Launched a year ago by the Quebec government to relieve emergency room congestion, specialized nurse practitioner (IPS) clinics have seen, in total, some 15,000 patients, according to data obtained by The duty. A number that appears low when we consider that around 5,000 Quebecers present themselves to the emergency room every day for a non-urgent problem. Quebec explains that these clinics are “in an evolving phase” and that access is improving “from week to week”. But many IPS positions still remain to be filled.
The Quebec Minister of Health, Christian Dubé, announced in November 2022 the establishment of IPS clinics, one of his flagship measures to reduce pressure on emergency rooms overwhelmed with patients. Since then, six clinics have opened their doors in the Montreal, Laval, Lanaudière and Saguenay–Lac-Saint-Jean regions. What conclusions can we draw from this? The duty notably asked health establishments the number of patients treated and positions filled in their IPS clinic.
At the CISSS de Laval, the university clinic-school for IPS and clinical nurses has seen 5,736 patients since December 19, 2022. One position in four is filled. “The specialized nurse practitioner who occupies the position is dedicated exclusively to the clinic,” explains communications advisor Marie-Eve Despatie-Gagnon. The thirty other NPs who work there share their time between the IPS clinic and their regular environment (family medicine group [GMF]university family medicine group or local community service center [CLSC]) or do so in voluntary overtime. »
The two clinics of the CIUSSS du Centre-Sud-de-l’Île-de-Montréal have welcomed 1,805 patients since December 15, 2022. Three IPS work there and five positions are posted, indicates the establishment.
At the CIUSSS du Nord-de-l’Île-de-Montréal, the clinic operates part-time (Tuesday, Thursday and Saturday). Only one IPS position is currently open. “It is filled by a rotation of several volunteer IPS from the GMFs and CLSCs of our CIUSSS without this affecting the offer in these environments,” maintains the establishment in an email. These IPS have carried out 1,360 consultations since January.
Between 1er December 2022 and November 24, the CIUSSS de l’Est-de-l’Île-de-Montréal clinic carried out 3,333 consultations in person or by telephone. Two IPS recently slammed the door, reported The Press, leaving two out of four positions vacant. In a letter of which The duty was able to become aware, they explain their resignation by “issues” having “impacts on the quality and safety of care”. They particularly deplore the lack of equipment and stability in the team as well as the virtual absence of clinical support.
In the evolution phase
Asked to comment on the results of the IPS clinics, the office of the Minister of Health responds that these clinics are “essential” to offer options other than emergency and improve access to the first line. “It is important to remember that a year ago, there were almost no IPS clinics in Quebec,” says the firm. It is therefore normal that there is a period of adaptation. » Work is being done to “make all necessary improvements”, particularly with regard to job postings.
The Ministry of Health and Social Services specifies that when the first clinics opened, the IPS worked there “on a voluntary basis and on additional availability to their tasks”, which had “an impact” on working hours. ‘opening. Now established, the clinics are “beginning” staffing. The ministry explains that in the public network, job postings take place “mainly” in January and September.
The president of the Association of Specialized Nurse Practitioners of Quebec, Christine Laliberté, considers it “normal” that the clinics saw fewer patients in their early days. “At some point, with time, equipment and resources, they will be able to see more patients,” she says.
Régis Blais, full professor in the Department of Management, Evaluation and Health Policy at the University of Montreal, is delighted that 15,000 patients have been able to benefit from IPS’ expertise. “But I would almost dare to say that it’s a drop in the ocean,” he says. He points out that Quebec has far fewer IPS than Ontario. There were 1,314 of them as of March 31.
According to him, the quality of service in clinics must also be taken into account. If an NP accepts that a patient addresses more than one health problem during a consultation, she does “a better job”, according to him, than a doctor who requires that only one problem be exposed during a consultation. appointment fixed by the Front Line Access Desk.
Once verified, patients can talk about more than one problem during a consultation in an IPS clinic. “If necessary, screenings can also be requested,” specifies the CISSS de Lanaudière. In Laval, however, the IPS allow between 20 and 30 minutes per patient, indicates the local CISSS. A second appointment is offered if necessary.
“Political marketing”
The president of the Federation of General Practitioners of Quebec (FMOQ), Dr.r Marc-André Amyot believes that with the current volume of consultations, IPS clinics will “not relieve emergency room congestion” and “will not solve the problem of the health network”.
“It’s much more political marketing than concrete solutions,” he says, stressing that he “does not at all question the role of the IPS.” “The concrete solutions lie in collaborative work, where everyone works together and not in silos in their clinic. » The FMOQ says it “favors” the GMF model, which brings together doctors, NPs and other professionals under the same roof.
Quebec, for its part, is staying the course on setting up 23 new IPS clinics by 2028. “It’s a model that works and that we will extend throughout Quebec in the coming years,” says the firm. . Ultimately, the clinics will include NPs, practical and clinical nurses, social workers and other professionals, such as physiotherapists, nutritionists and pharmacists. They will have to open their doors 60 to 68 hours per week and 39 hours during the holiday season.