PRIMARY HEALTH CARE STRATEGIC PLAN

PRIMARY HEALTH CARE STRATEGIC PLAN 2008-2013 SUBMITTED TO MINISTRY OF HEALTH OCTOBER, 2008

TABLE OF CONTENTS EXECUTIVE SUMMARY...I 1 WHERE DO WE WANT TO BE? VISION, PRINCIPLES AND GOALS FOR REGINA QU'APPELLE HEALTH REGION PRIMARY HEALTH CARE TEAM/ SITE DEVELOPMENT...1 1.1 Vision...1 1.2 Principles and Goals...1 2 HOW WILL WE KNOW WHEN WE GET THERE? KEY MEASURES OF SUCCESS...1 2.1 RQHR Indicators...2 2.2 Provincial Indicators Working Group...2 3 WHERE ARE WE NOW? CURRENT STATE...2 3.1 Organization of RQHR Health and PHC Services...3 4 HOW DO WE GET THERE? PLAN FOR PHC SERVICES...4 4.1 Improving Access to PHC Teams: Future Teams...5 4.1.1 New Teams in 2008-09...7 4.2 Chronic Disease Prevention & Management Strategy...8 4.3 Provincial PHC Information Solution Project...9 4.4 PHC Indicator Development...10 4.5 Other Priorities...10 4.5.1 Everyday Health Services...10 4.5.2 Twin Valleys Chronic Disease Prevention and Management...10 4.5.3 Women s Health Services...10 4.5.4 North Central Shared Facility...11 4.5.5 SWITCH Project...11 4.5.6 Aboriginal Health...11 4.5.7 Development of Mental Health and Addiction s role in PHC...11 4.5.8 Community Engagement...12 4.5.9 Team Development...12 4.5.10 Functional Space Planning For Teams...13 5 CHALLENGES...13 5.1 PHC Team Funding and Composition...13 5.2 Engaging Physicians as Stipulated in the 2003 PHC Planning Guidelines...14 5.3 Inconsistency and Inequity in Team Funding...14 5.4 Chronic Disease Prevention and Management Resources...14 5.5 Provincial PHC Information Solution Project...15 5.6 Organization of RQHR PHC Services and Team Development...15 5.7 Managing Expectations...15 5.8 Access Issues...15 6 COMMITTEES...16 6.1 Planning Teams...16 6.1.1 RQHR PHC Steering Committee...16 6.1.2 Twin Valleys CDPM and CKD Outreach Committees...16 6.1.3 RQHR North Central Shared Facility Working Group...16 6.2 Community Consultation Committees...17 6.3 Intersectoral and Interagency Partnerships...17

TABLE OF CONTENTS (CONTINUED) 7 COMMUNICATION...18 8 BUDGET...19 9 CONCLUSION...20 10 APPENDICES...21 10.1 Appendix 1 RQHR Principles for Primary Health Care Planning and Development June 2003 (revised May 2008)...21 10.2 Appendix 2: Pan-Canadian Primary Health Care Indicators...23 10.3 Appendix 3: RQHR Operating Plan Highlights 2007-2010...26 10.4 Appendix 4 - Selection of Communities for Development of Primary Health Care Teams 27 10.5 Appendix 5 Urban and Rural Primary Health Care Teams... 29

EXECUTIVE SUMMARY The Regina Qu'Appelle Health Region 2008-2013 Primary Health Care Strategic Plan addresses five key questions: Where do we want to be? How will we know when we get there? Where are we now? How do we get there? What challenges need to be overcome? Where do we want to be? Having five years of experience in Primary Health Care planning and team development, the Regina Qu'Appelle Health Region continues to envision Primary Health Care as the foundation of a reorganized, revitalized health care system. We remain committed to establishing interdisciplinary Primary Health Care teams and networks. The principles we use to guide planning and development address the following: Accessibility Public Participation Effective Health Promotion and Disease Prevention Proactive and Collaborative Approach to Management of Chronic Diseases Intersectoral Cooperation Patient/Client Centred Care Community Development Approach Human Resources Continuum Integration and Coordination of Services Communication / Information Sharing Appropriate Infrastructure and Resources Improved Health Status How will we know when we get there? Regina Qu Appelle Health Region has selected three indicators to evaluate our progress towards Primary Health Care team development: team effectiveness; client experience/ satisfaction with the care provided by the Primary Health Care team; and non-urgent visits to Emergency Departments in areas in which Primary Health Care teams exist. These are in addition to indicators already being tracked and reported to the Ministry of Health: the percent of the population with geographic proximity to Primary Health Care teams; number of discrete clients receiving Primary Health Care services ; number of HealthLine calls from Regina Qu Appelle Health Region residents. A provincial working group is currently reviewing other Primary Health Care indicators identified by the Canadian Institute for Health Information and potential evaluation tools for each of them. Primary Health Care Strategic Plan 2008-2013 Page I

Where are we now? As the largest health care delivery system in southern Saskatchewan serving the needs of 243,767 residents, the Regina Qu'Appelle Health Region provides an array of health promotion, illness prevention, treatment, specialty care, rehabilitation and end of life services organized into four main portfolios. The responsibility for Primary Health Care delivery falls within all of them. Primary Health Care strategic planning and team/ program/service development is led from within the Primary Health Care portfolio. Team members function in a matrix reporting relationship between the Primary Health Care Manager and their home department manager. By the end of 2007-08, 24.73 percent of people living in Regina Qu'Appelle Health Region had access to one rural and four urban Primary Health Care teams: Twin Valleys Primary Health Care North Central Regina (Four Directions Health Centre) Victoria East Medical Clinic University of Saskatchewan Academic Family Medicine Unit Regina Community Clinic. How do we get there? The Regina Qu'Appelle Health Region is taking action in several areas to support Primary Health Care development: Improving Access to Primary Health Care teams By 2013 there will be nine teams in Regina (with at least one in each city zone), and seven rural teams. Teams targeted for implementation in 2008-09 include: o Broad Street Medical Clinic (central team) o Core/ Al Ritchie (potential satellite of Broad Street Medical Clinic) o Indian Head. Development of a Chronic Disease Prevention and Management Strategy A comprehensive Regina Qu'Appelle Health Region Chronic Disease Prevention and Management strategy, consistent with a provincial strategy, will include an inventory of Regina Qu Appelle Health Region prevention and management services, an assessment of the current state, identification of specific strategies to support self managed care, and the identification of specific performance measures related to high priority areas. Provincial Primary Health Care Information Solution Project The Ministry of Health is leading a project to select and implement a software solution for Primary Health Care providers throughout the province. The Regina Qu'Appelle Health Region is actively involved in this work. Primary Health Care Indicator Development The development of indicators to evaluate Primary Health Care development and delivery is a priority of both the Ministry and the Regina Qu Appelle Health Region. Primary Health Care Strategic Plan 2008-2013 Page II

Other Priorities o Continued provision of everyday health services by teams o Full implementation of the North Central and Twin Valleys plans o Chronic disease prevention and management and Chronic Renal Insufficiency services in Twin Valleys o Women s health programming o Development of a Shared Facility in North Central Regina o Development of a student run health centre in inner city Regina o Continued focus on Aboriginal Health o Development of Mental Health and Addiction s role in Primary Health Care teams o Community engagement o Ongoing team development o Functional space planning for Primary Health Care teams. What challenges need to be overcome? Primary Health Care Team Funding and Composition More flexibility is needed in team funding. Moreover, Regina Qu'Appelle Health Region believes that funding should be available for the integration of other professionals besides physicians, Nurse Practitioners and pharmacists, with opportunities for the regions and communities to determine the types of health professionals best suited to meet local needs. Engaging Physicians as Stipulated in the 2003 Primary Health Care Planning Guidelines The Regina Qu'Appelle Health Region maintains its position that there needs to be more movement towards flexible means of engaging physicians Lack of Accuracy in Calculating Populations Served by Urban Teams The use of mixed methodologies and lack of data that accurately and consistently depicts the actual population being served by urban Primary Health Care teams makes it difficult to: o accurately determine the real number and percentage of Regina residents with access to Primary Health Care teams; and o effectively determine the number of urban Primary Health Care teams required. Inconsistency and Inequity in Team Funding A disparity exists amongst Regina Qu Appelle Health Region s Primary Health Care teams in terms of the amount of annualized funding that is provided by the Ministry of Health. Primary Health Care Strategic Plan 2008-2013 Page III

