objectives describe practice settings canada, detroit & denver and the type of patients that i...

ObjectivesObjectives

Describe practice settings Canada, Detroit Describe practice settings Canada, Detroit & Denver and the type of patients that I & Denver and the type of patients that I saw.saw.

Present patients of mine in each place and Present patients of mine in each place and time that benefited from a team approach time that benefited from a team approach to their care (particularly chronic diseases)to their care (particularly chronic diseases)

London, Ontario (Not England) London, Ontario (Not England) 1982-19921982-1992

London, Ontario 1982-1992London, Ontario 1982-1992

Medical Care Medical Care London, Ontario 1982-1992London, Ontario 1982-1992

Fee for service (solo FM practice)Fee for service (solo FM practice)1500 patients but still a micro-practice 1500 patients but still a micro-practice

(Low overhead and just one staff but could (Low overhead and just one staff but could easily see 25 patients a day)easily see 25 patients a day)

Young practice but a lot of home bound Young practice but a lot of home bound elderlyelderly

Type of Teams Promoting Care Type of Teams Promoting Care London, Ontario 1982-1992London, Ontario 1982-1992

Practice staff: Practice staff: + Receptionist was an extension of me. + Receptionist was an extension of me.

Knew patients well and promoted care.Knew patients well and promoted care. - No other office staff enabled to take - No other office staff enabled to take

responsibility for prevention or care.responsibility for prevention or care.

Support of Chronic Disease ManagementSupport of Chronic Disease Management - no disease specific team support in the - no disease specific team support in the

office. (No educators, counselors etc.)office. (No educators, counselors etc.)


Support of Chronic Disease ManagementSupport of Chronic Disease Management - no disease specific team support in the - no disease specific team support in the

office. (No educators, counselors etc.)office. (No educators, counselors etc.)+ wide range of specialty support and + wide range of specialty support and

services to access many times at no cost services to access many times at no cost to patients. Collegial shared care for every to patients. Collegial shared care for every patient with my office as the medical patient with my office as the medical home. Cardiac rehab, nutrition counseling, home. Cardiac rehab, nutrition counseling, pulmonary rehab etc. pulmonary rehab etc.


Support of Health PromotionSupport of Health Promotion - I was on my own in providing prevention. - I was on my own in providing prevention. + community health education initiatives + community health education initiatives

largely government promoted. largely government promoted. Immunizations free and vaccines readily Immunizations free and vaccines readily supplied to all practices.supplied to all practices.


Support of Community Care outside the Support of Community Care outside the Office WallsOffice Walls

+ extensive system of home care support + extensive system of home care support services, mostly without charge. Low turnover so services, mostly without charge. Low turnover so could depend on staff to provide good could depend on staff to provide good information on your patient. Government information on your patient. Government insurance paid a significant premium for house insurance paid a significant premium for house calls. Meals on Wheels available. Public health calls. Meals on Wheels available. Public health nurses provided home assessments of new nurses provided home assessments of new moms and babies. moms and babies.


Special Support: Palliative Care Special Support: Palliative Care + Many family docs cared for their palliative care + Many family docs cared for their palliative care

patients at home. Special palliative care nursing patients at home. Special palliative care nursing staff experts in symptoms control. staff experts in symptoms control.

Specialized palliative care unit with some Specialized palliative care unit with some inpatient beds but more importantly physicians inpatient beds but more importantly physicians and staff who consulted on problems by phone and staff who consulted on problems by phone through assessing patients at home.through assessing patients at home.

Cancer Center Neuro-Oncologist Pain Specialist Cancer Center Neuro-Oncologist Pain Specialist available.available.


Special Support: Palliative Care Special Support: Palliative Care - You were in charge and it could be emotionally - You were in charge and it could be emotionally

draining (but more often some of the most draining (but more often some of the most “memorable” care you gave.)“memorable” care you gave.)

Out in middle of night to sign death certificatesOut in middle of night to sign death certificates

Journey from the Forest City to the Journey from the Forest City to the Motor City -1992Motor City -1992

Crossing “Borders”Crossing “Borders”

Grace Family Practice Center & Grace Family Practice Center & Residency TeamResidency Team

(Weird) Teams in Motown(Weird) Teams in Motown

Meet Jack Kevorkian Meet Jack Kevorkian at the Peking House at the Peking House restaurant at lunch restaurant at lunch time. Palliative care time. Palliative care consults with “Dr. consults with “Dr. Death”Death”

Journey from the Motor City to the Journey from the Motor City to the Colorado -1999Colorado -1999

Crossing “Borders”Crossing “Borders”

Medical Care in Colorado -1999 toMedical Care in Colorado -1999 to

Teams in the AFW ClinicTeams in the AFW Clinic

Team Huddles helping team based careTeam Huddles helping team based careCINA EMR disease managementCINA EMR disease managementNutritional CounselingNutritional CounselingDiabetes teachingDiabetes teachingOn-Site behavioral science co-consults On-Site behavioral science co-consults

and co-management.and co-management.

ConclusionsConclusions

Gave a glimpse of a Canadian primary Gave a glimpse of a Canadian primary care practice.care practice.

Described the types of patients seenDescribed the types of patients seenGave a glimpse of the strengths and Gave a glimpse of the strengths and

weaknesses of team care in London, weaknesses of team care in London, Detroit & my current my practice.Detroit & my current my practice.

There is a team member that can help, in There is a team member that can help, in the office, in the community and in the the office, in the community and in the bigger health care system.bigger health care system.

objectives describe practice settings canada, detroit & denver and the type of patients that i...

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