SUCCESSShowcasing the power of Primary Care Networks in Calgary & area.

Network

SUCCESSShowcasing the power of primary care networks in Calgary & area

Network

Issue 2 / Publishing: March, July, and November 2012.

Issue 2INTERDISCIPLINARY

APPROACH TOMENTAL HEALTH

ORAL HEALTH INITIATIVE

SUPERVISED EXERCISE PROGRAMS

Pan PCn Calgary & area OPeratiOns COmmittee

Bow Valley PCnYvette Penman Calgary Foothills PCnLaurie BrochuLorraine BucholtzDr. Bill HallDr. Rick Ward

Calgary rural PCnDr. Les Cunning Calgary West Central PCnDr. Jane BallantineDan Doll Highland PCnDr. Sheri Lupul mosaic PCnDr. Oliver DavidJason Shehner south Calgary PCnDr. Ernst GreyvensteinMina Sisodiya

Message from Dr. Ernst Greyvenstein

In the past three months since our first edition of the Network Success magazine, our PCN landscape was characterized by uncertainty. We have reached an agreement in principle (AIP), as communicated by Dr. Slocombe in her president’s letter dated March 21, 2012. This desperately-needed funding increase of $12 per patient/year allows us as primary care networks to enhance our services and further expand access to quality primary care in our PCNs.

The provincial election has raised some questions regarding the way primary care will be delivered in Alberta, and how PCNs will fit into the political platform promises. Campaign promises sparked heavy criticism from the Calgary and area physician leads (CAPPAC) in recent months, and this reaction emphasized the support that PCNs have from our physician leaders, physician partners and team members.

More than ever before, PCNs have a responsibility to create an awareness of the remarkable changes we have brought about, leading primary care reform and supporting the medical home model by utilizing interdisciplinary team members.

In showcasing primary care networks’ successes, we hope that this, and future editions of this magazine, will confirm that PCNs are the future of primary care in this province, and that the collaborative efforts with all our partners are in the best interest of our patients.

Dr. Ernst GreyvensteinMedical Director, South Calgary PCN

INTROINTRO

alberta Health servicesDr. Ted BraunSheena CliffordPeter RymkiewiczChris Wood

editor Stephanie Baker

art DirectorAngela Bradley

PublisherJim Thornton

Contributing WritersDr. Bryan CummingsDr. Cynthia LandyDr. Ernst GreyvensteinHolden BakerMarilyn Duncan-WebbMatthew McTaggartMeghan PrevostSilvia Pikal

Intro EditorialDr. Ernst Greyvenstein

Web RegistryPan PCN

Pain Management ClinicCalgary Foothills PCN

Interdisciplinary Approach to Mental HealthHighland PCN

Geriatric Assessment & SupportCalgary West Central PCN Oral Health InitiativeMosaic PCN

Breastfeeding ClinicSouth Calgary PCN

Supervised Exercise ProgramBow Valley PCN

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Published for Pan PCN Calgary & Area Operations committee by:

Paragon Publishing Inc.Calgary, Alberta403.287.9818ads@paragonpublish.comwww.paragonpublish.com All rights reserved ©2012. Printed in Canada.

Member of the Canadian Federation of Independent Business

The Pan PCN Calgary and Area Operations committee would like to thank Pfizer Canada for their assistance in printing this medical commu-nication publication.

The Pan PCN Calgary and Area Operations com-mittee would like to thank Boehringer Ingelheim (Canada) Ltd.for their assistance in printing this medical communication publication.

boehringer-ingleheim.com

WEB REGISTRYWEB REGISTRY

Pan PCN

ince September 24, 2010, the pan PCN Web Registry program has connected approximately 8,000 patients with a family physi-cian in their community. The program is designed to address the health needs of individuals without a physician by connecting them to a family physician and additional health services through their primary care network. Participating PCNs include Calgary Foothills, Mosaic, Calgary West Central, South Calgary, Calgary Rural, Highland and Bow Valley PCN.

