Teamwork in respiratory care in a family practice Andrew Cave FCFP FRCGP Tanya Koenig RRT Hoan Linh Banh Pharm D Kaye Edmonton Clinic, University of Alberta

Conflicts of interest Dr. Cave has received research support and honoraria from AstraZeneca GSK Grifols Boerhinger Ingelheim Novartis Dr. Banh and Mrs. Koenig have no conflicts to declare

Kaye Edmonton Clinic

KAYE EDMONTON CLINIC Managed by Alberta Health Services Affiliated with University of Alberta Hospital Managed by Alberta Health Services Comprehensive ‘free’ services Multidisciplinary ambulatory clinic Adult focus Investigation services on site

PRIMARY CARE TEAM Population 6,000 patients registered 20,000 consultations per year Team members Office assistants Registered nurses Clinical pharmacist Chronic Disease Nurse Dietician

INTRODUCING A RESPIRATORY THERAPIST favourable factors Identified need Physician special interest Collaboration with specialists upstairs Shared records Therapist availability

Process of introduction of therapist Choosing services Negotiating with physicians Negotiating with administration Inviting patients

SERVICES IN RESPIRATORY CLINIC Assessment and diagnosis Spirometry Smoking cessation advice CPAP advice Medication review Inhaler technique tuition Asthma/COPD education Joint consultation (RRT and MD) Follow up if required

Issues Recruiting and advertising Evaluation Complexity Multimorbidity Availability

Evaluation Description of content Report to physicians Survey of other team members Patient satisfaction survey Outcomes analysis ?

Conclusions Desirable Meets a need Takes many steps to establish Takes TIME to establish Worthwhile Evaluation in progress