Wood Buffalo Primary Care Network

“I’m not sure if my family physician told them about all that I had gone through, but I felt they gave me special treatment. The minute I walked into the information session on diabetes, I felt cared for. They told me how to care for my feet, and eyes, and the information was amazing,” recalled Zaid, who has Type 1 diabetes, and has been a local resident for almost 10 years.

This year marks the 10th anniversary of the Wood Buffalo PCN, which has seen over 25,000 patients. Located in the Syncrude Sport & Wellness Centre, it is a healthcare model developed in 2003 as part of Alberta’s Primary Care Initiative. The After Hours Clinic, which provides evening and weekend access to family physicians for patients with semi-urgent concerns is also a PCN location.

Jordan Hiltunen, Communications & Program Coordinator for PCN explains.

“The Wood Buffalo PCN was actually one of the first five PCNs developed in Alberta. Our community is still home to many of the PCN’s founding physicians who were inspired by the Primary Care Initiative and who helped to launch the Wood Buffalo PCN – the commitment of our region’s physicians to team-based care and collaboration is one of the most significant reasons for our growth and success over the past 10 years.”

“The Wood Buffalo Primary Care Network is a local, non-profit healthcare organization led by the Family Physicians of Fort McMurray. In addition to their own private practice clinics, they also lead a support team of Dietitians, Nurses, Pharmacists, Exercise Specialists, Respiratory Therapists, and Mental Health Therapists, who work with them to develop and deliver care services for the community,” added Hiltunen.

Indeed, the team-based approach sees 28 family physicians; three pediatricians; 13 Registered Nurses, seven Licensed Practical Nurses; one Respiratory Therapist, one Exercise Specialist; two Pharmacists; three Registered Dietitians, and one mental health therapist on staff.

Services

In addition to the After Hours Clinic, which opened in April 2013, and has provided care to over 45,000 patients, the WBPCN provides a plethora of services. A few of these include Diabetes programming like managing the disease, providing insulin pumps, Diabetes Nephropathy Prevention Clinic, “care stream for patients whose Diabetes has progressed and compromised their kidney function, delivered by the PCN Diabetes Team, Family Physicians, and also an Endocrinologist and Nephrologist,” continues Hiltunen. And, weight management, women’s health, youth clinic, lung wellness, chronic care, and an outreach program for outlying areas.

Different from a Hospital

“The main purpose of a hospital is to provide acute care services — help for emergencies or short-term crises that require close observation and medical support. Hospitals typically don’t provide long-term care for patients; they help them to overcome urgent and severe illnesses, or to undergo surgery or childbirth, and then discharge them back into the community. In Fort McMurray, hospital care is delivered by Alberta Health Services. Hospital care isn’t meant to be anyone’s main source of care — that’s the role of Primary Care, the care that you receive in the community from a family physician and their supporting care teams. In fact, research shows that the more people access the Primary Care that is available to them, the less likely they are in need for hospital services,” notes Hiltunen.

“Even though there are 43 PCNs across Alberta, there is no such thing as a standard PCN model — each PCN develops the primary care programs and services that are needed by its community. The Wood Buffalo PCN is really unlike any other PCN — over our 10-year history, our entire organization has evolved to address the unique needs of our region,” says Hiltunen.

“We have a board of physicians that advocates for the health of our community at the local and provincial level, and also guides the direction of our clinical programming. We also have a dedicated evaluation specialist, public health epidemiologist Dr. Behnoush Ahranjani, who works to ensure that our programming is in alignment with the needs of our community and current best practices in care delivery. The WBPCN is always developing and implementing new programs and services; every three years, the PCN revisits its entire portfolio, checking it against the most recent research and population data available for our region. It is our goal to be our community’s map to wellness — as our community evolves, so too must our services to mirror it,” he notes.

WBPCN’s Executive Director, Lori Apostal grew up in Fort McMurray and began her career as a Registered Nurse securing her Nursing degree from Keyano. She came full circle four years ago, and brought back experiences in senior leadership roles with healthcare organizations in Alberta and British Columbia.