Chronic Disease Prevention and Management Resources The planning, implementation and ongoing management of a regional chronic disease prevention and management strategy requires dedicated human and financial resources. Without them, the long-term sustainability of the strategy is at risk. Provincial Primary Health Care Information Solution Project Regina Qu'Appelle Health Region will require additional financial and human resources as the information technology solution evolves and grows. Gaps in the computer skills of some team members will need to be addressed prior to implementation. Organization of Regina Qu'Appelle Health Region Primary Health Care Services and Team Development Assisting leaders and service providers to manage change and transition continues to present both challenges and opportunities. Managing Expectations The issue of what Primary Health Care can and cannot address has arisen in certain communities, as well as frustration by some that implementation is not occurring quickly enough. Access Issues Improving access to Regina Qu Appelle Health Region health services is currently a significant priority for the region and a number of initiatives are currently underway in both Regina and rural areas to achieve this. Committees A number of planning teams, committees and partnerships exist at many levels in Primary Health Care development to address overall and community specific priorities. Communication Our communication strategy is aimed at facilitating change. We will review and refine our strategy to ensure accurate, timely and consistent communication with all stakeholders regarding Primary Health Care development and services. Budget The Regina Qu'Appelle Health Region will require new and ongoing resources if the objectives of this strategic plan are to be realized. We have included the estimated funding requirements to support existing teams and to implement the new ones that are being proposed. Primary Health Care development is complex and continues to present us with many challenges and opportunities. The Regina Qu'Appelle Health Region is committed to continuing onward, and appreciates the ongoing support and guidance received from the Ministry of Health, Primary Health Services Branch. Primary Health Care Strategic Plan 2008-2013 Page IV

1 Where do we want to be? Vision, Principles and Goals for Regina Qu'Appelle Health Region Primary Health Care Team/ Site Development 1.1 Vision The 2003 Regina Qu'Appelle Health Region (RQHR) Plan for Primary Health Care conveyed a vision for Primary Health Care (PHC) team/ site development that was consistent with the vision identified in the province s Action Plan for Saskatchewan Health Care (2001) and The Saskatchewan Action Plan for Primary Health Care (2002). The RQHR now has five years of experience in PHC planning and team development and we have learned some important lessons that might cause us to carry out certain processes and strategies differently, however, the RQHR remains steadfast in our original vision. We continue to view PHC as the foundation of a reorganized, revitalized health care system. We continue to be committed to establishing PHC teams and networks with physicians, nurse practitioners and other health care providers working in teams with individuals, families and communities to meet everyday physical, mental, spiritual and social health care needs, and with other sectors to address other determinants of health. We believe that by doing so, services will be strengthened and will be delivered in a more effective and efficient manner. 1.2 Principles and Goals In 2003 the Regina Qu Appelle Regional Health Authority established Ten-year Outcomes for Primary Health Care that were based on the principles of PHC and were consistent with the province s vision for PHC, and the RQHR s Mission, Vision and Values, and goals. These outcomes were to guide the ongoing planning and development of PHC teams and networks. Upon review by the RQHR PHC Steering Committee in 2008, it was determined that rather than outcomes the statements (see Appendix 1 for the complete document) more accurately reflect over-arching principles for PHC planning and development: Accessibility Public Participation Effective Health Promotion and Disease Prevention Proactive and Collaborative Approach to Management of Chronic Diseases Intersectoral Cooperation Patient/Client Centred Care Community Development Approach Human Resources Continuum Integration and Coordination of Services Communication / Information Sharing Appropriate Infrastructure and Resources Improved Health Status 2 How will we know when we get there? Key Measures of Success In 2002 Saskatchewan Health stipulated that by the end of four years defined performance measures and indicators for PHC would be in place. The importance of establishing indicators to measure the success of PHC renewal at local, regional, provincial/ territorial and federal levels is widely recognized and already much has been accomplished. Primary Health Care Strategic Plan 2008-2013 Page 1

2.1 RQHR Indicators RQHR has selected three indicators to evaluate our progress towards PHC team development: team effectiveness; client experience/ satisfaction with the care provided by the PHC team; and non-urgent visits to Emergency Departments in areas in which PHC teams exist. We are reviewing potential evaluation tools for each of these indicators. During the next year we will establish a baseline, targets and a mechanism for their ongoing monitoring. As required of all Saskatchewan health regions by the Ministry of Health, RQHR will also continue to track and report on the following indicators: percent of the population with geographic proximity to PHC teams; number of discrete clients receiving PHC services number of HealthLine calls from RQHR residents 2.2 Provincial Indicators Working Group A provincial PHC Indicators Working Group has also selected three of 105 indicators identified by the Canadian Institute for Health Information (CIHI) pan-canadian Primary Health Care Indicator Development Project to evaluate Saskatchewan PHC teams and services: percent of PHC organizations who currently have specific programs for PHC clients/patients with specific chronic conditions percent of PHC clients/ patients 12 or older who were screened by their PHC provider for 9 common health risks in the past year; and percent of General Practitioners/Family Practitioners/Nurse Practitioners who are currently working in an interdisciplinary PHC team or network as their main practice setting, by type of PHC provider. The Working Group is reviewing potential evaluation tools for each of these indicators. The RQHR will add these indicators to those identified above once tools are established. (For more information about the CIHI Pan-Canadian Primary Health Care Indicator Development Project and the list of the 105 PHC indicators, see Appendix 2). 3 Where are we now? Current State RQHR is the largest health care delivery system in southern Saskatchewan and one of the most integrated health delivery agencies in the country. RQHR offers a full range of hospital, rehabilitation, community and public health, long term care and home care services to meet the needs of 243,767 residents (Saskatchewan Health Covered Population 2006). Seventy-six percent reside in Regina and the remaining twenty-four percent live in or near rural communities or on reserves. While general trends show an aging population, a significant percentage of First Nations people are in younger age groups. (Statistics Canada, 2008). The RQHR has a large Aboriginal population. There are 17 reserves, three tribal councils and a number of Métis communities within the region, more than any other Saskatchewan health region. Improving access to RQHR health services is currently a significant priority for the region and a number of initiatives are currently underway to achieve this. Other priorities are communicated Primary Health Care Strategic Plan 2008-2013 Page 2

in RQHR s 2007-2010 Operating Plan highlights (Appendix 3), which responds to six strategic themes. RQHR s ongoing commitment to the development of PHC services is embedded within the access initiatives and these themes. 3.1 Organization of RQHR Health and PHC Services An array of comprehensive health and medical services exists across the RQHR that encompass health promotion, illness prevention, treatment, specialty care, rehabilitation and end of life care. Services are organized into four portfolios: Medical Administration/Systems Wide Admissions and Discharge Department/Native Health Services/Spiritual Care and Volunteer Services Specialty Care Restorative and Continuing Care; and Primary Health Care. PHC delivery falls within all these areas of responsibility, with support for overall PHC strategic planning and ongoing team/ program/service development being led from within the PHC portfolio. Eagle Moon Health Office supports planning by offering information and advice on how to make services accessible, effective and appropriate for First Nations and Métis people. Implementation of PHC plans and the day-to-day management and operation of PHC teams are the responsibility of two PHC Managers. The Urban PHC Manager reports formally to the Executive Director, Population and Public Health and the Rural PHC Manager to the Director, Rural Facilities Administration (under Restorative and Continuing Care). In Regina most of the core services provided by PHC teams are provided by staff who report formally to a variety of program areas from within the PHC portfolio. In the rural areas of RQHR a mix of staff from both PHC and Restorative and Continuing Care provide services. Linkages are becoming increasingly important between PHC teams and Specialty Care programs especially in the areas of chronic disease prevention and management, pharmacy services and soon, midwifery. Physician team members are not RQHR employees, but are engaged through contractual arrangements either with the RQHR or the Ministry of Health. RQHR PHC team members function in a matrix reporting relationship between the PHC Manager and their home department manager. Strong linkages, common goals and good communication between the managers and also between PHC and the other portfolios are essential therefore, to ensure smooth coordination of services and effective integration of team members. Mental Health and Addiction Services (MH&AS) is somewhat unique in the PHC portfolio in that its continuum of services straddles acute care and community sectors, and program structures, in many cases already function in a manner consistent with PHC goals. Multidisciplinary teams exist within each of the clinical treatment areas. Most psychiatrists in the RQHR are on contract with the RQHR, rather than in private practice. The scope of services provided by MH&AS goes far beyond just treatment; attention is paid to the holistic needs of the individual that impact on health and wellbeing. In addition, MH&AS s leadership in the Social Determinants of Health and Wellbeing initiative taking shape in Regina strongly supports the aims of PHC. Primary Health Care Strategic Plan 2008-2013 Page 3

