Abstract
A major effort is underway to integrate primary and community care in Canada's western province of British Columbia and in Fraser Health, its largest health authority. Integrated care is a critical component of Fraser Health's planning, to meet the challenges of caring for a growing, elderly population that is presenting more complex and chronic medical conditions. An integrated care model partners family physicians with community-based home health case managers to support frail elderly patients who live at home. It is resulting in faster response times to patient needs, more informed assessments of a patient's state of health and pro-active identification of emerging patient issues. The model is intended to improve the quality of patient care and maintain the patients' health status, to help them live at home confidently and safely, as long as possible. Preliminary pilot data measuring changes in home care services is showing positive trends when it comes to extending the length of a person's survival/tenure in the community (living in their home vs. admitted to residential care or deceased). Fraser Health's case manager-general practitioner partnership model is showing promising results including higher quality, appropriate, coordinated and efficient care; improved patient, caregiver and physician interactions with the system; improved health and prevention of acute care visits by senior adult patients.
Highlights
Fraser Health is one of Canada’s largest and fastest growing healthcare authorities, providing public health care services for 1.6 million people residing in a southwestern British Columbia, Canada
This article is published in a peer reviewed section of the International Journal of Integrated Care
The results showed that people with chronic diseases who are regularly served by and attached to the same full-service family practice cost the healthcare system significantly less money those patients not closely attached to a family doctor
Summary
Fraser Health is one of Canada’s largest and fastest growing healthcare authorities, providing public health care services for 1.6 million people residing in a southwestern British Columbia, Canada. One of the best features is that medical needs can be better addressed at home, including some diagnostic testing, where the client is often more comfortable and relaxed She knows of cases where doctors have managed to expedite tests such as computerised tomography scans by working with a patient at home rather than having the patient go to an emergency room. Gloria Anonsen, 85, of Abbotsford, says she found the new Home Health approach a major benefit for her husband Eric, for whom she has been the primary caregiver since he suffered a stroke 10 years ago She found that with the integrated Home Health physician approach, it made a lot of sense for her and Eric to share the same doctor, building a greater attachment to their family physician: It’s great that she knows us, comes and sees us and talks to both of us. The data are consistent with the interpretation that the introduction of the case manager–general practitioner partnership in 2011 has resulted in keeping patients in the community for longer periods
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