Abstract
Introduction/objective: The Canadian healthcare system requires significant improvement to enhance patient access, navigation, and overall population health. New Brunswick launched a Primary Health Care Integrated Services Network (PHC ISN) to deliver a spectrum of healthcare services through local family health teams. Patients receive primary health care via a referral and coordination center, which redirects them to appropriate health care professionals or community services. The PHC ISN aims to enhance patient navigation, ensure care continuity and coordination, and bridge primary healthcare with community health resources, providing accessible, comprehensive, collaborative, quality, and tailored care to the New Brunswick population.
Method/intervention description: Adhering to the RE-AIM framework (Glasgow et al., 209), the initiative was planned, modeled, and co-constructed by Vitalit Health Network primary healthcare, research, planning, and performance sectors. Health professionals evaluated the feasibility of the model integration in their practices. Local services committees comprising managers, professionals, and community members, including patient partners, ensure effective community integration and coordination. A patient-tracing system tracks patient trajectories and collects testimonies for continuous improvement. Measured outcomes include patient wait times for regular and urgent minor appointments, number of patients attached to primary care practitioners, ER visits, and number and duration of hospitalization for chronic conditions appropriate for ambulatory care.
Results: The model has been rolled out in 0 of 3 communities, resulting in a reduced patient wait time (from 2.62 days to 7 days) and an increase in the number of New Brunswickers (n= 778) under the care of a local health team. A total of 53 family physicians representing 70.53% of family physicians, 7 nurse practitioners representing 37% of nurse practitioners, and 45 other health professionals working at Vitalit Health Network are engaged in the co-construction process or are already part of the local family health teams.
Conclusion: Preliminary results indicate that the PHC ISN is an effective strategy to improve timely access to primary healthcare for regular and urgent minor appointments, facilitate patient navigation, and ensure interdisciplinary patient management. Early findings also indicate low ER consultation for triage levels 4 and 5, low hospitalization rates for conditions more appropriate for ambulatory care, and increased engagement and satisfaction among health professionals and community members.Next steps: Continuous efforts and resources are deployed to implement, operationalize, and evaluate the PHC ISN. Scaling-up strategies includes ) developing a support-to-practice program for primary care providers, 2) improving complex and high-users of services patient management and 3) improving chronic disease prevention and management strategies in the community.