GMF, GMF-R, Cliniques-Reseau and Super-clinics - The differences are important. Read our latest blog.

Nurse Practitioners: What’s the deal?

Many of you may have noticed nurse practitioners popping up in your family medicine clinics lately. If you haven’t noticed them yet, you are very likely going to notice more of them soon. The Quebec government has invested $25 million dollars to help train new nurse practitioners in Quebec. Their goal is to have at least 2,000 primary care nurse practitioners trained in Quebec by 2025. We still have a long way to go to meet this goal; there are only 428 nurse practitioners in Quebec.

So what is a nurse practitioner? Simply, they are a family doctor for healthier people. Nurse practitioners are nurses who have gone back to school and received a Master’s degree and extra medical training. They are qualified to write prescriptions for certain medications, they can send you for blood tests, x-rays, ultrasounds, and other tests, and they can do procedures like stitches.

A nurse practitioner can follow healthy people from babies to older adults for their regular check ups. They can also follow healthy pregnant women until they are 32 weeks pregnant. You will also see them in walk-in clinics because they are able to manage most of the acute issues that bring people to a walk-in clinic.  If you are followed by a nurse practitioner all of your health needs are managed by the nurse practitioner much like if you had a family doctor.

Nurse practitioners are not completely alone. They work in partnership with family doctors who are there to act as the nurse practitioner’s specialist. Much like your doctor may send you to see a specialist, like a cardiologist, a nurse practitioner can “refer” to their partner physician. The nurse practitioner may discuss your case with their partner physician or, if needed, the doctor may see you for a visit.

The goal of the nurse practitioner is to help improve access to primary care. Nurse practitioners are able to help relieve the burden of the family doctors by following their own caseload. This increases the number of Quebecers who have a family doctor and it also allows family doctors to follow more complex cases.

 

https://www.oiiq.org/sites/default/files/rapport-statistique-2014-2015.pdf

http://www.cbc.ca/news/canada/montreal/quebec-super-nurses-1.4041873

Jennifer Reoch

Santé Kildare Nurse Practitioner Candidate

Santé Kildare à l’épicerie!

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Notre première édition de la visite santé au supermarché IGA Lipari fut un grand succès, nous remercions tous les participants qui se sont joint à nous!

Notre nutritionniste du GMF Sante Kildare Caryn a su nous  guider à choisir sainement et à comprendre le fonctionnement des coulisses alimentaires.

La lecture des emballages et les choix à privilégier n’ont plus de secrets suite à cette visite interactive et dynamique.

Nous planifions offrir plusieurs présentations sur la promotion de la santé dans les prochain mois, restez aux aguets! Au programme : nutrition chez les personnes âgées, diabète, soutien aux aidants naturels et plus encore!

Au plaisir de vous rencontrer bientôt!

No need to worry…Casino Montreal still has unlimited free parking!

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The running meter is a distraction that interferes with medical appointments.”
Dr. Rajendra Kale, former editor CMAJ

Our Facebook post last week on plans to reduce parking fees at Quebec hospitals was our most popular yet. Parking fees can be excessive and their appropriateness has been extensively debated.

In the March 6, 2012 issue of the Canadian Medical Journal (CMAJ), doctors debated the merit and necessity of charging patients for parking. Dr. Tom Closson, President and CEO of the Ontario Hospital Association, argued that parking fees are one of the most common ways of making up the deficit of hospital operating budgets. He stresses that provincial government cutbacks to hospitals eliminate “crucial revenues that hospitals use to fund clinical research and front-line patient care.” He admonishes the Journal’s editorial board, “surely CMAJ has something to say about these and other more relevant issues, instead of banging away on the populist drum about parking fees.

Dr. Tim Meagher of the MUHC takes the opposing position, “I support free hospital parking for patients. I would probably also support free transport to and from hospital visits, reimbursement for time lost from work due to hospital visits, and reimbursement for myriad of ancillary costs that hospital visits generate.”

