Empowering patients to take control of their own health care

Fort Langley family doctor Andre van Wyk has always tried to follow a proactive care model in his practice, but he recently made some innovations that have helped him change the doctor-patient relationship into a true partnership.

“I recognize that people are now better informed about health and their own situations, so my role has become different,” says Dr van Wyk. “Especially for people with chronic diseases, it’s important that I do more than just offer information.”

Van Wyk has had tremendous success in empowering his patients to take responsibility for their health, thanks to an innovative program that provides a structured method for patients to self-manage many aspects of their own health care and build their confidence.

Dr van Wyk is now following the protocols set out in the Patient Self-management module from the General Practice Services Committee (GPSC), a partnership between the BC Ministry of Health and the BC Medical Association. GPSC supports doctors by developing and implementing practice innovations, like Patient Self-management and other practice support programs, which improve job satisfaction for family physicians and primary health care for patients.

Taught by other family doctors, termed “GP champions,” the Patient Self-management program enables physicians and their staff to help patients take a bigger role in managing their own health. Physicians learn how to help patients identify behaviours they are prepared to change and how to help them develop a plan for changing those behaviours, one step at a time.

“As a family doctor, I need to not only help my patients set realistic goals for their health but also provide them with support and education for solving daily problems and then follow up with them regularly,” he says.

Richard Edge has been a patient of Dr van Wyk’s for nearly a decade and has found the Patient Self-management program very helpful in treating his Type 2 diabetes.

“I got to a point where my diabetes wasn’t as controlled as it should be—I was overweight, had hypertension, high cholesterol, and other issues,” says Edge. “But with Dr van Wyk’s help, I started taking a more active, self-managed role in my health care. I lost 60 pounds, took on an exercise program, and even went off all my medications at one point. Now I commute to and from work by bike all the time.”

Edge says he’s also gotten additional benefits from tackling his own health issues.
“I’ve lowered my blood pressure and cholesterol, I have more energy, and I’m better able to cope with the stresses I have.”

Dr van Wyk provided Edge with regular medical tests and a lot of support as well.
“I could e-mail him,” Edge exclaims. “He’s been very active to help find other help I needed—referrals to specialists, online resources. He’s great at providing me with information and taking the time to listen to me as well.”

Van Wyk likes the module’s emphasis on setting realistic goals. “We don’t always need to look for traditional medical goals,” he says, “but instead need to understand the patient goals. Look at what’s meaningful for a person.

“This required a paradigm shift for me as a doctor, because that’s not always how we’re trained,” he adds. “I truly believe that self-management is the keystone to patient attachment.”

Edge echoes this sentiment. “I’ve learned that I can’t just rely on the medical system,” he says. “This made it more of a team effort, and I was part of the team. We were all working together to see that I live as healthy a life as possible.”

Innovative group medical visits benefit both dementia patients and their caregivers

Many family doctors in British Columbia are holding group medical visits to see patients with similar conditions in a larger setting, but for Karin Blouw of Smithers, group visits are a chance to expand her work in geriatric psychiatry. She is the first BC doctor to hold group visits for patients with dementia and their caregivers.

“We’re holding these group visits monthly for six months, and while we’ve only had  three so far, to date it’s been very successful,” says Blouw. “The group dynamic is working better than I expected.”

Group medical visits are one of the practice innovations becoming popularized by the General Practice Services Committee (GPSC), a partnership between the BC Ministry of Health and the BC Medical Association. GPSC supports doctors by developing and implementing programs that improve primary health care for patients and job satisfaction for family physicians.

Blouw attended Practice Support Program sessions from GPSC on practice efficiency methods like group medical visits. The learning modules of Practice Support Program deliver education sessions, action periods and physician mentoring to help family doctors adopt new initiatives.

Blouw is both a general practitioner and consults in geriatric psychiatry. She has many patients with dementia, so decided to start up a group for them. Her first sessions have had six to eight patients per visit, along with one or two caregivers per patient. Each monthly session features a speaker, such as a dietician, occupational therapist, mental health expert or pharmacist.

The group visits are held in a large central space at the community healthy living centre and snacks are served. First, confidentiality agreements are signed, then there is a presentation from the speaker. Next Blouw holds a round-table discussion to find out how things are going for each patient, and there is time for questions, medical checks and prescription renewals.

“At first, it was tough to adjust to the group setting with patients,” says Blouw. “I’m used to doing things one-on-one in a closed office. But after we’ve done a couple, I see that the group dynamic is working better than I expected, and I’m getting used to it. The participants are very comfortable discussing their issues together.”

The patients in Blouw’s group have mild to moderate dementia. “They are all very respectful of each other, and there’s good interaction, lots of interest, and positive feedback.”

Kim De Sensi has been bringing her father to Blouw’s group visits and finds they offer a different level of interaction.

