The right care at the right time, in the right place, by the right specialist. This is the new mantra of the Department of Health and Human Services, which is embracing interdisciplinarity to improve accessibility of frontline care and reduce emergency room congestion. Le Devoir focuses on initiatives where professionals maximize collaboration for the benefit of patients. Now a nurse run clinic.
No doctor in the clinic. Nursing Assistants, Clinical Nurses, and Specialized Nurse Practitioners (IPS) only. your order? Assess the health status of patients waiting for a family doctor to treat and prevent diseases.
Last year, the team of the CIUSSS Center-Ouest-de-l’Île-de-Montréal “Clinic des GAMF” (access point for general practitioners) saw more than 1,500 people in their makeshift mobile home located in the parking lot of the Jewish General Hospital. “90% of the tested clients received an abnormal result,” says Marie-Christine Gras, initiator of the project and head of program administration.
Some orphan patients had serious illnesses. Like this woman who unknowingly contracted breast cancer, detected thanks to a mammogram prescribed at the GAMF Clinic. Or this man who was recently sent from an ICU to cardiology “out of breath and without common sense.” He had arrhythmia.
“I’ve already sent a patient straight to the ER,” says nurse Keryn Chemtob, who is interviewed between appointments in an exam room at the clinic. He had had chest pains for a year and did not know how to access health services. He was a novice. The man had to undergo bypass surgery.
The health problems identified at the GAMF Clinic are not all equally serious. Sometimes it’s a cholesterol level that’s slightly higher than recommended standards. “But it’s still something the client didn’t know,” says Marie-Christine Gras. And that he has a keen interest in surveillance.
Adel Belhassine was unaware he was “a little hypertensive” before being treated by the GAMF clinic. The 58-year-old Tunisian has not had a doctor since arriving in Quebec three years ago. He describes the follow-up he’s receiving as “remarkable”. “It feels good to have support,” he says.
Self Employed Nurses
In the area of the CIUSSS du Centre-Ouest-de-l’Île-de-Montréal, around 115,000 people are without a family doctor. Of these, 32,000 are on the GAMF waiting list.
The clinic, which has been running at full speed since September 2021, primarily addresses two clientele: “fit” people aged 50 and over (without any known chronic illness) and people aged 18 to 50 with a chronic illness. Target patients are contacted by administrative officials who offer them an appointment. If they agree, a care team accompanies them for a short time (e.g. three months) to identify health problems and stabilize treatment. Once aftercare is complete, orphan patients are directed to the First-Line Access Counter (GAP).
Marie-Christine Gras, a nurse who used to work in a CLSC, is convinced of the relevance of her project. She believes in prevention – her “hobby” – and in the full autonomy of her team, which consists of two nursing assistants, three clinical nurses (bachelors) and three primary care nurses. The population, according to the manager, can only benefit if nurses “get the best out of their practice”.
At the GAMF Clinic, clinical nurses can screen for diabetes, hypertension, hypercholesterolemia, osteoporosis, cervical and colon cancer via bulk prescriptions. If the test results are abnormal, they refer their patients to an IPS, which takes the investigation one step further. “There are very few cases where the IPS tells us, ‘I have to send her to the doctor,'” says Marie-Christine Gras, an impassioned spokesman with auburn hair.
Michel Godin, an IPS, loves his independence despite the challenges that come with it. “Of course it wasn’t easy from the start,” he says. The IPS of the clinic do not have a “partner doctor”. They therefore do not have access to the Service Request Dispatch Center, a system reserved for GPs that allows them to request a consultation with a specialist for a patient.
“We had to get more creative,” says Michel Godin. Medical specialists were contacted directly to see if they were accepting patients. The team has arrived.
No doctor at any price
The President of the Order of Nurses of Quebec, Luc Mathieu, believes that the GAMF Clinic is “a good idea, a good model that demonstrates the contribution of licensed practical nurses, registered nurses and specialist nurses”.
In his opinion, it is high time for Quebec to step out of the “paradigm” of a doctor for every citizen. “If we want to relieve the system and improve access to the first line, I think we should no longer say that a family doctor is absolutely necessary,” says Luc Mathieu. I still hear politicians say that. »
Quebec Liberal Party leader Dominique Anglade promises to offer all Quebecers who want a family doctor. “This is not the best solution to improve access to our network in the medium and long term,” said the Order’s President.
Luc Mathieu advocates care by a “family team” (nurses, ICU, pharmacist, etc.) instead of a family doctor. According to him, Quebec also needs to rely on clinics like the Coopérative de solidarité SABSA in Quebec, where patients are cared for by ICUs and clinical nurses, among others. “An IPS can monitor 600, 700 or 800 patients,” says Luc Mathieu. In most cases, these patients are not seen by a doctor. »