Dr. Rajendra Kale, editor in chief of the CMAJ, writes “”Parking fees amount to a user fee in disguise.” He urges Canadian hospitals to follow the example set in Scotland and Wales where hospital parking fees are abolished “because they burden (the) patient.” Dr. Kale concludes, “Those opposed to scrapping parking fees for patients need to recognize that such fees are, for all practical purposes, user fees and a barrier to health care. Using revenue generated from such surrogate user fees for health care is against the health policy objective of the Canada Health Act and could become the subject of a legal challenge.”

This opinion was supported by Dr. Brian Goldman, Host of CBC’s White Coat, Black Art, “I think hospital parking fees should be abolished because they punish patients.”
The highlights of the new hospital parking plan, starting April 1, are:
Hospital visitors will be able to park for free at hospitals in Quebec for the first 30 minutes, instead of paying as much as $10 for that first half hour.
• A flat daily rate will not be applied until a vehicle has been parked for more than four hours, a big change from the current practice of charging the maximum daily rate after 90 minutes.
• Health care institutions must offer weekly and monthly parking passes, as well as books of tickets, at reduced rates.
• Health care institutions must offer daily parking passes that allow motorists to come and go without penalty.

 

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MEDICAL DONATIONS: HOW CAN WE HELP AND WHAT ARE THE DRAWBACKS?

A nice story in the Gazette this week about sharing used medical equipment in Third World countries.
Furniture, bedside tables, equipment from the old Royal Victoria Hospital will be sent to Central Africa to be used in eight hospitals in Cameroon.
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Numerous organizations are identified by the World Health Organization to help distribute medical supplies, equipment, vaccines and donations:

HTTP://WWW.WHO.INT/MEDICAL_DEVICES/MANAGEMENT_USE/DONATION_ORG_ROLES.PDF

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In Canada, HOPE and HPIC are two organizations that help with this cause.

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HPIC (Health Partners International of Canada) is a relief and development organization dedicated to increasing access to medicine and improving health in the developing world.

HPIC is an independent charity that receives donations of medicines, vaccines and medical supplies from Canadian pharmaceutical and healthcare products companies, to be used for humanitarian purposes.  HPIC is funded in part by the Government of Canada, foundations, companies and individuals.

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Since 2012, Santé Kildare has sent supplies to JustWorld International to support the medical clinic located in Jocotenango, Guatemala.  Promoted through the international equestrian community, JustWorld supports basic education, nutrition, health & hygiene, and cultural development programs for children in impoverished communities in Cambodia, Guatemala, and Honduras.

Regrettably, medical equipment donated to developing nations is not always used.

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While medical equipment donations in theory enable hospitals in developing countries to receive expensive and advanced technology, in reality much of the equipment breaks easily and is not repaired.

study of seven hospitals in Haiti found that only 1/3 of the 115 pieces of medical equipment donated after the 2010 earthquake was working after 3 years and 1/2 of the broken equipment could not be repaired. Some of the donated devices, such as incubators for premature babies, were never used because of insufficient electrical voltage in Haiti.

The World Health Organization (WHO) estimates that only 10-30% of all medical equipment donations are ever put into operation.  Not only does the equipment need to be donated, it needs to be shipped, delivered, installed, and the local staff trained.

To address this concern, WHO defined 4 principles for a good medical equipment donation:

  1. Respect the recipient’s request
  2. Assure the donation will benefit the recipient
  3. Keep an open line of communication
  4. Ensure quality

 

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Is it my turn yet?

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It is no secret that we are (extremely) frustrated with long waiting times. Consecutive governments repeatedly promise to fix this problem but wait times only seem to grow longer.
As noted by the Fraser Institute: “excessively long wait times remain a defining characteristic of Canada’s health-care system, but this year (2016) is the longest we’ve ever seen and that should trouble all Canadians.” Bacchus Barua, senior economist at the Institute, continues, “long wait times aren’t simply minor inconveniences, they can result in increased suffering for patients, lost productivity at work, a decreased quality of life, and in the worst cases, disability or death.”
http://globalnews.ca/news/3083826/medical-wait-times-in-canada-are-longer-than-ever-hitting-20-weeks-in-2016-fraser-institute/

 

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The Canadian Institute of Health Information (CIHI) released a report based on The Commonwealth Fund’s 2016 international survey that highlighted this continued issue. According to the survey, Canada scored the poorest of all 11 countries surveyed when it came to access to specialists.  Fifty-six percent of Canadians wait longer than a month to see a specialist—as compared to the international average of 36 percent.

