NEW BRUNSWICK SENIOR CITIZENS FEDERATION DIALOGUE SESSION ON NOVEMBER 2010 DISCUSSION PAPER

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1 NEW BRUNSWICK SENIOR CITIZENS FEDERATION DIALOGUE SESSION ON NOVEMBER 2010 DISCUSSION PAPER «Improving Access and Delivery of Primary Health Care Services in New Brunswick» FEDERATION RESPONSE & RECOMMENDATIONS September 3, 2011

2 TABLE OF CONTENTS Pages INTRODUCTION 3 PILLAR 1 - ACCESS 4 A- Federation Response to PHCAC Recommendations 4 B- Federation Recommendations 5 PILLAR 2 - TEAMS 6 A- Federation Response to PHCAC Recommendations 6 B- Federation Recommendations 7 PILLAR 3 - TIMELY INFORMATION 8 A- Federation Response to PHCAC Recommendations 8 B- Federation Recommendations 9 PILLAR 4 - HEALTHY LIVING 10 A- Federation Response to PHCAC Recommendations 10 B- Federation Recommendations 11 C- Other Considerations Provincial Conference 11 2

3 INTRODUCTION On August 17, 2011, representatives from the New Brunswick Senior Citizens Federation participated in a dialogue session with Department of Health officials on Improving Access and Delivery of Primary Health Care Services in New Brunswick. Persons representing the Federation were: Hermance LeBlanc, Government Relations Committee Chair Raymond Dionne, Government Relations Committee member and contributor to the Federation s response to Government Beatrice Gray, contributor to the Federation s response to Government Conrad LeBlanc, Executive Director. The Federation is also indebted to Gérène Gautreau, Federation s Volunteer Program Coordinator, who was instrumental by acting as a resource person and project coordinator. During the Dialogue Session, the Department of Health was represented by: Lyne St-Pierre-Ellis, Associate Deputy Minister Bronwyn Davies, Director of Primary Health Care Bev Greene, Consultant, Primary Health Care. This document deals with the four pillars of Primary Health Care Services: 1. Access 2. Teams 3. Timely Information 4. Healthy Living. Furthermore in this document, the Federation outlines the following for each pillar: A- Federation s response to each recommendation submitted by the Primary Health Care Advisory Committee (PHCAC) B- Federation recommendations. 3

4 PILLAR 1 - ACCESS A- Federation Response to PHCAC Recommendations PHCAC Recommendations Every New Brunswicker has access to a family physician. Federation Response Everyone is able to see the right provider in the right place at the right time and at the right price. This is alternatively stated as access to health services that are available, accessible, appropriate and affordable. Mental health services are recognized as a important core services of primary health care, needed to deal with the increasing awareness of the burden of care related to mental health. People know where and how to appropriately access the health system. The patient is supported throughout their health care experience and across the continuum of care ranging from primary to tertiary levels of care and from community to institutional settings. There are surveillance processes in place on primary health care services with regular reporting on a dashboard of indicators related to access, to support benchmarking and ongoing quality improvement. 4

5 B- Federation Recommendations The Federation submits the following supplementary recommendations: 1. Whereas there are only approximately 30 health centres and 7 community health centres (with multidisciplinary teams) in New Brunswick, It is recommended that more community health centres be established in rural regions to better serve populations residing far away from medical services. The 30 health centres should be upgraded to community health centres. 2. Whereas there are communities located at a long distance from medical services; Whereas these communities do not have community health centres; It is recommended that a health care bus service, a type of mobile clinic, be established to provide health care services to these communities. 3. It is recommended that transport services be provided to low income seniors who need access to adequate health care services. Note: The Federation now has a New Horizons project dealing with this service. There is potential for partnerships in this endeavour. 4. Whereas community health centre services are established in accordance with needs identified by the community; Whereas community health centre services are provided by a multidisciplinary team, such as doctors, nurses (practitioner, registered, licensed practical), physiotherapists, dietician, etc. It is recommended that we educate the population on services provided by a community health centre. 5. In order to reduce the dependence on doctors, it is recommended that we educate the population on the role of a nurse practitioner. 6. It is recommended that community health centres provide follow-up services for all health care services provided by the centre. 7. For many seniors, community health centres are unable to respond to their health care needs. They need services provided by level 1, 2 and 3 nursing home care. The scarcity of beds in this area requires special attention by government. 5

6 PILLAR 2 - TEAMS A- Federation Response to PHCAC Recommendations PHCAC Recommendations The philosophy of working as part of a multidisciplinary team is promoted in the training of health care professionals. A mechanism is in place to help allied professions integrate within a network of PHC services and is supported by the regional health authorities (RHAs). There are defined organizational and educational supports available to assist in the development of teams including supports directed at ongoing team management. There is clarity between providers of the roles, based on competencies, and a high level of trust and respect among team members. Clear lines of responsibility are understood and incorporated into the working of the team. French translation: «Les chaînes hiérarchiques doivent être clairement comprises et intégrées dans le fonctionnement des équipes.» PHC practitioner provides comprehensive services whether in hospital, on call, in the office/clinic or to individuals in their homes. Federation Response Very Good. Example: Université de Moncton makes efforts to include students from different health service in the same courses. This prevents decisions made in silos later in professional life. During the Dialogue Session, Allied professions was defined as all health services except medical and nursing services. What does this recommendation mean? The French text talks about chain of command and teamwork. How can we harmonize chain of command (top down relationship) and teamwork (lateral relationship)? What is the role of the team leaders? During the Dialogue Session, it was agreed that the French version was more specific while the English version was more generic. 6

