Imagine you have a serious, complex, and perhaps terminal illness. Now imagine you are one of the almost one million British Columbians who doesn’t have a primary care provider. You’re scrambling because, up until now, people living in Vancouver had to have a primary care provider to access specialized palliative care community services. Urgently needing to find a family physician or nurse practitioner at such a time in your life is challenging and places a significant additional burden on patients and their caregivers, as well as on specialist providers and allied health workers in both acute hospital and community settings. This is the challenge Dr. Nori MacGowan, the program medical director of the Vancouver Community Palliative Care (VCPC) Program set out to meet with funding from VPSA’s Small Steps, Big Idea. She worked closely with Dr. Lynn Straatman, a cardiologist and interim medical coordinator of VCPC, Dr. Conor Barker, an acute care and community palliative care physician, Dr. Joseph Westgeest, a community palliative care physician, and Angela Remocker, a primary care nurse practitioner and program medical director for VCH’s Urgent Primary Care Centres. (Additional members have since been added to the project team including Moema Franco, project coordinator with VCPCP, and Kirsten Larsen, a nurse and the clinical coordinator for Outreach & Mental Health at the Downtown Community Health Centre.)
“Our goal was to develop a model of short-term integrated palliative and supportive care for patients in a community setting without a primary care provider,” explained Dr. MacGowan. “We consulted family, palliative care and other specialist physicians, primary and specialized palliative care NPs, allied health, and other key stakeholders. We engaged multiple possible referring sources from Vancouver Acute, urgent primary care centres, and community health nurses.”
The team conducted two series of focus groups over a four-month period. One series took input from palliative care specialists, with nurse practitioners informing the other.
“We were encouraged by the number of nurse practitioners and palliative care physicians who were interested in taking part,” said Dr. MacGowan. “ We initially had only planned for one focus group for each group. Due to the response, three focus groups were held for each of the groups. This led to a significant amount of data.”
Information gathered from the focus groups allowed Dr. MacGowan to develop initial criteria and identify a framework. Data was collected on potential benefits and barriers, referral criteria, care coordination challenges, and timing of service delivery. Key qualitative and quantitative measurements to test and evaluate the new model were also identified.
VPSA’s funding led to the development of a proposal for further funding from Doctors of BC. The team has received a $25,000 grant to begin the next stages of the project.
“We’ve developed a Delphi survey based on the focus group results,” said Dr. MacGowan. “This will soon be distributed to a larger community of palliative and primary care providers. Our goal with this survey is to identify and rank model characteristics and consolidate recommendations. The results will be available early in the new year.”
She also commented that the large number of participants meant there was greater dialogue about the idea and its application to other specialties where intense care by specialized physicians is needed over short time periods.
“We are grateful for the initial project funding from VPSA,” added Dr. MacGowan. “It allowed the project to get off the ground. Compensating physicians and NPs who came to the focus groups made them feel their time was valued.”
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Photo: Project team members (clockwise from left top corner): Dr. Nori MacGowan, Moema Franco, Dr. Joseph Westgeest, Angela Remocker, Dr. Lynn Straatman, and Dr. Conor Barker. Missing: Karen Larsen.