We all feel challenged and concerned by the spectacular overcrowding of the emergency services: the population is worried about the safety of the care provided in a context of triage pushed to the extreme; health professionals risk overwork in a deteriorating work climate; and managers and decision-makers are wondering about sustainable solutions and are struggling to contain an already imposing budget.
Posted yesterday at 10:00 a.m.
This problem, which has repeatedly made headlines over the years in Quebec, has prompted the initiation of several relevant projects: the improvement of interdisciplinary work and the broadening of the fields of practice of different professionals to improving accessibility; better access to frontline services including walk-in clinics; the possibility for every Quebecer to be registered with a first-line care team; improving home care; etc
These changes are critically important to our healthcare system, but more needs to be done to address the issue in a lasting way.
To the glaring question: “Are there other complementary solutions to improve this problem?” “, The answer is yes.
We are currently conducting a pilot project in two regions of Quebec, subsidized by the Ministry of Health and Social Services, to implement the V1SAGES approach.1in preparation for scaling up in the province later.
Nourished by our professional expertise of more than 25 years as a family doctor and nurse, and by the research work of the last ten years by our team on the organization of health services in collaboration with several partners from Quebec, Canada and internationally, this approach aims to improve the coordination of services for people with complex needs who frequently use emergency services in order to better meet their needs upstream.
Its potential to unclog emergencies has been well demonstrated.
Indeed, some people have complex health needs due to a synergistic interaction between physical health problems, mental health problems, and a precarious socio-economic situation. These people often meet multiple physical and mental health professionals (family doctors, nurses, pharmacists, specialists, psychologists, etc.) and social and community services (social workers, psychoeducators, etc.).
At risk of receiving fragmented and poorly coordinated care, they more frequently end up in the emergency room. We conducted a study across Quebec in 2019 which documented that 5% of patients seen in the emergency room generate 35% of total visits, hence the importance of acting more effectively with this population.
The V1SAGES approach proposes to clearly identify these people so that they can benefit from the services of a case manager at the hospital working in close collaboration with a navigator in a family medicine group or CLSC (nurse or social worker) to promote a comprehensive and optimal service offer by mobilizing the various partners of the health and social services system, as well as community and intersectoral partners, in a coordinated fashion.
The results of studies show an improvement in their experience of care and their health, in the satisfaction of professionals, in the efficiency of the health system and in health equity. The current crisis confirms once again that it is time to take action, both to relieve emergencies and a suffering health system and to provide better care to those affected.