“Approximately 250,000 people in the greater Calgary area do not have a family doctor,” says Dr. Rick Ward, Calgary Foothills PCN medi-cal lead. “The Web Registry is an opportunity for PCNs in Calgary and surrounding area to better understand the health needs of this population and address them on a local level.” Individuals register online at www.needadoctorcalgaryandarea.ca. ~ Meghan Prevost

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unattached patients in Calgary and area were connected with a family physician.

8,000of registrants were without a family doctor for under a year.41%

of registrants had one or more chronic conditions.27%of registrants required an annual physical exam.65%

of registrants were without a family doctor for over a year.56%

he Calgary Foothills PCN Pain Management Clinic was established in 2009 as a means to increase access to care for patients suffering from neuro-musculoskel-etal chronic pain. Developed in partnership with the Alberta Health Services Chronic Pain Centre (CPC),

the Pain Management Clinic’s two primary objectives include increas-ing access to comprehensive and interdisciplinary chronic pain care, as well as increasing support to family physicians caring for patients with chronic pain in their community practices.

Before the establishment of the Pain Management Clinic, the wait-ing period for patients seeking care at the CPC was approximately 18 months to two years. Between 2008 and 2010 there was a ten per cent drop in Calgary Foothills PCN referrals to the CPC. The current wait list for the Pain Management Clinic is two months.

At the core of the Pain Management Clinic is the interdisciplinary team, consisting of a family physician lead, chronic pain lead, behav-ioural health consultant, pharmacist, health management nurse, physiotherapist, kinesiologist, shared mental health consultant and registered dietitian. Considered an extension of the family physician’s care by supporting the medical home and its core team, the Pain Management group promotes patient education and self-management through goal setting, education and focused partnership.

New patients attend the Pain Management Clinic’s Explain Pain and Goals group appointment, which provides information on the impor-tance of pain management and prepares patients to actively engage in self-management. Patients can use online pain education resources, community pain classes and in-house group sessions depending on their own needs and interest. Regular individualized follow-up with appropriate Pain Management team members is arranged to assess the patient’s progress and to adjust their goals towards improved pain management. Once the patient has completed the program or has achieved their goal, they are integrated back into the community through their medical home and family physician.

The interdisciplinary team has integrated care across many traditional boundaries. The team’s successful partnership with a private physio-therapy clinic crosses the boundaries between private enterprise and public health services. Individual team members’ comprehensive approach with patients also breaks down the traditional boundaries between physical health care and mental health care. In addition, con-stant collaboration occurs through hallway consults, patient rounds and tele-consults with family physicians to ensure the best care and the most efficient use of resources.

The Pain Management program also includes many different resources to support family physicians and their core team who are providing chronic pain care for patients in their own practices. The pain special-ist and the chronic pain lead offer Lunch and Learn sessions in PCN physicians’ offices. The goal of these sessions is to provide PCN physi-cians and health professionals with an opportunity to ask questions, review patient case studies and discuss current updates in pain man-agement. In a 2010/2011 physician survey, 71 per cent of respondents agreed that the Calgary Foothills PCN has improved their ability to address chronic pain.

~ Matthew McTaggart

MULTIDISCIPLINARY PAIN TREATMENT CLINICS

Calgary Foothills PCN Pain Management ClinicAvailable to patients of Calgary Foothills PCN member physicians by referral only. P: 403.374.0244

AHS Chronic Pain CentreP: 403.943.9900 www.albertahealthservices.ca/2790.asp

University of Alberta, Multidisciplinary Pain CentreP: 780.407.8638

PRACTICE GUIDELINES

National Practice Guidelines for the Safe and Effective Use of Opioids for Chronic Non-Cancer Painhttp://nationalpaincentre.mcmaster.ca

PAIN ASSOCIATIONS

Canadian Pain Societywww.canadianpainsociety.ca

PAIN MANAGEMENT CLINICPAIN MANAGEMENT CLINIC

Calgary Foothills PCN

Network Success Magazine 5

Network Success Magazine 7

hysical and mental health are fundamentally linked but are usually addressed separately within the health-care system, according to the Canadian Mental Health Association. With a reduction in physical and mental functioning that can accompany mental illness, patients

are faced with additional challenges when attempting to overcome chronic conditions. It may be difficult for patients to continue with exercise, healthy eating and proper medication.