3.2 Existing Teams In 2002 the Ministry of Health set a target of 25 percent of the population having access to PHC teams by 2007. By the end of 2007-08 approximately 26 percent of Saskatchewan s population had access to PHC teams. The percentage of people living in RQHR with geographic proximity to a PHC team was 24.73 percent, up from 15.9 percent in 2006-2007. Table 1 provides the details. TABLE 1 SITE (C = central S = satellite V = visiting) Regina Community Clinic (C) RGH Family Medicine Unit (C) North Central (Four Directions Health Centre) (C) Twin Valleys (one C and two S) POPULATION SERVED Actual Percent 4,093 1.68 17,760 7.29 10,350 4.25 7,063 2.90 Victoria East Medical Clinic (C) 21,000 8.61 TOTAL 60,266 24.73 Population data is based on the Saskatchewan Health 2006 Covered Population 4 How Do We Get There? Plan for PHC Services The Ministry of Health and the RQHR, along with all other provincial health regions are actively involved in four areas of priority to support PHC development: improving access to PHC teams selection of a provincial PHC software solution evaluation of PHC teams and services; and development of a provincial chronic disease prevention and management strategy. RQHR has also identified several regional PHC priorities for the next five years: continued provision of everyday health services by PHC teams full implementation of the North Central and Twin Valleys PHC plans chronic disease prevention and management and Chronic Renal Insufficiency services in Twin Valleys women s health programming development of the North Central Shared Facility potential development of a student run health centre Aboriginal Health Primary Health Care Strategic Plan 2008-2013 Page 4

development of Mental Health and Addiction s role in PHC community engagement ongoing team development functional space planning for PHC teams. 4.1 Improving Access to PHC Teams: Future Teams The goal remains to provide 30-minute access to a PHC practitioner or a group of practitioners across the entire health region. To date, RQHR PHC plans have been developed for two types of PHC teams ones that are based in neighbourhoods or geographic communities and others that are physician practice based. We have taken a phased approach to implementing teams while maintaining enough flexibility to be responsive when new opportunities or needs pertaining to PHC services arise. We have also assessed the appropriateness of certain communities for PHC development by referring to a list of Items for Consideration (see Appendix 4). These processes have worked well and we plan to continue with them. The use of mixed methodologies and lack of data that accurately and consistently depicts the actual population being served by PHC teams is a concern. PHC annual reports submitted by the RQHR over the years have referred to both covered and assigned population counts. While covered population data may be more suitable for rural teams it is not particularly meaningful for those urban practices whose patients do not necessarily come from a specific geographical catchment area. Using assigned population counts only partially addresses this issue. This situation makes it extremely difficult to: accurately determine the real number and percentage of urban residents who have access to PHC teams within Regina; and effectively determine the number of urban PHC teams required. RQHR is aware that the Ministry of Health is revising its formula for determining populations served and that new data is forthcoming. Maps showing potential RQHR urban and rural PHC sites are in Appendix 5. The following tables identify existing and potential communities and physician practices targeted for exploration of PHC development over the next five years. The target dates identified in the tables are subject to discussions with local community members and health care providers. Primary Health Care Strategic Plan 2008-2013 Page 5

TABLE 2 PROPOSED RQHR URBAN PHC SITES BY CITY OF REGINA ZONES City Zone Population Sites Implementation Target Date Central Zone *39,420 North Central Existing site (Four Directions) (C) Family Medicine Unit Existing site (RGH) (C) Regina Community Clinic Existing site (C) Broad Street Clinic (C) 2008 Core and Al Ritchie (S) 2009 East Zone *39,868 Victoria East Medical Existing site Clinic (C) South Zone *31,559 Allied Health Centre (C) 2009 North Zone *23,455 Northgate Medical 2010 Centre** (C) West Zone *49,450 Stapleford Medical 2011 Clinic** (C) Other *1,258 N/A N/A Total urban *185,010 population (C=central, S=Satellite) * - based on Ministry of Health 2006 Covered Population ** - Potential site only. Further discussion is required. We have planned for at least one PHC team in each of Regina s zones, however we anticipate that as new urban teams are successfully implemented more Regina physician practices will become interested in becoming PHC sites. When planning and prioritizing therefore, continued flexibility will remain the key. Consideration will be given to areas of the city that have fewer teams and the greatest need. Primary Health Care Strategic Plan 2008-2013 Page 6

TABLE 3 PROPOSED RQHR RURAL PHC SITES Site Population (C = central S = Served satellite V = visiting) Twin Valleys (one C and two S) Indian Head ( C) (serving Indian Head and RM of Indian Head, Mclean, Qu Appelle, Sintaluta, Kendal, Montmartre (V) and RM of Montmartre, R.M. of South Qu Appelle, Carry the Kettle First Nation Lestock ( C) (serving Lestock, Raymore, Gordon, Muskowekan, Day Star, Kawacatoose First Nations) Imperial (C) (serving Imperial, Liberty, Simpson, Penzance, Holdfast, Findlater, Regina Beach, Bethune) Ft. Qu Appelle ( C) Balcarres (S) (serving Standing Buffalo, Little Black Bear, Star Blanket, Okanese, Peepeekisis, Pasqua) Southey (S), (serving Cupar,, Piapot, Muscopetung,) Implementation Target Date 7,063 Existing Site 5,916 2008 5,472 2009 4,175 2010 8,811 2011 4,066 2012 Moosomin ( C) (serving Moosomin Rocanville, Wapella, Welwyn, and Fleming.) TOTAL 40,787 5,284 2013 Population data is based on the Saskatchewan Health 2006 Covered Population 4.1.1 New Teams in 2008-09 Indian Head PHC planning in Indian Head is underway. Funding has been committed by the Ministry of Health for a satellite team. Nurse Practitioner (NP) services are currently being provided for the community on occasional weekends on a temporary basis and recruitment for a permanent Primary Health Care Strategic Plan 2008-2013 Page 7

position is ongoing. A physician is providing coverage under a temporary PHC contract while arrangements are being made for a more permanent solution. Members of the local Community Consultation Committee have been identified and development of the plan for PHC services for Indian Head and area will begin in early fall 2008. The PHC team will be centralized in Indian Head and will serve the towns of Mclean, Qu Appelle, Indian Head, Sintaluta, Kendal and Montmartre, the rural municipalities of Indian Head, Montmartre and South Qu Appelle, Carry the Kettle (CTK) First Nations community and the Village of Katepwa. Broad Street Clinic It is anticipated that the Broad Street Clinic will be established as a PHC team by the end of the 2008 fiscal year. Broad Street Clinic patients come from throughout the RQHR and the southern half of the province, although many elderly patients are from the surrounding neighbourhood. Overall, much of the Broad Street clinic population is elderly. The practice also sees a high proportion of Aboriginal patients. Many patients have diabetes, hypertension and other chronic diseases. The Broad Street Clinic has been actively involved in the Health Quality Council Chronic Disease Management Collaboratives and the team members there intend to continue with ongoing improvements to their chronic disease services. The Clinic is also one of the first family practices in the province to have implemented an electronic patient health record system. Dr. Mark Cameron, one of the clinic physicians, has been involved with the provincial PHC Information Solution Project described in section 4.3. Core and Al Ritchie The Core and Al Ritchie neighbourhoods are two inner city Regina neighbourhoods with a combined covered population in 2006 of 12,523. Al Ritchie has many young families. Both neighbourhoods are multi-cultural communities, with Core in particular having a large number of immigrant, First Nations and Métis residents. The Plan for Primary Health Care for the Core and Al Ritchie Neighbourhoods (2006) reflects a strong focus on achieving health through addressing the determinants of health and through services that are neighbourhood based and community directed. During the next year we will concentrate on implementing the strategies identified in the plan as having first priority. In addition, a plan by the RQHR to develop an Addictions Treatment Centre within Core presents a potential opportunity for a co-located PHC team as a satellite of the Broad Street Clinic. 4.2 Chronic Disease Prevention & Management Strategy The growing prevalence and impact of chronic conditions is a serious concern, and across Canada and internationally people are looking for solutions to many of the same problems. In 1998 the World Health Assembly adopted a resolution on non-communicable diseases calling for the development of a strategy, which could address the growing global burden of chronic health conditions. Primary Health Care Strategic Plan 2008-2013 Page 8

Development of a provincial Chronic Disease Prevention and Management (CDPM) strategy is increasing as a priority for the Ministry of Health. To date, actions by the Ministry include: Funding the start-up costs for a provincial self management support program called Live Well with Chronic Conditions ; Preliminary work on a CDM information system (described under 4.3); Leading preliminary efforts by a provincial CDPM Strategy Working Group to develop a strategy and funding proposal. The development of a comprehensive RQHR CDPM strategy is also underway. Several activities during the last year have prepared us for this work: RQHR is involved in the provincial CDPM Strategy Working Group. RQHR underwent Accreditation in April 2008 according to Accreditation Canada s newly developed Populations with Chronic Conditions standards. A CDPM Strategy Development Consultant was hired for a nine-month term and a committee was struck to steer the strategy development. RQHR hired two Chronic Conditions Nurse Educators, assigned to the North Central and Twin Valleys PHC teams. In Twin Valleys planning for a formalized CDPM program and a Chronic Kidney Disease outreach program in collaboration with the Chronic Renal Insufficiency Program is underway. Work continues to fully implement the RQHR Diabetes Plan RQHR has actively participated in the Health Quality Council CDM Collaborative (CDMC) focused on diabetes and coronary artery disease. Beginning in 2009, we will participate in CDMC II which will focus on depression and chronic obstructive pulmonary disease. RQHR staff participated in the initial HQC consultation which initiated these two priorities this past June and continue to assist with the review of the specialized tools and materials which are being developed. Development and delivery of the Live Well with Chronic Conditions program continues to expand. The completed strategy will include an inventory of RQHR prevention and management services, an assessment of the current state, identification of specific strategies to support self managed care, and the identification of specific performance measures related to high priority areas. 4.3 Provincial PHC Information Solution Project The Ministry of Health is leading a project to select a software solution to be used by PHC providers throughout the province to facilitate electronic clinical documentation and communication. Providers will share a single chart for their PHC clients and will be able to effectively track and monitor the effects of their interventions. As part of this project work is also being done to integrate web-based Chronic Disease Management Toolkits (currently being used by practices involved in the Health Quality Council Chronic Disease Collaboratives). Vendor proposals have been submitted and will be short-listed by September 2008. Selection of a vendor is anticipated by December 2008. Primary Health Care Strategic Plan 2008-2013 Page 9

