Improving Patient Access and Preventative Care
How a rural Alberta clinic is implementing quality improvement
New Year’s resolutions come in all shapes and sizes: vowing to spend more time with our families, eating out less, actually using the gym membership we bought three years ago and keep forgetting to cancel. What they all have in common is the concept of improvement.
Health care in Alberta is no exception, with many physicians and clinics looking for ways to continuously improve their practices and ultimately, provide the best possible care to patients.
“I would imagine most clinics are doing some degree of quality improvement, they just may not label it that way,” says Dr. Andrea Hargrove, a rural family practice physician and Community Medical Director at The Taber Clinic in Taber, Alta. “I think, as physicians, we’re motivated to improve and keep learning, and we’re already doing this in most cases; it’s just recognizing quality improvement for what it is and celebrating it.”
Part of the Chinook Primary Care Network (PCN), The Taber Clinic is a high-functioning patient medical home, with 13 physicians and a healthcare team of over 40 providing team-based, primary care.
“We’re always looking for ways to deliver our care in more efficient and effective ways, to make sure the best person is doing the job and we’re all working to our full scope, which is always our goal with team-based care,” added Dr. Hargrove.
The clinic recognized that in order to best serve their patients and the community, enhanced access to health care had to be a priority. They adopted Access Improvement Measures (AIM) to ensure same-day access if a patient requires immediate attention. Dr. Hargrove notes this doesn’t always mean the patient’s regular physician will be available. However, it could mean a visit with a nurse practitioner, counsellor or other appropriate provider.
Additionally, the clinic looked for ways to eliminate appointment delays and began tracking the third-next available appointment (since the next or second-next available appointment may be as a result of a cancellation or other non-predictable or reliable event).
“We’re always tracking this and of course it can fluctuate up to three weeks or a month for an individual provider, if someone is on holiday for example. But as we average it out for our clinic, we aim for that next-available appointment to be in less than a week." Furthermore, the clinic strives to accommodate patients above and beyond measured availability whenever necessary, so as to keep the patient's care in their medical home.
Providing immediate access is not always an easy task in a clinic that cares for around 17,000 patients, in addition to managing hospital business—as many rural physicians do—but Dr. Hargrove attributes their success to an open-door policy and strong relationships amongst all team members.
Another facet of primary care that Dr. Hargrove and the team at The Taber Clinic are always looking to improve is preventative care.
“Our PCN is really forward-thinking, providing data around how well we’re doing with offers of screening to our panels. Things like diabetes screening, cholesterol, high blood pressure, vaccinations, colon cancer and cervical cancer; there’s about a dozen measures we’re looking at annually.”
Each physician works with a medical office assistant, who helps identify when a patient is due for a particular screening and ensures it’s offered to the patient the next time they have an appointment.
On a quarterly basis, each physician receives data on their individual panel of patients, which allows them to compare what their rates are to the clinic average and the PCN average.
“Every year, we spend a few hours as an entire team looking at where our results are from the year before and where they are currently, divide it up into panels, and then we’ll brainstorm as to why a screening rate has gone up or down, or different ways we might go about improving it.”
They also meet on a yearly basis with the other 30 clinics that make up the Chinook PCN, to review screening rates and discuss results.
“We live in a first-world country and have the ability to do preventative screening. It would be a shame not to offer patients these services when we can identify illnesses and treat them to prevent worse outcomes, and I think we’re all driven and feel quite passionately about that.”
TPP Alberta Announcement: Antibiotics
Antibiotic resistance has become a global issue. According to the Council of Canadian Academies, approximately 26 per cent of infections were resistant to the drugs generally used to treat them in 2018. By 2050, the rate of resistance is likely to grow to 40 per cent.
Feedback through multiple physician forums supports antibiotic monitoring and CPSA is pleased to announce that, starting in 2020, physicians will have access to antibiotic dispense data collected via TPP Alberta (monitred as a Type 2 drug). As per other drugs monitored through TPP Alberta, Alberta Health has supported and facilitated access to and use of dispense data from the Pharmaceutical Information Network (PIN). A TPP Alberta Antibiotic Atlas will be released early in 2020, featuring antibiotic data from the last two years. In addition, CPSA will release an antibiotic-specific MD Snapshot-Prescribing report later this year, as a practice support tool for physicians.
For more information on prescribing antibiotics, including practice guidelines and support tools, visit the Prescribing Resources and Tools page at cpsa.ca.
May 20 & 21, 2020, Delta Hotels by Marriott South Edmonton Conference Centre
Don’t miss the One Health Antimicrobial Stewardship Conference in Edmonton featuring Keynote Speaker, Tim Caulfield. The theme for 2020 is One Health opportunities for antimicrobial stewardship in animals, humans and the environment.
With great sadness, we recognize the passing of two of our colleagues.
Dr. Shekoufeh Choupannejad was a passenger on Ukraine International Airlines Flight PS752 when it crashed moments into its flight on Jan. 8, 2020. She was travelling with her two daughters, Sara and Saba, who also passed away. Saba was an undergraduate student who had recently applied to attend medical school. Dr. Choupannejad worked at the Northgate Centre Medical Clinic in Edmonton.
Dr. Laura Kosakoski passed away over the weekend after being caught in an avalanche in Banff while skiing with her husband. Dr. Kosakoski was a family physician at the Canmore Associate Medical Clinic.
Please join the CPSA team in extending our sincerest sympathies to the friends, colleagues and families of Dr. Choupannejad and Dr. Kosakoski, and keeping them in your thoughts.
If you are in need of support during this time, the Alberta Medical Association’s Physician and Family Support Program is available 24/7 by calling 1-877-767-4637. This program is accessible to physicians, post-graduate trainees, medical students and their immediate family members.
From Alberta Health: Immunization Regulation Pilot Program
Alberta Health is in the process of producing a vendor independent web based direct submission form to allow health practitioners or their representatives to submit immunization information to the provincial immunization repository (Imm/ARI) in order to meet the new reporting requirements outlined in the Immunization Regulation.
If you are interested in learning more about participating in a pilot test group that will allow you to start submitting immunization information prior to the Immunization Regulation coming into effect on January 1, 2021 please respond to Health.Imm@gov.ab.ca with the subject line "Direct Submission Form Pilot Test" by Jan 31, 2020.
For those who respond, Alberta Health will provide information sessions between Feb. 10 and Feb. 24 to allow potential candidates to make an informed decision as to if they have both the desire and the capacity to participate in the Pilot Program.
Potential candidates who choose to proceed will be asked to commit to the Production Pilot program by Feb. 28, 2020.
Potential Candidate Requirements:
- Must give immunizations all provided on a regular cadence (weekly, daily).
- Able to access the internet and have infrastructure to support an online form.
- Able to meet working group participation commitments.
Successful Candidates Will:
- Participate in user groups meetings (cadence to be negotiated later) to provide feedback on topics anywhere from solution design to workflows and usability.
- Participate in user training and onboarding activities and provide feedback on support and helpdesk material.
- Use the new method of entry as appropriate for their situation to meet planned Immunization Regulation
Benefits to Candidates:
- Allow them to work out operational process to meet Immunization Regulation requirements using the direct submission form.
- Provide input on how the final solution should work.
- Become a champion for the adoption of more thorough immunization reporting across the province.
A commitment to participate is not required at this time. To attend information sessions mentioned above, please respond by Jan 31, 2020.