Physicians developing local, scalable and sustainable solutions for seniors
British Columbia has long been the chosen destination for Canadian seniors with the means and mobility to escape a lifetime of harsh winters and the attendant woes of snow shovelling and white-knuckle commutes. It’s little surprise, then, that the province anticipates a 120% growth in the number of residential care patients in the coming 20 years.
Facing that challenge, BC’s General Practices Service Committee instituted a residential care initiative aimed at enabling physicians to develop local, scalable and sustainable solutions. The core of the initiative consists of five best practices:
- 24/7 availability and on-site attendance when required;
- proactive visits to residents;
- meaningful medication reviews;
- completed documentation; and
- attendance at case conferences.
The system-level goals are threefold: reduce unnecessary or inappropriate hospital transfers, improve the experience of patients and providers, and reduce the cost per patient by providing a higher quality of care.
Early results from across the province indicate that the initiative’s projects are making a difference in the quality of care provided to seniors living in care facilities. All divisions of family practice are now working on projects covered by funding for the initiative, meaning that 97% of the eligible 30,000 residential care beds in the province are now included. Evaluation data from eight divisions of BC’s regional health authorities — Fraser Northwest, Kootenay Boundary, Mission, Richmond, Shuswap North Okanagan, Victoria and Vancouver — show that projects underway in those communities are already meeting some or all of the five best-practice expectations, and some are moving toward fulfilling the three system-level goals.
In Vancouver, for example, the number of physicians attached to residential care facilities has increased by almost 50%. Fifty-nine residential care physicians (30 of whom are new to residential care in Vancouver) are now caring for 995 residents in 30 facilities. Additionally, residents in 22 facilities can reach a family doctor within an average of two minutes through a new after-hours care program, with 27 doctors providing after-hours on-call care to 1,700 residents.
In Victoria, a new after-hours call system covers all residents at each of 29 sites. Coverage is provided between 5 pm and 7 am on weekends and at all hours on Saturdays, Sundays and holidays, to ensure that facilities can reach a physician in less than five minutes by calling one convenient number.
In Fraser Northwest, which includes New Westminster, Coquitlam, Port Moody and Port Coquitlam, residential care patients are now attached to a most responsible physician. The number of family doctors providing care to residential care patients has doubled, reducing the median number of patients per family doctor from 80 to 35. The division has also implemented a standardized 24/7 call system. In the first 20 months of the program, emergency department transfer rates from residential care facilities were reduced by 5%, acute care admissions were reduced by 9% and acute care length of stay was reduced by 19%. Data show that these results have led to cost savings of more than $1.5 million to the health care system in less than two years.
Overall, these projects have successfully reduced hospital transfer rates through strategies like proactive visits, meaningful medication reviews and after-hours on-call coverage. Patient attachment efforts and regular physician visits to residential care facilities have ensured that work is shared between a greater number of physicians, reduced the median number of patients per family doctor and enabled doctors to take vacations and sick leave when necessary. This work has dramatically improved the overall experience of patients and providers.
These early results from around the province show that the residential care initiative is already saving the system money through cost avoidance by reducing the number emergency department transfers and acute care admissions, shortening acute care stays and eliminating unnecessary prescriptions. Once all local and regional data have been collected, a clearer picture will emerge of the initiative’s provincial impact, including an estimate of overall provincial cost savings.