Team-Based Care and Attachment - Our Strategies
Patient Navigator
Patient Navigator (runs from April 20, 2015 to March 31, 2017)
Attachment Assessment Clinic
- This program has now ended.
Cultural Competency
Team-based Incentives
Activites
- Vulnerable unattached patients wanting a GP assessed & attached on priority basis as new GPs hired and as current GP capacity allows
- Mobile support for high needs patients to help navigate the health system
- Experiential training workshop for physicians
- Monetary incentives to support GP recruitment
Short-term Outcomes
- Improved care for vulnerable unattached patients
- Improved experience of care for patients requiring extra supports
- More coordinated care
- Better supports for GPs
- Increased competency when working with First Nations patients
- Increased capacity of the physician team; ability to take on AAC priority patients and reduce impact of retiring GPs
Medium & Long-term Impacts
- Better health outcomes
- Reduced admissions and readmissions to ER
- Increased cultural competency among GPs and improved care for First Nations populations
- Increased primary care capacity
- Increased patient satisfaction
- Increased system sustainability
- Supports the Triple Aim
Target populations
- Unattached patients
- Vulnerable/high-needs patients
- First Nations patients
- Family physicians
- New family physicians
- Community