The following article was published in the Edmonton Prime Times on October 29, 2018.
By Chris Zdeb, Edmonton Prime Times
Can’t find a family doctor or think your family doctor doesn’t understand your issues as an older adult? Wish your medical appointments lasted longer than 10 minutes so the doctor could answer all your questions?
Some seniors have found an alternative. Since March they’ve been able to access a wide variety of primary health care services at a first-of-its-kind clinic staffed by nurse practitioners on site at the Seniors Association of Greater Edmonton (Sage) location downtown.
The Sage clinic, located downtown at 15 Churchill Square, operates in cooperation with the University of Alberta Faculty of Nursing. It is one of the sites of a nurse practitioner demonstration project being funded for three years with $10 million from the provincial government to provide care to low-income clients. It’s also the only nurse practitioner clinic not located in an existing community health centre.
The project will be evaluated by the Institute of Health Economics and the results used to help develop future primary health care policies in Alberta.
Nurse practitoners – registered nurses with a master of nursing degree – can do almost everything that a family doctor can with no difference in a patient’s health outcomes or satisfaction, says Anne Summach (pronounced sue-mac), the clinic’s director of health services.
“A nurse practitioner’s additional training allows her to diagnose, prescribe, order tests, interpret tests. She is trained to the same level as a family practitioner. Nurse practitioners can’t prescribe eyeglasses, which most family physicians wouldn’t do anyway, and we are unable to prescribe cannabis,” Summach adds.
They also can’t sign a death certificate or a driver’s medical because existing legislation explicitly uses the word physician in describing who is authorized to do so and would require acts to be changed.
Nurse practitioners do what they do at a cost savings to the health care system because they are paid a salary, not paid per fee the way doctors are.
“It doesn’t matter to me if I go to someone’s (a housebound client’s) home, I can spend an hour with a senior who has a lot of questions,” Summach explains. “They can go to a family doctor in the community and be told you can ask one or two questions and that’s it and they get 10-15 minutes and that’s it, and that’s often not sufficient to address seniors very complex health and social needs.”
Older adults can have mental health issues as well as heart and lung issues, COPD (Chronic Obstructive Pulmonary Disease), and heart failure and they are often on many medicines, some of which have been prescribed for many years and may not be needed anymore, Summach says.
“We have the freedom to provide primary care to seniors who are looking for a more time attentive care model and also to seniors who used to have a family provider but because they can no longer get to their family provider they end up really orphaned.”
Elizabeth Wetheral, 73, who has visited the Sage clinic several times since it opened thinks it’s a great idea that should be adopted throughout the province.
“My background is rural and family community services … and I have always believed that nurses in the community could take care of the needs of the whole area.
“A lot of times I find with doctors’ offices that you don’t get a choice of female doctors and it’s especially bad in rural Alberta. I know a woman who hasn’t been to a doctor for five years because she won’t go to a male doctor for her pap test.”
Wetheral said she found the nurse practitioners were “good listeners. I felt i was getting more time and more attention than I have with doctors.”
She didn’t have to wait to make an appointment and she didn’t have to sit and wait for hours to be seen.
The addition of the clinic to the social and human services Sage already has in place – everything from housing assistance, income assessment, a hoarding program, a seniors safe house to life enrichment activities and long-term social work – now makes it a one-stop shop, providing everything under one roof, says Summach, something previous executives began working on in 2010. More than 1,000 seniors thus far have been seen by the clinic’s two full-time and one part-time nurse practitioners. The clinic can handle 4,000-5,000 clients.
Plans are currently underway to enhance care with weekly visits by mobile health care providers such as a podiatrist, denturist, hygienist, optometrist and rehabilitation medicine expert.
“We need to start treating seniors as a distinct population that has individual needs, something that is well-known and established in the medical field,” Summach says. “People go to see a geriatric specialist but even better than having just specialty care would be to be able to go to somebody whose primary focus for your primary care is geriatrics.”
Summach says her goal is to “keep people’s chronic diseases managed in a way that is appropriate based on their age and vitality, looking at seniors as seniors.”
You don’t have to be a Sage member to use the clinic. You do have to be eligible for Alberta Health care and you have to identify as a senior; you’re over 50 and have the kinds of disorders seniors struggle with, you have multiple medical problems or you’re on AISH (Assured Income for the Severely Handicapped), frail or homebound.
Summach remembers “one lovely, elderly gentleman who is struggling with end-stage cancer and who I’d seen a number of times. He shook my hand and said I don’t care that you’re not a doctor, you’re just as much a doctor to me. That’s often what I get once people have been here a couple of times.
“I want seniors to understand that if they’re not happy with the care they’re getting they have an option.”