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 presents initiatives where professionals push collaboration to the maximum, for the benefit of patients. First text of three.
“I was living on borrowed time, and there, I borrow and I don’t give it back! Nicole Berthelet, 81, has never been so happy to get into debt. She was close to death, and her prognosis is grim. She suffers, among other things, from heart failure, lung problems and kidney problems. To survive, she must take about fifteen medications a day.
Nicole Berthelet is closely monitored by a multidisciplinary team from the Laval university family medicine group (GMF-U), located at the Cité de la santé. “I think, if they weren’t here, my borrowed time would be over, it’s been a long time!” she blurts out on the phone, bursting out laughing.
This citizen of Sainte-Thérèse is cared for by a family doctor from the GMF-U — Dr.r Jean Rivest, her “good Lord”, as she says -, but also by a team of pharmacists, including Marie-Claude Vanier. She knows M.me Berthelet for fifteen years.
“Doctors are hard to reach, and with Marie-Claude, it’s number 1! said Nicole Berthelet. She, she can reach him, the Dr [Jean] Rivest. She can ask her questions and she will call me back and advise me. It reassures me about many things. »
When passing the To have to at the GMF-U Laval, the pharmacist was talking on the phone with Ms.me Berthelet of the results of his last blood tests and told him the doses of anticoagulant to take accordingly. She took the opportunity to ask her about her other health problems.
After the call, Marie-Claude Vanier faxed a request to the CLSC de Sainte-Thérèse so that a nurse from the home service comes to Mrs.me Berthelet and takes new samples. Recently, the pharmacist also asked that her patient be seen at home by a physiotherapist. Mme Berthelet struggles to get around, especially since his recent hospitalization for pneumonia.
“Patients like that, complex, we help them navigate the system,” explains Marie-Claude Vanier, sitting in front of her computer screen, writing notes in the electronic medical records software.
An exception
The GMF-U Laval is an exception in the Quebec health network. Since 2004, a pharmacist has been present there from Monday to Friday. In Quebec, the vast majority of FMGs with a pharmacist on their team employ him part-time. “Currently, their presence is on average only 16 hours per week,” confirms the coordinator of the Quebec Network of GMF pharmacists, Anne Maheu.
The group of approximately 350 professionals is calling for pharmacists to be integrated into all FMGs in Quebec and for the positions to be raised to a full-time equivalent for every 10,000 patients registered. A call that is beginning to be heard. The Ministry of Health and Social Services (MSSS) recently granted funding to five FMGs in various regions (Montreal, Lanaudière, Bas-Saint-Laurent, Beauce and Saguenay) in order to upgrade pharmacist positions to full-time.
At GMF-U Laval, four pharmacists share a full-time task. The position is funded by the MSSS (two days a week), the University of Montreal and the CISSS de Laval.
According to Marie-Claude Vanier, the presence of a full-time pharmacist frees up the time of doctors and specialized nurse practitioners (IPS). She and her colleagues follow up many patients who suffer, for example, from chronic pain, depression or anxiety. They also respond to questions from physicians and NPs regarding medication or dose changes, over the phone or through electronic medical record software messaging.
I’m sure that the pharmacists’ follow-up helped to avoid consultations in the emergency room.
“One of the challenges we currently have is that, although we are full-time, we are having difficulty meeting the demand,” says Marie-Claude Vanier, also full clinical professor at the Faculty of Pharmacy from the University of Montreal.
Pharmacists try to transfer simple follow-ups to community pharmacists, in order to focus on more complex cases. They have increased power thanks to an agreement called “advanced practice in partnership” concluded with the clinical team. They can prescribe a drug without the approval of a doctor, “for any patient whose health problem is already diagnosed”, specifies Marie-Claude Vanier.
A popular service
The DD Pascale Thomas-Couture admits to being “one of the great users of pharmacists” at GMF-U Laval, where she has been practicing for three years. “We couldn’t do without it! The young family doctor, who has additional training in care of the elderly, follows 600 patients, including 130 aged 75 and over. These seniors come from the family doctor access window.
“These are patients who have not been seen for a long time by a doctor, sometimes for five or seven years, specifies the DD Thomas Couture. It can be supports that are heavy. They come up with a list of ten problems. »
Pharmacists help her “rationalize” (the new term for “deprescribing”) medications deemed irrelevant. “To wean off certain pills, it takes time, explains the DD Thomas Couture. You have to go there for months. »
During withdrawal, the patient should be contacted every two or three weeks to avoid adverse effects, such as confusion, she continues. ” [Comme médecin], we can’t afford to do that, she says. I’m sure that the pharmacists’ follow-up helped to avoid consultations in the emergency room. »
The Dr Jean Rivest, who practices at GMF-U Laval, considers the team approach “essential” in complex cases. “Maybe some older doctors were insulted when they got a notice [de la part de pharmaciens], but I don’t think that’s the case anymore, he says. The patients are heavier and there are a lot more drugs than before. »
Future physicians are exposed to interprofessional collaboration in FMG-Us such as Laval. A second-year pharmacy student shared Marie-Claude Vanier’s office during our visit. An IPS was supervising a medical resident remotely. A camera captured his intervention live with a patient in a room of the GMF-U.
“Here, there is no hierarchy,” says IPS Caroline Renaud. She welcomes the new laws that allow various professionals to work with their “full skills” and “to [faire] see the right patient, at the right time by the right professional”.
A miracle cure, interdisciplinarity? No, answers the Dr John Rivest. But one of the remedies to relieve the first line and, above all, orphan patients.