Family Practice Networks

Announcing a New FPN!
We are pleased to announce that a fourth FPN has been approved! Congratulations to the physicians of the “rural eastern” area on their focused effort during the winter and spring months, resulting in a fourth FPN in the province. Our newest network encompasses a wide geography including the Burin and Bonavista Peninsulas and rural communities on the Avalon Peninsula. This brings our total number of FPN members to over 220 and counting!

Priorities for the rural eastern Network include improved engagement with the Regional Health Authority (RHA), particularly in relation to consulting and allied health team services, and addressing recruitment and retention needs for community family physicians. 

If you would like to speak to some of the family physicians involved in development of the Rural Eastern FPN, they would be happy to answer your questions and provide more information:

• Dr. Megan Hayes, Harbour Grace
• Dr. Sarah Small, Clarenville
• Dr. Gordon Stockwell, Clarenville
• Dr. Erin FitzPatrick, Burin

Next steps for the FPN include selection of a Board of Directors, hiring an Executive Director, engagement of area family physicians, and working with Eastern Health to move forward on priority areas. Stay tuned for more updates!

Collaborative Services Committees

You may recall that Collaborative Services Committees (CSCs) are new structures, consisting of FPN and RHA members. The intent of the CSC is to work together to achieve common health care goals and contribute to population health outcomes. Significant CSC development work has occurred in recent months in each region of the province, and members can look forward to tangible progress over the coming months.

Shalloway, Endeavor and Long Range FPNs
To find out more about each of the other FPNs, and/or to complete an application for membership, please visit the respective FPN pages on our website: Long Range, Shalloway, and Endeavor. Each FPN also has its own newsletter, in which you will hear specific news relevant to your own FPN.

Our FPNs are currently working on development of their annual budgets and workplans, developing programs in priority areas, continuing engagement with the physician community, and planning for their first Annual General Meetings (AGMs) in the fall.

First Provincial Meeting of FPN Board Chairs and Executive Directors
On June 14, the three Board Chairs and Executive Directors met with FPRP program staff for a day in St. John’s to share ideas across FPNs and to collectively plan for common priorities. These meetings will occur on a regular basis, rotating around the province. A productive and valuable day was had by all!

(Clockwise from bottom left) Dr. Shanda Slipp (Long Range FPN Chair), Dr. Heather Cuddy (Endeavor FPN Chair), Mr. Adam Wylie (Endeavor Executive Director), Ms. Glenda Nash
(FPRP Program Director), Mr. Ian Hodder (FPRP Senior Program Consultant), Dr. Jared Butler (Shalloway FPN Chair), Mr. Gary Kelly (Long Range FPN Executive Director) and Ms. Monica Bull (Shalloway FPN Executive Director).

Provincial Meeting of FPN Boards
This fall, the program will also host its first ever meeting of FPN Boards, an event we plan to hold annually. Stay tuned for further details.  

COPD Code (Coming Soon!)
The Family Practice Renewal Committee has approved a new fee code for enhanced care of patients with Chronic Obstructive Pulmonary Disease (COPD). Specifics are noted:

• The code is payable at $50 per visit, up to two times per patient over a 12-month period, to a maximum of 80 patients per physician annually.
• First payment requires either a confirmed diagnosis of COPD or a request for spirometry.
• COPD diagnosis, by spirometry, must be confirmed for the third billing.
• All billlings require:
  • Documentation of exacerbations.
  • Use of the COPD flow sheet for documenting guideline-informed care. (Note: A new flow sheet/visit template has been developed in consultation with family physicians, respirology, and eDOCSNL. This visit template will be uploaded into MedAccess and available online for printing for non-EMR clinics.)
  • The COPD code can be billed in addition to other codes applicable to the office visit.

Launch of the COPD code is expected in the fall. More details to follow.

Reminder: Registration for Shared Care and Telephone Codes
Registration for FPRP’s Fee Code Program began in early October. We now have 157 physicians in the program, who are now eligible to bill two new fee codes: 

Shared Care Code: Provides participating physicians with compensation for two-way collaborative conferencing with other healthcare providers for development of a patient care plan.