Dr. Josh Tepper, CEO of Health Quality Ontario, along with Vanessa Milne and Sachin Pendharkar, published “Four ways Canada can shorten wait times for specialists” at Healthydebate.ca.  Their prescription for success focuses on simple, achievable concepts:

 

1.Do virtual consults, not visits

Not every patient needs to see a specialist.  Often the family physician needs some guidance and a virtual consult system can help.

The Rapid Access to Consultative Expertise (RACE) is a phone based system available in parts of British Columbia. Family physicians call a central phone number during business hours on weekdays, and a specialist calls back within a couple of hours.

The success of RACE in B.C. inspired a similar program in Ontario, called The Champlain BASE e-Consult service. In this system, primary care providers complete a form that includes patient information and the medical question. Test results and images can be attached. The information is then sent to a specialist.

From 2010 to 2015, the BASE service was used in over 10,000 consultations in the Champlain region. The average wait time for a response from the specialist was two days.  Most impressively, in 40% of cases the patient did not need to see the specialist.

 

2.Add physician directories and e-referrals

Alberta currently offers paperless referrals through e-Referrals. The system includes referrals to Oncologists and Orthopedics.  Family doctors get an idea of wait times BEFORE submitting the referral and can chose a specific specialist.

 

3.Try pre-assessment in specialized clinics

Another approach is adding an assessment step in between the referral and the specialist.  This method has been successfully introduced for patients with severe low back pain (Interprofessional Spine Assessment and Education Clinics (ISAEC)).

Known as CareAxis in B.C., Saskatchewan, Ontario and Quebec, wait times are reduced by training physiotherapists to triage potential surgical candidates.

 

4.Switch to central intake

Pooled referral systems (aka central intakes) allow family doctors to select a specific specialist or the first-available.  Newfoundland, Ontario, Saskatchewan and Calgary all use this model.  Quebec’s model, CRDS, launched in the Fall of 2016, offers central intake for 9 specialties: Cardiology, ENT, Gastroenterology, General Pediatrics, Nephrology, Neurology, Ophthalmology, Orthopedics, and Urology.

Information can be found at:

Tél. : 514-762-CRDS (2737)
Téléc.: 514-732-5121
Courriel: crdsmontreal.ccsmtl@ssss.gouv.qc.ca

https://www.santemontreal.qc.ca/professionnels/medecins/crds-centre-de-repartition-des-demandes-de-services-montrealais/

So…can wait times be fixed?

All four models can help reduce wait times and simplify the process.  However, the authors caution, “Canada is notorious for being a land of pilot projects in health care, where good ideas aren’t scaled well. For systems like this, where getting buy-in from many professionals is crucial, that problem is especially important to overcome.”

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In Response to Dr.Goldman

Thank you Dr. Brian Goldman for supporting my profession.  I went to Mcgill University and studied dietetics and human nutrition which included  4 levels of stage.  It takes 3 and half years to complete this program and when you graduate you become an expert in the field of nutrition care.  I will admit that I did not feel like an expert until I had accumulated a certain amount of professional experience.  Currently, I work at GMF Kildare.  If you want to know what a GMF is click here.  I also work at CLSC Benny Farm.

Dietitians help patients with such a wide variety of issues.  I help the bulk of my patients with chronic disease state management for such illnesses as diabetes, high blood pressure, sub-optimal cholesterol and of course weight management.  Sometimes I see seniors that appear malnourished.  This can be very serious and requires a skilled intervention to prevent further complications.  I have colleagues who specialize in pediatric nutrition and prenatal care and others who are experts in tube feeding on surgical units in acute care.  Another colleague is a home care specialist and provides direct nutrition care in patients own living environment.  Some dietitians are even food service managers who run the acute care, rehab and long term care kitchens; ensuring that patients receive appropriate meals and snacks.

