Healthy Living in the North

“Catching people in the net of the team:” patient-centred care in practice

Headshot of Carey Mastre, Mental Health & Addictions Clinician in Mackenzie BC.For Carey Mastre, working in a patient-centred model makes total sense. She’s a Mental Health and Addictions Clinician in Mackenzie who trained in Calgary, AB, at a large not-for-profit agency.

“In practice, the expectation was that we would make contact with the patients’ doctors,” Carey says. “We were allowed to share information with each other, but the doctors and the mental health clinicians didn’t really have time for it. It was rarely fruitful…”

Carey started working with Northern Health in October 2016.

She was initially working offsite from the rest of the health care team, which wasn’t totally functional for her. In January 2018, she moved into the same building as the team and the primary care providers. Because they’re now located together, she can walk the patient to the doctor and vice versa. This has been particularly helpful for patients who are new to the community and for crises.

“At Northern Health, it’s so wonderful to have a scheduled time with the doctors and a working relationship to support client care,” Carey says. “We need to know and trust each other and trust each other’s judgment. Being co-located creates that sense of immediacy and we’re often able to better anticipate and meet the patient’s needs. Everything flows better.”

Another great thing about the team is the flow of information. There are clear ways to follow up with referrals and find out if appointments happened and to learn the outcome.

“It’s super helpful when you’re joining a team to have that regularity. Relationships are created far more quickly. There’s also so much culture to learn at Northern Health; belonging to a health care team allows you to become functional in your role much more quickly – so much is learned through osmosis,” Carey says.

There are two mental health and addictions care providers in Mackenzie and patients come to them either directly or through the doctor’s office.

On a health care team, the team members can also support the hospital, and help the patients when they transition out of hospital.

The team model ensures that “fewer clients fall through the cracks – people are typically caught in the net of the team,” Carey says. “We’re mentally prepared for care transitions and we can better anticipate needs.”

From her perspective, good things did happen in the old model – but she finds it far easier to work as part of a health care team in the new integrated model.

The team in Mackenzie in particular is “just so warm and inviting,” Carey says. “The leaders in Mackenzie really role-model ‘team’ — it’s just been the best thing.”

Bailee Denicola

About Bailee Denicola

Bailee is a communications advisor in the Primary Care Department and was born and raised in Prince George. She graduated from UNBC with an anthropology degree and loves exploring cultures and learning about people. When not at work, Bailee can be found hanging out with her dogs, building her house with her husband, or travelling the world.

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Canadian Patient Safety Week: Not all meds get along

Rob Pammett, Research and Development Pharmacist, holding a large bag of meds.

Rob Pammett, Research and Development Pharmacist – Primary Care, removing expired and unneeded medications from a patient’s home.

Canadian Patient Safety Week is October 29 – November 2, and this year’s theme is Not All Meds Get Along. It’s a reminder that modern medicine is very complex and requires careful monitoring to make sure people don’t experience medication-related harm.

Two thirds of Canadians over age 65 take at least five medications regularly, and more than 25% take over 10. We enjoy longer, healthier lives partly thanks to effective modern medications, but we should always be aware of the possibility of medication-related harm.

Medication interactions

Sometimes medications can interact with each other, making them work too well or not well enough, with serious consequences.

For example, imagine taking a natural health product that made your blood pressure medication work too well – you might start feeling woozy, low-energy, or even faint. This is a real example of what might happen if you took  peppermint extract and felodipine, a common blood pressure medication.

The importance of reviewing medications

Medication reviews help develop a clear list of your medications and how you’re taking them. A medication review can also help optimize your medications, making them easier to manage, safer and more effective. A review also gives both you and your healthcare team an up-to-date list of your medications, which can be vital if your health status changes, or if you need emergency care.

A wide variety of medications on the counter.Before starting any new medications (including over-the-counter products from a pharmacy, natural health products and vitamins, or even cannabis products), it’s important to talk to your pharmacist, doctor, or nurse practitioner. They can review your medications and give advice on whether they’ll be safe and effective for you.