The RQHR is actively involved in this project. PHC and Information Technology managers from the RQHR are involved on various planning and working committees. Computer hardware to support the project and funded by the Ministry of Health has been purchased and installed. Frontline PHC staff will be involved in evaluating potential software solutions in September 2008. 4.4 PHC Indicator Development Discussed above, the development of PHC indicators is a priority of both the Ministry and the RQHR. The development of PHC indicators and the use of an electronic data system will ultimately become critical elements for the Ministry in determining and adjusting regional funding levels for PHC initiatives. 4.5 Other Priorities 4.5.1 Everyday Health Services PHC teams will continue to provide everyday health services to the individuals, families and communities they serve. The North Central and Twin Valleys teams will continue with a phased approach to implementing the strategies that were identified as priorities in their original PHC plans. 4.5.2 Twin Valleys Chronic Disease Prevention and Management All PHC teams will implement chronic disease prevention and management initiatives consistent with the comprehensive RQHR strategy, once developed. The Twin Valleys team is developing specific implementation plans; one which is focused on a service provision model for CDPM in general, and one that is focused specifically on collaborating with the Chronic Renal Insufficiency Program to provide local services for people with chronic kidney disease. 4.5.3 Women s Health Services The need for specific women s health programming is beginning to emerge in the statistics pertaining to patient visits submitted by our NPs. This will be fully explored during the next year. The provincial government has proclaimed legislation allowing for the delivery of regulated midwifery services in Saskatchewan. The RQHR is actively recruiting to the first of four funded urban midwifery positions. Office space is set up in shared space in the Regina General Hospital Medical Office Building. Once at least one midwife is hired, final planning of the service will occur, including communication with stakeholders regarding midwifery roles and scope of practice, communication with community regarding this type of service provider, and finalization of policies for midwifery practice. An RQHR Midwifery Steering Committee will be reinstated to provide input in to the final stages of implementation and integration. Ultimately, midwives will be integrated as part of certain urban PHC teams. Primary Health Care Strategic Plan 2008-2013 Page 10

4.5.4 North Central Shared Facility In North Central the RQHR will work with the North Central Shared Facility Steering Committee consisting of the North Central Community Association, the City of Regina, Regina Public Schools, Regina Police Service, Regina Public Library, Scott Infant and Toddler Care Centre, REACH, Ministry of Education (on behalf of Ministry of Social Services and Ministry of Corrections, Public Safety and Policing), and Regina Catholic Schools, to develop and implement a detailed plan in which the North Central PHC team will integrate with other human services within a state-of-the-art shared community facility located on Scott Collegiate property. 4.5.5 SWITCH Project The RQHR will collaborate with the University of Saskatchewan, College of Nursing and College of Medicine to plan and implement a student-run health clinic for inner city residents. Detailed planning will begin in August 2008, with implementation targeted for January 2009. 4.5.6 Aboriginal Health We will continue to work with First Nations Communities, providing regular on-reserve clinics where they currently exist, and explore opportunities to provide this service elsewhere. In communities where a significant number of First Nations and Métis people live, efforts will continue to close the gaps that currently exist in their health status. 4.5.7 Development of Mental Health and Addiction s role in PHC The quality of mental health services, the prevention of mental disorders and the promotion of mental health wellbeing are becoming a greater part of the public consciousness and discourse, as symbolized in increased media attention of late. The formation of the national Mental Health Commission and the push for the development of doable mental health strategies at all levels (including the RHA level) has prompted MH&AS in the RQHR to examine the range and the quality of its services. While discussions will continue about improving the quality, quantity and accessibility of the full range of our treatment services (inpatient and community based), an interesting dialogue has emerged with regard to the role of mental health services within PHC sites, specifically about clients currently not served by our existing services (those screened out). These clients would benefit from a less intense form of intervention that could prevent their deterioration by intervening early. However, as was stated earlier, MH&AS already functions in ways that are highly reflective of PHC goals. Some examples are: One contracted psychiatrist has been traveling to Grenfell and Fort Qu Appelle, each on a monthly basis for several years. Referrals for professional consultation services and case patient consults come from General Practitioners (GPs) in the eastern part of the health region and the rural Mental Health and Addictions staff based in these offices. Another psychiatrist has been meeting monthly with doctors in training and GPs at the Family Medicine unit to review cases, and to do some patient consultations. The intent is to expand this activity to include some structured training sessions on mental health topics with the medical students. In the past year, one psychiatrist has started attending the Harm Reduction Clinic (Methadone replacement therapy) on a regular basis. Primary Health Care Strategic Plan 2008-2013 Page 11

Provincial discussions occurred in 2007 about a possible shared care initiative, and Dr. Nick Kates was brought to Saskatchewan to lead Telehealth training sessions for mental health professionals and physicians. At this time, health regions are proceeding with their own shared care initiatives, and no provincial approach is underway. A consultant from the Ministry of Health Primary Health Services Branch will be joining the Mental Health and Addictions Regional Directors for discussion about further development in September, 2008. 4.5.8 Community Engagement Ongoing community engagement will continue to be a priority. The RQHR Principles for PHC Planning and Development states There will be meaningful partnerships between the community and the RQHR for the purposes of identifying health care related needs/priorities and for decision making Local community involvement will be key to developing partnerships. (see Appendix 1) Engagement of community(s), over the next five years will focus on: The continued formation of PHC Consultation Committees to encourage and support community members to be active partners in the development of a PHC Plan. Community Consultation Committees are described in more detail in section 6.2 of this document. Utilizing processes which embrace the sharing of the community perspectives, values and priorities for primary health care; and that will guide the development of programs and services based on the unique characteristics and health needs of the community. The sharing of information by the RQHR, with the community and committee members, to enable informed decision making in keeping with RQHR s values of respect, collaboration and stewardship. Ongoing communication and consultation with the community about PHC, once the Community s Primary Health Care Plan has been submitted to RQHR. 4.5.9 Team Development Building effective multidisciplinary PHC teams in a matrix environment is complex and requires considerable time, effort, cooperation and collaboration to first build, then maintain the teams. The RQHR PHC Development Consultant / Team Facilitator supports the Urban and Rural PHC Managers in their leadership of existing and new PHC teams and works closely with them in designing and implementing unique roadmaps for each team s development. Over the next five years, team development will focus on: Initial and periodic assessment of each team s effectiveness, which provides opportunity for them to assess themselves and monitor their own progress. Teams may also use the results to focus their team s ongoing learning and development. Increased emphasis on quality improvement methodology as a tool for making changes in service delivery. Opportunities for PHC teams to come together for shared learning, networking and/or collaborating on matters of mutual interest. Increased opportunity for the emergence of new care delivery models, such as: o blending aboriginal and traditional health practices; o exploring ways for more collaboration between solo practitioners especially in rural areas; o enhanced local services within Twin Valleys for people with chronic kidney disease. Integration of new team members into existing teams: Primary Health Care Strategic Plan 2008-2013 Page 12

o discussions are underway with respect to incorporating pharmacists into existing teams; o a physician will soon be hired for the North Central team and will first be integrated with the Four Directions Community Health Centre staff; o recruitment is underway for midwives who will provide visiting services as members of multiple urban PHC teams. Significant planning to bring the North Central team to a single location in a shared facility with other organizations and opportunities for new partnerships and alliances. Discussions with service providers are expected to commence in the fall of 2008. In Twin Valleys, new service delivery models for chronic disease prevention and management, especially for clients with chronic kidney disease. For other teams, as the region s strategy for chronic disease prevention and management is developed and becomes a reality, it is anticipated that all PHC teams will become much more engaged and therefore a focal point for team development. Skills, knowledge, and communication processes necessary to implement a PHC IT system. Continuation of the RQHR PHC Nurse Practitioner Network. Continuing efforts toward developing a network of PHC teams across the region. 4.5.10 Functional Space Planning For Teams As existing teams expand and new teams are formed availability of adequate office and clinical space is becoming more of an issue. For instance: by July 2008, Four Directions Health Centre will, out of necessity, operate out of two locations in North Central; with the upcoming expansion of the number of College of Medicine students in Regina the Family Medicine Unit will quickly out-grow its existing facilities at the Regina General Hospital; full implementation of a PHC team in Core and Al Ritchie Regina will be impossible in the space currently occupied by the Al Ritchie Health Action Centre. In conjunction with RQHR Facilities Management a comprehensive plan will be developed to meet the imminent and anticipated functional space needs for all RQHR PHC teams. 5 Challenges 5.1 PHC Team Funding and Composition More flexibility is needed in team funding. While the recent provision of one-time funding by the Ministry of Health to support the integration of pharmacists as part of PHC teams is welcome, the RQHR believes that funding should be available for the integration of other professionals as well, with opportunities for the regions and communities to determine the types of health professionals best suited to meet local needs. Although physician involvement on PHC teams is strongly preferred, this is not essential to initiating a functioning team within an identified community. In rural communities in particular, there are many instances in which access issues could be addressed by making the best use of the health professionals that are available and where, if there was more flexibility in their funding, NP s could address some of the gaps in physician services. Primary Health Care Strategic Plan 2008-2013 Page 13