The first time I meet a new patient I will do an initial evaluation.  This can take about an hour. I will ask many health related and social questions to fully understand the client’s lifestyle habits.  This information will help make me the right assessment and give the appropriate intervention for that client.  It’s important to understand that each nutrition care intervention is individualized and created just for that person. This is what I am trained to do and how I am able to help people.  It is just  like doctors who are trained to ask the right questions, make the proper diagnosis and provide the right treatment for each patient they see.

There are so many variables that make up a person’s medical and social history.  Each person’s experience is going to determine what type of nutrition care they will need.  It’s very important to get a sense of what the patient is willing to change. As a professional dietitian, I must be able to work with where the patient is at, on any given day. I need to ask, are they ready to make a big change like reducing simple sugars or are they willing to try something a bit easier like add a glass of water to their daily intake?  Sometimes it takes many nutrition care follow ups before a client is even willing to think about changing a behavior.

I provide information concerning the management, of a disease or condition, but it is the patient’s responsibility to use the information to promote change. The patient always has the right to make the choice that works for them and sometimes that means not following dietary advice.  Not everybody is ready to work on their diet and lifestyle habits. Either way, I provide motivation and can coach clients wherever they may be on the behavioral change continuum.

Caryn Roll

The truth about GMF’s

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“Created to improve access, Montreal clinics often turn away patients,” published in the Gazette on February 15, 2017, is a misleading and misrepresentative article. It makes false assumptions and reaches incorrect conclusions.
The article states that “there are 86 family medicine groups in Montreal that rely on government funding to stay open longer than private doctors’ offices.” The author contends that “fewer than half the clinics are actually open seven days a week.”
The reality is GMFs are neither super-clinics nor general walk-ins. They are grouped, private, family medicine practices that offer care to a defined, registered patient population. Emphasis is placed on assiduité, fidélisation and prise en charge. In other words, GMFs prioritize their own patients while super-clinics or GMF-reseau (known previously as cliniques-reseau) are designed primarily for patients who do not have a family doctor.
These distinctions are available at: http://www.msss.gouv.qc.ca/professionnels/statistiques-donnees-services-sante-services-sociaux/acces-premiere-ligne/ and http://sante.gouv.qc.ca/systeme-sante-en-bref/groupe-de-medecine-de-famille-gmf/.
GMFs do not all receive the same funding and are not expected to maintain the same number of operating hours or days. While larger GMFs are open 68 hours/week, smaller GMFs only need to be open 5 or 6 days/week.
Yes – GMF walk-in clinics generally extend appointments to non-registered patients whenever possible. “All” patients can come irrespective of age, gender or medical history. Clinics, doctors, nurses are all working to improve access and help patients in need. But the GMF is not a “general” walk-in clinic – and hasn’t been since their inception in the early 2000s.
At the end of the day, the article should have asked – “can patients obtain timely appointments with their own family doctor?” Bottom line – register with a family doctor.

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“We are drowning in information but starved for knowledge.” John Naibitt

“We can just Google it!” writes Dr. Jalees Rehman of the University of Illinois at Chicago in Scientific America on August 2, 2012.  “Identifying the websites with the most accurate and relevant information are critical skills that are necessary for navigating our way in the digital information jungle, but unfortunately, these skills are rarely taught. In most cases, inaccurate or irrelevant information on the internet merely delays us for a few minutes until we do find the answer to what we are looking for. However, when it comes to medical information, inaccurate or irrelevant information could potentially have a major detrimental impact on our well-being.

I invite you visit the sites below (and at our newest website feature: Patient Resources –www.santekildare.ca/services/patient-resources/) which provide diverse, relevant and reliable medical information.  Some help calculate risk for cancer, osteoporosis and heart disease, while others prepare patients for appointments, review medications, discuss controversies in screening and limitations in treatments, and provide patients with easy-to-understand information about prevention and management of common illnesses.

With apologies to J.K.Rowling, “Understanding is the first step to healing.”

