Last May’s kick-off workshops for the new Practice Support Program (PSP)—launching an 18-month intensive educational opportunity for BC’s family physicians—attracted 1778 GPs and 1900 medical office assistants and health authority representatives in 20 locations around the province. The workshops constituted phase one of the PSP, a joint undertaking of the BCMA and Ministry of Health (MOH) aimed at helping family physicians better manage their practice while improving patient care.

Phase two of the program, which runs until September 2008 and includes the implementation of four learning modules by regional health authorities, is already well underway and garnering positive feedback, according to local implementation managers.

“The Practice Support Program offers a huge opportunity to engage physicians in change management, as well as to acknowledge them financially and to support them in making those changes,” says Ms Jean McKinnon, manager of the collaborative program for service integration for Vancouver Island Health Authority (VIHA).

The PSP is an initiative of the BCMA/MOH General Practice Service Committee (GPSC), whose responsibility is to find solutions for challenges faced by BC’s full-service family physicians. Funding in the 2006 Agreement was made available for initiatives such as the PSP, which in turn is meant to facilitate access—through change-management strategies—to financial incentives covered by the Agreement, such as guideline-based diabetes, congestive heart failure, and hypertension care.

Currently, up to four training modules—topics and contents based on GP input—are being implemented at the health authority level:

• Advanced access—based on a system of patient scheduling in which appointment calendars are left open so patients can be seen on the same day they call, if necessary.
• Group visits—enabling a more efficient method of care for groups of patients with a specific condition, such as diabetes.
• Managing patients with chronic diseases—offering guidance for changing clinical care and office management to improve the management of patients with any chronic disease.
• Patient self-management—addressing three areas of responsibility for patients: managing the medical aspects of their illness, clarifying the roles of the patient and physician, and managing the emotional impact of their illness.

VIHA has chosen to implement all four modules at once, says Ms McKinnon, and is hosting sessions for 232 physicians, surpassing their initial target of 225. Fraser Health is adopting a different process, in which modules are introduced one by one, starting with advanced access.

“We have seven cohorts of 60 participants each—30 physicians and their medical office assistants,” says Ms Jivi Khehra, manager of Fraser Health’s program. “The advanced access module was a natural for us, as we’ve been working on enhancing family practice for several years.” Feedback suggests participants appreciate the hands-on, interactive and patient-driven nature of the sessions, says Ms Khehra.

PSP modules are delivered through didactic, accredited, and remunerated learning sessions followed by action periods, during which physicians and staff put their learning into practice with support from their regional practice support team. Included on these teams are peer champions—GPs and MOAs who have already implemented the new practices and can offer advice based on firsthand experience. Support is also provided through physician engagement coordinators, who serve as an information resource for GPs and their office staff as they work to bring new processes into their clinical practice.

With a flexible, learn-at-your-own-pace design, the PSP is designed to help GPs gain greater control of their workload, better manage their time for patients with complex chronic illnesses, increase their work-life balance and job satisfaction, and increase their practice revenue. Patients benefit from more timely access to physicians, increased quality of care, increased ability to self-manage their condition, and a reduced need for hospitalization.

Although it’s still early days, physicians are already seeing results, says Mr Brian Evoy, manager of new practice development for Vancouver Coastal Health, which has launched both the advanced access and CDM modules.

“At our second session, when I asked who had been able to immediately apply what they’d learned at the first session, a lot of people put up their hands!” says Mr Evoy. “One strategy, for helping manage vacation absences, seemed particularly effective, with physicians telling us this was the first time they returned from vacation and didn’t feel completely overwhelmed.”

For more information, see www.practicesupport.bc.ca [10].

— Liza Kallstrom
Lead, Change Management and Practice Support, BCMA