The days when every little Quebecer was followed by a pediatrician are well and truly over: healthy children will now be cared for by specialized nurse practitioners (NPS) or family doctors. According to the Institute for the relevance of medical acts (IPAM), pediatricians must above all devote themselves to sick children who require their expertise.
It is for this reason that the CISSS de Laval now offers SPI to all newborns in its territory. The program was launched at the end of February, following the decision of IPAM.
This independent organization – created in the wake of the 2019 agreement between the Federation of Medical Specialists of Quebec (FMSQ) and the Legault government – has the mission of cleaning up medical acts deemed inappropriate or not in accordance with good practices. As part of its work, it recommended, among other things, abolishing the billing for the general pediatric examination for healthy children. The measure entered into force on 1er last December.
The Association of Pediatricians of Quebec (APQ) had proposed this change to IPAM. “It is not relevant that a medical specialist be paid to see a child in perfect health, without acute or chronic problem”, explains the president of the APQ, the DD Marie-Claude Roy. Parents need not worry, however. Pediatricians will not abandon the so-called “normal” children they already care for, she assures. “It’s a change that will happen gradually,” she says. This should be seen as a realization of a necessary culture change. »
Unprecedented initiative in Laval
In order to fill the void left by pediatricians, the Ministry of Health and Social Services has asked all CIUSSSs and CISSSs in Quebec to “plan the necessary services” to follow up on healthy babies and children.
The CISSS de Laval has therefore chosen to set up an SPI program for newborns. In four months, 152 Laval infants have been cared for in this way.
This is the case of cute Khyra, born on March 22 (the same day as her mother).
His parents say they are relieved to know that they can count on an IPS. Especially since their respective family doctors, “saturated” with patients, could not take care of their little girl. “Of course it’s much more reassuring because we have easier access, easier monitoring,” says the mother, Ghaya Jouni. “At first, we had a problem stabilizing our weight. So we had a close follow-up. »
Between diapers, feedings and interspersed naps, she and her spouse – who are on their first child – therefore did not have to multiply the phone calls to find a family doctor. One source of less stress, given that the first follow-up appointment takes place at four weeks of life, according to the indications of the CISSS.
According to the Régie de l’assurance maladie du Québec, 6,040 children under the age of one were on the waiting list for the access window to a family doctor (GAMF) as of June 30. “In Laval, there should no longer be any healthy newborns registering with the GAMF,” notes the CISSS director of nursing, Elaine Cardinal.
New parents in Laval can make an appointment with an SNP at one of the five sites offered by the CISSS as soon as they leave the hospital. The healthcare professional will follow the child for the long term. “Until his retirement! says Stéphanie Guindon, head of advanced practice and skills development at the CISSS de Laval.
The project is ambitious. Some 4,000 children are born each year in Laval and, for the moment, five IPS participate in the initiative. According to M.me Guindon, those with at least three years of experience can monitor between 500 and 900 patients.
Lots of support
IPS Sara-Maria Viens-Vega did not expect to have so many requests when she embarked on the project. “I have to do three to four new treatments [de patients] a week,” she says.
Babies may be healthy, but they require a lot of consultations. “They are more at risk of ear infections, of all kinds of respiratory infections, explains Mme Come-Vega. These are children we will see often — much more so than an adult in their thirties, for example. Their parents ask questions as well. “Sometimes it’s just reassurance on the phone. And if necessary, of course, I give them a face-to-face meeting, ”notes the IPS.
Families without a doctor also often implore him to take care of them, parents and children included. “Obviously, I accept them,” says Mme Come-Vega. “Finally, the demand is exponential. But at the same time, that’s family medicine. It’s nice to be able [s’occuper de] the whole family. »
Stéphanie Guindon already sees a phase 2 in the project. The CISSS de Laval also wishes to obtain funding from the Ministry to add clinical nurses to its SNP team. “They will be able to follow up alternately with specialized nurse practitioners,” says Ms.me Guindon. It will allow us to take [en charge] even more patients. »
The DD Roy welcomes this “excellent” initiative, which aims to ensure that the “patient sees the right professional at the right time”. “It’s a start with the CISSS de Laval, and it should follow shortly throughout the province,” she says. She also believes that, thanks to this shift, the services offered by pediatricians will be “more quickly accessible for children who need them”.