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Stewart primary care staff working to improve patient care

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A one-story building with a peaked enterance..
The Stewart Health Centre.

(Editor’s note: There may be changes to the operations and flow of the Health Centre as NH makes changes as part of the COVID-19 preparations. If it’s appropriate for you to be on site, please pay attention to new signage on how to navigate services and restricted areas.)

Staff at the Stewart Health Centre are working to address the needs of their patients and improve quality of care. Primary care assistants, a family doctor, primary care nurses, diagnostic staff, and site management make up the team. The team has made significant changes to improve access and outcomes for patients, and have positively impacted the health of people in the community through individual and community-wide initiatives. Keep reading for examples of their great work!  

New team members create stability in the community

The team works to improve delivery of care through primary and community care, which has been strongly promoted by the combined Site Manager/Laboratory/X-ray Technician who was hired in 2014. Her insight into the needs of the community and commitment to the health and welfare of community has been vital during this transitional time.

Stewart also has a permanent doctor (as of April 2018) in the community, which has helped immensely with the changes they’re making. Previously, there was a lot of doctors coming in and out, which it made it difficult to establish a relationship between the doctor and patients.

Proactive care

By reviewing patient charts, the team works together to identify patients with outstanding needs, which has led to positive patient outcomes. As a result, the number of patients being seen through the emergency department has been drastically reduced. Considering how small the Health Centre team is in Stewart, the reduced number of after-hours emergencies has improved morale and work-life balance for staff members.

At the beginning of each month, the team uses the electronic medical record to identify patients with outstanding needs. Those patients are then called for follow-up appointments with either the physician or primary care nurse. Team meetings at the beginning of each week encourage communication and creates the opportunity to identify and plan patient needs, bringing in other health care professionals as required.

Improving care for people with chronic disease

The staff started an initiative to improve care for people with diabetes. Staff members pull a report from the electronic medical record to identify patients who have specific levels of Hemoglobin A1Cs (a blood test used to monitor blood sugar levels).

Identified patients see the doctor, a primary care nurse, and diagnostics for blood work, a physical exam, and an overall assessment. From these assessments, the team can see if there are any outstanding supports the patient may require. This includes interventions that can be offered in Stewart, such as diagnostics, education regarding their condition, medication reconciliation, and updating immunizations. The use of Telehealth makes it possible to connect with health care professionals, like the dietitian in Terrace, without travel.

The health care team reassessed the first group of diabetic patients 6-8 months later and noticed improved Hemoglobin A1C levels and a decrease in emergency department visits.

Changes to clinic scheduling

Stewart also changed the flow of their clinic to leave Friday afternoon appointments open for patients with complex concerns. Patients come for a check-in before the weekend and discuss anything that could turn into an issue. This usually prevents the patient from having to go to the emergency department. The doctor has seen increasingly positive results, especially in those patients with COPD and diabetes.

One example of a patient who benefitted from Friday afternoon appointments has COPD and diabetes; the doctor has seen significant health benefits for them. The patient was able to see an occupational therapist and the team supported them through education. They would check their kidney function and contact them to see if anything needed to be adjusted before heading into the weekend.

Another example is a diabetic patient with poor renal function who was able to make dietary and lifestyle changes, which drastically altered their kidney function results. If the patient would have required dialysis, they would have had to move to Terrace as there’s no dialysis in Stewart. These lifestyle changes made it possible for them to stay in Stewart longer.

Stewart also made some changes to the clinic on Mondays, so they can see patients who were seen in the emergency department over the weekend and require follow-up care. They don’t book routine appointments for the first appointment on Monday mornings so that they’re able to follow-up with these weekend patients. Before this change, Mondays were always hectic, as they were trying to squeeze in patients that were seen in the Health Centre over the weekend.

The changes to the structure of clinic scheduling, patient bookings, and consultations has improved access and offers proactive care opportunities. The preventive approaches taken in Stewart have been successful in reducing complications and in keeping community members with health care concerns in the community longer.