7 Effective partnerships are forged between multidisciplinary teams, nongovernment agencies (NGOs) and communities. B- Federation Recommendations The Federation submits the following supplementary recommendations: 1. It is important that all community health centres have multidisciplinary teams to better serve the population. 2. It is recommended that the population be educated on the benefits of receiving primary services relevant to the primary needs of each individual. A person does not necessarily need a doctor to initially deal with a health need. Persons need to learn not to expect services from a doctor at the beginning. 3. It is recommended that the Department of Health and Wellness in collaboration with the NB Senior Citizens Federation increase the awareness of seniors with respect to the role of the nurse practitioner. This will foster a more trusting relationship and credibility between the senior and the nurse practitioner. 4. It is recommended that Community Health Centre team members meet regularly to: Evaluate the quality and effectiveness of services offered. Ensure that services always respond to community needs. 7

8 PILLAR 3 - TIMELY INFORMATION A- Federation Response to PHCAC Recommendations PHCAC Recommendations Care providers and health system planners are supported by robust information systems and adequate staffing resources. 50 per cent of family physicians use an electronic medical record, that is interfaced with OPOR Tele-health (e-health) supports the delivery of community-based care, with technologies and systems designed and deployed to meet the needs of users. One patient/ One record, is fully operational (Health Care System) Federation Response It is agreed during the Dialogue Session that this is a long standing recommendation. The Federation considers this to be an urgent matter. See Section B for Federation recommendation. Health professionals realize the benefits of the virtual network (especially those working in rural areas) and use it so that information on services and results of services to individual patients/patients are electronically connected and well coordinated. A virtual network supports a population health approach, i.e. system is connected with wellness, social support services, education, allied health professionals, as well as with the medical providers. Current systems work in silos. They need to be interconnected in a global system One Patient, One Record (OPOR) including: Electronic Medical Record Tele- Health (e-health) Information Portal System (Internet) Electronic Pharmaceutical Record 8

9 The virtual network exists, so that allied health professionals do not necessarily have to be co-located. An information (portal) system exists that has clear and consistent data definitions which allow for ongoing tracking of information (utilization, pressure points of access, results of referrals, etc.), evaluation and performance review across all parts of the health care system.. B- Federation Recommendations The Federation submits the following supplementary recommendations: 1. The Federation cannot insist enough on the importance of establishing a Provincial Electronic Record System in order to ensure continuity of care and prevention of abuse in the current system such as overmedication. 2. The Federation considers the One Patient One Record System as a top priority. Within 5 years, 100% of doctors should be connected to the system. This government action will have a significant impact on the overmedication problem within the senior population of New Brunswick. 9

10 PILLAR 4 - HEALTHY LIVING A- Federation Response to PHCAC Recommendations PHCAC Recommendations The public understands the social and biological factors that contribute to good health (determinants) and makes lifestyle decisions accordingly. Benchmarks related to health are set and the health of the population is monitored for continuous improvement, and a balanced scorecard made public on a designated basis. Government promotes healthy living as a feature of the agenda in all government departments with action strategies that include primary prevention, injury prevention and health promotion. Government supports healthy communities through assertive regulation and legislation such as compulsory helmet use, tobacco restriction, gambling restrictions, salt restrictions, banning of cell phone use in cars etc. Patients set the priorities and are part of the goal setting for their health and well-being. Patients are comfortable with the training and education they receive on self-care of chronic conditions so that symptoms do not escalate unnecessarily. Healthy living is recognized as the anchor point in developing a sustainable primary health care system and supported through the school system. Federation Response During the Dialogue Session, it was agreed that this is the responsibility of the New Brunswick Health Council. 10

11 B- Federation Recommendations The Federation submits the following supplementary recommendations: 1. It is recommended that the Federation and the Department of Health and Wellness organize an educational day on health services provided to New Brunswick seniors. 2. It is recommended that Government deal with poverty amongst seniors in the province. Too often, low income seniors will not buy good food because they cannot afford it. Food cost has increased 5% during the past 12 months. 3. It is recommended that Government determine the impact of poverty on health care costs. C- Other Considerations - Provincial Conference Federation Executive Director informed the Dialogue Session that the Federation plans to organize a provincial conference On staying at home as long as possible: Obstacles and Solutions. This conference will be organized in partnership with governments and other provincial stakeholders in New Brunswick. Department officials were very receptive to the idea and offered suggestions on how to acquire Provincial Government partnership in this project. 11

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