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Transforming health care in the Boundary

When the sliding door of Walter Gambles’ van slammed closed and left a toonie-sized gash in his arm, the 82 year-old resident of Christina Lake figured he was destined for a trip to the emergency department in Grand Forks.

On a whim, Gambles decided he’d check in at the Christina Lake Medical Clinic where he met with new primary care nurse Svetlana Dalla Lana. In consultation with the clinic physician, Dalla Lana cleaned and dressed the wound and Gambles got the care he needed without ever leaving town.

“It was great,” says Gambles. “We’ve never had this kind of service here before.”

Dalla Lana saw Gambles for three follow-up appointments for ongoing wound care and dressing changes and educated Gambles on taking care of his injury on his own as it healed.

Until recently, Boundary residents have had to rely on the Boundary District Hospital emergency department for needs that could be addressed through an appointment with their regular doctor at the local clinic or through a home health nurse. This created potential delays in treatment and a lack of continuity of care, as patients were often seen by a different emergency department physician each time. It also created ongoing pressures on the Boundary Hospital emergency department.

Gambles’ case is an example of a new approach to health care in the Boundary. Dalla Lana is one of five new primary care staff hired through the Grand Forks/West Boundary Primary and Community Care Transformation Initiative, which is focused on getting residents across the Boundary the right care in the right place, from the right health-care provider when it is needed.

“It’s working very well,” says Dalla Lana. “Our team approach allows us to best meet the individual patient’s needs in a timely manner. When a patient walks or calls in, our medical office assistants do an excellent job of referring the patient to the right care provider at the right time.”

The Initiative includes a $500,000 annual investment by Interior Health (IH) and an enhanced partnership between IH, local physicians and the Kootenay Boundary Division of Family Practice (the Division).

”Experiences like Walter’s with theGrand Forks/West Boundary Primary and Community Care Transformation Initiative show the strong impact of having the right care close to home,” says Minister of Health Adrian Dix. “And in tight knit communities like Grand Forks we’ll see the positive ripple effect of these new staff throughout the area.”

”Changes to our complex health care system can be challenging and I want to applaud the efforts of our Boundary physicians, staff and leadership team for moving this project forward,” says IH Board Chair Dr. Doug Cochrane. “Above all, this is about improving timely access to appropriate care for our patients.”

The additional funding supports four new primary care nurse positions and a full time social program officer. These staff are providing care out of clinics in Grand Forks, Christina Lake and the West Boundary (Greenwood, Midway and Rock Creek), enhancing the Patient Medical Home (PMH) model. A PMH is a primary care clinic comprised of family doctors and/or nurse practitioners and other health professionals working together as a team for the benefit of patients.

"Our focus at the Division is on improving health care for our patients. We know that the best care is delivered by a wide range of expertise – doctors, nurses, social workers, etc. And that there is no 'one size fits all’ in health care,” says Dr. David Merry, board chair of the Division. “The Patient Medical Home model has been proven to work in many places around the world. It helps us to use the right practitioner at the right time, and then, with the patient at the centre, work together as a team to keep them healthy.”

Boundary PMHs are being integrated into a broader Primary Care Network that provides improved links to and collaboration with existing IH teams and services such as mental health, public health, home health, and diabetes and other chronic disease management.

Access to regular primary care and other services keeps people healthier and helps them avoid crises situations that lead to a trip to the emergency department and possibly even a stay in hospital.

“It’s important to reserve our emergency department in Grand Forks for true emergencies and start relieving some of the pressure on the hospital,” says Dalla Lana. “We will work with those patients that live with chronic diseases, chronic pain, and disabilities to help better their quality of life. Our community members should feel they can connect with their health-care team members when they need us. We want the patients to feel that we are exactly that, their Medical Home.”

In addition to the new investment in staffing, IH has reconfigured some services at Boundary District Hospital, moving all home health nursing services into a single location adjacent to the emergency department. This allows home health staff to treat appropriate patients (dressing changes, etc.) directly and relieve the pressure on the emergency department physicians.

Individuals with urgent care needs should continue to call 9-1-1 or visit the emergency department at Boundary Hospital. All patients who present at the emergency department will be assessed by a trained nurse and receive the care they require.

Interior Health and the Division are consulting with the Ktunaxa and Okanagan Nations, Boundary All-Nations Aboriginal Council, and Métis Association to ensure these changes continue to meet the needs of First Nations patients in the region.

The Kootenay Boundary Division of Family Practice represents doctors in 14 communities across the region including Castlegar, Christina Lake, Fruitvale, Grand Forks, Greenwood, Kaslo, Midway, Nakusp, Nelson, New Denver, Rock Creek, Rossland, Salmo, and Trail. The Kootenay Boundary Division works to improve patient access to local primary care, increase local physicians’ influence on health care delivery and policy, and provide professional support for physicians. The Division of Family Practice initiative is funded by a joint committee of the BC Ministry of Health and Doctors of BC.