 

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CTFPHC

The Canadian Task Force on Preventive Health Care (CTFPHC) has been established by the Public Health Agency of Canada (PHAC) to develop clinical practice guidelines that support primary care providers in delivering preventive health care.

Patient Engagement in Guideline Development: The CTFPHC involves members of the public in its guideline development process. Specifically, the CTFPHC uses feedback from the public to guide the search for evidence on the guideline topic and to develop knowledge translation tools to accompany the guidelines

http://canadiantaskforce.ca/tools-resources/videos/

http://canadiantaskforce.ca/general-public/general-information/

 

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Choosing Wisely Canada

Choosing Wisely Canada is a campaign to help physicians and patients engage in conversations about unnecessary tests, treatments and procedures, and to help physicians and patients make smart and effective choices to ensure high-quality care. Unnecessary tests, treatments and procedures do not add value to care. In fact, they take away from care by potentially exposing patients to harm, leading to more testing to investigate false positives and contributing to stress for patients. And of course unnecessary tests, treatments and procedures put increased strain on the resources of our health care system.

http://choosingwisely.ca/

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My CancerIQ

Designed by Cancer Care Ontario (CCO), My CancerIQ is a website that helps you understand your risk for cancer and what you can do to help lower that risk.

A series of risk assessments estimate your risk of cancer compared with other Ontarians of the same sex age 40 and over. At the end of each assessment you’ll receive a personalized risk assessment and action plan with tips and resources based on your personal risk factors.

https://www.mycanceriq.ca/

 

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Lung Foundation Australia

Lung Foundation Australia Primary Care Respiratory Toolkit supports the promotion of lung health as well as the early diagnosis and best practice management of lung disease. Evidence shows that Chronic Obstructive Pulmonary Disease is under-recognised, under-diagnosed and under-managed. The Primary Care Respiratory Toolkit has been developed to redress this.

The Lung Age Estimator has been developed to support clinicians to motivate current smokers to quit, by providing a graphic illustration of estimated lung age.

http://doctorwidget.com/alf/ignition/index.php/alf_pcrt#

 

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Medstopper

Medstopper is a tool to help clinicians and patients make decisions about reducing or stopping medications. By entering the list of medications a patient is receiving, Medstopper sequences the drugs from “more likely to stop” to “less likely to stop”, based on three key criteria: the potential of the drug to improve symptoms, its potential to reduce the risk of future illness and its likelihood of causing harm. Suggestions for how to taper the medication are also provided.

http://medstopper.com/

 

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Canadian Patient Safety Institute

Established by Health Canada in 2003, the Canadian Patient Safety Institute (CPSI) works with governments, health organizations, leaders, and healthcare providers to inspire extraordinary improvement in patient safety and quality.

Shift to Safety offers tips and tools for talking to you healthcare team. Empower yourself with information to help you ask good questions, connect with the right people, and learn as much as you can to keep you or a family member safe while receiving healthcare.

http://www.patientsafetyinstitute.ca/en/toolsresources/questions-are-the-answer/pages/default.aspx

 

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Calorie Counter

How many calories should you eat?  One-size-fits all recommendation do not work – each plan needs to be customized to each individual. Science tells us that 1 pound of fat is equal to 3500 calories so, in theory, a daily calorie deficit of 500 should result in 1 pound per week fat loss. Regrettably, in reality things don’t quite work that efficiently.

http://www.bmimedical.ca/calculator.aspx

 

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CVD Calculator

This Cardiovascular disease (CVD) calculator from the Therapeutics Education Collaboration uses both Framingham and the new ASCVD formulas.  It displays benefit estimates for all treatments – diet, lifestyle and medications. The calculator promotes itself as the BEST tool for calculating cardiovascular risk.

http://chd.bestsciencemedicine.com/calc2.html

 

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Journal of the American Medical Association

Explore the latest patient information from The JAMA Network, including easy-to-understand information about prevention and management of common illnesses.

http://jamanetwork.com/collections/6258/for-patients

 

Calcium Calculator

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Fracture Risk Assessment

http://www.shef.ac.uk/FRAX/tool.aspx?country=19