Volume 1 - December 2015 | Divisions of Family Practice

Volume 1 - December 2015

Doctors of BC and the BC government are committed to increasing timely access to support and services for child and youth mental health and substance use in BC through funding of one of the largest initiatives of its kind - the Child and Youth Mental Health and Substance Use (CYMHSU) Collaborative.

The Collaborative involves an unprecedented number of stakeholders - over 1000 youth, parents, family doctors, specialists, three government ministries, the RCMP, school counselors, First Nations groups, and others are now involved.

Relationship-building and practical, sustainable solutions are the focus of the Collaborative’s Local Action Teams and Working Groups as they address communication barriers, delivery service gaps, and coordination of care, not just at the local level, but system-wide. The Collaborative has now spread to all regions of the province.

The following communities involved in our Division are in the process of implementing, developing or considering Local Action Teams:

Initiatives are underway in North Vancouver Island and Salt Spring Island
Funds transfer agreements are in place in Long Beach and Clearwater
Project manager hiring is underway in Ashcroft, Lillooet and Lytton
A community meeting has been held in Hazelton and discussions started on Gabriola

Our Chapters:

Bella Bella, Bella Coola, Clearwater, Gabriola Island, Hazelton, Lillooet, Long Beach, North Vancouver Island, Open, Pemberton, Revelstoke, Salt Spring Island.

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Capacity Café Gives Youth a Voice

The Salt Spring Island Local Action Team (LAT) on Child and Youth Mental Health is involving local youth to help improve community services.

Through a Capacity Café model, local youth can talk about their needs and struggles. Capacity Café is the name given to a unique event where parents and community members listen to the lived experiences of youth by creating a safe space where youth speak and adults listen.

The aim of the Café model is to help youth view themselves as a much-needed resource within the community. The overall goal is to encourage young people to feel listened to respected and valued and help adults (parents and providers) gain increased understanding of the stresses youth encounter.

Creating a safe space for open sharing in a small community can be challenging and will require testing of ideas and processes. Initially the Capacity Café will involve high school youth and may be expanded depending on its success.

The Salt Spring youth team, a group of three young women of high school age who meet with a Community Developer, has also been working with AnxietyBC on improving peer mentoring and peer-to-peer focused programs. There are several areas under discussion such as:

A teen survey to assess the prevalence of anxiety, what tools youth access and what they would like to have available
A “friendly faces” campaign where people wear a button if they are able to support someone with anxiety
Building awareness for how peers can support someone dealing with an anxiety episode
Building on existing peer mentoring programs to increase awareness around anxiety and depression

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Child and Youth Mental Health: Increasing Awareness of NVI Community Services

A survey among North Vancouver Island communities shows more needs to be done to improve awareness of local services related to alcohol and drug use among youth. A mental health and substance use survey undertaken earlier this year showed only 14 per cent of respondents know what local services are available such as Discovery Family Youth Substance Use Services operated by Island Health.

Of parents who responded to the survey, 29 per cent said they would talk to their doctor, nurse practitioner or hospital if their child or youth was experiencing problems with alcohol or drug use while 23 per cent said they would access youth counseling or the Kid’s Helpline. The survey will help identify future initiatives to support child and youth mental health and families in North Vancouver Island communities.

A Local Action Team (LAT) meets regularly to identify, discuss and plan initiatives to best meet community needs. One important initiative has included updating and redesigning the Community Resource Directory using several formats to reach a wider range of audiences such as rack cards for distribution by providers and community agencies and a Facebook page.

Developing a better understanding of the cultural aspects related to First Nations health is very important to improving access to mental health services and health outcomes.

Increased participation among new physicians and other organizations in the Indigenous Cultural Competency (ICC) Mental Health/Health online learning module will contribute to improved relations and service delivery. The ICC module was developed by the Provincial Health Services Authority.

You can learn more about the ICC module here: www.culturalcompetency.ca

Another initiative involved a pilot presentation on the Neuro-sequential Model in Education (NME) that was delivered to an elementary school. Positive results have generated interest in further NME workshops. (Dr. Bruce Perry will deliver an NME workshop in early April 2016 for North Vancouver Island).

