By Courtney Ellis
Access to comprehensive, continuous primary care is a challenge throughout Canada and BC is no exception. In Victoria, BC, it is virtually impossible to find a family doctor if you need one, there are hour long waits at many walk-in clinics and emergency rooms, and such challenges make the news headline news almost weekly. With as many as 15% of Victoria residents without a family doctor, the time has come for Victoria, and British Columbia, to follow Ontario’s lead with the creation of Nurse Practitioner-Led Clinics (NPLCs).
The first NPLC was conceived and implemented in Ontario in 2007 by two Nurse Practitioners in response to thousands of patients lacking a primary health care provider. Within one year, the NPLC was so successful, the Ontario government announced it would add an additional 25 NPLCs. NPLCs provide treatment of both episodic and chronic illness for individuals who do not currently have a primary care provider. NPLCs are primary care offices that patients are registered with for all their primary health care needs and includes access to a group of nurse practitioners (NPs), as well as a multidisciplinary team that can include a physician, pharmacist, registered nurse, social worker, or dietician, depending on the needs of the community. The features of an NPLC are that NPs are the most responsible primary care provider for a group of patients – meaning the NP has the overall responsibility for directing, coordinating and managing each patient’s care, the clinic director is an NP and the board of directors is made up of 51% NPs, with the remaining board made up of community members to ensure the needs of the citizens are being met. Founded on a nursing model, NPLCs promote the patient as a partner in the care process and focus on wellbeing, health promotion and disease prevention. NPLCs allow NPs to work to their full scope of practice. Practically speaking, this means that NPs are not only able to independently diagnose, order labs and medical imaging, and prescribe medications, but are also able to be leaders in the communities they work which is consistent with the Canadian Nurses Association’s framework of advanced practice nursing. With their knowledge of community assessment and program planning, NPs improve the delivery of health care that ultimately benefits the public. Funding for the Ontario NPLCs is provided by the Ministry of Health and Long-Term Care, with NPs in the clinic paid a salary and not on a fee-for-service basis.
NPLCs demonstrate high levels of patient satisfaction and thoroughness of care, increased accessibility to primary health care services and decreased wait times. Extended hours are offered, and appointments are scheduled either on the same day or within two weeks depending on the urgency of the need, which is cost effective and reduces the number of walk in clinic and emergency department visits. Patients receive comprehensive care at NPLCs, including care for emergent problems, health promotion and prevention programs, immunizations, support for complex social or financial challenges, counselling about lifestyle issues such as diet and exercise, and management of chronic illnesses, including diabetes, arthritis, heart disease, asthma and mental health conditions. Overall, NPLCs lead to improved coordination and navigation of the health care system.
A NP-led geriatric outpatient clinic specializing in memory issues, functional decline, mood issues, and falls and fall-related issues highlights the cost-effectiveness of NPLCs. Patients with complex, age-related issues are referred to this clinic for urgent attention and implementable recommendations, including fall prevention and memory improvement strategies. In addition to being assessed for these concerns, other issues are frequently identified and managed, including education about nutrition, bowel function, and medication management, with most patients provided information on at least one community support service, such as Meals on Wheels, resulting in comprehensive, practical care. Cost-effectiveness is further evident at an NP-led clinic specializing in chronic heart failure. In comparison to usual care, patients were seen on a more regular basis, which allowed for close monitoring of side effects so that medications could be increased more quickly to target dosages per national guideline recommendations. As a result, the cost per patient was less and resulted in improved patient outcomes.
With the current NDP government pledging to roll out 200 NP positions over the next three years, including potential for NP group practice, the first steps have been taken in increasing access to primary health care. In order to continue this process and promote truly innovative health care reform, the formation of NPLCs must be a priority. This will ensure cost-effective, comprehensive and safe primary health care delivery that enhances health care outcomes for the residents of Victoria and British Columbia.
Courtney Ellis is a Registered Nurse and a first year student in the Master’s of Nursing program – Nurse Practitioner option. She has experience working in General Medicine, Oncology and Pediatrics in Victoria, BC.