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The reasons why Santé Kildare will not become a “Superclinic” any time soon

 

The Montreal Gazette recently published an exposé on “Quebec’s super clinics and their side-effects.”  It’s hard to escape the hype with near weekly announcements by the Minister of Health touting these “new” establishments as a solution to ER overcrowding.  Proponents call them the long-overdue solution to a chronic problem.  Opponents call them “all smoke and mirrors.”  I prefer the term “McMedicine” – Be wary of the adverse complications of Supersizing.

1.     Superclinic ≠ Supercare

What’s in a name?  Superclinics sounds spectacular – nurses with capes, doctors with superpowers.  The Avengers the Primary Care!

However, we have to question who provides the care.  This does not mean that superclinics don’t have super-doctors or super-nurses, but excellent care really emanates from a nurtured doctor-patient relationship.  “Supercare” is delivered by the health team that knows you.

As Dr. Premji laments in healthydebate.ca – “We promote convenience over continuity.”  In fact, “relational continuity” is associated with better care outcomes than speed.

2.     We perpetuate myths about ER use

No doubt our ERs operate above capacity, but do superclinics solve the problem?  As the Gazette correctly points out, ERs continue to work beyond recommended limits even with the weekly openings of new superclinics.

As Dr. Premji explains, we have to address and solve the underlying problems for ER overcrowding – such as overflowing inpatient wards, too few long-term care beds and an inadequate supply of home care services.

3.     “All smoke and mirrors”

Superclinics did not apparate out of thin air.  They are an extension of the pre-existing Clinique Reseau (CR) model established by Minister of Health Couillard more than a decade ago.  Like superclinics, CRs were open on weekends and evenings with on-site access to radiology, labs and specialists.  The difference – 4 hours on Saturday and Sunday.

 

Again the Gazette exposes the less-than-impressive truth: new superclinics may offer at least 40,000 consultations for walk-in patients each year (using the Pierre Boucher superclinic as an example), but the previously named Pierre Boucher Family Medicine Group had already surpassed that goal in 2016, reporting 47,000 consultations for walk-in patients that year!

4.     It’s the PREMs!

If the acronyms CLSC, CSSS, CIUSSS, GMF, GMF-R, UMF are not confusing enough – consider the punitive PREMs.  The Plans régionaux d’effectifs médicaux or PREMs, is a system the Ministry created to determine how many family doctors can practise in a specific area.

Sometimes access has nothing to do with hours – but with hiring adequate staff to meet the need.

As Dr. Mark Roper, Director of the superclinic at the Queen Elizabeth Health Complex comments: “We have doctors applying to work with us, but they are not permitted to work with us because of the government restrictions.”

The Gazette writes: “The PREMs, Roper argues, have tended to favor the outlying regions to the detriment of Montreal. Montreal doctors treat both local residents and those from the off-island suburbs who commute to the city, yet both Liberal and PQ governments have resisted allocating more permits to what is known bureaucratically as Region 6. Politically, more votes are up for grabs off island than in Montreal.”

5.     Who is your clientele?

A big source of confusion remains who is responsible for care.  Family Medicine Groups (GMFs) meet the needs of its defined, rostered population.  Superclinics offer appointments to anyone.  In an ideal world, superclinics bridge the gap between GMFs and ERs, but in reality, the system is contradictory, unnecessarily complex, and at times, adversarial.

Family doctors are financially penalized when their patients seek care elsewhere yet an aggressive advertising campaign for superclinics literally entice and lure patients away from their family doctors.

Combined with the fact that superclinics are also GMFs, the primary care equation becomes unrecognizable.  Solve this formula: GMFs need 80% of its registered patients to see GMF doctors exclusively AND the same GMF-R (aka superclinic) is mandated to book non-registered patients 80% of the time!  Care seems more paradoxical than complimentary.

