Residential Care Initiative: Early data show impact and successes

The GPSC’s Residential Care Initiative (RCI) was launched in 2014, with the goal of improving care for one of BC’s most vulnerable populations—seniors living in care facilities.[1] All divisions of family practice are working on RCI projects, meaning that 97% of the eligible 30 000 residential care beds in the province are now covered by projects funded by the initiative. Data from divisions and health authorities show that these projects are already making a significant impact on health outcomes and access to care.

Achieving system-level outcomes
RCI funding enables divisions to design local solutions for attaching residential care patients to a most responsible physician, ensuring comprehensive care throughout each patient’s life cycle and therefore improving quality of care for the frail elderly. 

To assist divisions in developing these solutions, the GPSC created five best-practice expectations and three system-level outcomes (Table) as benchmark goals for the initiative. 

RCI evaluation data show that many division projects are now meeting some or all of the five best-practice expectations, and moving toward fulfilling the RCI’s three system-level outcomes. 

Reduced unnecessary or inappropriate hospital transfers
To meet this outcome, doctors are improving access to regular medical care at facilities, evaluating more problems on-site, and ensuring that medications are reviewed regularly and end-of-life plans are clearly documented.

Doctors in Nelson have been providing regular medication reviews and regularly scheduled visits to facilities to ensure continuity of care. This work, coordinated by the Kootenay Boundary Division, has contributed to a hospital transfer rate in Nelson that is now five times lower than the Interior Health regional average. Doctors from the Fraser Northwest Division have implemented a 24/7 call system and worked to double the number of GPs providing proactive visits to residential care patients. These efforts have contributed to reducing emergency transfers by 5%, acute care admissions by 9%, and length of ER stays by 19%. 

Meaningful medication reviews in Mission have resulted in an 18% reduction in the number of patients on nine or more medications, and an 11% reduction in the use of antipsychotic medications. These improvements to patient care have contributed to a 33% reduction in ER transfers. 

Improved patient and provider experiences
Recognizing that care facilities are usually the last home for residents, doctors are committed to ensuring that these vulnerable patients can live and die with dignity. Providing residential care patients with access to regular, consistent care from a GP is an important component in improving their quality of life and overall health outcomes. Improving physician coverage also ensures that doctors feel supported and enables them to take the time to provide complex care when needed.

Fraser Northwest Division has reached the goal of ensuring that every residential care bed in the region is attached to a GP. Vancouver Division is working toward that goal by increasing the number of residential care GPs by almost 50%, and developing a succession planning strategy that helps newly graduated GPs take on residential care patients from retiring GPs.  

Reduced costs per patient with higher quality of care
Doctors and staff at residential care facilities are lowering system costs through efforts to reduce unnecessary or harmful medications, reduce unnecessary transfers to acute hospitals, and increase on-site care by GPs who know the patient (preventing duplication in the use of specialist, lab, and investigative resources).

Doctors in Victoria are organizing meaningful medication reviews that are scheduled to ensure that both a physician and a pharmacist can attend, and Fraser Northwest and Mission doctors are also working on division-organized projects to reduce unnecessary prescriptions through medication reviews. 

Fraser Northwest, Victoria, and Vancouver divisions have implemented after-hours call systems through which patients can access 24/7 care from a physician. Facility staff can connect with a doctor after hours in as little as 3 to 5 minutes in some cases.

South Okanagan Similkameen Division studied medication wastage at local care facilities, creating a report that recommends testing policy changes to address wastage issues. Recommendations include changing the default for medication orders from “STAT” to “next pouch day,” and creating a provincial working group to assist with standardizing medication order sheets and ensuring that successful practices from individual health authorities become generalized. Solving the medication wastage issues detailed in the report could save the province $550 000 per year.

More results to come
These early results highlight only a small sample of the RCI work being done by divisions of family practice. As more results become available through the evaluation process, a clearer picture will emerge of the ways in which access to care for residential care home patients is being improved consistently in communities around the province. 

For more information on any of the data or projects outlined in this article please e-mail residentialcare@doctorsofbc.ca.
—Brian Winsby, MD
—Darcy Eyres
Co-leads, Residential Care Initiative

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This article is the opinion of the GPSC and has not been peer reviewed by the BCMJ Editorial Board.

References

1. Winsby B, Eyres D. GPs innovating local strategies to improve residential care across BC. BCMJ 2015;8:358-359.