) 47.6% 44.3% 67.4%
    • 13. Preliminary Results 2011/12 – new questions Visited by the Aboriginal Patient Liaison
    • 14. Preliminary Results 2011/12 – new questions
    • 15. Preliminary Results 2011/12 – new questions
    • 16. Navigation through the Health System: The Aboriginal Patients JourneyCase Example 1:Patient 1 (P1)Gentleman from a small isolated community past Fort St. John, BC.He and wife travelled from there to Pr George, then onto Vancouver.Required his wife to translate.Challenges/Barriers: Having to travel from their isolated community for the first time, language barrier, and having to coordinate medical appointments for possible cancer diagnosis.
    • 17. Navigation through the Health System: The Aboriginal Patients JourneyPrince George Vancouver
    • 18. Navigation through the Health System: The Aboriginal Patients Journey• Challenge/Barriers: Culture shock being in a new environment, not knowing how to navigate through the city, not familiar with the facilities as his appointments were at different hospitals and clinics.• P1 remained in Vancouver for a further 3 months undergoing cancer treatments.
    • 19. Navigation through the Health System: The Aboriginal Patients JourneyCase Example 2: Challenges and barriers, and success…Patient 2 (P2), is a single lady originally from Prince Rupert, BC, and was residing in Kamloops, she is in her late 50’s. Originally referred as a psychiatric inpatient in Vancouver with a bipolar disorder.Challenges: Needing to be referred to a mental health community facility, trauma related as one of her daughters was a missing woman from the “highway of tears” missing women in BC, and she recently ended a long term relationship.
    • 20. Navigation through the Health System: The Aboriginal Patients Journey• P2 was very catatonic, at times unresponsive. After approx. 1.5 months as an inpatient and noticeable improvement, she was discharged to a mental health group home, where supports were available.• APN action: accompanied P2 to her mental health worker appointments, doctor follow up appointments, and kept in contact with her mental health team on planning and medication changes.
    • 21. Navigation through the Health System: The Aboriginal Patients Journey• Keys to success:Accompanied to alcohol/drug counseling for trauma issues.Patient referral to residential treatment program.Patient received news her daughters remains were found, patient traveled to attend funeral.Patient felt supported during her recovery.
    • 22. Navigation through the Health System: The Aboriginal Patients Journey• P2 returned from the funeral, and appeared to have had closure, and was optimistic of her recovery and moving on with her treatment plan.• Within a few months, P2 was set to travel to Vancouver Island, to attend a residential treatment program.• She expressed her gratitude and felt strongly she could not have achieved this level of recovery without the assistance of the APN program.
    • 23. APL Evaluation Northern Health Colleague survey (n=14) Liaison interviews & survey (n=7) Patient interviews (n=10)
    • 24. 100% of patients felt…• Their health concerns were heard better• They were more comfortable with the health care received• Their health care needs were met Lillian with a patient
    • 25. Highlights – Colleague Survey• 93% felt important to have a APL in the community to support improvements in health care of Aboriginal people• 73% Felt APLs improved Aboriginal people’s access to care Yvonne Tupper and• 75% felt APLs improved patient partnerships
    • 26. APL Evaluation Most Significant OutcomesPatient Outcomes Provider Outcomes • Patient Satisfaction and • Improved communication comfort between patients, • Patient knowledge and communities and understanding providers • Continuity of care • Increased awareness of System Outcomes Aboriginal health issues • Increased collaboration and barriers • Improved use of resources • Increased cultural • Reductions in health care competence gaps
    • 27. Other things we are doing…
    • 28. Listening to Community• Listen to community as they express their experiences with the health care system• Learn as communities share their local culture Terrace and area AHIC
    • 29. Partnering with First Nations Health Council• On May 26, 2011, First Nations in British Columbia passed a historic resolution to assume greater control and decision-making over their health and wellness.• Tripartite relationship between Provincial, Federal and First Nations FNHC – Brian Mairs with• For more info: NH – Agnes and Victoria
    • 30. On-line Indigenous Cultural Competency Program • Designed to increase Aboriginal- specific knowledge, enhance individual self awareness and strengthen skills for health care professional working directly or indirectly with Indigenous people • To register:
    • 31. Aboriginal Health Conferences• 3 conferences each year• One in each of the NW, NE and NI• Planned by the local AHICs Old Massett at the Conference
    • 32. Aboriginal Health Improvement Committees Evaluation: Most Significant Outcomes• Increased awareness of • Enhanced service delivery – local Aboriginal Health issues including access – each others health service • Cultural competency realities • Aboriginal Patient Liaison• Enhanced positions communication, relationships, tru st and collaboration AHIC Gathering 2010
    • 33. Communication• Newsletter• Website• http://www.northernhe riginalHealth.aspx
    • 34. Opportunities for Ongoing Improvement• Strengthen the APL program• Ongoing survey in field now• Building upon our Indigenous Cultural Competency strategy• Deepen the work of Aboriginal Health Improvement Committees• Recruitment Christa a NH Chronic Disease Nurse Educator
    • 35. For More Information:• Jenny Morgan: 604-875- 5600 x63290• Agnes Snow: 250-649-4812• Victoria Stewart: 250-622- 6303 All Native Basketball Tournament Prince Rupert 2012