Who should have a medication review?

I use the following 5 questions to help identify people who might benefit from a medication review:

  1. Do you regularly take 5 or more medications? (including prescription and non-prescription products, vitamins and minerals)
  2. Do you take 12 or more doses of medication each day?
  3. Are you currently taking medications for 3 or more medical conditions?
  4. Have your medications or the instructions on how to take them changed 4 or more times in the past year?
  5. Do you take any of the following medications?
    • Anti-epileptics
    • Anti-coagulants
    • Drugs for chronic pain
    • Insulin
    • Drugs to lower blood sugar
    • Lithium
    • Digoxin
    • Methotrexate

Answering “Yes” to 3 or more of these questions means there’s a good chance that your medications can be optimized: you should ask for a medication review. Stay healthy and have a great Canadian Patient Safety Week!

Rob Pammett

About Rob Pammett

Rob Pammett is the Research and Development Pharmacist – Primary Care, a partnership between Northern Health and the Faculty of Pharmaceutical Sciences at the University of British Columbia, where he holds the rank of Assistant Professor (Partner). He has an active clinical role in multiple primary care homes in Prince George and works with interprofessional teams to provide comprehensive care to patients.

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Primary and Community Care transformation is hard: How one nurse changed her perspective

An NH Connections bus parked out front of the Mackenzie & District Hospital & Health Centre.

An NH Connections bus parked out front of the Mackenzie & District Hospital & Health Centre.

At first, changing the way she worked seemed like a terrible idea.

“I don’t like change and I knew I was retiring soon,” Kathy Sloan says.

She was not interested in going through a major career shift.

Kathy, 64, had been a Home and Community Care (HCC) nurse in Mackenzie for 17 years. She mainly worked alone, consulting with the Health Services Administrator on complex issues.

The new way of working, in an integrated primary and community care model, would mean she had to start working on an interprofessional team and in a different way with the primary care physicians.

Kathy didn’t see the benefit.

“I’ve always worked as a team,” Kathy says. “I had easy access to everyone and the doctors and other nurses were always close by.”

“I was in a groove in my role,” she adds. “I resisted the change so much that I wore a groove right in the pavement!”

But when Kathy realized that this new way of working was here to stay, she decided to shift her perspective.

“I started to think about the clients and the people I’m serving,” Kathy says. “If the change is better for them, then I need to get on board.”

Fast-forward a year or so, and now Kathy is on an interprofessional team that she describes as “great,” with “awesome support” for each other.

Kathy has seen many benefits from the new team approach.

“Everyone gets on board [to help the patient] quicker,” she says. “As we work together, it’s so fruitful.”

Other benefits Kathy has seen from working in an interprofessional team:

  • The team is very client-focused.
  • It’s amazing what comes out of team huddles in only a half-hour period.
  • Everyone is contributing – community paramedics, primary care nursing, life skills worker, doctor, mental health counsellors, etc.
  • There is more awareness of serving the client and helping out other team members.

“I really felt defensive to the change at first,” Kathy says. “It made me question, was I doing my job properly?”

But in the end she came to realize that the changes were not about her, they were about the people we are here to serve. Kathy has a great team lead in Mackenzie who has been supportive throughout the process and collaboration is so much easier now.

To anyone who is new to the work, or maybe even struggling with the change, Kathy suggests to just “keep going, you are always developing and changing at work, as a person and in life. There are good leaders out there that will help you in your transitions, connect with them, share your frustrations, ask for help and push past your comfort zone and take a chance on moving forward!”

Bailee Denicola

About Bailee Denicola

Bailee is a communications advisor in the Primary Care Department and was born and raised in Prince George. She graduated from UNBC with an anthropology degree and loves exploring cultures and learning about people. When not at work, Bailee can be found hanging out with her dogs, building her house with her husband, or travelling the world.

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