Calgary medical clinic whittles down waitlist with unique spin on team-based care

A Calgary medical clinic is working to tackle the shortage of family physicians by empowering other health-care providers to play key roles in patient care.

Faced with a waitlist of thousands of people, the Crowfoot Village Family Practice (CVFP) recently launched the Rainbow Project, a team of publicly funded health providers caring for patients who don’t have a family doctor.

“We are not going to hire enough physicians to provide the care we need in our health system,” said Shauna Thome, executive director of CVFP.

The Rainbow Project is designed to eliminate a bottleneck in the system by bypassing the need for patients to see a family doctor to access care.

“Every day I see patients in my office who are begging me to help relatives or friends or neighbours find a family doctor,” said Dr. Rick Ward, a family physician and senior partner at the Crowfoot clinic.

“Some of the stories are really heartbreaking.”

Crowfoot Village Family Practice, which operates under an alternative funding model, has had multidisciplinary teams in place for years.

And while it had already moved away from the traditional doctor-patient relationship by providing a variety of health providers, physicians were still acting as the guardians of those teams.

“Even in our clinic the barrier to care has been the family physician. Accessing the team had to happen first by seeing the family physician,” said Ward.

That’s changing.

The Rainbow Project includes registered nurses, a health navigator, a physician assistant and a family physician supporting the team.

“The nurses have taken a care-lead approach,” said Jordan McPhee, a registered nurse on the team.

“We are able to assess and triage patients for a variety of different things and try and help create that care plan with them without necessarily having to book them with a physician.”

Each day starts with a morning huddle, where team members meet up, with laptops in hand, and discuss the day’s patients and how best to approach them.

Family physician Dr. Julie Croteau works with the team and consults on cases, but doesn’t see every patient.

“We tried to design a system where instead of the family physician directing care or being a bottleneck in care, we’re trying to make the care accessible to the whole team,” she said.

Croteau said it’s leading to faster access for patients when they need care. 

“So patients can call in and we’re trying to set them up with the best team member to meet their needs as opposed to having to see the physician first,” she said.

One of the first things nurses do for new patients, who have often gone years without a primary-care provider, is update routine screening.

The team has already caught cases of undiagnosed diabetes, high blood pressure and even cancer, according to Thome.

“That’s been really exceptional … that we’re catching things they didn’t know they had,” she said, noting that if these issues hadn’t been identified patients could have ended up in the emergency room or admitted to hospital.

Since its launch in January, the Rainbow Project has taken on nearly 300 patients who were without a primary-care provider. The team hopes to expand to 1,000 patients by the end of the year and ultimately ramp up to 2,000 next year.

There are also plans to include other care providers such as pharmacists, mental-health specialists and physiotherapists, depending on the needs of patients.

While the clinic has asked the province for additional funding to run the Rainbow Project, it hasn’t received any. It’s offering care to these patients within the current parcel of funding it gets from Alberta Health.

For his part, Ward hopes this changes how people think about primary care.

“We’ve been saying the same thing for 20 years and longer. And during that time costs have elevated, the shortages are worse. So we’ve got to find a different solution to just saying we need more family doctors.”

“I think the big paradigm shift is ‘My primary-care provider is not an individual, it’s a team.’ It is a different paradigm than ‘Dr. Rick knows everything.'”

Other primary-care networks have reached out to find out more about the program, he said.

According to Thome, the clinic is able to provide care to about 30 per cent more patients with a team-based model and she hopes the Rainbow Project will catch on elsewhere.

“I see this as an innovation that will spread across the province over time,” she said.

“We are designing the primary care of the future.”