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Volume 1 / Issue No. 1 /December 2011

MEET OUR BOARD OF DIRECTORS The new Board of Directors elected for 2011/2012 is:

Season’s Greetings

Dr. Dr. Dr. Dr. Dr. Dr.

Murali Venkataraman, Physician Lead, Chair Khati Hendry, Vice Chair Allan Romanchuk, Treasurer Lorraine Kane, Board Member Jeff Harries, Board Member Garnett Tarr, Board Member

The Board meets regularly with staff to oversee the Division projects. Many thanks also to outgoing Board Members, Dr. Elizabeth Watters and Dr. Tim Phillips.

MESSAGE FROM THE BOARD

NEW OFFICE AT 197 WARREN

Welcome to the first edition of the South Okanagan Similkameen Division of Family Practice (SOS DivFP) Newsletter. Feedback and ideas for topics are appreciated! Contact us at terrie.sosdivisionfp@shaw.ca. Dr. Murali Venkataraman, Physician Lead Terrie Crawford, Executive Lead

The SOS DivFP has a new office at 197 Warren Avenue East, Unit 106, not far from Cherry Lane Mall. This is a great location with lots of parking and room for meetings and education programs. It is the home base for Terrie Crawford (Executive Lead), Deb Wood (Administrative Assistant), and Deanne Neufeld (Shared Care Coordinator).

SOS DivFP OVERVIEW A quick review of the sometimes confusing world of the Divisions of FP. Based on an agreement with the BCMA and Ministry of Health, there is funding for a variety of programs through the General Practice Support Committee (GPSC), including Divisions of Family Practice. In the South Okanagan Similkameen, our Division represents family physicians in Summerland, Penticton, Naramata, Oliver, Osoyoos, Keremeos, and Princeton. So far our projects include the Doctor of the Day program in Penticton, the Shared Care project to improve Specialist and Family Physician communications, a Residential Care project, support in exploring the complexities and potential opportunities to improve and sustain physician coverage of emergency coverage in Oliver, and collaboration with Interior Health services.

“Promoting a collaborative and innovative approach to improve patient care, increase primary care physicians’ influence on health care delivery and improve the well-being of our communities.

MISSION AND GOALS The SOS DivFP will engage and support primary care physicians to enhance comprehensive patient care in our community. The Division will accomplish this through promoting a collaborative and innovative approach to improve patient care, increase primary care physicians’ influence on health care delivery and improve the wellbeing of our communities. The Board met on August 16 th, 2011 to begin work on the SOS DivFP Strategic Plan. The feedback from the Members’ Survey distributed June/July 2011 provided input into the plan and helped us develop the goals that will provide direction for the next year: 1. Facilitate the development and improvement of systems that enhance the health of our communities; 2. Develop, implement and maintain a range of primary health care programs that support and promote full service practice with appropriate compensation; 3. Foster a healthy culture and community primary care that engages and supports physicians; 4. Develop a physician recruitment, retention and locum pool strategy to help build sustainable family practices throughout our Division; 5. Ensure quality Division management and governance.

The Bulletin / South Okanagan Similkameen Division of Family Practice

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KEEPING RECORDS FOR DOC OF THE DAY SOS DivFP assumed the administration of the Penticton Doc of the Day program this Fall. We are required by the Ministry of Health to do some shadow billing, so physicians are asked to collect stickers on all patients seen during their sessional hours (19:00 to 22:00 and 07:00 to 09:00), and turn them in to the Division mailbox in the doctors’ lounge at the end of their shift. Nurses have been asked to help provide stickers for patients on whom physicians are called during the sessional time, and Division staff will complete all other documentation.

WORKING TOGETHER ON ELECTRONIC RECORDS Adoption of EMRs in the South Okanagan Similkameen continues to grow, over 90% of Physicians here are on an EMR. The South Okanagan Community of Practice (COP) is working with several different groups to introduce EMRs to facilitate better integrated care for patients in our communities. There are over 71 MDs using the COP EMR, including 13 Specialists, and 4 Midwives, with new installations occurring over the next few months. It is impressive to know that 20,000 eReferrals have been done between BC MDs so far with the MedAccess system. MOAs and GPs can get support for their offices through the COP user groups, as well as events like the recent EMR conference held on September 31st and October 1st at Spirit Ridge Lodge in Osoyoos, where Dr. Keith Hepburn presented on The Paperless Office. The Division has provided additional support and funding to encourage uptake of EMRs as a means of increasing integration and shared care in our region. We assisted the Penticton Indian Band (PIB) to write a proposal for an EMR, which has since been approved. Many residents of the Penticton Reserve are without a family doctor and go without care or use the local walk-in clinics and ERs for episodic care. The PIB Wellness Clinic’s use of the EMR system will help the staff nurse and other local care practitioners provide these patients with enhanced care. Also, at the end of the 2011 fiscal year the Division invested its budget surplus to help improve the quality, consistency and continuity of patient care within our communities through the expansions of the EMR. In Penticton, funding was made available to the Penticton Primary Maternity Clinic as well as the community Midwives, enabling them to provide shared care to maternity patients. Through the same funding we were able to contribute to the Nurse Practitioner in Princeton to facilitate integrated care for the patients she serves in this rural community. Our fourth project is a pilot that allows an ER doctor to access the EMR system at the hospitals in Penticton, Princeton and Oliver. The goal is to improve

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access to information for ER physicians, thus supporting improved understanding of the patient's history, current care plan, Advanced Care Directives, and to make the best possible decisions for each patient who presents to the ER.

