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Marina Afanasyeva1, Elizabeth Muggah2, Cleo Mavriplis2, Manon Bouchard2, Rosamund Lewis1, Sharon Johnston2,

Helga Ehrlich2, Jay G Mercer2, Debbie McGregor2

Development of a

Nurse-Led Periodic Health Visit to Promote Evidence-Based Preventive Care for Adults

19, 2014

1 Ottawa Public Health

2 Bruyère Academic Family Health Team

Disclosure of Commercial Support CFPC Conflict of Interest

Presenter Disclosure

Presenter: Marina Afanasyeva Relationships with commercial interests: • Grants/Research Support: None • Speakers Bureau/Honoraria: None • Consulting Fees: None • Other: None

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• Origins

• Objectives

• The format of the new model of periodic personal health visit

• Pilot project: methods and results

• Lessons learned

• Summary

Public Health / Primary Care Project

Outline

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• Many traditional elements of the annual physical examination are ineffective in preventing disease in healthy people

• Moving away from ‘one size fits all’ towards individualized approach

• MOHLTC now funds a periodic personal health visit once a year for healthy people instead of the old annual physical examination

Public Health / Primary Care Project

Origins of the Project:

Shift Away from Annual Physical for All

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How the Project was Created

•Emerging evidence, changing patients’ needs, and changing billing codes have spurred the review of how routine preventive health care is delivered •Historically the annual physical has been done by physicians •The team read literature and brainstormed •The decision was made to incorporate team-based approach

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• Shift towards team-based care through greater involvement of nurses and allied health professionals

• This trend has been reflected in the creation of Family Health Teams

Public Health / Primary Care Project:

Origins of the Project: Towards Team-Based Care

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Advantages of Team-Based Care

• Comprehensive and improved care for patients • Leveraging the skills of various types of health professionals • Optimization of human resources in the most cost-effective way

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Overall Project Objectives • Develop a model of periodic personal health visit

• Patient centred • Based on the latest evidence • Standardized across all health care providers • User friendly

• Utilize team-based care

• Emphasize individualized approach (according to individual risk factors and

concerns)

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• 30-min visit with a nurse (ultimately 15 min) History and counselling (based on risk factors) Based on a checklist template

• Nurse – physician handover

• 15-min visit with a physician

• focus on issues raised by a nurse • address additional patient’s concerns

The New Model of Periodic Health Visit: Using a Nurse – Physician Team

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• Different templates for different ages and sexes

• Follow the latest preventive medicine guidelines

• Incorporated into an electronic medical record system • Practice Solutions (Telus)

• Ensures standardization across all health care providers

Checklist Template

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Pilot Project

• Understand the benefits and challenges of the new model • Identify gaps • Improve the model

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• Quality indicators (rather than performance indicators)

• Process indicators (rather than outcome indicators)

Methods: Quality Improvement Research

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Methods: Indicators

• Patient satisfaction

• Health provider satisfaction • Physicians • Nurses

• Comparison to the old annual physical exam

•For patients and for health care providers •Likert scale

•Qualitative data from open-ended questions

• Was there anything in your last annual physical examination or “check-up” that you liked and was missing in today’s visit? Please specify ________________

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Methods: Questionnaires

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Pilot Results: Patient Satisfaction

11 patients The most satisfied group! Gaps identified: French version was missing

Questions Overall Agreed Number (%)

Strongly Agree Number (%)

Did not answer

My concerns have been addressed

11 (100%) 10 (91%) 0 (0%)

Prefer the new structure 9 (100%) 4 (44%) 3

• 5 physicians • All preferred the new format • Positive feedback: 4 of 5 appreciated the fact that they could focus only on the issues identified by a nurse and on the new complaints • Negative feedback: checklist templates are wordy and need work

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Pilot Results: Provider Satisfaction Physicians

• 2 nurses • Less enthusiastic ratings compared to physicians • Positive feedback:

Enjoyed the opportunity to interview and counsel patients Enjoyed participating in the pilot

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Pilot Results: Provider Satisfaction Nurses

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• Negative feedback/suggestions for improvement:

Checklist templates are not user-friendly

Nurses should be involved in the development of templates

Challenges incorporating the new model into the current nurses’ schedule/workload

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Pilot Results: Provider Satisfaction Nurses

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Lessons Learned / Future Directions

• Patient satisfaction: positive response from patients – French questionnaires

• Provider satisfaction: overall prefer the new format • Future directions

• Work on templates • Involve nurses in planning • Adjust nurses’ schedule to accommodate the new model

• Test on more patients of different age groups, health status etc. • Review… improve … implement…

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Public Health - Primary Care Collaboration: Lessons

Primary Care • Improve patient care

• Develop a new model of

team-based patient-centred efficient periodic health visit

Public Health • Promote health • Prevent disease

• Enhance risk

factor detection

• Collaborate with primary care

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Public Health - Primary Care Collaboration: Lessons

Primary Care

Boundary Spanner • Functions as liaison • Interested in learning the ‘other’ discipline

Collaborative Project Public Health