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. Second text of three.
Monique Lebeau, 69, fell from a stepladder last week while cleaning the outside of her trailer in Vermont. His right hip took the hit. Struggling with severe pain, she returned to Quebec to consult a doctor in a clinic. She did not find an appointment and ended up in the emergency room of Charles-Le Moyne Hospital in Greenfield Park. “I was told there was an 18-hour wait,” she says.
The hospital center offered him an appointment the next morning at a nearby superclinic, the GMF-R Azur. Monique Lebeau was welcomed and assessed by a physiotherapist, not a doctor. “The physiotherapist went to see the doctor and she said, ‘we’re going to have the X-rays’,” explains the retiree. Then the medical diagnosis fell: fracture at the head of the femur. Monique Lebeau was transferred to Charles-Le Moyne and operated the next day by an orthopedist.
In the “emergency” of the Azur clinic, patients with musculoskeletal problems are first seen by a physiotherapist, then by a doctor. “While the physiotherapist is evaluating a musculoskeletal case, she is already advancing the treatment plan, the probable diagnosis, I have time to see other patients,” says Dr.r Laurent Vanier, doctor in charge of the GMF-R and emergency physician at Charles-Le Moyne.
In addition to triage, physiotherapist Danielle Richer begins taking care of the patient. She cites as an example the recent case of a baseball player who sprained his ankle. “I told the doctor ‘we’re going to prescribe an orthosis right away to speed up the return to play.’ I started the exercises with him. I corrected his crutches because obviously he had crooked crutches, ”she explains.
In Quebec, physiotherapists remain rare in “walk-in” clinics. The GMF-R Azur was a pioneer in 2016 when it launched its pilot project, in partnership with the private clinic Physiothérapie Universelle. The latter provides two physiotherapists free of charge to Azur, in order to ensure a part-time presence in the emergency room (the service was interrupted during part of the pandemic).
Léna Mardelli, regional and development director at Physiothérapie Universelle, assures us that this “donation” is not used to redirect patients to her clinic. Its employees do not wear corporate shirts at the clinic. They direct users to the website of the Professional Order of Physiotherapy of Quebec (OPPQ) if they wish to undertake private treatment.
The physiotherapist – a passionate person, according to people in the community – was the first to work in the emergency room of the GMF-R Azur at the start of the project. She is convinced that professionals like her can help unclog emergency rooms. “90% of musculoskeletal cases are easily treatable by front-line physiotherapists,” she estimates. The first time you have back pain, if it’s fixed right away, you’ll know exactly what to do. You won’t come back four times [à la clinique]. »
Léna Mardelli stresses that her team and that of Azur have “invented nothing”. “In the Canadian military, patients are seen by physiotherapists initially, not doctors, when it comes to musculoskeletal issues,” she adds.
According to her, physiotherapists find it stimulating to work on the front line, in collaboration with doctors. This changes therapy sessions in the clinic. “It’s candy for them,” she thinks.
For people without insurance
In addition to having launched a physiotherapy project in the emergency room, the GMF-R Azur has chosen to integrate a full-time physiotherapist, Marjorie Gingras (the professional is “on loan” to the clinic by the CISSS de la Montérégie-Centre).
His mission ? Evaluate the condition of patients without private insurance and with musculoskeletal problems, and equip them, in a few therapy sessions, to improve their condition and prevent recurrences. Without falling into the vicious circle of painkillers…
Marjorie Gingras is not short of work. The GMF-R Azur has more than 25,000 registered patients (the equivalent of 29,000 taking into account their vulnerability). “Initially, when I arrived here, the doctors referred patients to me saying to themselves ‘we have tried everything, let’s do physio,’ she says. Today they send patients to me saying “hip pain, what do you think?” »
Hair pulled up in a bun, powder blue running shoes, “Physio” t-shirt, Marjorie Gingras gets her patients moving as soon as they arrive. During the visit of To have to Last Friday, Keith Carrier, 81, went up and down stairs in the clinic, in addition to performing a series of movements (flexions, rotations, etc.) with his legs. This cycling enthusiast was sent to physiotherapy by his doctor for hip pain.
After evaluation, Marjorie Gingras advised her on various exercises. She also recommended to him, with a smile, “not to kid the pain”, that is to say to avoid voluntarily reproducing the pain by useless gestures or palpation. Keith Carrier enjoyed his first date. “I feel better informed,” he says.
Marjorie Gingras dreams that the 372 FMGs in Quebec will have a physiotherapist on their team to support doctors and specialized nurse practitioners. “Currently, about 20 FMGs have them and they are not all full-time,” she laments. However, “20 to 30% of consultations with family doctors are musculoskeletal in nature,” she adds.
The president of the OPPQ, Denis Pelletier, salutes the “political will” of the Legault government to make more room for the various professionals in the health network. Since May 2020, physiotherapists have the right, under certain conditions, to prescribe X-rays for trauma that occurred less than 72 hours ago. A physiotherapy service is also now offered in the emergency room of the CHU de Québec.
But Denis Pelletier believes that we must go even further. “Instead of going to a GMF or to the emergency room, you could go to a physiotherapy clinic where a physiotherapist would give you a service that he would bill to the Régie de l’assurance maladie du Québec,” he says. he.