NEW “SHARED CARE” PROJECT COORDINATOR We welcome Deanne Neufeld, the new Project Coordinator of the Shared Care project. This project is working on improving communication between Specialists and Generalists and is piloting forms to acknowledge when referrals are received, and how long a wait is anticipated. Physicians, MOAs, and patients work together on the Shared Care committee. Deanne comes with lots of experience; she has a Masters in Social Work, specializing in human service leadership, and was Program Facilitator with Alberta Health Services. She will work closely with Terrie Crawford and Deb Wood, and can be reached at deanne.sharedcare@shaw.ca .

IMROVING REFERRAL PROCESS There is a new group bringing together the SOS Division Shared Care project, PITO/Community of Practice (COP), and Med Access to improve the referral process. The idea is to take the work of the Shared Care project and put it into the Med Access system. The EMR will generate an acknowledgement of receiving the referral, advise what additional information may be needed, and use the eReferral process to improve the back-and-forth communication between the Specialist and the Family Physician. Stay tuned. It should be ready by the Spring.

SHARED CARE WITH RENAL CLINIC Dr. Mike Surkan, Dr. Andrew Robertson and Dr. Brian Forzley are meeting with people from the renal clinic to review current renal prescribing practices, how meds are prescribed there and how this affects the family physicians’, care planning, what role the various health providers play in the care of renal patients, and how to improve communication. Greg Wheeler (a community pharmacist), IH Renal Clinic staff, Terrie Crawford and Deanne Neufeld are part of the discussions.

THE PATIENT VOICE The Patient Voices Network is a local group that works with the health system to improve care from the patients’ perspective. Deanne Neufeld and Terrie Crawford are meeting with patient representatives to identify ways to reach out to the public at large with information on how to navigate the health system and manage their own health care better. SOS Division will be hosting a world café round table discussion with a larger group of patients on January 23rd to figure out next steps.

The Bulletin / South Okanagan Similkameen Division of Family Practice


DIVISION PILOTS PROGRAM TO ENHANCE RESIDENTIAL CARE Beginning in the New Year, SOS DivFP, in partnership with the Interior Health Authority (IHA) and the Ministry of Health (MoH), will begin a pilot project aimed at improving the quality of care for patients in residential care facilities – a total of 619 beds in seven facilities in the Penticton and Summerland communities. “These patients should have access to the same quality of care as all our others,” says Dr. Mark Lawrie, a Penticton family physician whose practice includes many people in residential care.

already begun addressing residential care in their communities in partnership with the Fraser Health Authority. At the same time, there was a need to consider the unique aspects of practicing family medicine in smaller communities. More doctors here than in urban areas continue to treat their patients once they enter residential care. Dr. Lawrie and his fellow committee members worked with the Health Authority and the Ministry to establish goals and funding options. Their aim was to encourage long-term doctor-patient attachment and continuity of care, while improving the quality of that care and the supports for the physicians who provide it. Maintaining their family physician as MRP has been set as the benchmark. Phase 1 Pilot Project The outcome of their work is that, in the program’s first phase, standards for care will be introduced. Proactive, preventative care will be provided through:  Regular visits approximately every three months;  Annual physicals as well as conferences with patients and their families;  Doctors will commit to being available by phone and fax for urgent consultations when needed, and after-hours and weekend coverage will be provided through a Doctor of the Day model.

Yet there’s recognition that quality of care for residential patients needs improvement. It was one of the top priorities identified in a survey of South Okanagan Similkameen Division members, and as a result, a committee was formed to identify solutions. Dr. Lawrie, along with Dr. Michael Surkan of Penticton, Dr. Murali Venkataraman of Summerland, Terrie Crawford Division Executive Lead, and representatives from IHA and MoH have worked collaboratively on a proposal that supports the needs of these communities. Unlike healthy elderly people living in the community, residential care patients often have multiple, complex health issues associated with end of life, and may require frequent, acute interventions. The question is how to provide them with better, more proactive care while reducing hospital admissions and addressing other management issues including polypharmacy. This would be in a structure that maximizes the effectiveness of their family physicians. Dr. Lawrie says tackling this primary care issue is a great example of how Divisions of Family Practice work. “We can have a discussion with local physicians to discover local solutions, and build enthusiasm and commitment to change.” The SOS DivFP was able to learn from other Divisions like Abbotsford and White Rock-South Surrey, which have

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MRP Compensation  $200.00 per year per residential care patient on their panel;  Fee-for-services for proactive preventative care. DoD – Urgent Coverage  Sessional payment of $250.00 in addition to DoD sessional;  Fee-for-services billable outside of sessional payment hours. The Division will also work to help everyone understand the extensive billing codes available for this type of care. Dr. Lawrie says it needn’t be a drain on physicians to provide regular care to these patients. “There’s value in having a diverse group of doctors providing longitudinal care to patients at the end of their lives. We want to support those who have an interest in doing so by helping them manage their practices efficiently, removing barriers in the residential facilities and ensuring they are well compensated. At the same time, we want to ensure that those who choose not to be involved in residential care can confidently pass their patients on to another doctor.” As for future plans, the hope is that in phase two, lessons learned in South Okanagan Similkameen will be shared within our Division and with Interior Health for potential expansion of this program to other communities. Ideas may need to be adjusted to meet local needs, says Dr. Lawrie, but “we don’t need to keep re-inventing the wheel. Others can learn from the gains, efficiencies and outcomes we achieve.” 

The Bulletin / South Okanagan Similkameen Division of Family Practice

Profile for Divisions of Family Practice

Winter 2011 The Bulletin  

South Okanagan Similkameen Division of Family Practice first edition of Division newsletter

Winter 2011 The Bulletin  

South Okanagan Similkameen Division of Family Practice first edition of Division newsletter

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