Interdisciplinary teams address multiple patient needs, including mental health, which allows patients to manage their conditions more effectively. The Highland PCN has seen great success with providing a holistic approach to patient needs. Interdisciplinary teams were imple-mented within Highland PCN in 2008. The Highland Complex Care Clinic in Airdrie takes advantage of the interdisciplinary approach to treat patients. Michelle MacDonald, a clinical pharmacist at the Highland Complex Care Clinic, said that the clinic has seen positive results due to the collaboration between team members.

“Professionally, it’s a very rewarding environment to work in,” MacDonald said. “Seeing our patients succeed, become bet-ter self-managers, appropriately use medications and resolve some of their health concerns and problems has been really positive.”

A favourable outcome that the Highland Complex Care Clinic has experienced is an improvement in mental health amongst patients. The most recently analyzed data reveals that depression scores have improved significantly. Patients were surveyed using the PHQ-9 depression scale from 2010-2011. The baseline survey results gave an average score of 11.18, indicating major depression with mild severity. A six month follow-up revealed an average score of 8.25, indicating minimal depressive symptoms.

MacDonald credits the interdisciplinary approach for the improve-ment in depression scores amongst patients. “Patients feel heard, supported and there are the appropriate professionals accessible to them - to come alongside them and help address their needs in a holistic, patient centered way that enables them to become positive self-managers,” MacDonald said.

Regan Paddington is a chronic disease management nurse at the Highland Complex Care Clinic. Paddington said that the qual-ity of life has significantly increased for patients thanks to the team approach. “Many of them tell us we gave them hope,” Paddington said. “Many are functioning better in their day to day life as a result of some of our interventions and their ability to self-manage better.” The clinic runs one day a week and operates 46 weeks out of the year. The Highland Complex Care Clinic team includes a family physi-cian, registered nurse, pharmacist, social worker, registered dietitian and behavioural health consultant. Group assessments are completed together with several team members, as opposed to a patient seeing each specialist separately.

According to Paddington, working with patients alongside other pro-fessionals provides a much higher level of care. “Many of our patients have identified to us that they feel like people are listening to them,” Paddington said. “They are able to tell their whole story but they only have to tell it once, not to multiple providers every time they see them.”

Highland PCN includes the communities of Airdrie, Carstairs, Crossfield, Didsbury and surrounding areas. Currently, Highland PCN encompasses 14 clinics, 37 physician members and serves over 50,000 patients.

~ Silvia Pikal

INTERDISCIPLINARY APPROACH TO MENTAL HEALTHINTERDISCIPLINARY APPROACH TO MENTAL HEALTH

Highland PCN

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GERIATRIC ASSESSMENT & SUPPORTGERIATRIC ASSESSMENT & SUPPORT

ne of the areas identified by Calgary West Central PCN physicians was a need for help with their seniors and especially those with complex

medical issues.

For the past three years, Calgary West Central PCN’s Geriatric Assessment and Support (GAS) program has been meeting needs for seniors in two main ways. The first is a com-munity assessment service in which RNs with geriatric experience make a comprehensive assessment in the patient’s home while focus-ing on those concerns identified by their doctor.

The second route is through a clinic-based, multidisciplinary team consisting of a pri-mary care physician with a special interest in geriatrics, a certified pharmacist, a certified gerontological nurse and a licensed practical nurse. As part of this service, a simple referral form enables patients to be triaged into the appropriate care stream that best serves their needs and meets the request of the referring physician.

