Do you have patients with mobility issues, or who struggle to come into your clinic for necessary appointments? This was the challenge Dr. Lawrence Yang at Gateway Medical Clinic was having – and they found a solution in the Nurse Debbie pilot program developed by the Fraser Northwest Division in 2016.  

The pilot was so successful that FPSC published an article about it, highlighting that programs like this one help to reduce the number and frequency of homebound patients who end up in the ER. Dr. Yang also explained that patients feel better cared for when they are able to see a nurse who is connected to their physician. 

That was several years ago, and Dr. Yang is still working with Fraser Health's Home Health nurses to see his patients in their homes. These nurses communicate with the clinic every month or two to provide important updates.  

What has changed since the FPSC article was published is that the nurses are no longer required to document their visits in the FP’s EMR – something that had been burdensome for the nurses, but that was one of Dr. Yang’s favourite aspects of the program. Now, Dr. Yang copies text communications from the nurses manually into his EMR. 

To any FPs who are interested in working with Home Health nurses, Dr. Yang offers this advice: “It is important for Family Doctors and home health nurses to be proactive about meeting in person at least once. This makes the working relationship much better.  Sharing cell phone numbers is also very helpful.” 

Family Physicians: Do you know who your Community Health nurse is? Ask your MOA about the fax cover letter that was sent out to clinics last month, visit the Home Health Office page on Pathways. 

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