Patient Care Telephone Code: Provides participating physicians with compensation for two-way telephone communication between the physician (or other health care provider employed within the physician’s office) and the patient (or the patient’s medical representative).

For more details on each new code, and to access supporting resources, please visit our Resources page. 

To complete online registration for the Fee Code Program, please click here.

Recent Events
Since October of 2018, FPRP has had 209 family physicians attend Practice Improvement events. These event included focus areas of COPD and Care of the Older Adult (Frailty 1: Dementia, Delirium), as well as initiatives aimed at improving collaboration between family physicians and consultants, and fee code integration and support. 

Evaluation results for the fall and spring Family Physician/Consultant events, COPD sessions, and Frailty 1 were very positive, so subsequent offerings have either taken place or are being planned. 

Frailty 1 (Dementia, Delirium)
55 family physicians attended this April 2019 event in St. John’s.

All attending physicians described two ways in which they would change their practice as a result of attending the program, with the “use of non-pharmacological interventions” a common theme. Some select responses are noted:

• “More vigilance on med prescribing; use more non-pharm approaches.”
• “Be more aware of delirium in patients. Continue to deprescribe, especially antipsychotics.”
• “Evaluate dementia with greater skill.”
• “My approach to Dementia and Delirium in the geriatric population will be more structured, organized and focused.”
• “I will change the way I assess for dementia. I am more aware of the high prevalence of undiagnosed dementia. I have an improved approach to management of dementia/BPSD.”
• “Use different tools for major neurocognitive disorders.”
• “More attentive of environmental factors, hearing loss, and non-pharmacological reactions.”
• More organized approach to office visits for assessment for dementia.”

Fall Frailty 1 Events are Being Planned as Follows — Stay Tuned for Details:

Saturday, September 21: Eastport
Saturday, October 26: Corner Brook

COPD: Comprehensive Management of COPD for the Family Physician
Led by Dr. Gokul Vidyasankar (Respirologist) and Dr. Roxanne Cooper (Family Physician), sessions have been held, in person and via webinar, with topics including: Diagnosis, Approach to Pharmacotherapy, Choice of Inhaler, Strategy for NLPDP coverage, Exacerbation Management, Remote Patient Monitoring, and Referrals. More than 40 family physicians have attended these COPD offerings.

Feedback has been very positive and FPRP has been asked to provide a third offering at the upcoming College of Family Physicians NL conference in September (Sat, Sept. 28th). Using a mock patient case, this event will focus on:

• Best practices in the treatment and management of COPD;
• How the new COPD fee code can be used in clinical practice and patient care; and,
• How to utilize the COPD flowsheet in a patient visit.

For evaluation results from the January 2019 webinar offering, please click here.

Upcoming Practice Improvement Priorities

Upcoming priorities include:

• A comprehensive Quality Improvement Program aimed at improving clinic workflow, practice management, and enhanced patient access (early 2020);
• Setting Up/Transitioning Your Practice (early 2020);
• Addictions Treatment — Advanced Training (Fall 2019);
• End-of-Life Care (early 2020); and,
• Frailty 2: Appropriate Prescribing, Elimination, Falls, Capacity Assessment, Advanced Care Planning (early 2020).

FPRP will host several events again this year at the 2019 Family Medicine Conference in St. John’s, including: 

Saturday, September 28: Navigating the COPD Patient Visit

Saturday, September 28: Networking Lunch — Get to Know Your Family Practice Network

Sunday, September 29: Information Session — Quality Improvement, Practice Management and Enhanced Access for Family Physicians (Two sessions)

For more information on the CFPC conference, click below.

Accountability and evaluation are a critical part of FPRP’s work. Melissa LeDrew, MSc is with the Newfoundland and Labrador Centre for Health Information (NLCHI) and is FPRP’s Evaluation Consultant. To learn more about FPRP’s evaluation work, please click here.

         
                      Melissa LeDrew (on right) presenting FPRP’s evaluation poster at
                       the Primary Healthcare Research Unit (MUN) PriFor 2019 event.