“At first, I wasn’t sure what the group visit was about, but by the second one, we were sharing medical information and feeling completely comfortable about that,” says De Sensi. “The speakers offer great information, and this is definitely more medical than my usual caregiver support group. I’m glad to see new stuff like this.”

While Blouw admits its still early days for her with this group, she believes it is valuable for the patients and for her so far. “I’ve already had requests from others wanting to join the next group,” she says.

Group visits let doctors spend more time with patients without taking up more time

Sean Ebert hosts some of the most popular gatherings in Vanderhoof. The busy family doctor is even getting stopped on the street lately to find out when his next group will meet. Ebert isn’t hosting a party or quilting bee, but rather group medical visits that have innovated and rejuvenated his practice.

For many patients, especially those with a chronic disease, seeing their doctor for a 15-minute visit may not provide them with all the information they need to learn how to manage their disease. With group medical visits, Ebert can see about a dozen patients at once in a 1.5-2 hour visit.

“In a group visit, I have more time to talk, more time to pass on critical information about chronic disease management,” says Ebert. His Omineca Medical Clinic hosts about three group visits every week in Vanderhoof for a variety of chronic conditions.

Group visits are one of the practice innovations becoming popularized by the General Practice Services Committee (GPSC), a partnership between the BC Ministry of Health and the BC Medical Association to support doctors by developing and implementing programs that improve job satisfaction for family physicians and primary health care for patients.

Ebert attended Practice Support Program sessions from GPSC on practice efficiency methods like group medical visits and chronic disease management. He is now a GP champion and helps teach some of these programs to other family doctors. The learning modules of Practice Support Program deliver education sessions, action periods and physician mentoring to help family doctors adopt new initiatives.

Sherry Wright, who suffers from auto-immune disease, is a regular at Ebert’s group medical visits, and is a big fan. “I really enjoy the group visits,” she says. “They have definitely made me feel less alone with my condition.”

For most chronic conditions, there are symptoms that all patients share, common lifestyle and dietary countermeasures they can all take and certain information they all need to understand. Instead of having to repeat the same information for each patient, Ebert can say it once to a whole group and then spend more time going in-depth about disease management. Patients are required to agree to keep confidential any information that comes out about other peoples’ conditions

"I find group visits are a great opportunity to educate my patients and help them manage their own health,” says Ebert. “And the bonus in these sessions is that a group can provide great social support as well.”

The Omineca clinic hosts a variety of group visits, with four doctors holding group visits regularly. For the patients, group visits mean they have improved access to their doctor, and decreased wait times to get into the clinic. For the doctors, it’s meant a decrease in their backlog of patients and a more manageable practice. A win-win situation.

 
Practice innovations in mental health improves patient and doctor satisfaction

Like most family doctors, Herman Keyter of Valemount saw many patients dealing with mild to moderate depression, but his ability to help these patients depended more on referrals and medication than he’d have liked. But now, Dr. Keyter is armed with new tools to help him manage mental health situations that allow him and his patients more control over their treatment.

Dr. Keyter now follows the protocols set out in the Mental Health module from the General Practice Services Committee (GPSC), a partnership between the BC Ministry of Health and the BC Medical Association. GPSC supports doctors by developing and implementing practice innovations, like the Mental Health and other practice support programs, that improve job satisfaction for family physicians and primary health care for patients.

The module for mental health – Making it Real – enables general practitioners like Dr. Keyter to screen their patients more thoroughly for mental illness and diagnose conditions that were previously more difficult to detect. The program includes common screening scales, a diagnostic assessment interview tool, a tool for organizing patient issues, a cognitive-behavioural skills program, and a patient self-management workbook.

“The module provides a structure to my work with patients who have mental health issues and adds an extra dimension to the treatment,” says Dr. Keyter. “With a process in place, including worksheets for me and the patient, there is much less frustration for both of us.”

Taught by other family doctors, termed ‘GP champions,’ the mental health program helps physicians develop a care plan that incorporates cognitive behavioural interpersonal and problem solving skills in real office time. A child and youth component will be launched later this year.

Jeanette (who asked that her last name not be used) has been through several programs to deal with her depression, but is very happy with her current treatment from Dr. Keyter.

“It’s easier for me to do appointments with him,” she says. “It’s much more personal, and I prefer the one-on-one. He’s my doctor, and he knows a lot of my situation and how to work with me. And he is so compassionate. He could be a counsellor. ”

Jeanette also likes getting new worksheets at each appointment with something for her to work on or a list of resources. “Being able to write things down and go through it with Dr. Keyter face-to-face is wonderful,” she adds.

For Dr. Keyter, the Mental Health module has not only meant more patient satisfaction but also more self-satisfaction.

“As my patients become empowered, I feel much less frustration with my practice,” he says. “I’ve always tried to help patients with mental health problems, but now I feel I have the tools to deal with the whole patient in a more patient-centred way.”

An overview of Rheumatology Specialist Group Medical Visits in Prince Rupert

Click here for the .PDF document: Rheumatologist GMV overview