Making
Rural
Primary Care Delivery Work:
For Patients, For Providers, For
“Geography is an Indicator of Health”
Roy Romanow 2002Advanced Age
Seasonal Work
Low Income
Low Education
Few Support Services
Isolation
23.2%
53.6%
100%
Iqualuit City (pop=6699)
12.4% 19.4% 39.1% 31.9% 11.3% 19.6% 51.7% 38.9% 34.9% 42.2%
Statistics Canada 2011 Census
Rural = 35%
( up 2% over 2006 census )
Urban = 65%
Rural Funding
Of the Federal Governments’ Health Transition
Fund: $150 million for 140 projects
$14 million
(just under 10%)
was earmarked for 27
projects
(just under 20%)
with a rural and remote
focus.
http://www.hc-sc.gc.ca/hcs-sss/pubs/system-regime/2010-fed-comp-indicat/index-eng.php#f1
The Fixable Problems….
•
Focusing on acute care
•
Funding a model of illness management
•
Focusing on institutionalized care
•
Funding physicians for primary care
•
Funding pharmaceuticals as first line
management of chronic disease
•
Avoiding use of technology in primary care
Parry Sound Nursing Stations
Hospital
NP Nursing Station Model
Buildings, Donations, In-kind
Funding,
Grants
Operations
NP
Station
2013 RNAO Resolution:
In Support of Nursing Stations
WHEREAS: RN managed Nursing Stations have been a model of care in Ontario for 100 years, and Nurse Practitioner-managed Nursing Stations have been a model of care in Ontario for 35 years, serving 22,000 patients annually; and
WHEREAS: funding to recruit and retain Nurse Practitioners and Registered Nurses in Nursing Stations has lagged behind other models of care; and
WHEREAS: Nurse Practitioner and Registered Nurse-managed Nursing Stations have been shown to increase access to care for those in remote and rural parts of Ontario;
THEREFORE BE IT RESOLVED THAT RNAO advocate for the sustainability of Nursing Stations as a viable model of care in Ontario, through increased funding for Nurse Practitioner and Registered Nurse positions.
Scope of Practice
Diagnosis and
Treatment
NP
MD
RN
Specialist
Top of Scope
Primary Care
Specialist
Family MDInter-Connected through Technology
Nurse Practitioner Managed Nursing Station
Type of Care Provided
20% 22% 25% 33% Preventative Curative Diagnostic SupportivePatient Acuity: ER/Nursing Stations
ER Triage Score
(7% Unknown) Percent Nursing Station Acuity Percent
1 - Resuscitation .02% 1 – Life Threatening 0%
2 - Emergent 5% 2 - Emergent .09%
3 - Urgent 27% 3 - Urgent 2%
4 – Semi-Urgent 53% 4 - Complicated 21% 5 – Non-Urgent 7% 5 – Episodic/Chronic 77% Total Patients seen
in the WPSHC ER 2010
22,126 Total Patients seen in six Nursing Stations 2010
Hospital Usage by Postal Code
Region by
Postal Code # NP’s/MD’s 2011 Census ER Visits ER visits/
year/ person Hospital Admissions 65+ years Re-Admissions Within 30 Days Town of Parry Sound 15 MD’s 3 NP 6191 11069 1.8 484 19 Georgian Bay 1 Part Time NP 2124 1097 .50 42 4
Seguin 1 NP 3988 2746 .69 77 0
Whitestone 1 NP
(3 months no NP) 918 739 .80 42 3
Archipelago 1 NP 566 222 .39 11 0
Central West 1 NP 1100 482 .44 32 0 McDougall No Health Care
Compassion Accountability Rights and Responsibilities Excellence
• Reduced:
• Wait times for primary care • Visits to the ER
• Hospitalizations for chronic illness
• Increased
• Access to health care for rural seniors • Opportunities to ‘Age in Place’
• Monitoring for compliance with treatments and health outcomes • Collaboration with all health care providers
• Opportunities for health teaching and illness prevention • Continuity of care and advocacy
• Understanding of patients living conditions and support system
Compassion Accountability Rights and Responsibilities Excellence
•
Change Family Doctor title to ‘Primary Care Specialist’ to promote top-of-scope functioning.•
Enable Nurse Practitioners and RN’s to work in their full scope of practice.•
Implement NP Managed Nursing Stations as a model of primary care delivery in rural areas throughout Canada for a collaborative, sustainable, and accessible, method of entering the health care system.Compassion Accountability Rights and Responsibilities Excellence
Questions – Thank you!
Donna Kearney, BScN, RN(EC), MHST
West Parry Sound Health Centre [email protected]
