1. Compassion  Accountability  Rights and Responsibilities  Excellence Donna Kearney, BScN, RN(EC), MHST Rosseau Nursing Station Nurse Practitioner - Manager Meeting Community Needs Through Integrated Care

2. Compassion  Accountability  Rights and Responsibilities  Excellence Rural Indicators of Health “Geography is an Indicator of Health” Roy Romanow 2002 Advanced Age Seasonal & Low Income Minimal Education Few Employment & Social Opportunities Few Support Services High Dependency

3. Compassion  Accountability  Rights and Responsibilities  Excellence Age Demographics Ontario 2006 District of Parry Sound 2006

4. Compassion  Accountability  Rights and Responsibilities  Excellence Rural versus Urban Parry Sound Rural Parry Sound 2006 Town of Parry Sound 2006

5. Compassion  Accountability  Rights and Responsibilities  Excellence Primary Care Providers by Region Region By Postal Code Number of Primary Care FP/NP’s 2006 CensusPop. change since 2001 census Town of Parry Sound15 FP’s 1 NP @ FHT 5818Down 5% Georgian Bay Township 1 part-time NP@ Moose Deer Point 2340Up 17.5% Seguin Township1 NP@ Rosseau 4276Up 15.6% Whitestone1 NP @ Whitestone 1030Up 20.8% Archipelago1 NP@ Pointe au Baril 576Up 14.1% Unorganized Central West 1 NP@ Britt 1212Up 10.3% Unorganized Central East 1 NP@ Argyle1212Up 10.3% McDougall02704Up 3.7%

6. Compassion  Accountability  Rights and Responsibilities  Excellence Nursing Stations: An Extension of the Hospital Hospital Nursing Stations

7. Compassion  Accountability  Rights and Responsibilities  Excellence Nursing Stations - Model Buildings, Donations, In-kind Funding,Grants Operations NP Station NP Station

8. Compassion  Accountability  Rights and Responsibilities  Excellence Scope of Practice Diagnosis and Treatment NP MD RN Specialist Allied Health Care Providers

9. Compassion  Accountability  Rights and Responsibilities  Excellence Research: Purpose 1) To evaluate a model of primary health care delivery appropriate for rural populations. 2) To determine the scope and collaborative nature of NP practice in a rural nursing station setting.

10. Compassion  Accountability  Rights and Responsibilities  Excellence 3) To define the level of importance of hospital affiliation in reducing cost of care. 4) To show the impact on ER usage, hospital admissions, and wait times for primary health care. Research: Purpose

11. Compassion  Accountability  Rights and Responsibilities  Excellence Research: Process 12 month data collection period (March 1, 2009 – February 28, 2010) Used electronic reporting tool developed for the project to improve consistency and accuracy by all 6 nursing stations Used hospital statistics for ER usage & acuity, admission, and re-admission rates

12. Compassion  Accountability  Rights and Responsibilities  Excellence Research: Variables Moose Deer Point nursing station decreased services from 5 days to 2 days per week due to lack of patients. H1N1 Pandemic NP vacation time, education time, and sick leaves not replaced consistently One station dropped out of the study

13. Compassion  Accountability  Rights and Responsibilities  Excellence Research Findings: Demographics Totals: 48% Adults (16-64), 44% Seniors (65+), 8% Children (0-15)

14. Compassion  Accountability  Rights and Responsibilities  Excellence Patients Without a Family Doctor

15. Compassion  Accountability  Rights and Responsibilities  Excellence New Patients

16. Compassion  Accountability  Rights and Responsibilities  Excellence Type of Care Provided: Nursing Stations

17. Compassion  Accountability  Rights and Responsibilities  Excellence Referral Rates from Nursing Stations Total Referral Rate = 11%, Consult Rate = 19%

18. Compassion  Accountability  Rights and Responsibilities  Excellence Patient Volumes: Nursing Stations

19. Compassion  Accountability  Rights and Responsibilities  Excellence Patient Volumes: ER/Nursing Stations

20. Compassion  Accountability  Rights and Responsibilities  Excellence Patient Acuity: ER/Nursing Stations ER Triage Score (7% Unknown) PercentNursing Station Acuity Percent 1 - Resuscitation.02%1 – Life Threatening0% 2 - Emergent5%2 - Emergent.09% 3 - Urgent27%3 - Urgent2% 4 – Semi-Urgent53%4 - Complicated21% 5 – Non-Urgent7%5 – Episodic/Chronic77% Total Patients seen in the ER 22,126Total Patients seen in Nursing Stations 19,240 Triage/Acuity Level 4 & 5: 60% in ER 98% in Nursing Stations