You can learn more about NME and the work of Dr. Perry here: childtrauma.org/nme/

The Mount Waddington LAT includes representatives from a number of organizations including government, First Nations, health authority, division of family practice and community agencies.

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Accessing Funding for Small Group Learning

Funding to host small group learning sessions is available for Chapter members through the Practice Support Program.

Learning topics are flexible depending on areas of need in relation to perceived gaps in care and the level of interest among local physicians. Working with your Regional Support Team (RST) Coordinator, you can identify a topic that focuses on ways to improve service quality or patient access.

Examples of eligible topics include:

Clinical quality improvement
Office efficiency
EMR optimization
Advanced access
Clinical workflow improvements

In the Long Beach Chapter, local doctors got together to discuss ways to better optimize their EMRs.

After hosting a session, participating doctors can receive in-office support from physicians, MOA peer mentors and/or their RST Coordinator. Depending on the chosen content, small group learning sessions have been approved for Mainpro-C accreditation at one credit per hour.

Our Division has been allocated $20,000 and current year funds are available until the end of March 2016. Small group learning session funding may be used for: space rental, curriculum development and project leadership, food catering, EMR vendor participation for topics focused on EMR optimization, and/or sessional payments for physicians who lead small group learning sessions (e.g., prep time and event lead time), or for peer mentors who support small group learning sessions.

Sessional payments for doctors attending a small group learning session are funded outside of the division’s total small group learning session funding (e.g., through the PSP’s sessional fund). In-practice coaching support is not eligible for sessional payment.

To learn more, contact your RST Coordinator, your Chapter Coordinator, or go online at:

www.gpscbc.ca/what-we-do/professional-development/psp/group-learning-sessions

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The Rural Voice in the FPSC Visioning Process

Earlier this year, the General Practice Service Committee (FPSC) coordinated a province-wide consultation process with BC’s almost 6,000 family doctors to share their ideas about the future of primary care.

The consultations involved small group discussions and a process that enabled doctors to review and rank over 5,000 thoughts and ideas shared by the more than 1,100 doctors who participated in the online “share” and “star” steps of the visioning process.

As part of the 26 face-to-face visioning events co-hosted with divisions of family practice across BC, Rural and Remote Division physicians participated through Chapter-based discussions and were networked through a province-wide videoconference.

Highlights from discussions involving what rural and remote doctors want to see in the future included:

Generalism is especially important as an underpinning for rural health care
The ability to develop collaborative, interprofessional teams
Recognition of the important role of telehealth to provide access to clinical knowledge sharing and consultations
Different, more flexible funding models
Support for innovation (and leadership) by rural communities
Effective rural patient transportation to improve access and reduce burdens on rural patients and providers
Recognition of the unique contexts of providing health services in rural and remote communities

The FPSC’s Visioning Steering Committee (VSC) is analyzing the extensive comments and preparing a report for the FPSC. The ideas shared will help the FPSC create a GP-led vision for the future of primary care in BC and identify priorities to support GPs, influence policy, and allocate its $208 million budget. Stay tuned for details at www.gpscbc.ca/what-we-do/collective-voice/visioning.

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Indigenous Cultural Competency Training Program

Physicians who work in Rural Practice Subsidiary Agreement (RSA) A, B or C communities qualify to have the Indigenous Cultural Competency Training Program course covered by Rural Education Action Plan (REAP).

Qualifying physicians pay for the course up front and then submit their receipts to REAP – this is actually advantageous, as participants are covered for more than just the course rate.

You can find more information here: phsa.editmy.website/training/rural-education-action-plan-reap

If you have a health authority email and belong to any health authority except Vancouver Coastal Health (VCH), then the email alone will grant you a free spot. Without the email, working in a health authority allows you to get a funded course spot as well. Physicians can only apply through one avenue – REAP or the Health Authority covering the community in which they work.

Communities covered by the RSA are subject to meeting the minimum point requirement under the Medical Isolation Point Assessment system, based on an annual assessment.

