Family physicians in N.S. helping rheumatologists and their patients in shared-care model

HALIFAX | Family doctors in Nova Scotia are helping rheumatologists address growing wait lists in a shared-care model believed to be unique in Canada.Under the new model, first implemented in 2011 in the Queen Elizabeth II Health Sciences Centre in Halifax and expanded last year to Cape Breton, family physicians are trained to provide patient support at local rheumatology clinics. In Halifax, Dr. Sam Hickcox and two physiotherapists (who received special training for this program in Ontario) see patients for one visit. If all is well, the rheumatologist will not see those patients until their next visit to the hospital-based clinic.“That meant I cut my returns down by half, which allowed me to see new patients,” Dr. Evelyn Sutton, former head of the QEII’s rheumatology division, told The Medical Post in an interview.“I’m not aware of family doctors being used in this way anywhere else in the country,” she added.Now that Dr. Sutton has accepted additional administrative duties at Dalhousie University, the shared-care model has “allowed me to still take care of my patients,” she noted.The need for a new model of care was identified in 2010 when three full-time rheumatologists closed their practices in Nova Scotia within a few months of each other. “That represented a significant burden to the remaining rheumatologists,” said Dr. Sutton. “We were really in a bad state. There is a national shortage of rheumatologists.”The hospital team considered nurse practitioners to fill the void, but budgetary and training issues made this option unfeasible. The health department agreed to vary the alternate funding arrangement it had in place with the rheumatology division so that Dr. Hickcox could be hired part time as a rheumatology extender. Since then two family physicians have been trained to work in Sydney alongside a local rheumatologist.Dr. Sutton believes the collaborative use of family doctors and specialists goes beyond addressing physician shortages noting that as a family physician Dr. Hickox can identify issues she might not pick up on such as depression. “I think patients get better care.”Another benefit is increased consistency of care. “This shared-care model forced us to really adopt guidelines treating to target and using objective measures,” said Dr. Sutton.Currently, the program is undergoing an evaluation to assess impact on disease activity and patient satisfaction. From a patient-flow perspective however, the initiative has been successful. “This model has worked really well for us,” said Dr. Sutton. “Now Dr. Hickcox can do the clinic even if I’m not there.”

Family physicians in N.S. helping rheumatologists and their patients in shared-care model

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