6.     Shuffling the deck

With PREMs limiting physician movement, who staffs the new wunderclinics?  You guessed it – the same doctors from the GMFs, former CRs and even the ERs.  As one family doctor commented to the Gazette – “I’m thinking of going to work in a super clinic, but that’s just a reshuffling of the cards, isn’t it?”

Other clinics (often the former CRs) are caught in GMF/GMF-R purgatory – too big for one yet small enough for the other.  Funding is threatened and operators fear the demise of their services.  One doctor notes, “It makes no sense.  Since we want to create these super clinics, we’re in the process of hollowing out clinics that used to function well, clinics like mine.”

In the end, GMF Santé Kildare remains committed to providing supercare to our super-patients.  We are fortunate to have a super-team committed to your health and wellbeing.

 

New Flu Information for 2017-2018 from cdc

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New Flu Information for 2017-2018 from cdc.gov/flu

Getting an annual flu vaccine is the first and best way to protect yourself and your family from the flu. Flu vaccination can reduce flu illnesses, doctors’ visits, and missed work and school due to flu, as well as prevent flu-related hospitalizations.

What’s new this flu season?

A few things are new this season:

  • The recommendation to not use the nasal spray flu vaccine (LAIV) was renewed for the 2017-2018 season. Only injectable flu shots are recommended for use again this season.
  • Flu vaccines have been updated to better match circulating viruses (the influenza A(H1N1) component was updated).
  • Pregnant women may receive the flu vaccine

What flu vaccines are recommended this season?

This season, only injectable flu vaccines (flu shots) are recommended. Some flu shots protect against three flu viruses and some protect against four flu viruses.

Live attenuated influenza vaccine (LAIV) – or the nasal spray vaccine – is not recommended for use during the 2017-2018 season because of concerns about its effectiveness.

What viruses will the 2017-2018 flu vaccines protect against?

There are many different flu viruses and they are constantly changing. The composition of flu vaccines is reviewed annually and updated as needed to match circulating flu viruses. Flu vaccines protect against the three or four viruses (depending on vaccine) that research suggests will be most common. For 2017-2018, three-component vaccines are recommended to contain:

  • an A/Michigan/45/2015 (H1N1)pdm09-like virus (updated)
  • an A/Hong Kong/4801/2014 (H3N2)-like virus
  • a B/Brisbane/60/2008-like (B/Victoria lineage) virus

Quadrivalent (four-component) vaccines, which protect against a second lineage of B viruses, are recommended to be produced using the same viruses recommended for the trivalent vaccines, as well as a B/Phuket/3073/2013-like (B/Yamagata lineage) virus.

When should I get vaccinated?

You should get a flu vaccine before flu begins spreading in your community. It takes about two weeks after vaccination for antibodies to develop in the body that protect against flu, so make plans to get vaccinated early in fall, before flu season begins. CDC recommends that people get a flu vaccine by the end of October, if possible. Getting vaccinated later, however, can still be beneficial and vaccination should continue to be offered throughout the flu season, even into January or later.

Children who need two doses of vaccine to be protected should start the vaccination process sooner, because the two doses must be given at least four weeks apart.

Can I get a flu vaccine if I am allergic to eggs?

The recommendations for people with egg allergies are the same as last season.

  • People who have experienced only hives after exposure to egg can get any licensed flu vaccine that is otherwise appropriate for their age and health.
  • People who have symptoms other than hives after exposure to eggs, such as swelling, respiratory distress, or vomiting; or who have needed epinephrine or another emergency medical intervention, also can get any licensed flu vaccine that is otherwise appropriate for their age and health, but the vaccine should be given in a medical setting and be supervised by a health care provider.

Protective Actions

What should I do to protect myself from flu this season?

CDC recommends a yearly flu vaccine for everyone 6 months of age and older as the first and most important step in protecting against this serious disease.