In some areas, physicians interested in working within a team may be more eager to engage with a Chronic Conditions Nurse Educator or Addictions Counsellor to provide better management of chronic diseases than an NP. 5.2 Engaging Physicians as Stipulated in the 2003 PHC Planning Guidelines Most physicians on alternate payment within the province are already part of a PHC team, while many fee-for-service physicians are hesitant to move forward without a sanctioned model contract from the Saskatchewan Medical Association. There needs to be more movement towards flexible means of engaging physicians, such as: sessional fees; blended contract arrangements; not requiring all physicians in a clinic to move to alternate payment in order to engage in the initiative; the ability to engage new physicians as part of PHC teams without the requirement of a previous fee-for-service billing history; the ability to engage solo practitioners as part of central teams; the initiation of a team without physician involvement with the goal to engage the physician in the future. 5.3 Inconsistency and Inequity in Team Funding A disparity exists amongst RQHR s PHC teams in terms of the amount of annualized funding that is provided by the Ministry of Health. For instance, the Family Medicine Unit (FMU) is the only PHC site in the RQHR that does not receive annual team development and clerical funding. This creates difficulties especially as we work towards enhanced communication, coordination and networking between the teams. It also limits the ability of FMU team members to participate in such things continuing education activities or strategic initiatives. In Twin Valleys spreading the $35,000.00 currently provided for clerical support and consumables between three full-time NPs located in three different communities is becoming increasingly challenging. This funding is in significant disproportion with other PHC teams that receive the same amount of clerical funding to support an individual nurse practitioner working at a single location. This problem will be even more evident once the Indian Head team is in place. The Indian Head PHC site does not neatly fit the Ministry of Health definition of a central team and it is being funded as a satellite. This means therefore, that there are no additional clerical and consumable or team development dollars being provided. The already insufficient central team funding for Twin Valleys cannot possibly be stretched further to support Indian Head. 5.4 Chronic Disease Prevention and Management Resources The planning, implementation and ongoing management of a regional chronic disease prevention and management strategy requires dedicated human and financial resources. As was mentioned, the RQHR has funded a temporary position to develop our strategy. However, without ongoing funding for a chronic disease manager and for coordination of the Live Well with Chronic Conditions program, sustainability in the longer term is at risk. Primary Health Care Strategic Plan 2008-2013 Page 14

5.5 Provincial PHC Information Solution Project Although important, RQHR does not have the capacity to dedicate full-time human resources to the PHC Information Solution project. A considerable amount of staff time and resources are being required, however. Consideration for reasonable turn around times for meetings and completion of tasks is essential. Additional financial and human resources will be required as the information technology solution evolves and grows. As implementation draws nearer, another concern is arising. Some PHC team members are now identifying gaps in their computer skills that must be addressed before they can successfully use any new system. 5.6 Organization of RQHR PHC Services and Team Development It requires considerable time and effort to first build, then maintain PHC teams. Assisting leaders and service providers to manage change and transition is a significant component of team development and continues to present both challenges and opportunities. The formation of multidisciplinary teams in a matrix environment is complex and requires considerable cooperation, collaboration and commitment. As anticipated, we are experiencing varying degrees of enthusiasm, willingness and readiness of existing team members and others across the organization to think and work together in new ways, and to change the way they interact and do their day-to-day work. Progress is impeded by an inability to get people to the table to form teams. However, successful matrix relationships and PHC team development with more people taking ownership and responsibility will broaden the opportunities to shift to a different service delivery model. 5.7 Managing Expectations The issue of what PHC can and cannot address has arisen in certain communities. There appears to be a perception held by some, of PHC as a catch-all to address every type of health care issue, and an expectation that PHC should include all services, even those that are highly specialized (such as dialysis) in order to meet community needs. Frustration has also been expressed within these communities that the implementation of PHC is not fast enough, with results not always being clearly visible. Considerable efforts have been made to communicate the concepts and principles of PHC. We have described it in the context of providing everyday health services aimed at preventing the need for highly specialized services where possible, and effective linking with these services where needed. A number of actions have also been taken to communicate the progress of PHC development. It appears however, that our messages are not consistently being received or understood. We have begun therefore, to review our communication strategies and to identify alternate means of exchanging information with communities. 5.8 Access Issues Improving access to RQHR health services is currently a significant priority for the region and a number of initiatives are currently underway to achieve this. In Regina, the main focus is on improving access to beds within the two acute care facilities. One of the six initiatives that has been established to address access issues relates to admission rates and lengths of stay for Ambulatory Care Sensitive Conditions. A Chronic Disease Prevention and Management Committee has been established and will be taking leadership in the development of a chronic disease strategy, one component of which will be ambulatory care sensitive conditions. Primary Health Care Strategic Plan 2008-2013 Page 15

In rural areas, perceived and actual shortages of physicians and other health care providers exist. Many rural physicians are working in solo or small practices. They need assistance to develop linkages and work collaboratively with other providers in nearby communities and to work more effectively with other team members. 6 Committees Planning teams, community consultation committees and intersectoral and interagency partnerships exist at many levels in PHC development to address overall and community specific priorities. A number of examples follow. 6.1 Planning Teams 6.1.1 RQHR PHC Steering Committee The role of the RQHR PHC Steering Committee is to provide overall leadership to the Region in furthering the principles of primary health care, ensure the development and implementation of strategic plans for primary health care, and facilitate the coordinated delivery of primary health care. The Committee is Chaired by the Vice President, Primary Health Care. Other members include: o One other Health Services Vice President o Strategic Planner, Primary Health Care o Three to five Executive Directors o Medical Health Officer o Regional Intersectoral Committee (RIC) Coordinator o Director of the Eagle Moon Health Office (or designate) o Department Head, Department of Family Medicine o Representative of Research and Performance Support o Representative of the Saskatchewan Medical Association (via the Region Medical Association) o Department of Health, Primary Health Services Branch representative Other representatives are invited to meetings as needed. 6.1.2 Twin Valleys CDPM and CKD Outreach Committees These two committees, comprised of local PHC and Specialty Care managers, PHC team members, Specialty Care team members and local First Nations health care providers are planning the implementation of specific services designed to meet the needs of local community members who are at risk for and/or who have chronic conditions, particularly diabetes and chronic kidney disease. 6.1.3 RQHR North Central Shared Facility Working Group As the Shared Facility project progresses, the RQHR has formed a working group representative of the programs and services that will be offered in the facility. This RQHR Working Group is focused on the integration of health services with the other partner services, development of the RQHR team, and will oversee the actual space development for the Four Directions Primary Health Care Centre in the Shared Facility. Primary Health Care Strategic Plan 2008-2013 Page 16

6.2 Community Consultation Committees Up to now, public participation and community engagement in PHC planning and development have been mainly through Community Consultation Committees (CCCs) comprised of local community members, local human services providers and RQHR staff. The CCCs have been extremely valuable in assisting the RQHR with planning local PHC services by providing input and ideas regarding local health issues and needs that PHC could address, and potential PHC programs and services to address those needs. The role of the CCC once initial planning is complete has been discussed extensively by the RQHR PHC Steering Committee during the past year. Initially, the intent was that the committees would continue to meet from time to time. Committee members would be kept apprised of progress being made in terms of implementation and would continue to advise the RQHR on matters pertaining to community needs. This process has had its limitations and challenges and the RQHR is now considering other means of engaging and communicating with community members on an ongoing basis. It is anticipated that models will differ from community to community, recognizing the unique characteristics of urban, rural and First Nations communities. 6.3 Intersectoral and Interagency Partnerships RQHR PHC leaders and staff continue to be involved with many intersectoral and interagency partnerships and projects aimed at improving quality of life for certain populations such as KidsFirst, the Regina and Area Drug Strategy, In Motion, the Health Quality Council, the Regina Regional Intersectoral Committee (RIC) and the Regina Inner City Community Partnership Steering Committee. It is through intersectoral partnerships within Regina that the concept of a shared facility in North Central was conceived. The development of the North Central Shared Facility has been guided by a Steering Committee composed of representatives from the North Central Community Association, Regina Public Schools and Scott Collegiate, Regina Police Service, Regina Public Library, Ministry of Education, Ministry of Corrections Public Safety and Policing, Scott Infant and Toddler Care Centre, Regina Education and Action on Child Hunger (REACH), City of Regina, and the File Hills Qu Appelle Tribal Council. This Steering Committee has been chaired by RQHR s VP Primary Health Care. In addition to the Steering Committee, an Interim Management group has been formed consisting of City of Regina, North Central Community Association, Ministry of Education, Regina Public Schools, Regina Public Library and RQHR. Through the RQHR s involvement with the RIC and the Mayor s Taskforce on Sustainability, MH&AS has had the opportunity to take a leadership role in the development of a broad initiative aimed at taking action on the social determinants of health or the determinants of well being of our community. A framework has been accepted and a preliminary work plan for this initiative embraced by the agencies represented by the RIC. The framework centers on three key action areas: creating awareness and community dialogue about the importance of the social determinants; developing a common policy lens through which all emerging social policy can be examined; and measuring our progress towards community well being with highly integrated cross-sectoral indicators. Members of a Community Support Team have been identified by participating agencies to develop and direct this work. Together, and within the organizations they represent, the team will encourage each sector in their collective responsibility to do business in a way which not only fulfills their individual mandates, but also contributes to significant and sustained improvement in the overall well being of our community. Primary Health Care Strategic Plan 2008-2013 Page 17

