Journey toward change

The Family Medicine Unit of the University of Saskatchewan’s Department of Family Medicine in Regina is a multidisciplinary family practice that provides primary health care while simultaneously functioning as a family medicine residency training site. In an effort to determine if patients’ health care needs were being met by the unit’s services, we embarked on an interdisciplinary, collaborative journey. Our goal was to elicit patients’ views on health care issues and service concerns, identify health risks, and respond by developing new programs and service enhancements.

Our journey began with the addition to our staff of a primary health care nurse practitioner, who was the lead researcher on this project. After she completed an environmental scan and literature search, the rest of the team—10 physicians, 1 nurse, 1 social worker, and 3 research scientists—jumped on board and collaboratively designed a 35-item survey.^1–5 Surveys were mailed to 10% of the clinic’s adult patients and responses were analyzed according to areas of concern and interest to both staff and patients.⁵

If a picture can tell a story, so can a profile of a practice. In our case, we discovered that the unit’s patients were largely well-educated adult women from urban areas who were socially stable. One-third of the patients follow complex medication regimens and, therefore, might be at risk of adverse events. Almost half have been diagnosed with chronic conditions and 15% use tobacco products. Forty-five percent of patients have been encouraged to engage in some kind of lifestyle modification such as increasing exercise or improving eating habits. Patients identified lack of timely access to their family physicians as a problem in our practice. They preferred to see their own family physicians instead of family medicine residents. On the other hand, 37% of patients reported that the quality of care they received was what they liked most about the Family Medicine Unit.

After reviewing the data, we prioritized the findings and considered resources (both internal and external to the unit) to facilitate practice development.^5–10 We formed an implementation committee to ensure that in the hectic day-to-day practice of family medicine we maintained a steady course of service enhancements. We have implemented several new initiatives: an interdisciplinary smoking cessation program, participation in a province-wide chronic disease management collaborative, formation of an outpatient diabetes education group, and establishment of a new working relationship with community pharmacists who specialize in chronic lung conditions.^5,9,11 We also implemented an evidence-based practice-to-provider formula to decrease patients’ wait times. In the near future, we will shift patients among the various physicians in the practice to improve access to care.

Was the considerable time and effort devoted to this project worth it? Unequivocally, yes. Although labour-intensive, the knowledge gained by surveying patients was an important step in understanding what program and service enhancements were needed. It was great to get feedback about what patients like and appreciate about the Family Medicine Unit, and learning about what we can do better is, as Martha Stewart would say, “a good thing.”