21. Compassion  Accountability  Rights and Responsibilities  Excellence ER Usage by Postal Code and Age Region by Postal Code # NP’s/ MD’s 2006 Census ER Visits % Pop using ER Child (0-15) Adult (16-64) Senior (65+) Town of Parry Sound 1 NP 15 MD’s 581811,069190%1435 (13%) 6829 (62%) 2805 (25%) Georgian Bay1 P/T NP 234010976%146 (13%) 699 (64%) 252 (23%) Seguin1 NP4276274664%455 (17%) 1644 (60%) 647 (23%) Whitestone1 NP103073972%52 (7%) 422 (57%) 265 (36%) Archipelago1 NP57622238%22 (10%) 149 (67%) 51 (23%) Central West1 NP121248240%61 (13%) 248 (51%) 173 (36%) Central East1 NP121200000 McDougall027046024223%411 (7%) 5033 (84%) 580 (9%)

22. Compassion  Accountability  Rights and Responsibilities  Excellence Hospital Admissions/Re-Admissions Region by Postal Code Hospital Admissions 65+ years % PopulationRe-Admissions Within 30 Days % Re-Admits Town of Parry Sound 4848.3%193.9% Georgian Bay (MDP) 421.8%49.5% Seguin (Rosseau) 771.8%00 Whitestone (Whitestone) 424%37% Archipelago (PAB) 111.9%00 Central West (Britt) 322.6%00 Central East (Argyle) 0000 McDougall813%56%

23. Compassion  Accountability  Rights and Responsibilities  Excellence Cost Analysis 6 Nursing Stations Budget: 1.3 million total Staff: 1 NP, 1 Admin Hours: 5 days (7.5 hours) Patient Volume: 19,240 Acuity Rates: 98% level 4 & 5 Cost per Patient Visit: $70 WPSHC Emergency Room Budget: 3.3 million total Staff: 1 MD, 4+ RN’s, 1 Admin Hours: 7 days (24 hours) Patient Volume: 22,126 Acuity Rates: 60% level 4 & 5 33% level 1,2,3 Cost per Patient Visit: starts at $152 Cost Analysis information is not available for FHT’s or NP Led Clinics to date, therefore comparisons are not possible.

24. Compassion  Accountability  Rights and Responsibilities  Excellence Reduced:Reduced: Wait times for primary careWait times for primary care Visits to the ERVisits to the ER Hospitalizations for chronic illnessHospitalizations for chronic illness IncreasedIncreased Access to health care for rural seniorsAccess to health care for rural seniors Opportunities to ‘Age in Place’Opportunities to ‘Age in Place’ Monitoring for compliance with treatments and health outcomesMonitoring for compliance with treatments and health outcomes Collaboration with all health care providersCollaboration with all health care providers Opportunities for health teaching and illness preventionOpportunities for health teaching and illness prevention Continuity of care and advocacyContinuity of care and advocacy Understanding of patients living conditions and support systemUnderstanding of patients living conditions and support systemConclusions

25. Compassion  Accountability  Rights and Responsibilities  Excellence Recommendations: Local Level Create permanent NP positions in the ER at WPSHC. Provide after hours primary care services to residents in the Town of Parry Sound. Relief funding is needed to replace NP’s at the nursing stations during absences. Increase operating budgets of nursing stations to allow hiring of additional staff (RPN’s, NP’s), and to provide mentorship opportunities to prepare new NP’s to work full scope in rural nursing stations.

26. Compassion  Accountability  Rights and Responsibilities  Excellence Change FP title to ‘Primary Care Specialist’ to promote top-of-scope functioning of all health care providers. Implement this model of primary care delivery in rural areas throughout Canada for a collaborative, sustainable, and accessible method of entering the health care system. Recommendations: Provincial/National

27. Compassion  Accountability  Rights and Responsibilities  Excellence Questions – Thank you! Donna Kearney, BScN, RN(EC), MHST West Parry Sound Health Centre dkearney@wpshc.com