7 Communication Our communication strategy has and will continue to be aimed at facilitating change. To date a multitude of venues and services have been utilized to communicate the progress of PHC development including local newspapers and RQHR publications mail drops bulletin boards town council meetings and civic organizations Community Consultation Committees RQHR PHC internet and intranet sites presentations to students and various health professional groups a standard PHC PowerPoint presentation for use in many situations. During the next year we will review and refine our strategy, making improvements as necessary to ensure: accurate, timely and consistent communication between RQHR leaders and PHC team members, RQHR staff and physicians about PHC development; and accurate, timely and consistent communication between RQHR leaders and local community residents about PHC services. Primary Health Care Strategic Plan 2008-2013 Page 18

8 Budget The following chart reflects the anticipated year of implementation for a team with the attached funding required to support the team in subsequent years. These figures are based on information provided to all health regions in 2007. The amounts are annualized and would be pro-rated depending on the start date of the potential initiative. Site 2008-09 2009-10 2010-11 2011-12 2012-13 North Central* (C) $268,900 $268,900 $268,900 $268,900 $268,900 SWITCH $50,000 $50,000 $50,000 $50,000 $50,000 Family Medicine Unit* (C) $76,000 $76,000 $76,000 $76,000 $76,000 Regina Community Clinic* (C) $178,900 $178,900 $178,900 $178,900 $178,900 Victoria East Medical Clinic* (C) $188,100 $188,100 $188,100 $188,100 $188,100 Broad Street Clinic (C) $313,100 $188,100 $188,100 $188,100 $188,100 Core/ Al Ritchie (S) $128,100 $103,100 $103,100 $103,100 $103,100 Allied Health Centre (C) $313,100 $188,100 $188,100 $188,100 Northgate Medical Centre (C) $313,100 $188,100 $188,100 Stapleford Medical Clinic (C) $313,100 $188,100 Twin Valleys* (C) $366,700 $366,700 $366,700 $366,700 $366,700 Indian Head* (C) $103,100 $103,100 $103,100 $103,100 $103,100 Lestock (C) $313,100 $188,100 $188,100 $188,100 Imperial (C) $313,100 $188,100 $188,100 Fort Qu Appelle (C) $313,100 $188,100 Balcarres (S) $128,100 $103,100 Southey (S) $128,100 Moosomin (C) $313,100 Total $1,672,900 $2,149,100 $2,525,300 $3,029,600 $3,195,800 * -indicates existing sites C= Central; S= Satellite Primary Health Care Strategic Plan 2008-2013 Page 19

9 Conclusion The RQHR Strategic Plan for Primary Health Care (2008-2013) provides a sound framework for PHC development for the next five years; for getting from where we are now to where we want to be. We have identified the indicators we will use to measure our progress, and we have identified a number of priorities for action. There are many challenges that need to be addressed in order to effectively move forward, and we are confident that there will be continued efforts to do so, by both the RQHR and the Ministry of Health. The RQHR is well positioned to implement this strategic plan. We have many dedicated managers and staff committed to PHC development, and we have valuable relationships with a number of important community partners. The next several years will continue to be exciting as we increase the number of teams and types of PHC services available to RQHR residents, continue with team development, implement a Chronic Disease Prevention and Management strategy and go live with a PHC information management system. Primary Health Care Strategic Plan 2008-2013 Page 20

10 Appendices 10.1 Appendix 1 RQHR Principles for Primary Health Care Planning and Development June 2003 (revised May 2008) Introduction The Regina Qu Appelle Health Authority considers the development of Primary Health Care Services to be one of its top strategic priorities. Based on the principles of Primary Health Care, the Authority has established key principles to serve as the basis for the development of multi-year work plans. Accessibility Everyday health care needs of individuals, families and communities will be met in a more timely manner, through the programs and/or services most appropriate to meet those needs, either in a location close to home or in the home. Health needs will be met in a less intrusive and more cost-efficient manner. Effective Health Promotion and Disease Prevention Health promotion and disease prevention will provide the foundation for programs and services in a primary health care environment and will also be an integral component of secondary and tertiary care. Public Participation / Community Development There will be meaningful partnerships between the community and the RQHR for the purposes of identifying health care related needs/priorities and for decision making. Roles of the community and service providers in this context will be clearly defined. Local Community Advisory Committees will be key to developing partnerships. Community members will be encouraged and supported to be active partners - not just as consumers, but in being actively responsible for their own health. Programs and services will draw on the strengths of the community and be based on the health status of the community, community needs and community expectations. At the same time unique needs of individual community members will be recognized and supported. Patient / Client Centered Care The focus will be on the person in the context of family and community. Individuals will be supported in self-care. They will have the information necessary to make decisions regarding their own health. They will be encouraged in seeking out available resources to achieve the outcomes they desire. Co-operation, Co-ordination and Integration of Services There will be an integrated service response in all phases of client contact with the primary health care system. Focus will be on the person in the context of family and community. The primary health care system will assume responsibility for ensuring there is an integrated plan for care delivery and support, working with other sectors (including commerce, employers, non-profit agencies, education, justice and social services) in initiatives aimed at improving overall health status and addressing issues related to the determinants of health. Primary Health Care Strategic Plan 2008-2013 Page 21

RQHR Principles for PHC Planning and Development (continued) Proactive and Collaborative Approach to Management of Chronic Diseases Chronic illness will be managed by inter-disciplinary teams in the community in partnership with patients and their families. Management will be based on established quality standards. There will be effective mechanisms in place for tracking and monitoring patient progress and team compliance to quality standards. Certain chronic diseases may be selected for special attention based on the health status of various communities. Communication / Information Sharing Communication and information sharing will build on the strength and diversity of team members and will be supported by the appropriate technology. Sound evidence will be available through the use of technology to facilitate decision making and to monitor and evaluate programs, and changes to health status/health outcomes. Human Resources Continuum An integrated continuum of health care providers from the client, family members and lay service providers, to very specialized health professionals will work as a team. All providers will be utilized to their fullest potential so that service is provided most effectively. The human resources continuum will also be multi-sectoral in nature. Team members from sectors other than Health and the health provider team will integrate to address issues related to the determinants of health. The RQHR will play an active role in fostering appropriate academic preparation for health and other human service professionals to support a primary health care environment. Orientation for all new employees of the RQHR will include education on the fundamental concepts of primary health care. Resources Resources will be targeted where they will have the most positive impact on health outcomes of the community. Incentives will be in place to support integration and inter-disciplinary primary health services delivery. Infrastructure An adequate infrastructure will exist, comprised of the equipment, human resources, information technologies and facilities needed to support effective service delivery. Culture A culture will exist, which supports innovation, research, knowledge management and creativity in the development and delivery of primary health care services and programs. Improved Health Status The actions taken to develop and advance primary health care delivery will result in an overall improvement in the health status of the RQHR population. Gaps in health status between different populations will be narrowed. Health care providers and the public will be confident that the quality of those programs and services being delivered has been measured against specific performance indicators related to primary health care. Primary Health Care Strategic Plan 2008-2013 Page 22

10.2 Appendix 2: Pan-Canadian Primary Health Care Indicators Pan-Canadian Primary Health Care Indicators: Background In 2004 Health Canada established the Primary Health Care Transition Fund (PHCTF) National Evaluation Strategy and in 2005 Canadian Institute for Health Information (CIHI), funded by the PHCTF, launched the pan-canadian Primary Health Care Indicator Development Project. The project aimed to: Develop a set of agreed-upon PHC indicators with which to compare and measure PHC at multiple levels within jurisdictions across Canada. Provide advice on a future data collection infrastructure that could supply the data to report these indicators across Canada. The work resulted in the identification of 105 indicators (attached) grouped into eight categories: access to PHC through a regular provider; comprehensive care, preventive health and chronic condition management; continuity through integration and coordination; 24/7 access to PHC; patient-centred PHC; enhancing population orientation; quality in PHC; and PHC inputs and supports. Given the challenges of developing and reporting information for each indicator, an abridged list of 30 indicators was also identified by the project team. Full project reports can be obtained at: http://secure.cihi.ca/cihiweb/disppage.jsp?cw_page=contact_e#publications Primary Health Care Strategic Plan 2008-2013 Page 23

