Shared Care Projects
Older Adults with Complex Health Conditions and/or Frailty Medical Neighbourhood
Building a 'Medical Neighbourhood' one step at a time, this project is supporting connection, communication, and collaboration between Family Physicians and other healthcare providers and organizations in Abbotsford. It aims to strengthen integrated, coordinated care and transitions in care through:
- Providing feedback to a developing electronic collaborative care plan;
- Supporting the work of a Clinical Pharmacist in clinics;
- Collaborating on medication reviews;
- Hosting clinical education workshops on the palliative approach to care, advance care planning, and chronic health conditions (dementia, depression, cardiovascular disease, COPD, and diabetes).
- Presenting at the City’s Seniors Week on health promotion and disease prevention.
Join us June 13, 2020 when we will be hosting a community education event to bolster health promotion, disease prevention, end of life planning and to create awareness about many resources available to our growing aging community.. Visit the event website for more details: http://agewellplanwell.ca/
Abbotsford Child and Youth Mental Health and Substance Use Local Action Team
This project focused on increasing awareness about resources, services and addressing timely access to care. In two years over a dozen actions were taken, including:
- Eating Disorders workshops with physicians, NPs, a pediatrician, a psychiatrist, and AHPs
- Adolescent Day Treatment Program video with providers, youth, and parents
- START and Young Parent’s Mental Health Resources Lunch and Learns at clinics
- Public Mental Health Forum with providers, youth, parents, School District, and community organizations
Now completed, thank you to all who participated and lent their support. If Members would like more information about materials from this project, please contact: email@example.com.
Maternity Patient Pathway
This project developed a comprehensive maternity care map, in English and Punjabi, outlining resources and key contacts, care milestones, and provider scope of practice for providers and patients in Abbotsford and Mission. Developed through focus groups with GPs, OB/ GYNs, and Registered Midwives and consultation with Fraser Health and community members this joint project between Abbotsford and Mission built partnerships and relationships.
Four workshops were held with Specialist, Maternity GP, AHP, and community organization presenters. The topics were: early pregnancy; pregnancy loss; maternal mental health and psychiatry; and well baby. Clinic lunch & learns covered referral processes to maternity care providers and addressed maternity care questions.
If Members would like copies of the maternity care map, contact lists of Specialists and Registered Midwives, or presentation materials, please contact the Abbotsford Division at: firstname.lastname@example.org
Access Facts about Midwives here: Midwifery facts.pdf
Access the Maternity Pathway Brochure here: Maternity Pathway Brochure English.pdf
Access The Punjabi Maternity Pathway Brochure here: Maternity Pathway Brochure Punjabi.pdf
Strengthening Medical Imaging-GP Processes & Communication
The project strengthened:
- Communication between Family Physicians, Radiologists, Medical Imaging (MI) staff, and clinic staff;
- Supported effective referrals to MI; and
- Improved clarity about urgent and non-urgent referrals
The project developed materials to support these aims and hosted education events to bolster enhanced skills and connection. The project had impressive effective referral results. If Members would like education materials on Choosing Wisely / Appropriateness including handouts on appropriate CT, IV, Shoulder Pain; Interventional and Musculoskeletal Radiology; limitations of tests performed; MRI vs. CT scan ordering, and tips for completing referrals, or the ARH MI Referrals and Levels of Urgency Card, please contact the Abbotsford Division at email@example.com
Transgender Patient Pathway
The Transgender Patient Pathway project was initiated to address gaps and awareness of services and referral pathways for transgender care in Fraser East. Two pathways have been created in collaboration with Members, Specialists, allied health professionals, community organizations, and patients: a provider pathway and a patient and loved one's roadmap. All of the providers surveyed said the provider pathway and patient roadmap support:
- Awareness of transgender care resources and services,
- Access to transgender care resources and services in the Fraser East, and
- A clearer, more consistent approach for transgender care in the Fraser East.
Hundreds of copies of both documents have been distributed locally and across the province. A patient and loved one part of the project opened up the February 2019 Joint Collaborative Committee event, The Power of Togetherness, in Vancouver. Physicians from across the province attended this event.
The project hosted education events and supported the development of a community of practice. If Members would like education resources on Gender 101, Medical-Legal Aspects of Gender-Affirming Care, or Gender-Affirming Primary Care, please contact the Division at firstname.lastname@example.org
Access the Patient and Loved ones roadmap here: Gender affirming roadmap.pdf
For the Provider roadmap contact the Abbotsford Division
Increasing Cervical Cancer Screening
For two years, this project has worked to increase public awareness and address cultural and language barriers in practice for cervical cancer screening; with a particular focus on females in South Asian and new immigrant communities. A community awareness campaign has been implemented in English, Punjabi, Arabic, Spanish and Korean. This has included radio interviews, newspaper and bus ads. This campaign has reached over 430 women through its community education events, 10,000 women via social media and 44,000 households through print materials.
A list of female physicians who have stepped forward to support their male colleagues in providing cervical cancer screening was developed. The project created a webpage (www.screening4health.com) to support spreading community education. Additionally, 750 culturally relevant PAP posters and appointment cards were distributed to local clinics. Resources for doing EMR queries to identify outstanding screenings and standardizing call backs were created. If clinics would like to receive copies of these materials, please contact the Abbotsford Division at: email@example.com.
The project created a webpage with health information about PAPs: http://www.screening4health.com/
The Abbotsford Division created a system that supports women in Abbotsford to have PAP test options. Ask your doctor about options, including having your PAP test done by a female provider who speaks English and Punjabi if you would like this. If you don't have a doctor, you can contact the following clinics to book a PAP test, by clicking the ‘Clinic Locator’ button towards the bottom of the webpage: http://www.screening4health.com/