The right care at the right time, in the right place, by the right professional. This is the new mantra of the Ministry of Health and Social Services, which relies on interdisciplinarity to improve the accessibility of front-line care and relieve emergency room congestion. The duty focuses on initiatives where professionals push collaboration to the maximum, for the benefit of patients. Today, a clinic run by nurses.
In the clinic, not a doctor. Only nursing assistants, clinical nurses and specialized nurse practitioners (IPS). Their mission? Evaluate the state of health of patients waiting for a family doctor to treat and prevent illnesses.
Over the past year, the CIUSSS Center-Ouest-de-l’Île-de-Montréal “clinic of the GAMF” (family doctor access window) team has seen more than 1,500 people in its temporary trailer. located in the parking lot of the Jewish General Hospital. “90% of the clients who were tested received an abnormal result,” says Marie-Christine Gras, project instigator and head of program administration.
Some orphan patients had serious illness. Like this woman who unknowingly suffered from breast cancer, detected thanks to a mammogram prescribed at the GAMF clinic. Or this man “out of breath without common sense” lately, sent to cardiology by an IPS. He had arrhythmia.
“I have already sent a patient directly to the emergency room,” says nurse clinician Keryn Chemtob, interviewed between two appointments in an examination room at the clinic. He had had chest pain for a year and did not know how to access health services. He was a newcomer. The man had to undergo bypass surgery.
The health problems detected at the GAMF clinic are not all equally serious. Sometimes it is a cholesterol level that is slightly higher than the recommended standards. “But it’s still something that the client did not know,” says Marie-Christine Gras. And that he has every interest in monitoring.
Adel Belhassine was unaware that he was “a little hypertensive” before being taken care of by the GAMF clinic. The Tunisian of origin, 58 years old, has been without a family doctor since his arrival in Quebec three years ago. He describes the follow-up he receives as “remarkable”. “It feels good to have support,” he says.
Autonomous nurses
Some 115,000 people are without a family doctor on the territory of the CIUSSS du Centre-Ouest-de-l’Île-de-Montréal. Among them, 32,000 are on the GAMF waiting list.
The clinic, which has been running at full speed since September 2021, is targeting two clienteles in particular: people aged 50 and over who are “fit” (without known chronic illness) and people aged 18 to 50 with a chronic illness. Targeted patients are contacted by administrative officers who offer them an appointment. If they accept, a team of nurses follows them for a short period (eg three months), the time to detect health problems and stabilize the treatment. Once the follow-up is complete, the orphan patients are directed to the first-line access counter (GAP).
Marie-Christine Gras, a nurse clinician who once worked in a CLSC, is convinced of the relevance of her project. She believes in prevention — her “hobby” — and in the full autonomy of her team, made up of two nursing assistants, three clinical nurses (bachelors) and three primary care nurses. According to the manager, the population has everything to gain from nurses being able to “get the most out of their practice”.
At the GAMF clinic, clinical nurses can screen for diabetes, hypertension, hypercholesterolemia, osteoporosis, cervical and colon cancer through collective prescriptions. When the test results are abnormal, they refer their patients to an IPS, which takes the investigation a step further. “There are very few cases where the IPS tell us: ‘I need to send them to a doctor,'” says Marie-Christine Gras, a passionate verbomotor woman with an auburn mane.
Michel Godin, an IPS, loves his independence, despite the challenges it can pose. “Of course it hasn’t been easy from the start,” he says. The clinic’s IPSs do not have a “partner doctor”. They therefore do not have access to the service request dispatch centre, a system reserved for family physicians and allowing them to request a consultation with a specialist for a patient.
“We had to be more creative, says Michel Godin. Specialists were contacted directly to see if they were accepting patients. The team got there.
Not a doctor at all costs
The president of the Order of Nurses of Quebec, Luc Mathieu, believes that the GAMF clinic is “a good idea, a good model, which demonstrates the contribution of licensed practical nurses, nurse clinicians and specialized nurse practitioners”.
According to him, it is high time for Quebec to get out of the “paradigm” of a doctor for each citizen. “If we want to unclog the system, improve access to the first line, we should no longer, in my opinion, say that it absolutely takes a family doctor,” says Luc Mathieu. I still hear politicians say that. »
The leader of the Liberal Party of Quebec, Dominique Anglade, promises to offer all Quebecers who want a family doctor. “This is not the winning solution for improving access in the medium and long term in our network”, thinks the president of the Order.
Luc Mathieu pleads in favor of care by a “family team” (clinical nurses, IPS, pharmacists, etc.) rather than by a family doctor. According to him, Quebec must also rely on clinics such as the Coopérative de solidarité SABSA, in Quebec, where patients are cared for by IPSs and clinical nurses, among others. “An IPS can monitor 600, 700 or 800 patients,” says Luc Mathieu. In most cases, these patients are not seen by a physician. »