Communities that do not qualify for the Recruitment Retention Program under the RSA receive 50% of the previous year’s retention allowance for one year.

Physicians practicing in A, B, or C communities are eligible for all the rural programs subject to meeting individual program requirements.
‘A’ communities – 20 or more ‘B’ communities – 15 to 19.9 
‘C’ communities – 6 to 14.9 ‘D’ communities – 0.5 to 5.9
You can get more information here:www.culturalcompetency.ca

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Telehealth’s Benefits for Patients and Physicians

Through funding from the Joint Standing Committee on Rural Issues, Rural and Remote Division is actively supporting the expansion of telehealth in a number of our communities, and contributing to dialogue regarding telehealth as an important enabler to sustaining rural health services. Integral to this work is the leadership and support of Helen Truran, project manager, who brings a strong background in telehealth initiatives in the province.

One example available to all doctors in BC is the Teledermatology initiative ConsultDerm developed by Dr. Jaggi Rao at the University of Alberta and implemented in BC through the leadership of Salt Spring Island GP Dr. Shane Barclay and dermatologist Dr. Patrick Kenny. There are currently about 450 GPs actively using the program in BC supported by six dermatologists.

To learn more or to register go to: www.consultderm.com

Gabriola Community Health Centre has been very interested to have telehealth, however, as a non-health authority facility did not have access to the technology. Through the Division and in partnership with Island Health, Gabriola is in the process of installing videoconferencing equipment and developing processes to support local clinical, administrative, and educational needs.

Gabriola first trialed videoconferencing for our Division’s AGM and FPSC Visioning session in September, enabling local physicians to participate with rural physicians in sites across the province.

The first telehealth client consultation will be with Victoria-based Seniors Health Clinician, Dr. Pakrasi. On receiving a referral from a local GP, the consulting specialist will determine the suitability for a telehealth consult and the specialist will then notify the patient and book the equipment. The initiative will help fill an important service gap, be more convenient for patients and reduce travel time and costs.

Partnering with Island Health has been key to ensuring clinical and technical standards are met. A very special and sincere thank you to volunteer Harvey Graham, chapter coordinator Nancy Rowan and Gabriola physicians, especially Dr. Maciej Mierzewski.

In Bella Bella, Drs. Stuart Iglesias and Lauri-Ann Shearer are actively supporting enhanced telehealth services in partnership with the First Nations Health Authority, Hailika’as Heiltsuk Health Centre Society and Vancouver Coastal Health (VCH).

Division staff recently travelled to Bella Bella to support a new Plastic’s Pre-operative Telehealth Clinic held at the Heiltsuk Health Centre with Dr Van Laaken, a Vancouver-based plastic surgeon who travels to smaller communities. Working with VCH, further training for local telehealth coordinators is being provided. Other services in development include tele-physio, Diabetes’ Clinic, and rheumatology.

Prototypes are being considered for expanding telehealth in rural and remote communities to:

Increase access to primary care services for remote communities
Enhance continuity of care particularly for outreach services
Support patients with chronic diseases, mental illness and substance use; access to specialists; and acute care services in remote service areas
Decrease provider isolation and build stronger interprofessional linkages
Increase access to continuing professional development

Rural and Remote Division Board recently engaged with Marc Pelletier, Senior Strategic Advisor to the Ministry of Health and consultant Nancy Gabor regarding the draft Virtual Care Charter being developed for the province. This document reinforces the important role of telehealth and other virtual care approaches in supporting quality health services.

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A GP For Me: Rural Roundup

The following is an overview of A GP for Me initiatives undertaken by Rural and Remote Chapters.

Salt Spring Island
A Social Program Officer (SPO) began work in August and received her first referral the day she started. Time-savings for GPs is expected to accrue steadily due to a combination of the SPO supports and patient panel clean-up work undertaken in the A GP For Me assessment and planning phase. The success of the SPO initiative is due in large part to an effective collaborative relationship with Island Health.

Since January, 2015 the community has attached approximately 180 patients to island practices. As well, the Chapter’s Primary Care Home model working group continues to explore new ways of improving care and patient access to services.

