The introduction of the BC patient medical home last year prompted many rural GPs to reflect on how they are currently working, including working in teams to deliver integrated services and whole-person care that wraps around patients.
“Many small rural communities are ahead of the curve and doing this work very well, out of necessity,” says Dr Rebecca Lindley, Chair of the Rural and Remote Division of Family Practice.
She explains that working together and being creative is what health care providers in small communities do to make the most of scarce resources, optimize capacity, and minimize the impact of provider departures from the community.
Health care providers and patients in rural communities must also contend with challenges such as weather, geography, limited resources, and services available only at a distance. These challenges are particularly acute for rural GPs and others providing outreach services to remote communities. In this context, collaborative, creative approaches have been integral to supporting patients and colleagues. These approaches also provide valuable learnings for physicians and partners across the province who are working toward the patient medical home model in their communities.
In addition to working in teams, many rural GPs and other health care providers work as generalists across the full spectrum of services, including primary, community, acute, residential, palliative, maternity, surgical, and other specialized care. So patients may see the same rural care team for a minor illness, acute emergency care, speciality care, home care, or palliative care.
The result is patients have access to a team, and care is usually well-coordinated within a community.
The model – the combination of teams and services provided – may look different from one rural community to the next, depending on geography, socioeconomic factors, and available resources and services.
“While there are improvements to be made, the experiences of rural communities can contribute insights to the enrichment of patient medical homes right across the province,” says Dr Lindley. “The enablers and supports that are needed to improve patient medical homes in rural areas may be very different from the resources needed in larger areas and must be individualized to each community.”
What's working well in rural communities?
(Note: The following provides a rural perspective and is not intended to preclude the same being true for physicians in non-rural and remote settings.)
Patient medical homes extend beyond primary care. In many small rural communities, primary care is not a separate system and is well-integrated with acute and community care services.
Patient-centred, whole-person care comes naturally. Strong patient-provider relationships often enable rural teams to wrap services around patients. Most providers live in the community, interact often with patients, and know their issues well. Care is grounded in local community and culture.
Comprehensive care and team-based care go hand in hand. Integrated, inter-professional teams of generalist providers (e.g., GPs, MOAs, nurse practitioners, nurses, mental health providers, social workers) can deliver comprehensive, full-spectrum care to patients and the community. Teams often look after patients collectively, sometimes without individually-defined patient panels. Providers work together to provide continuous care for patients when other team members are providing acute services or travelling to remote areas outside their community.
Commitment extends to the community as well as patients. In many rural communities, small populations and geography foster a sense of awareness and closeness between providers and the community. With this in mind, many rural providers have committed not only to care of their patients but also of their health care team and the health and the wellness of the entire community.
Coordination of care generally works well within a community. Smaller communities provide unique opportunities for providers to get to know each other, and often they can pick up the phone or walk down the hall to discuss patient care with their colleagues.
Patients usually know where and how to appropriately access care, but it looks different from one community to another. Often, creative approaches are used to give patients access to services when and where they need them. For example, in many communities, the ER is an appropriate place for patients seeking after-hours non-emergency primary care.
With team-based care and integration of services in place for many, family doctors in rural environments offer a unique perspective on what is working well and what enablers are needed to further enhance the patient medical home in rural communities.
Many family doctors across BC have experienced close, collegial, and team-based relationships similar to those in rural communities. The work toward full realization of the patient medical home model has the potential to reinvigorate a sense of medical communities across the province, to enable doctors to rediscover the joy in practice, and to enhance patient care.