Dr. Eric Cadesky Updated: June 30, 2018
The Vancouver Sun’s series on seniors’ care in B.C. brings to light challenges in how we care for people who bear the greatest burden of chronic disease. The provincial government has offered solutions such as hiring more care aids, opening additional long-term care beds and increasing support for seniors living at home. Readers should also be aware that B.C.’s medical doctors are working with the provincial government on the Residential Care Initiative.
Through non-profit organizations called Divisions of Family Practice (also funded by Doctors of B.C. and the provincial government), family doctors are creating local, grassroots residential-care solutions that reduce unnecessary hospital transfers, improve care experiences for patients and providers and reduce costs to the system while improving quality of care. All divisions have RCI projects, meaning that 99 per cent of the eligible 30,000 residential-care beds in the province now benefit from RCI work in some way.
RCI projects around the province provide residential-care patients with access to comprehensive care from their family doctor through regular visits, after-hours on-call coverage and care team meetings. Strong doctor/patient relationships play an important role in improving patients’ overall health and quality of life, especially when a patient has complex needs such as dementia, diabetes and heart and lung disease.
Providing patients with regular physician visits in local facilities has reduced unnecessary hospital transfers significantly in many regions. For example, transfer rates have been reduced in Mission by 33 per cent, in Kootenay Boundary by 34 per cent and 31 per cent in Salmon Arm.
Meaningful medication reviews are another component of RCI projects. Care teams — which can include doctors, pharmacists, nurses, care aids, family members and the patients themselves — review the goals of care and the current plan in order to avoid negative medication interaction, eliminate unnecessary prescriptions and investigations and reduce the number of patients prescribed antipsychotic medications (an issue outlined in the Vancouver Sun series’ fourth instalment, entitled, The problems with residential care.)
Physician-organized medication reviews in the Kootenay Boundary region have reduced the number of patients on antipsychotics without a diagnosis of psychosis by 28 per cent and reduced the number of patients on nine or more medications by 15 per cent. Medication reviews in Mission have also helped reduce the number of patients on nine or more medications by 18 per cent. Reviews in Abbotsford facilities have reduced the number of patients on multiple medications by 6.7 per cent and the number of patients being prescribed antipsychotics by 8.7 per cent.
These early data represent a small fraction of the results, as meaningful medication reviews are underway in facilities in Vancouver, Victoria, the Fraser Northwest and Shuswap-North Okanagan regions and in other communities around B.C.
To ensure value, RCI projects undergo in-depth evaluation and the early results are encouraging. While the RCI will not fix all of the systemic challenges facing our aging population, we commit to continuing to improve our patients’ quality of life through this work. Further evaluation of local RCI projects will identify which initiatives can be scaled to residential-care patients in communities around the province. It also shows that when we all work together — doctors, government, health authorities, health providers and patients — we can truly make a difference in the health of our patients and communities.
Dr. Eric Cadesky is president of Doctors of B.C.