1. Expanding access to team-based care
- Date: 2024-10-24
- Concurrent Session: Concurrent Session C
- Time: 4:45 – 5:15 pm
- Room:
- Style: Presentation (information provided to audience, with opportunity for audience to ask question)
- Focus: Balance between both (e.g. Presentation of a best-practice guideline that combines research evidence, policy issues and practical steps for implementation)
- Target Audience: Leadership (ED, clinical lead, board chair, board member, etc.) Clinical providers Representatives of stakeholder/partner organizations
Learning Objectives:
Participants will learn:
- The focus of the presentation is to describe the facilitators and barriers in designing and implementing a model of interdisciplinary and interagency primary care team for frail homebound seniors, drawing on lessons learned from the Seniors Home Support Program.
- Key performance measures and evaluation methods are discussed in depth, along with policy and research considerations for modernizing the field of team-based primary care at home.
Summary/Abstract:
Expanding on evidence-based models for home-based primary care, the Eastern York Region North Durham Ontario Health Team (Canada) launched the Seniors Home Support program in June 2021 to improve access to primary care for homebound seniors. Success of this program is in its patient-centered design, which has fueled the integration of geriatric and palliative care within a primary care service for a seamless patient experience across the continuum of care. Frail homebound seniors face a myriad of challenges to accessing traditional office-based primary care due to cognitive, physical, or social factors. Frailty, coupled with trends in increasing lifespans and chronic diseases, puts homebound seniors among the highest users of acute medical services and highly vulnerable to receiving fragmented care across health care settings. The Seniors Home Support program is a sustainable model of care that improves health care delivery and the patient and caregiver experience through one integrated team of primary care providers, nursing, allied health, and paramedics working across health sectors. In this presentation, we will reflect on first 3 years of program implementation. Key enablers and challenges will be discussed in delivering team-based primary care within an Ontario Health Team in the context of partnership and the role of family health teams. Using the quadruple aim with equity approaches, we evaluated the impact of an integrated primary care program on patient and caregiver experiences, provider satisfaction, health outcomes, and health system costs. Drawing on our lessons learned and evaluation, future research and policy implications are explored.
Presenter:
- Dr. Elizabeth Mui CCFP (COE), Family Physician Oak Valley Health
- Susan Ng RN, MN, CHPCN(C), CGN(C), Advanced Practice Nurse Oak Valley Health
- Sheetal Desai RPh CDE Pharmacist Markham Family Health Team