Dr. Barry Clarke, a family physician in Nova Scotia, has made it his priority to ensure seniors across the province receive more coordinated, efficient care that ultimately frees up hospital beds and emergency rooms.
His idea to create a new system of care, designed specifically for the aging population, came to him during long shifts in the emergency department, where he observed senior patients being readmitted to hospital time and time again because they had nowhere else to go.
“When they arrived, there was very little we could do for them,” says Clarke. “My motivation evolved out of sheer frustration. We knew we could do more for these patients, but we weren’t sure how to do it.”
Looking for solutions, Clarke flew to the Netherlands after hearing success stories about their long-term care model aimed at bringing care directly to the patient.
Drawing on inspiration from his travels, Clarke created Care by Design. He and his team now manage the care of 19 different long-term care homes across the province. Family physicians are assigned to a specific facility, working alongside other care providers on the floor. Residents receive weekly check-ups and have access to urgent care 24 hours a day.
“The quality of care improved when we really started to understand the patient population,” says Clarke. “When you’re in a hospital environment, the knee-jerk reaction is to over-treat and overact, which doesn’t benefit the very, very frail.”
It’s this type of model that the Canadian Medical Association has been advocating for over the past year. Care by Design is an example of an initiative that draws on community resources to provide more tailored care. It also allows for a deeper relationship between the patient and physician.
Care by Design has been recognized as a “promising practice” by many provinces across the country. British Columbia’s Fraser North East community recently implemented the program and parts of Alberta have shown interest as well.
“It’s a challenge to reproduce it exactly, but the principles are there and that’s what we’re trying to achieve: a good, principled approach,” says Clarke.