In addition to getting a seasonal flu vaccine, you can take everyday preventive actions like staying away from sick people and washing your hands to reduce the spread of germs. If you are sick with flu, stay home from work or school to prevent spreading flu to others. In addition, there are prescription medications called antiviral drugs that can be used to treat influenza illness.

What should I do to protect my loved ones from flu this season?

Encourage your loved ones to get vaccinated.

Do some children require two doses of flu vaccine?

Yes. Some children 6 months through 8 years of age will require two doses of flu vaccine for adequate protection from flu. Children in this age group who are getting vaccinated for the first time will need two doses of flu vaccine, spaced at least 28 days apart. Children who have only received one dose in their lifetime also need two doses.

What can I do to protect children who are too young to get vaccinated?

Children younger than 6 months old are at high risk of serious flu complications, but are too young to get a flu vaccine. Because of this, safeguarding them from flu is especially important. If you live with or care for an infant younger than 6 months old, you should get a flu vaccine to help protect them from flu.

How effective will flu vaccines be this season?

Influenza vaccine effectiveness (VE) can vary from year to year among different age and risk groups and even by vaccine type. How well the vaccine works can depend in part on the match between the vaccine virus used to produce the vaccine and the circulating viruses that season. It’s not possible to predict what viruses will be most predominant during the upcoming season.

Will this season’s flu vaccine be a good match for circulating viruses?

It’s not possible to predict with certainty if the flu vaccine will be a good match for circulating flu viruses. The flu vaccine is made to protect against the flu viruses that research and surveillance indicate will likely be most common during the season. However, experts must pick which flu viruses to include in the flu vaccine many months in advance in order for flu vaccines to be produced and delivered on time. Also flu viruses change constantly (called drift) – they can change from one season to the next or they can even change within the course of one flu season.

How long does a flu vaccine protect me from getting the flu?

Multiple studies conducted over different seasons and across flu vaccine types and influenza virus subtypes have shown that the body’s immunity to influenza viruses (acquired either through natural infection or vaccination) declines over time.

Can the flu vaccine provide protection even if the flu vaccine is not a “good” match?

Yes, antibodies made in response to vaccination with one flu virus can sometimes provide protection against different but related flu viruses. A less than ideal match may result in reduced vaccine effectiveness against the flu virus that is different from what is in the flu vaccine, but it can still provide some protection against flu illness.

In addition, it’s important to remember that the flu vaccine contains three or four flu viruses (depending on the type of vaccine you receive) so that even when there is a less than ideal match or lower effectiveness against one virus, the flu vaccine may protect against the other flu viruses.

Can I get vaccinated and still get the flu?

Yes. It’s possible to get sick with the flu even if you have been vaccinated (although you won’t know for sure unless you get a flu test). This is possible for the following reasons:

  • You may be exposed to a flu virus shortly before getting vaccinated or during the period that it takes the body to gain protection after getting vaccinated. This exposure may result in you becoming ill with flu before the vaccine begins to protect you.
  • You may be exposed to a flu virus that is not included in the seasonal flu vaccine.

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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!

The Next Frontier

With Grand Prix behind us, there is lots to look forward to in Montreal this summer. In honor of the upcoming Comiccon convention from July 08 to 10, 2016, it’s time to look forward to some exceptional .medical innovations on the not-so-distant horizon.

Qualcomm Tricorder XPrize moving forward

Winner of $10 million contest expected to be named in early 2017

By Mike Freeman | May 26, 2016 |

Tatiana Rypinski, a Johns Hopkins student, heads Team Aezon, which is one of seven contestants remaining in the $10 million Qualcomm Tricorder XPrize competition.

Now in its fifth year, the $10 million Qualcomm Tricorder XPrize competition — which aims to create a portable medical device akin to the fictional tricorder of Star Trek fame — is moving toward naming a winner in early 2017.

The ambitious milestones for teams trying to develop the tricorder have been eased a bit. Instead of being capable of diagnosing 16 conditions without the help of a physician as originally proposed, the tricorders now must diagnose 13 ailments.

