By Melanie Jollymore
Any time his stage-four COPD flares up, Sheldon Williams can end up spending several breathless hours in the emergency room, waiting to be assessed and given the medication he needs to clear the obstructive secretions from his compromised lungs.
The Shelburne-area resident is eager to see if his participation in a health services study through the Shelburne Collaborative Family Practice will improve his access to timely care when he has a flare.
“They’re trying to improve how I get my medicine,” says Mr. Williams, 71, of the study team. “They are seeing how they can set it up so I can go straight to the nurses at the family practice, instead of going to emergency and sitting there for hours.”
The study—dubbed PriCARE: Partners for Patients First—is a four-year, five-province research effort involving Nova Scotia, Newfoundland, New Brunswick, Saskatchewan and Quebec, the lead province. Funded by the Canadian Institutes of Health Research, it aims to transform the way primary care providers work with patients who have one or more chronic disease, so these patients receive the services they need to function in their day-to-day lives and keep their symptoms and underlying illness under control.
BRIC NS (Building Research for Integrated Primary Healthcare in Nova Scotia, insert link to BRIC NS), a primary health care research network based in Dalhousie’s Department of Family Medicine, is facilitating Nova Scotia’s participation in the study. This involves senior administrative leaders in primary care and chronic disease management at Nova Scotia Health Authority (NSHA), as well as Dalhousie-based researchers and frontline service providers at family practice test sites in Shelburne and New Minas.
“We want to learn how health care teams in collaborative family practices can integrate with programs in the broader community to coordinate services for patients with chronic disease,” notes Dr. Tara Sampalli, director of research and innovation, NSHA Primary Care and Chronic Disease Management. “Beyond that, we want our health systems to support primary care providers in these efforts, so patients can manage their diseases more easily and avoid repeat visits to the doctor, trips to the emergency department, and hospitalizations that could be prevented with more proactive care.”
Kyra Taylor, a registered nurse in the Shelburne Collaborative Family Practice, is working with Sheldon Williams and a growing number of patients she has enrolled in the study. Her target for the study is to enroll 30 patients.
“I assess patients’ health and satisfaction with the care they’re receiving, and work with them to set goals for their participation in the study,” explains Ms. Taylor. “Then we create a health care plan and meet with other providers in the community to see how we can all work together to provide each patient with the unique mix of supports they need to meet their health care challenges.”
While Ms. Taylor and Ciara Stevens, the registered nurse managing the study at the New Minas test site, work with individual patients, NSHA health services managers are forging new connections with potential allies in the community.
“As part of the research, we are reaching out to see who we can involve in helping our patients,” says Melanie Mooney, a primary health care services manager in Nova Scotia’s Western Zone who works with Kyra Taylor on the study. “This could be to do with mobility, transportation, financial assistance, mental health, healthy meals… whatever is required to meet each patient’s needs, as a whole person.”
As Ms. Mooney explains, older patients with one or more chronic disease often live alone and, in some parts of Nova Scotia, have no close neighbours and no access to transportation. They may be overwhelmed by a complex medication regimen, and they may have hearing, vision or cognitive problems that make instructions more difficult to follow. They may not even know where to start when it comes to seeking help.
“Partners for Patients First has started a whole new conversation among care providers,” remarks Shannon Ryan Carson, NSHA’s director of chronic disease and wellness for Primary Health Care in the province. “We are now looking at how we can re-design the health care system to create structures that support a proactive, holistic model of care at the family-practice level.”
The fact that university-based researchers, health system leaders and frontline care providers are working together is a major shift.
“This makes the research so much more alive for people on the ground and adds impetus to our efforts to remove the barriers to proactive care,” notes Ms. Ryan Carson. “It is a great opportunity to have health providers, decision makers and researchers working together.”
The involvement of other provinces is another key to making the most out of large-scale collaborative research projects like Partners for Patients First.
“We are tripling our insights,” says Dr. Tara Sampalli. “Every province in the study is doing things differently, so we are learning from each other so much more about what works and what doesn’t than we could learn on our own.”
And this is ultimately what the research comes down to: what works and what doesn’t.
“Partners for Patients First is true implementation science,” notes Dr. Fred Burge, a professor in the Department of Family Medicine at Dalhousie and a leading primary care researcher in Canada, who set the scientific stage for the project with an earlier literature review. “We are focused on identifying what specific approaches work best in what practice environments, and what infrastructure and human resources are required. It’s very detailed, practical work, with outcomes that will hit the ground in participating provinces in year three of the study.”
According to Dr. Burge, Partners for Patients First will provide a roadmap for Nova Scotia’s health system leaders, to guide them in designing and supporting services that will help patients stay healthier and take pressure off emergency departments and inpatient units in the province.
“The new models we’re exploring will help Nova Scotia’s doctors get off the fee-for-service treadmill and work more effectively with teams,” says Dr. Burge. “It’s a win-win-win for everybody—patients with complex needs receive holistic, proactive care that helps them stay healthier, professionals have the satisfaction of working to their full scope of practice, and the system as a whole functions more efficiently and cost-effectively, with better results for patients.”