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Sudbury District Nurse Practitioner Clinics <ul><li>An Innovative Community Solution </li></ul><ul><li>Mary Geroux, NP-PHC...
SDNPC <ul><li>Who?   What? Where? When? Why? How? </li></ul><ul><li>Challenges/Successes </li></ul><ul><li>Managing Patien...
Who are we? <ul><li>Canada’s first NP led clinic </li></ul><ul><li>3 sites: Sudbury (2800), Lively (1600), Chapleau (6 out...
Who are we? <ul><li>5.5 NPs  </li></ul><ul><li>2 physicians (22 hours per week) </li></ul><ul><li>Consulting pediatrician ...
What is a NP clinic? <ul><li>Group of NPs coming together to form not for profit corporation </li></ul><ul><li>Board of Di...
What do we do? <ul><li>Full scope comprehensive primary health care that reduces numbers of “orphan patients” </li></ul><u...
Sudbury District Nurse Practitioner Clinics Chapleau Lively
When & Why? <ul><li>Tens of thousands of Sudburians without access to care </li></ul><ul><li>8 unemployed NPs </li></ul><u...
How? <ul><li>Marilyn Butcher & Roberta Heale </li></ul><ul><li>Vision created over time during practice   experiences  ( W...
Sudbury District Nurse Practitioner Clinics
Process <ul><li>Intake form is completed, reviewed by the director with input from NPs & MDs </li></ul><ul><li>Large major...
Managing patients within the Team <ul><li>Patients generally see “their NP”  </li></ul><ul><li>NP is patient navigator/cas...
Referrals <ul><li>Patients are mainly referred to other team members  </li></ul><ul><li>Specialist referrals need to be co...
Challenges <ul><li>Complex/high needs patients who have not been accepted by family practices and have attended walk in cl...
More Challenges <ul><li>Physician compensation </li></ul><ul><li>Current method of payment not supportive; not lucrative <...
Successes <ul><li>Full support of government </li></ul><ul><li>Announcement of next 12/25 NP led clinics based on our mode...
Sudbury District Nurse Practitioner Clinics
Impact/Outcomes <ul><li>Addressing the orphan patient population </li></ul><ul><li>7% ↓ in volume of ER visits, directly a...
Impact/Outcomes <ul><li>Detection of previously undiagnosed chronic diseases (ie. DM, HTN, Chol, cancers) </li></ul><ul><l...
What does the future hold? <ul><li>Much promise!! </li></ul><ul><li>Increasing support for this model of care </li></ul><u...
YWCA Women of Distinction Award 2009 Sudbury District Nurse Practitioner Clinics
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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 &amp; 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 of "Mary Geroux"

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