Many of these geriatric patient referrals were triggered by issues of decline in cognition and functioning. A typical patient profile is one that is often in their late 70’s or 80’s and beginning to fail at home due to a multiplic-ity of disorders complicated by forgetfulness or other cognition difficulties. Many patients are trying to decide if they can still cope in their current residence, continue to operate a vehicle and whether their adult children can provide the support needed when other means are limited.

Our experience and physician member feed-back suggests that the two geriatric service options provide a valuable adjunct to the pri-mary care environment. It is rare that patients themselves do not express appreciation for our

efforts after a ‘tune up’ from the GAS clini-cians - no automotive puns intended!

A referring doctor receives an initial report on our first assessment of their patient. Three to eight weeks is often the average length of our involvement before providing a final report when patients are discharged from the service. Throughout the process, the referring doctor retains the ongoing care of their patient, who is encouraged to follow up with their physi-cian soon after our last visit.

The goal of this seniors program is to respond to the specific concerns of their primary phy-sician. We do not attempt a comprehensive assessment of all of the patient’s health issues, as we feel that the family physicians are best able to provide the breadth of medical care required. Rather, we attempt to augment family physician efforts with a more intensive review and occasionally an intervention of senior patients. We strive to respond to initial referrals within a two to four week period and are able to draw upon the expertise of medi-cal specialists including geriatric medicine, psychiatry and neurology as well as social workers and registered dietitians to provide further consultations within the context of our service.

Complexity of care is a given in much of the care of seniors and places a significant burden of time and effort on family physicians. We accept this as part of primary care.

Our collaborative care approach with senior patients is an invaluable service to physicians, patients and their families who are also some-times overwhelmed with the needs of their elderly parents. The program also seeks to decrease this caregiver burnout.

~ Bryan Cummings, MD Physician lead, GAS

Calgary West Central PCN

osaic PCN is offering free dental treatment for chil-dren ages one to three at Village Square Community

Health Centre in northeast Calgary. This is a unique opportunity for parents to get a head start on their toddler’s oral care, create a lasting relationship with a den-tist in the community, and learn just how connected dental health and overall health are.

The initiative is designed to act as a first step towards an ongoing dental health plan. Patients can drop in with their child for the free oral health screening and fluoride varnish treatments, or be referred to the program by a Mosaic PCN physician. During the appoint-ment, a health professional will also provide a cavity risk assessment and answer parents’ questions about their child’s oral health.

The initiative’s main goal is to provide early access to preventative care. “Families are often unaware of the connection between the health of the mouth and the rest of the body,” says dental hygienist Jacqueline VanMalsen. “Early access to preventive care is paramount because evidence supports that children who have a dental visit by age one have lower den-tal related expenditures and restorative dental costs, as well as fewer emergency visits.” The link between primary and dental care is the key to this initiative. By targeting a gap in care in their population, Mosaic PCN is not only dealing with dental issues, but preventing fur-ther burdens to the system in the future.

Family physicians also play a huge role in helping to educate their patients about the importance of early dental screening.

“Through the program we hope to help cre-ate a paradigm shift in which dental exams by age one are a societal norm, oral health is emphasized as an integral part of systemic health, and the value of preventive care is rec-ognized,” explains VanMalsen. Physicians can help by promoting first year dental check-ups, asking if their patients have seen a dentist or hygienist in the last year and advising them of the importance of routine dental check-ups.

With the program spreading by word of mouth, the clinic has already seen approxi-mately 650 patients since August, 2011. “The ultimate goal,” VanMalsen says, “is to link patients we see for screening with a dental home.” The success of this program has helped to create a directory of over fifty dentists from

which Mosaic PCN staff and physicians can refer their patients, starting families on a long-term dental health track.

The clinic, located in the Village Square Community Health Centre, is open three to five days a week and has capacity to take new patients. For more information, contact main reception at Mosaic PCN at 403.250.5059 or visit www.mosaicpcn.ca.

