Primary Health Care Service Delivery Models in
Remote and Isolated First Nations Communities
Health Council Of Canada
National Symposium on Integrated Care
Toronto
October 10, 2012
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To present issues related to service delivery
in remote and isolated First Nations
communities
To outline the proposed approach/model to
address issues
Communities situated south of 60 that provide primary care and
treatment service and which share characteristics that make the
delivery of primary care services complex and challenging
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Primary and Secondary Research
◦ FNIHB and AANDC data bases
◦ Community data collection in Clinical and Client
Care Logs and Community Workbooks
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Key Informant Interviews
◦ Community-Based Interviews
◦ FNIHB Interviews
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Literature Review
Provincial/Territorial Review
Visioning and Synthesis Meeting
External Expert Review
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Services are primarily focused on acute episodic care and a series of stove-piped
programs that are rarely integrated or complementary at the community level, let alone
with provincial health services
There are significant unmet health service needs, particularly in the areas of chronic care
and mental health coupled with a growing inability to meet basic public health needs
Costs are becoming unsustainable with growth rates of over 5% a year.
Significant problems related to recruitment and retention of nursing staff – 40% vacancy
rate the norm; there is room in many of the communities to move to an interdisciplinary
staffing model
System incentives reward high utilization and dependency.
Lack of surveillance and monitoring and inadequate or non-existent data collection
systems
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Initial introduction of new positions (LPN’s,
pharmacy clerks) have improved service
access, improved community engagement,
increased work satisfaction
Changes in hours of operation have reduced
overtime, improved client and provider
satisfaction
Telehealth in over 300 communities has
improved provider education and client
access to care
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A new paradigm of service delivery is needed. One
that is:
ƒ Grounded in the holistic First Nations vision of health;
ƒ Provides a comprehensive range of high quality and
effective health services;
ƒ Focuses on population health and health
determinants;
ƒ Has a strong infrastructure of professional and allied
health services;
ƒ Built on cooperation and integration at all levels; and
ƒ Is more responsive, resilient, sustainable, affordable ,
efficient, effective and accountable
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Address Service
Access
Address Cost
Drivers
Re-orient to an
Interdisciplinary
Expanded Care
Model
A Modern Sustainable
High Quality Health Service
Optimize
Technologies,
Information
Management and
Infrastructure
Strengthen Community
Voice and Focus on
Population Health
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A Modern Sustainable High Quality Heath Service Re‐orient to an Interdisciplinary Expanded Care Model
•Incorporate all primary, public health and community‐based services into model
•Adopt a case management approach and a common process regardless of the point of entry
•Change staffing model team composition to optimize skill mix, including LPNs, technicians, multi‐role workers, ITC workers based on needs and utilization patterns •Standardize practices, tools, and guidelines based on interdisciplinary service frameworks Address Cost Drivers
•Reduce reliance on and cost of agency nursing services
•Implement flexible hours of operation in Nursing Stations
•Set budgets for each facility managed by FNIHB
•Reduce and realign medical transportation
•Use existing FTE’s to meet adjusted staffing mix
•Implement a common Manitoba/Ontario nursing resource pool and surge capacity •Increase the use of distance education to meet mandatory and non‐mandatory training requirements Address Service Access
•Increase the use of Telehealth and Telemedicine
•Enhance skills of existing community‐based staff
•Increase, where appropriate, specialist (Physician and other Health Occupations) presence in community •Adopt the Basket of Services recommendations related to essential service elements for Clinical and Client Care Strengthen Community Voice and Focus on Population Health •Strengthen community control and design over health services •Enable informed client choice and self‐management
•Increase collaboration between primary care and community health program staff
•Shift the culture of care from a provider‐centred model to a patient/client/family/community centred model
•Develop MOUs with communities and/or First Nation health authorities for primary care services delivered by FNIHB Optimize Technologies, Information Management and Address Infrastructure •Implement an electronic health/medical record for each individual and work with provinces to establish data standardization and data sharing agreements on patient records within the EHR info‐structure •Provide/refurbish diagnostic equipment were usage warrants it
•Update capital standards and plans based on new model of services •Address challenges associated with Health Canada databases to ensure accurate, complete and comparable data that allows monitoring of health services delivery and impact
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Comprehensive
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Client and Community Centered
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Interdisciplinary
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Integrated
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Grounded in Community Development
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Evidence Based
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Flexible
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Facilitates integration with provinces as more closely
aligns with provincial health service direction
Facilitates eventual First Nation management as will
address issues already identified by them and involves
them in redesign
Can work equally at the Community or Tribal Council or
other First Nation health authority level
Will bring more stability and predictability to the system
Will eventually positively impact nursing recruitment and
retention
Will increase the capacity and skills of the communitybased health workers
Most importantly, will improve the quality of health care
and health outcomes of the population
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A five year managed change process involving the active
participation of First Nation communities, FNIHB Regions, and
FNIHB Headquarters
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Questions?
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