CIHI Primary Health Care Indicators PHC Indicators Appendix A PHC INDICATORS Category # Indicator Data Source Available Access through a regular PHC provider Enhancing the population orientation of PHC Comprehensive Whole Person Care Enhancing an Integrated Approach to 24/7 Access Quality of PHC Quality of PHC (Con't) 1 % of population who currently have a regular PHC provider CCHS (only for GP/FP providers) Yes 2 % of adult population who experienced difficulties obtaining required routine or ongoing PHC from regular provider over the past year Modified CCHS No 3 % of adult population who experienced difficulties obtaining required health information or advice from regular provider over the past year Modified CCHS No 4 % of adult population who experienced difficulties obtaining immediate care for an emergent, but minor health problem from regular provider over the past year Modified CCHS No 5 % of PHC organizations who used information on the composition of their practice population to allocate resources for programs/services over the past year Survey No 6 % of PHC organizations who currently have a client/patient registry for chronic conditions Survey No 7 % of PHC organizations who currently have specific programs for PHC clients/patients with specific chronic conditions Survey No 8 % of PHC organizations who currently have processes for community input for planning the organization's services Survey No 9 % of PHC organizations that currently do outreach to deliver PHC services to vulnerable/special needs populations Survey No 10 % of PHC organizations that currently provide specialized programs for vulnerable/special needs populations Survey No 11 % of PHC organizations that currently receive information or process support from their health region to serve vulnerable/special needs populations Survey No 12 % of PHC organizations who currently provide a list of 12 key services Survey No 13 % of PHC clients/patients 12 or older who were screened by their PHC provider for 9 common health risks in the past year Survey No 14 % of PHC clients/patients 12 or older who are smokers and received specific help to quit from their PHC provider over the past two years CCHS (only for GP/FP providers) Yes 15 % of PHC clients/patients 12 or older with problem alcohol drinking who received specific help to manage alcohol consumption from their PHC provider over the past two years Survey No 16 % of PHC clients/patients 12 or older with unhealthy eating habits who received specific help or information on healthy diet from their PHC provider over the past year Survey No 17 % of inactive PHC clients/patients 12 or older who received specific help or information on regular physical activity from their PHC provider over the past year Survey No 18 % of PHC organizations who currently have specific programs to reduce five common health risks Survey No 19 % of health regions who currently have specific programs to reduce five common health risks Survey No 20 % of population 12 or older who are current smokers CCHS Yes 21 % of population 12 or older who currently consume five or more servings of fruits and vegetables daily CCHS Yes 22 % of population who are currently overweight or obese CCHS Yes 23 % of population who currently engage in regular physical activity CCHS Yes 24 % of population 12 or older who report heavy alcohol drinking behaviour in the past year CCHS Yes 25 % of adult PHC clients/patients with a chronic health condition(s) whose PHC organization provided them with resources to support self-management or self-help groups Survey No 26 % of informal caregivers who received support for their care giving role from their PHC organization over the past year Survey No 27 % of adult PHC clients/patients with a chronic condition(s) who had sufficient time in most visits to confide their health-related feelings, fears and concerns to their PHC provider Survey No 28 % of adult PHC clients/patients with chronic condition(s) who actively participated in the development of a treatment plan with their PHC provider in the past year Survey No 29 % of adult population who experienced difficulties obtaining immediate care for an emergent, but minor health problem from regular PHC provider after hours over the past year Modified CCHS No 30 % of PHC organizations who currently provide after hours coverage for their practice population Survey No 31 Average number of extended hours provided by PHC organizations per month, by PHC organization Survey No 32 Average length of time in days between client/patient appointment request with their regular PHC provider and the appointment for an emergent, but minor health problem Administrative Data No 33 % of adult PHC clients/patients who are satisfied with wait time to obtain an appointment with their regular PHC provider for an emergent, but minor health problem Survey No 34 % of adult PHC clients/patients who are satisfied with wait time to obtain an appointment with their regular PHC provider for non-urgent routine care Survey No 35 Age-standardized acute care hospitalization rate for conditions where appropriate ambulatory care prevents or reduces the need for admission to hospital/100,000 population under 75 HMDB Yes 36 % of PHC clients/patients 18-64 with established diabetes mellitus who have had an acute myocardial infarction or leg amputation or began chronic dialysis in the past year DAD or HMDB with PHC encounter Data No 37 % of PHC clients/patients 6-55 with asthma who visited the emergency department in the past year NACRS with PHC encounter data No 38 % of PHC clients/patients 20-75 with CHF who visited the emergency department in the past year NACRS with PHC encounter data No 39 % of adult PHC clients/patients with diabetes mellitus in whom the last HbA1c was 7.0% or less in the last 15 months Clinical administrative data No 40 % of adult PHC clients/patients with hypertension for duration of at least one year, who have blood pressure measurement control Clinical administrative data No 41 % of PHC clients/patients 65 and older who received influenza immunization within the past year Clinical administrative data and CCHS No 42 % of PHC clients/patients 65 and older who have received a pneumococcal immunization Clinical administrative data No 43 % of PHC clients/patients who received screenings for congenital hip displacement, eye and hearing problems by 3 years of age Clinical administrative data No 44 % of PHC clients/patients who received required primary childhood immunizations by 7 years of age Clinical administrative data No 45 % of women PHC clients/patients who had a live birth and received counseling on breast feeding, education programs and postpartum support to promote breast feeding Clinical administrative data No 46 % of women PHC clients/patients who are pregnant or post partum who have been screened for depression Clinical administrative data No 47 % of PHC clients/patients with children under 2 years who were given information on child injury prevention in the home Clinical administrative data No 48 % of PHC clients/patients 50 and older who received screening for colon cancer with Hemoccult test within the past 24 months Clinical administrative data No 49 % of women PHC clients/patients 50-69 who received mammography and clinical breast examination within the past 24 months Clinical administrative data and CCHS No 50 % of women PHC clients/patients 18-69 who have received a papanicolaou smear within the past 3 years Clinical administrative data and CCHS No 51 % of women PHC clients/patients 65 and older who received screening for low bone mineral density at least once Clinical administrative data No 52 % of women PHC clients/patients 55 and older who had a full fasting lipid profile measured within the past 24 months Clinical administrative data No 53 % of male PHC clients/patients 40 and older who had a full fasting lipid profile measured within the past 24 months Clinical administrative data No 54 % of adult PHC clients/patients who had their blood pressure measured in the past 24 months Clinical administrative data No 55 % of adult PHC clients/patients with coronary artery disease who received annual testing within the past year for all of four key factors Clinical administrative data No 56 % of adult PHC clients/patients with hypertension who received annual testing within the past year for all of five key factors Clinical administrative data No 57 % of adult PHC clients/patients with diabetes mellitus who received annual testing within the past year for all of five key factors Clinical administrative data No 58 % of PHC clients/patients 18-75 years with diabetes mellitus who saw an optometrist or opthamologist within the past two years Clinical administrative data No 59 % of PHC clients/patients 6-65 with asthma who were dispensed high amounts of short-acting beta2-agonist within the past year and who received a prescription for preventer medicatio Clinical administrative data No