“Working for the PCN has been such a rewarding experience. We have an incredibly dedicated team here who have always been driven to continuously improve service delivery and to help our patients reach their optimal levels of health.

Since the wildfire, that resolve is stronger than ever and we are actively pursuing opportunities to help the people of our region to emerge stronger and healthier,” says Apostal, who was awarded the Nursing Excellence in Administration Award last December by the College and Association of Nurses in Alberta (CARNA). In 2016, she was also one of the 100 influential nurses honoured with a Centennial Award in celebration of CARNA’s 100-year history.

Re-entry

When the wildfires raged through the community, health issues remained a question mark. WBPCN’s core team remained in touch, and collaborated with the provincial HealthLink line, Alberta Health, Alberta Health Services, and other PCNs to coordinate access to care for all of the patients displaced across the province.

The After Hours Clinic re-opened on June 1, the first day of the re-entry, with a Family Physician, Registered Nurse, and Respiratory Therapist. 

“As of December 2016, six months post-wildfire, we’ve welcomed over 6800 patients for 8100 visits back to our After Hours Clinic. Our central clinic in the Syncrude Sport & Wellness Centre, where we deliver the vast majority of our preventative care and chronic disease management programs, suffered extensive smoke damage and required months of restoration work; consequently, our patient volumes are still rebounding in the wake of our return to our central clinic this September,” continues Hiltunen, who has been with the group for four years.

“Our After Hours Clinic, though, required far less restoration work. Our patient volumes for the After Hours Clinic have only dipped slightly compared to the same interval from the year prior, roughly equivalent to the estimated decline in our community’s population.”

Ready for Next Steps

“Our community has done a remarkable job of anticipating and understanding the emotional and mental health toll that a disaster of this magnitude can incur,” continues Hiltunen.

“Even though six months have elapsed since we all returned, though, research indicates that we have to be ready for additional waves of care needs in the coming months and years. The day-to-day survivor mentality that a disaster can introduce is a byproduct of resilience, a coping mechanism that helps people to grapple with the changes and the challenges that they’re facing. It’s also one which can, unfortunately, detract from a focus on long-term wellness and care planning; you can become prone to reaching out only when you need a prescription refill, or when you really feel under the weather.”

In the six months following the wildfire, the WBPCN’s program development launched new Dermatology and Psychiatry services, in partnership with two Edmonton-based specialists.

“We are thrilled to be working closely with Dr. Jaggi Rao, a dermatologist, and Dr. Vincent Agyapong, a psychiatrist who used to live in Fort McMurray, to address the gaps in care for dermatology and psychiatry services in our community. We have also embarked upon a multi-year commitment to the CHANGE Cancer Alberta Research study, attempting to study the long-term cancer prevention benefits of addressing metabolic conditions like Obesity and Diabetes through dietary and physical-activity interventions delivered by our multidisciplinary team in our Central Clinic.”

Speaking of multidisciplinary team, Ignatius Anane-Ansah, WBPCN’s pharmacist was delighted to move to PCN from a retail environment.

“From my Pharmacist point of view, it’s to do with collaboration. In the world of retail, you are by yourself in a bubble, you make your decisions, and that’s it. I very seldom collaborated with doctors. Back then, I never once talked to a Nurse. Never once talked to a Dietitian. Never once talked to an Exercise Specialist. Occasionally you would fax a doctor to briefly let them know that a patient had a side effect, and that was about it. But, the PCN model changed all of that for me. This is where you can actually have relationships with Nurses, Exercise Specialists, and other professionals as a Pharmacist –it’s just seamless communication, amongst all of these health professionals, by design. And it matters. Sometimes you see a patient, and you’ve maxed out your medication options... what’s the next thing? You can’t add anything, you can’t subtract anything, and they might have a lab result like a Hemoglobin A1C which is still far too high. Sometimes, you realize that the answer is for them to work on their diet and to increase their activity, you as a Pharmacist can’t do anything more for them – here at the PCN, you speak with a Dietitian, and the problem is basically solved, it’s no longer an impasse.”

Julie Mellon, WBPCN Registered Nurse agrees.