And the number of remaining teams has dropped from 10 to seven. One team dropped out and two merged.

Now teams are refining and testing their tricorders in preparation for a preliminary evaluation slated at UC San Diego late this summer.

“What we are attempting to do is require teams to demonstrate to us a certain level of performance on their devices so that we can qualify them to come back at UCSD and enter the final phase,” said Grant Campany, senior director of the Tricorder XPrize.

The final evaluations — including tests with real patients and doctors — are expected to begin in September and continue into early next year. San Diegans who wish to volunteer can email xprize-ctri@ucsd.edu or call (858) 230-4339.

When it officially kicked off in early 2012, the Tricorder XPrize expected to name a winner early this year. But building a hand-held medical device that can continuously read five vital signs, diagnose conditions ranging from pneumonia to diabetes to urinary tract infection and still be easy to use for the layman has proven difficult.

“As with most XPrizes, we set the bar relatively high,” said Campany. “We like to say it is audacious yet achievable. We are trying to create a high hurdle because we want to see breakthroughs occur.”

UC San Diego built a regulatory/approval framework to pave the way for consumer testing of these experimental tricorders. That framework has been used by teams to conduct initial tests in their hometowns in preparation for this summer’s preliminary cut.

Team Final Frontier, for example, includes emergency room physician Basil Harris, who is getting feedback on the team’s device with patients in Pennsylvania, said Campany.

Team DMI of Boston, headed by physician Eugene Chan, has posters up at public transit stations to recruit volunteers, he added.

“I think we are all going to be pleasantly surprised at the improvements that these teams have made in their operating systems and how these devices operate without the interaction of a health care provider,” he said.

The Tricorder XPrize aims to push wireless medical technology into the mainstream. San Diego-based Qualcomm pledged the prize money. The company has long viewed mobile technology as key to cutting health care costs and improving results.

“When you look at the developing world, which has a shortage of doctors, how do you allow technology to step in and extend the reach of health care providers through these types of devices?” said Campany. “That is really what this is all about.”

In addition to Final Frontier and DMI, others teams are: Aezon, which is made up of undergraduate students from Johns Hopkins; CloudDX of Canada; Danvantri of India; Dynamical Biomarkers Group of Taiwan; and Scanadu/Intelesens from the U.S.

 

Smile!

Have you ever heard the saying “It takes 17 muscles to smile and 42 to frown”? Turns out it’s actually a myth, it actually takes about the same amount of muscles to do both! I read an interesting paper recently that discussed the health benefits of smiling and I wanted to share it with you. Smiling can help lower your blood pressure, improve digestion as well as decrease anxiety. One more reason to smile!

Liz

http://www.aana.com/resources2/health-wellness/documents/nb_milestone_0511.pdf
Abel, MH, Hester, R. (2002)

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What?! Speak louder, I can’t hear you!

I read this news report on CTV recently and I felt it reflects very well what we tell patients. Ear wax is not a bad thing, it’s actually a protective barrier, unless of course it’s uncomfortable or painful then it should be looked at. Remember the old saying “Don’t put anything smaller than your elbow in your ear” It’s completely true! If having your ears cleaned is absolutely necessary we have an iron clad confidentiality agreement…we promise not to tell your spouse (you can keep pretending the wax is still there)

http://www.ctvnews.ca/health/ear-wax-is-mother-nature-s-way-to-protect-mechanisms-of-hearing-mds-say-1.1774926

Liz932533_61847438

Sugar Rush

I saw this interesting post on CBC and then again on the Canadian Diabetes Association Website last week. It’s incredible the amount of sugar the average person consumes in one day! One can of Cola has about 10 tsp of sugar, we should be only be consuming 6 tsp of sugar a day as per the World Health Organization. Do you think you could live up to that challenge?

http://www.cbc.ca/news/health/lower-sugar-intake-to-less-than-5-of-daily-calories-who-says-1.2560639

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