Quality of PHC (Con't) Patient-Centered Care Continuity through Integration and Coordination Health Human Resources Interdisciplinary Teams Information Technology 60 % of adult PHC clients/patients with CHF who are using ACE inhibitors or ARBs Clinical administrative data No 61 % of adult PHC clients/patients with established CAD and elevated LDL-C who were offered lifestyle advice and/or lipid lowering medication Clinical administrative data No 62 % of PHC clients/patients who have had an AMI and are currently prescribed a beta-blocking drug Clinical administrative data No 63 % of PHC clients/patients with depression who are taking antidepressant drug treatment under the supervision of a PHC provider and who had a follow-up for review within two weeks Clinical administrative data No 64 % of adult PHC clients/patients with depression who were offered treatment or referral to a mental health provider Clinical administrative data No 65 % of adult PHC clients/patients with a diagnosis of panic disorder or generalized anxiety disorder who are offered treatment or referral to a mental health provider Clinical administrative data No 66 % of PHC clients/patients with prescription or illicit drug use problems who were offered, provided or directed to treatment by the PHC provider Clinical administrative data No 67 % of PHC providers whose PHC organization has processes and structures in place to support a non-punitive approach to medication incident reduction Survey No 68 % of PHC organizations who currently use an electronic prescribing/drug ordering system that includes client/patient specific medication alerts Survey No 69 % of PHC organizations who implemented at least one or more changes in clinical practices as a result of quality improvement initiatives over the past year Survey No 70 % of PHC organizations with a process in place to ensure that a current medication and problem list is recorded in the phc client's/patient's health record Survey No 71 % of PHC clients/patients who report that their regular PHC provider has not explained the side effects of medications when prescribed, within the past year Survey No 72 % of PHC providers and support staff whose PHC organization provided them with support to participate in continuing professional development within the past year Modified NPS for GP/FP No 73 % of adult PHC clients/patients who were satisfied with the care received from their regular PHC provider(s) over the past year CCHS (only for GP/FP providers) Yes 74 % of the adult population who were satisfied with the telephone health information or advice line over the past year CCHS Yes 75 % of adult PHC clients/patients who would recommend their regular PHC provider to their family or friends Survey No 76 % of adult PHC clients/patients who were involved in clinical decision-making regarding their health with their regular PHC provider over the past year Survey No 77 % of clients/patients who were satisfied with the level of privacy provided by their PHC organization over the past year Survey No 78 % of adult PHC clients/patients who experienced language barriers when communicating with their regular PHC provider over the past year Survey No 79 % of PHC organizations who currently coordinate client/patient care with other health care organizations using standardized clinical protocols or assessment tools Survey No 80 % of PHC organizations who currently have collaborative care arrangements with other health care organizations Survey No 81 % of PHC organizations who currently have collaborative care arrangements with providers/organizations beyond the health care sector Survey No 82 % of adult PHC clients/patients who felt that unnecessary medical tests were ordered because the test had already been done, over the past year Survey No 83 % of PHC FPs/GPs/NPs who repeated tests because findings were unavailable, over the past month Survey No 84 % of PHC providers who had complete information at the point of care, most of the time, over the past year Survey No 85 PHC provider FTEs per 100,000 population by type of PHC provider Scott's Medical Database and NPDB only for GP/FP Yes 86 Ratio of PHC providers entering/leaving the workforce over the past 12 months, by type of PHC provider Scott's Medical Database and NPDB only for GP/FP Yes 87 % of PHC organizations that are currently accepting new PHC clients/patients NPS only for GP/FP Yes 88 % of PHC providers who are satisfied that they utilize the full extent of their skills, by type of PHC provider Modified NPS for GP/FP No 89 % of PHC providers who report that there are currently adequate provisions to ensure their safety in their workplace, by type of PHC provider Modified NSWHN only for nurse providers No 90 % of PHC providers who had a workplace related injury over the past 12 months, by type of PHC provider NPS and NSWHN only for GP/FP and nurse providers No 91 % of PHC providers who missed work due to burnout over the past 12 months, by type of provider NPS and NSWHN only for GP/FP and nurse providers No 92 % of PHC providers who were satisfied with the overall quality of work-life balance over the past 12 months, by type of PHC provider NPS and NSWHN only for GP/FP and nurse providers No 93 % of health regions that are currently implementing a plan to meet their PHC health human resource needs Survey No 94 % of population who received PHC services from an interdisciplinary PHC organization, over the past 12 months Modified CCHS No 95 % of GPs/FPs who currently work in a solo PHC practice as their main PHC practice setting NPS Yes 96 % of GPs/FPs who currently work in a group physician PHC practice as their main PHC practice setting NPS Yes 97 % of GPs/FPs/NPs who are currently working in an interdisciplinary PHC team or network as their main practice setting, by type of PHC provider MPS, NSWHS No 98 % of PHC clients/patients who report that the current range of services offered by their PHC organization meets their needs Survey No 99 Average team effectiveness for 11 categories Survey No 100 % of PHC organizations that primarily use electronic systems to complete their professional tasks Survey No 101 % of PHC organizations that currently use a variety of electronic communication modalities in the exchange of health centre information with other PHC providers Survey No 102 % of PHC organizations that currently have two-way electronic communication linkages (beyond fax and telephone) with other health care organizations Survey No Needs-Based Resource Allocations 103 Average annual per capita operational expenditures of PHC services for five categories Administrative Data No Provider Payment Methods 104 % of PHC providers who were primarily remunerated by each type of payment method over the past 12 months, by provider NPS only for GPs/FPs No 105 Average % of PHC provider income derived from each type of payment method for one fiscal year, by type of PHC provider NPS only for GPs/FPs No

Regina Qu Appelle Health Region s Operating Plan Our Map to the Future What is the Regional Operating Plan? The 2007-2010 Regina Qu Appelle Health Region s Operating Plan is the map that leads us to our Vision, and our preferred future as a health care organization. The Operating Plan lays out the steps the RQHR is taking to achieve its six Strategic Themes. There are 15 objectives that support the Strategic Themes. The Region has consciously selected these objectives to focus its efforts and resources. They are propelling the organization forward on its journey to becoming the health care provider it has envisioned in its Mission. To achieve each of the objectives, there are specific program initiatives that are being undertaken by various areas of the Region. As each year passes, the objectives may change as program initiatives are completed and goals are achieved. But what remains constant are our values and our commitment to service and safety. What do you need to know about our Operating Plan? Quite simply, you need to know that we have a plan, that it supports our Vision, and that you and your team may have a role in achieving some of our 15 objectives. You are the heart of our organization. Your contribution, every day, in the provision of quality health care is essential to the Region s success. The 15 objectives that support the six Strategic Themes in the Regional Operating Plan are: Strategic Theme 1 Achieve Sustainable Quality Services Provide appropriate, safe and trusted services within available resources. 1. Improve service quality and safety 2. Provide services that are appropriate at a local, provincial and regional level 3. Enhance public confidence and trust in services 4. Effectively manage resources Strategic Theme 2 Advance a Positive, Innovative Work Environment Enhance the individual experience through a work environment which fosters respect, pride, accountability and Living Our Values. 5. Achieve employee/physician engagement and teamwork 6. Provide safe, supportive, quality workplaces 7. Increase leadership capacity Strategic Theme 4 Foster Population Well-being Promote individual and community wellness through actions addressing the determinants of health and encouraging individual and social responsibility for health. 10. Build partnerships with community stakeholders to positively impact the determinants of health 11. Improve access to primary health care 12. Achieve the goals of the Population Health Promotion Strategy Strategic Theme 5 Enhance Specialized Services Strengthen RQHR as a provincial resource and referral centre through the determination of services best delivered in our Region, Saskatchewan and in western Canada. 13. Provide new innovative specialized services responsive to population needs. Strategic Theme 3 Enhance Aboriginal Health Improve the health status and outcomes of Aboriginal people by offering holistic service delivery, supporting traditional ways of healing, and engaging the voice of the community. 8. Positively impact health outcomes for Aboriginal people 9. Engage the voices of the First Nation and Metis people to improve their service experience Strategic Theme 6 Advance Knowledge, Teaching and Research Enhance our performance as an academic health services organization that supports, creates and applies knowledge through research, learning partnerships and personal and professional development. Objectives (2) 14. Use technology and innovation to develop better ways to provide health services 15. Enhance and support a culture of teaching, research and learning September 2007

10.4 Appendix 4 - Selection of Communities for Development of Primary Health Care Teams SELECTION OF COMMUNITIES FOR DEVELOPMENT OF PRIMARY HEALTH CARE TEAMS ITEMS FOR CONSIDERATION Community Characteristics Size Distribution Demographics Growth trends and projections Cultural characteristics Business/ trade patterns Local commerce Recreation Relationships with neighbouring communities/towns Geography Soft boundaries Surrounding communities Ease of access Travel distances Infrastructure Other related human services/programs (e.g. schools, RCMP, Housing) Experience with intersectoral or other community collaboration initiatives Existing facilities Human resources existing potential for recruitment and retention opportunities for sharing, networking, etc. between sites Community development activities/ initiatives Health Status/ Health Service Needs Health issues/challenges Determinants of health Existing programs/ services Health care utilization patterns Local Health Care Team Interest in participating in a PHC delivery model Experience with, and commitment to community participation in planning and development Sustainability of health professional/ physician practice current and future ability to recruit and retain the necessary PHC team members must be demonstrated Primary Health Care Strategic Plan 2008-2013 Page 27

Community Leadership Interest and willingness to participate in planning and development of PHC sites Interest and willingness to work with leaders from surrounding communities in planning and development Interest and willingness of leaders of surrounding communities to participate in planning and development of PHC sites Community Interest/ Capacity Interest in a PHC model for health care delivery Commitment to, and preparedness for participating in planning and development Other community initiatives that would support PHC Capacity to sustain a PHC site now and in the future Primary Health Care Strategic Plan 2008-2013 Page 28

10.5 Appendix 5 Urban and Rural Primary Health Care Teams PHC Teams by City of Regina Zone Existing PHC Sites Future PHC Sites Primary Health Care Strategic Plan 2008-2013 Page 29

RQHR s Primary Health Care Teams For Regina, see previous map TWIN VALLEYS Existing PHC Sites Future PHC Sites Primary Health Care Strategic Plan 2008-2013 Page 30