“Before coming to the WBPCN, I worked for six years in hospital care, and what really urged me to step outside of that was the culture of health… of disease treatment versus health promotion. And ultimately, for my own sense of fulfillment, that is how I want to leave a mark, an impression on the world – to put my efforts towards changing the culture of health, through health promotion, to help keep people out of the hospital. In the Women’s Health program, for example, it’s so much more than having women come in for their routine pap test. We screen women for their personal and family medical histories, and when they should initiate screening for breast cancer, bone mineral density, cervical cancer, colon cancer, diabetes, heart disease, obesity, hypertension and so on. I attend Grand Rounds with the Family Medicine Resident Physicians every week, I get the opportunity to always stay up to date with the latest in our preventative medicine standards, and can really hone the exceptional care we can provide for our patients. Being able to help others feel better, and to strive to live their healthiest lives, is truly a privilege.”

Going the Extra Mile

Whether by using Telehealth technology or by developing programs with distant specialists who are then hosted in PCN clinics, the group connects thousands of patients each year with Ophthalmologists, Neurologists, Endocrinologists, Nephrologists, Geriatricians, Chronic Pain Specialists, Psychiatrists, Pulmonologists, Pediatric Respirologists, and Dermatologists.

In the early years of the WBPCN, relative to the provincial average, Fort McMurray’s female population was under-screened for cervical cancer; in response, WBPCN developed a Women’s Health Check service, which offers pap tests and other sexual health screenings at their downtown central clinic.

“Largely as a result of this service, Fort McMurray no longer has that problem — the women in our region access preventative screening services with much greater regularity. This is a real success for us. One of our guiding principles is the importance of connecting each patient with the right care, from the right professional, at the right time. Women’s Health is one of many such areas that we’ve been able to make a consistent difference in, year after year,” says Hiltunen.

“The gold standard of care for patients with longstanding COPD (Chronic Obstructive Pulmonary Disorder) is Pulmonary Rehabilitation, a combined education, condition management, and exercise program that helps patients with compromised lung function to regain their quality of life. Unfortunately, in Canada, only 1.2% of all eligible COPD patients have access to this kind of care. We are very proud to be able to offer a comprehensive Pulmonary Rehabilitation service to our community, to be able to connect our patients with Lung Specialists and comprehensive rehabilitation services delivered here in Fort McMurray by an Exercise Specialist and Respiratory Therapist. Our Central Clinic team works in partnership with Pulmonologists and the care team from Covenant Health’s G.F. MacDonald Center for Lung Health in Edmonton to deliver this specialized care, making our community one of the very few in Canada able to support the COPD care needs of its population to this degree,” he says.

A Decade of Care

“Our first 10 years were very much defined by our work to address the chronic disease burden in our community — we developed programs and services to care for the thousands who cope with Diabetes, Cardiovascular Disease, Obesity, Stroke, Chronic Pain, and Lung Disease. That work will continue, but as we enter our second decade of care, we will be placing an increased focus on prevention and early detection, now that we have established robust programs to care for these patients once they have been diagnosed.

We will be commemorating our anniversary by launching a week of wellness on April 24, 2017, a way for us to celebrate through service, and to begin our next decade with an emphasis on the healthcare principles that will define our direction in the years to come. We will be hosting a number of events throughout the city during our anniversary week, and look forward to inviting everyone in our community to participate,” Hiltunen enthuses.

For more information, find WBPCN on Facebook (facebook.com/woodbuffalopcn). Twitter (@woodbuffalopcn), at hello@wbpcn.ca, or call 780-714-2193.

List of clinics taking new patients:

• Rhema Medical Clinic
• CBI Medical Clinic
• Tamarack Medical Clinic
• Al-Salam Medical Clinic
• Al-Madina Medical Clinic
• Morrison Medical Clinic
• Dr. Kruger’s Medical Clinic
• Holistic Medical Clinic
• Aurora Medical Clinic
• Access Medical Clinic
• River City Family Clinic

List of local pediatricians:

Dr. Vida Kazembe, Dr. Thresiamma James, Dr. Lindi Nyati.