A11.2 Development of a Nurse Led Periodic Health Visit_ Marina Afaanasyeva

Development of a Nurse-Led Periodic Health Visit to Promote Evidence-Based Preventive Care for Adults 19, 2014 Marina Afanasyeva1, Elizabeth Muggah2, Cleo Mavriplis2, Manon Bouchard2, Rosamund Lewis1, Sharon Johnston2, Helga Ehrlich2, Jay G Mercer2, Debbie McGregor2

1

Ottawa Public Health

2

Bruyère Academic Family Health Team 1 of 20

CFPC Conflict of Interest

Disclosure of Commercial Support Presenter Disclosure Presenter:

Marina Afanasyeva

Relationships with commercial interests: • • • •

Grants/Research Support: None Speakers Bureau/Honoraria: None Consulting Fees: None Other: None

Outline Public Health / Primary Care Project

• Origins • Objectives • The format of the new model of periodic personal health visit • Pilot project: methods and results • Lessons learned • Summary 3 of 20

Origins of the Project: Public Health / Primary Care Project

Shift Away from Annual Physical for All

• 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 4 of 20

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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Public Health / Primary Care Project:

Origins of the Project: Towards Team-Based Care • 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

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

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Checklist Template • 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

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Pilot Project • Understand the benefits and challenges of the new model

• Identify gaps • Improve the model

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Methods:

Quality Improvement Research • Quality indicators (rather than performance indicators) • Process indicators (rather than outcome indicators)

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Methods: Indicators • Patient satisfaction • Health provider satisfaction • Physicians • Nurses

• Comparison to the old annual physical exam

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Methods: Questionnaires •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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Pilot Results: Patient Satisfaction 11 patients 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

The most satisfied group!

Gaps identified: French version was missing

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Pilot Results: Provider Satisfaction Physicians • 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 Nurses • 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 • 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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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 Public Health

Primary Care

• Promote health • Prevent disease

• Improve patient care

• Enhance risk factor detection • Collaborate with primary care

• Develop a new model of team-based patient-centred efficient periodic health visit

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Public Health - Primary Care Collaboration: Lessons

Public Health

Collaborative Project

Primary Care

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

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