North Vancouver Island
Training has been provided to 16 home support workers, 24 primary care clinicians and six volunteers/caregivers. The training included: working with patients/clients with dementia and one-to-one therapeutic recreation activities. New learned skills were immediately put into practice.

In September NVI received approval for $50,000 from the Joint Standing Committee for additional Adult Day Program (ADP) support for NVI. This funding will support the ongoing A GP for Me initiative through:

the current ADP pilot launched in Port Hardy in November
support to additional ADP in other communities starting in 2016

The Mount Waddington Collaborative Working Group/NVI is partnering with Mount Waddington Health Network in the development of the "Community Action Initiative - Promoting Mental Health and Wellness in Older Adults and their Caregivers". This work builds on the A GP for Me pilot program to further enhance the supports available in the communities including hiring a recreation facilitator to deliver ongoing programs.

Gabriola
A collaborative initiative has involved the integration of a social worker with physicians' practices and local not-for-profit social services agency.

Now that the social worker has been working with the local health care team for over six months, physicians see this position as having a vital role within the clinic. The social worker is supporting patients meet their basic needs of adequate housing, income support, food security, social integration, system navigation and coping strategies. It has become evident that regardless of a specific diagnosis of mental illness or substance use the majority of patients referred to the social worker suffer from dysthymia and need additional support beyond medical intervention in maintaining their health. The social worker has been effective in providing services across traditional boundaries and has supported individuals and families referred through the school, social services agency and preschool programs with access to medications, housing, income support and health insurance programs. The physicians are delighted that they are able to offer patients a resource that supports their health and well-being, strengthens attachment and in turn reduces reliance on the health care system.

In addition to the above, GP for Me funds are being used to support the development of a Community Health and Wellness Collaborative. Thirty-one organizations and groups were represented at a Visioning Conference in October and embraced the notion of working collaboratively. A public forum brought forward many ideas from community members around needs and concerns to be addressed by the Collaborative as well as addressing the “Social Determinants of Health”.

Long Beach
The Long Beach Chapter is collaboration with the Coastal Family Resource Coalition to enhance their web-based health and social services resource directory as well as producing a service map for physician offices of mental health and integrated health care providers to be available to the West Coast’s nine communities.

A Community Health Survey will further investigate service gaps and access issues. A Health Care Service Provider Survey has also been completed and results of both surveys will inform a series of community education events.

All Long Beach GPs attended a West Coast Primary Care Forum hosted by the First Nations Health Authority (FNHA) marking the importance of a strong ongoing relationships between GPs , the local First Nations, the Nuu-chah-nulth Tribal Council service providers and the FNHA. GPs have also engaged with FNHA around their Tele-Health Expansion Project coming soon to a number of communities.

The Chapter established a Mental Health and Substance Use/GP Working Group looking at communications and effective workflow issues and will include other organizations over time. The MHSU-GP Working Group invited the RCMP to participate in a conversation around drug-induced mental breaks/psychosis within the ER setting and the NTC’s Teechuktl (Mental Health) Coordinator has been invited to meet to support a collaborative working relationship with their service providers. The Pacific Rim Hospice Society will be sharing offerings with physicians to find innovative solutions to gaps in seniors’ care on the coast.

Pemberton
The Pemberton Chapter continues to work on a Primary Care Case Management Model that incorporates a health navigator. It is expected that as physicians become more exposed to the health navigator’s role and availability, patient referrals will continue to increase.

Referrals to date through the health navigator have been related to health care coordination, transportation, housing and financial aid.

The Chapter has been successful in pulling together patient care conferences that are helping to coordinate and clarify various services, build collaborative relationships, and improve communication between physicians and allied health providers.

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When Rural Practice Runs in Your Blood

Rural practice is in Dave Whittaker’s blood. After two years of post-grad training in hospitals in Kwazulu Natal and the Western Cape in South Africa, Dave worked with a group of rural docs in Springbok located in the Kalahari Desert.

Springbok is the largest town in the Namaqualand area of the Northern Cape province of South Africa with a population of around 13,000 and situated on the road that connects the Cape with Namibia.