~ Holden Baker

Network Success Magazine 9

ORAL HEALTH INITIATIVEORAL HEALTH INITIATIVE

Mosaic PCN

BREASTFEEDING CLINICBREASTFEEDING CLINIC

he World Health Organization recommends exclu-sive breastfeeding for the first six months of life, and then with the addition of complementary foods, continued breastfeeding until two years and beyond.1 This has been shown to decrease the risk of

infection, autoimmune disease, hematological cancer, hypercholester-olemia and obesity in children. It is also associated with a decreased risk of breast cancer, ovarian cancer, and osteoporosis in mothers.2 Despite these recommendations, only 32 per cent of Calgary mothers are still exclusively breastfeeding to six months.3 Why the discrep-ancy? Many mothers stop breastfeeding early due to painful nipples, low milk supply or a lack of confidence. These are all issues that can be corrected with a few simple interventions if families are treated in a timely fashion. The longer patients have to wait to seek assistance, the more likely they are to stop breastfeeding.

The South Calgary PCN Circle Medical Breastfeeding Clinic opened in 2008 because the need for breastfeeding services exceeded the available resources in the community. The clinic is funded by South Calgary PCN, and is the only breastfeeding clinic in Southern Alberta to provide a multidisciplinary team of registered nurse lacta-tion consultants and family physicians to assist patients. Nurses are empowered to work to their full scope of practice, and approximately 64 per cent of clients will be managed exclusively by lactation consul-tants. Physicians work in conjunction with these lactation consultants to offer prescription medications and correction of tongue ties, in addition to managing more complex cases.

Since opening, the clinic has seen over 1,600 patients, with an average of nine to 10 families per week. The majority of the babies seen are less than two weeks of age, and the average waiting time to be seen is less than five days. Many patients, in fact, are seen within one to two days of referral. Family physicians refer 27 per cent of these patients, and

53 per cent are referred from Public Health. The top three reasons for referral are latch issues/nipple pain, tongue ties and low milk supply.

Results from a recent patient survey reveal that 96 per cent of cli-ents are satisfied with the support they received at the Circle Medical Breastfeeding Clinic, and 96 per cent would recommend the service to others. Many mothers reported that if the services they received had not been provided, they might have stopped breastfeeding prematurely.

Patients can access the clinic through referral from a healthcare pro-fessional, but self-referrals are also accepted. At the first visit, families are booked for a one hour appointment with a lactation consultant, who can spend the time required to observe a full feeding, as well as provide education and support. After a thorough assessment, if a medical intervention is required, a family physician is immediately available to evaluate and treat the family.

The Circle Medical Breastfeeding Clinic is open Tuesday, Wednesday and Thursday evenings, and is located at 123, 15566 McIvor Blvd SE, Calgary. Referrals can be made by fax at 403.726.0579 or phone at 403.726.0524. All patients are eligible; however, priority is given to patients of South Calgary PCN physicians or patients residing in south Calgary.

~ Cynthia Landy, MD, CCFP, IBCLC

1. World Health Organization, (2003). Global Strategy for Infant and Young Child Feeding. Singapore: Minimun Graphics.

2. American Academy of Pediatrics. Policy Statement: Breastfeeding and the Use of Human Milk. Pediatrics, 115(2): 496-501.

3. Fjeld, M., (2004). Workbook: Part I – Eighteen Hour Course on Breastfeeding. Calgary: Calgary Breastfeeding Centre.

South Calgary PCN

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Network Success Magazine 11

ow Valley PCN’s twelve- and eight-week exercise programs are producing positive outcomes for patients needing to recover from, manage, or reduce the potential

risks of chronic health conditions. Today, both programs are run at Canmore General Hospital with plans to pilot the eight-week program in Banff as well.

The twelve-week Medically Supervised Exercise program is for people recuperating from cardiovascular events or procedures, living with cerebrovascular or pulmonary conditions, or diabetes and other metabolic syndromes. Some patients have multiple con-ditions and all are referred by a physician.

