mary geroux

Sudbury District Nurse Practitioner

Clinics

An Innovative Community SolutionMary Geroux, NP-PHC

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SDNPC

• Who? What? Where? When? Why? How?

• Challenges/Successes

• Managing Patients Within the Team

• Impact/OutcomesSudbury District Nurse Practitioner

Clinics2

Who are we?

• Canada’s first NP led clinic• 3 sites: Sudbury (2800), Lively

(1600), Chapleau (6 outreach Well Women clinics/year)

• Bilingual Services• Multidisciplinary Team: NPs, MDs,

RN, Pharmacists, Social Worker, Dietician

Sudbury District Nurse Practitioner Clinics

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Who are we?

• 5.5 NPs • 2 physicians (22 hours per week)• Consulting pediatrician (5 hours per

week)• Pharmacist (15 hrs per week)• RN (40 hours per week)• Support staff (Office manager,

medical secretary)

Sudbury District Nurse Practitioner Clinics 4

What is a NP clinic?

• Group of NPs coming together to form not for profit corporation

• Board of Directors includes 51% NP representation.

• Develop board bylaws that are respectful of collaborative practice and patient centered

• NP at Director level


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What do we do?

• Full scope comprehensive primary health care that reduces numbers of “orphan patients”

• Target underserviced populations• Interdisciplinary Practice• Programs (Why Weight?!, Diabetes

Education, Spirometry)• Partners with the community (Lively

Highschool)Sudbury District Nurse Practitioner Clinics 6

7Sudbury District Nurse Practitioner Clinics

Chapleau

Lively

When & Why?• Tens of thousands of Sudburians

without access to care• 8 unemployed NPs• Formal submission to government

Feb 2006• MOHLTC announced clinic in Nov 06,

clinic doors opened in August 2007


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How?• Marilyn Butcher & Roberta Heale• Vision created over time during practice

experiences (Working, lobbying, writing proposals, introducing role to communities & agencies)

• Solicited support from municipal leaders, nursing organizations and media

• Public responded positively


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Process• Intake form is completed, reviewed by the

director with input from NPs & MDs• Large majority of patients are accepted• Patients registered to clinic as an entity (not

rostered to a physician or the clinic) • Intake appointment scheduled with an NP• After intake, patients are scheduled for a

physical exam and may be sent for investigations/tests

• We cannot take everybody


Managing patients within the Team

• Patients generally see “their NP” • NP is patient navigator/case manager• Physician functions as primary health

care specialist, seeing patients referred to them by the NP; follow-up may continue until problem is resolved or patient is stable

• Many complex patients are co-managed • Pharmacist and RN


Referrals

• Patients are mainly referred to other team members

• Specialist referrals need to be co-signed by physician due to a payment discrepancy – this can cause unnecessary delays

• Many community programs - where the specialist is under a different payment model - do not require a co-signature


Challenges

• Complex/high needs patients who have not been accepted by family practices and have attended walk in clinics for years

• Chronic diseases with many co-morbidities, complications, mental illness, developmentally delayed, elderly, low socioeconomic status


More Challenges

• Physician compensation

• Current method of payment not supportive; not lucrative

• OMA/colleague pressure

• MD support is keySudbury District Nurse Practitioner

Clinics15

Successes

• Full support of government

• Announcement of next 12/25 NP led clinics based on our model

• Not reorganization of existing practices, addressing orphan patients


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Impact/Outcomes• Addressing the orphan patient

population

• 7% ↓ in volume of ER visits, directly attributed to ↑ access to primary care

• High profile NP clinics important for Bill 179


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Impact/Outcomes

• Detection of previously undiagnosed chronic diseases (ie. DM, HTN, Chol, cancers)

• Clinic evaluation done after 6 months• MOH evaluation last year, results

pending• Outcome evaluation later this year• Historic system change, grassroots,

nursing initiativeSudbury District Nurse Practitioner

Clinics19

What does the future hold?

• Much promise!!

• Increasing support for this model of care

• Additional NP clinics

• Bill 179Sudbury District Nurse Practitioner Clinics 20

YWCA Women of Distinction Award 2009


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mary geroux

Health & Medicine

team patients

referrals patients

np followup

np representation

complex patients

patient centered np

numbers of orphan patients

clinic doors