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Mary Geroux

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  • Clinic Logo: Colour waves represent NPs, other health care providers, and administration The white waves represent individual, family & community The black outline represents the goal of optimal health Waves circling around each other and meeting in the centre indicates that each has autonomous decision-making but works collaboratively with the other Dark Blue = water; Light Blue = sky; Green = forests; and this represents the Sudbury District!
  • What sets a NP led clinic apart from the rest is in the governance.
  • Northern Ontario Sudbury (300km E of SSM; 390 km N of Toronto), Lively (20 km W of Sudbury),Chapleau (410 km N of Sudbury)
  • When patients are registered to the clinic instead of rostered to a physician, if and when a physician leaves, that patient remains under care of their NP. Patients do not have access to book with physician directly
  • David MacNeil – VP Clinical Services SRH Bill 179:Regulated Health Professions Statute Law Amendment Act, 2009 (“Bill 179”), which received Royal Assent on December 15 th , 2009. Bill 179 decreases barriers, increases access to primary care by expanding scopes of practice of certain regulated health professions. New NP clinics will continue to increase access to primary care
  • 6 month clinic evaluation: Satisfaction survey, overall high to very high satisfaction with service provided
  • Transcript

    • 1. Sudbury District Nurse Practitioner Clinics
      • An Innovative Community Solution
      • Mary Geroux, NP-PHC
    • 2. SDNPC
      • Who? What? Where? When? Why? How?
      • Challenges/Successes
      • Managing Patients Within the Team
      • Impact/Outcomes
      Sudbury District Nurse Practitioner Clinics
    • 3. Who are we?
      • Canada’s first NP led clinic
      • 3 sites: Sudbury (2800), Lively (1600), Chapleau (6 outreach Well Women clinics/year)
      • Bilingual Services
      • Multidisciplinary Team: NPs, MDs, RN, Pharmacists, Social Worker, Dietician
      Sudbury District Nurse Practitioner Clinics
    • 4. Who are we?
      • 5.5 NPs
      • 2 physicians (22 hours per week)
      • Consulting pediatrician (5 hours per week)
      • Pharmacist (15 hrs per week)
      • RN (40 hours per week)
      • Support staff (Office manager, medical secretary)
      Sudbury District Nurse Practitioner Clinics
    • 5. What is a NP clinic?
      • Group of NPs coming together to form not for profit corporation
      • Board of Directors includes 51% NP representation.
      • Develop board bylaws that are respectful of collaborative practice and patient centered
      • NP at Director level
      Sudbury District Nurse Practitioner Clinics
    • 6. What do we do?
      • Full scope comprehensive primary health care that reduces numbers of “orphan patients”
      • Target underserviced populations
      • Interdisciplinary Practice
      • Programs (Why Weight?!, Diabetes Education, Spirometry)
      • Partners with the community (Lively Highschool)
      Sudbury District Nurse Practitioner Clinics
    • 7. Sudbury District Nurse Practitioner Clinics Chapleau Lively
    • 8. When & Why?
      • Tens of thousands of Sudburians without access to care
      • 8 unemployed NPs
      • Formal submission to government Feb 2006
      • MOHLTC announced clinic in Nov 06, clinic doors opened in August 2007
      Sudbury District Nurse Practitioner Clinics
    • 9. How?
      • Marilyn Butcher & Roberta Heale
      • Vision created over time during practice experiences ( Working, lobbying, writing proposals, introducing role to communities & agencies)
      • Solicited support from municipal leaders, nursing organizations and media
      • Public responded positively
      Sudbury District Nurse Practitioner Clinics
    • 10. Sudbury District Nurse Practitioner Clinics
    • 11. Process
      • Intake form is completed, reviewed by the director with input from NPs & MDs
      • Large majority of patients are accepted
      • Patients registered to clinic as an entity (not rostered to a physician or the clinic)
      • Intake appointment scheduled with an NP
      • After intake, patients are scheduled for a physical exam and may be sent for investigations/tests
      • We cannot take everybody
      Sudbury District Nurse Practitioner Clinics
    • 12. Managing patients within the Team
      • Patients generally see “their NP”
      • NP is patient navigator/case manager
      • Physician functions as primary health care specialist, seeing patients referred to them by the NP; follow-up may continue until problem is resolved or patient is stable
      • Many complex patients are co-managed
      • Pharmacist and RN
      Sudbury District Nurse Practitioner Clinics
    • 13. Referrals
      • Patients are mainly referred to other team members
      • Specialist referrals need to be co-signed by physician due to a payment discrepancy – this can cause unnecessary delays
      • Many community programs - where the specialist is under a different payment model - do not require a co-signature
      Sudbury District Nurse Practitioner Clinics
    • 14. Challenges
      • Complex/high needs patients who have not been accepted by family practices and have attended walk in clinics for years
      • Chronic diseases with many co-morbidities, complications, mental illness, developmentally delayed, elderly, low socioeconomic status
      Sudbury District Nurse Practitioner Clinics
    • 15. More Challenges
      • Physician compensation
      • Current method of payment not supportive; not lucrative
      • OMA/colleague pressure
      • MD support is key
      Sudbury District Nurse Practitioner Clinics
    • 16. Successes
      • Full support of government
      • Announcement of next 12/25 NP led clinics based on our model
      • Not reorganization of existing practices, addressing orphan patients
      Sudbury District Nurse Practitioner Clinics
    • 17. Sudbury District Nurse Practitioner Clinics
    • 18. Impact/Outcomes
      • Addressing the orphan patient population
      • 7% ↓ in volume of ER visits, directly attributed to ↑ access to primary care
      • High profile NP clinics important for Bill 179
      Sudbury District Nurse Practitioner Clinics
    • 19. Impact/Outcomes
      • Detection of previously undiagnosed chronic diseases (ie. DM, HTN, Chol, cancers)
      • Clinic evaluation done after 6 months
      • MOH evaluation last year, results pending
      • Outcome evaluation later this year
      • Historic system change, grassroots, nursing initiative
      Sudbury District Nurse Practitioner Clinics
    • 20. What does the future hold?
      • Much promise!!
      • Increasing support for this model of care
      • Additional NP clinics
      • Bill 179
      Sudbury District Nurse Practitioner Clinics
    • 21. YWCA Women of Distinction Award 2009 Sudbury District Nurse Practitioner Clinics

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