As part of a group of nine GPs who ran a 50-bed hospital, Dave quickly gained a broad range of skills from working in maternity to minor general surgery, emergency care and a full scope of diagnostics. The GP group had responsibility for providing primary care for the whole region which required working in collaboration with other care providers.

“It was a model that worked,” says Dave. And a model that taught him early in his career about the value to collaborative partnerships and shared care.

“In late 2012, we made the difficult decision to leave South Africa, although at the time it was not intended to be a long term plan. I had completed my pre and post-grad training and although the year in Springbok had been one of the most rewarding of my life, I needed a change,” Dave recalls.

He had the option of going into a specialization like internal medicine, but the draw of family practice was stronger. “So my wife-to-be and I decided to go on an adventure.”

Dave remembers “stumbling onto Port McNeill” through the help of Dr. Stuart Johnstone, a family friend and found himself “lucky enough” to get the opportunity to work with and be mentored by Dr. Granger Avery, perhaps the most well-known GP in North Vancouver Island communities and a great champion of rural family practice.

“He welcomed me to the community and I still learn from him every time we have the opportunity to talk. I would hope that all young doctors new to a region could have the introduction and experience that I got,” says Dave, now with several years working in NVI communities.

Thinking back over the past few years, Dave recalls how the community lost three physicians, leaving just himself and Dr. Prean Armogam as the only GPs to cover the full call roster including visits to eight remote communities as well as keeping the local clinic running.

“It would not have been possible without Prean’s leadership and fantastic support from our MOA staff and hospital nurses,” says Dave who recalls doing up to 17 days of call in a row. “It was a tough time for everyone.”

Without an active locum pool and with “communities in crisis”, Dave says it was challenging to attract new docs to do rural practice in these conditions. It was during this time that Dave and his wife welcomed their first child, Stuart into the community so he was now balancing being a new dad with a demanding rural practice.

“We worked as many hours as we could in the clinic, taking booked and walk-ins and always accepting new patients. It meant that during the 18-month period we had only two physicians yet we managed to keep our emergency room numbers from increasing,” recalls Dave.

Maintaining a rural-medicine teaching program was a way of “keeping connected with the outside world” as well as being able to “focus on good medicine and not just surviving”.

Dave credits Prean with being able to attract some IMG residents for their return-of-service rotations with two-month rotations through the community. “This allowed us to recruit some fantastic IMGs,” says Dave.

He also recalls the value and benefit of being part of the formation of the Rural and Remote Division of Family Practice that he says is an ongoing learning experience.

“It has been an absolute honour to be a part of the Division and I am sure that our region would not be in the healthy position that it is today without it,” says Dave who is quick to credit the physician leadership of Dr. Rebecca Lindley and executive guidance of Kathy Copeman-Stewart.

“We keep telling people that Rural is different. Some of those differences though have meant that our leadership has had to work incredibly hard and creatively to get us to where we are today,” he notes.

In a fitting closing remark, Dave reflects on the fact that he was able to participate in developing this personal profile while sitting near a pool in Maui watching his son laugh and play while knowing his clinic is fully staffed with all call slots full.

“I suppose it’s a sign that things are on the up,” he says in such an understated reflection.

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Rural Locum Mentor - Mentee Initiative

The Open Chapter of the Rural and Remote Division of Family Practice is piloting a locum mentorship program in response to feedback at the Rural Locum Forum in February 2015.

Background: Many newly graduated and transitioning urban physicians are interested in serving rural communities, but express a lack of confidence in their rural clinical skills. Teaming up with an experienced rural locum or fellow peer can ease this transition and offer a wide variety of practice and life experiences.

The purpose of the Rural Locum Mentor-Mentee Initiative istobuild clinical confidence in physicians who are new to rural practice, to provide support for communities in crisis and to improve the locum experience. Other benefits of this initiative include knowledge sharing and the ability to explore different areas of BC. The mentors and mentees who have already stepped forward for this program are excited about the opportunity to learn from one another! Please contact Hayley Schwarz, Open Chapter Coordinator for further information at hschwarz@divisionsbc.ca or 604-558-7656.

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