Each participant starts with a one-on-one consultation with Bow Valley PCN’s physi-cal therapist, Todd Wolansky, to draw up an “exercise prescription” in collaboration with a physician. This typically focuses on rehabili-tation and building capacity and endurance through progressively increasing activity levels. “Patients referred may have had an acute event or undergone surgery or a procedure, such as angioplasty,” says Wolansky. “Throughout the program we monitor vital signs, track prog-ress and support their personal efforts.”

Canmore resident Ken Ritchie completed the twelve-week program following angioplasty, two knee replacements and hip replacement surgery. His four days-per-week exercise pre-scription included increasing levels of walking speed up to a brisk 3.5 miles an hour, lifting weights and other physical activities aimed at improving flexibility and overall fitness levels. “Todd and the nurses were excellent,” says Ritchie. “I’m getting around so much better.”

reducinG risks, preventinG cOMplicatiOns

The eight-week Active Living Exercise pro-gram targets people who have stable chronic health conditions or are at risk of developing a chronic condition. The goals are to reduce risk or prevent complications of these disorders. Participants receive an individual consulta-tion as well, but can use exercise equipment independently and self-monitor vital signs under the guidance of program staff (a physi-cian, registered nurse and physical therapist). Participants can be referred by a physician or other health provider.

Bow Valley PCN registered nurse, Beulah Schneider, specializes in chronic disease man-agement and frequently refers patients to the Active Living program. “I recently referred an oxygen dependent patient with chronic respi-ratory infections and [his] improved muscular strength is helping him clear his lungs more effectively,” she explains.

In addition to managing their conditions, most program graduates enjoy increased endurance and leg strength, waist circumfer-ence reduction and increased wellbeing. At the end of the eight- or twelve-week sessions, participants can meet with Bow Valley PCN’s active living consultant, Randi Lynn Rinaldi. Her role is to encourage sustained activity levels and integrate them into a permanent lifestyle. Bow Valley PCN also runs regular free community wellness workshops that pro-mote healthy eating practices and appropriate exercise.

OnGOinG suppOrt

“In the future, we want to focus more on the longer term outcomes and maybe expand to address a wider scope of health issues,” continues Wolansky. To this end, six- and twelve-month re-evaluations will, as Wolansky sees it, “help us decide what worked, what didn’t and put in place further structures to provide ongoing support and prolong improvements.”

~ Marilyn Duncan-Webb

SUPERVISED EXERCISE PROGRAMSSUPERVISED EXERCISE PROGRAMS

Bow Valley PCN

Bow Valley Primary Care networkServing Banff, Canmore, Exshaw, Morley, and surrounding areas.

P: 403.675.3000 | F: 403.675.3002 | www.bowvalleypcn.ca

Calgary Foothills Primary Care networkServing north Calgary and Cochrane.

P: 403.284.3726 | F: 403.284.9518 | www.cfpcn.ca

Calgary rural Primary Care networkServing Black Diamond, Bragg Creek, Chestermere, Eden Valley, Claresholm, DeWinton, High River, Nanton, Okotoks, Siksika First Nation, Strathmore, Vulcan and surrounding areas.

F: 403.206.7027 | www.crpcn.ca

Calgary West Central Primary Care networkServing central Calgary.

P: 403.258.2745 | F: 403.258.2746 | www.makinghealthhappen.com

Highland Primary Care networkServing Airdrie, Carstairs, Crossfield, Didsbury and surrounding areas.

F: 403.206.7027 | www.hpcn.ca

mosaic Primary Care networkServing northeast Calgary.

P: 403.250.5059 | F: 403.250.5227 | www.mosaicpcn.ca

south Calgary Primary Care networkServing south Calgary.

P: 403.256.3222 | F: 403.256.3223 | www.scpcn.ca

Calgary and area Primary Care networks

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