One-stop visits for health care

Albert Hammill likes to refer to his medical appointment at the new integrated care clinic at St. Paul’s Hospital in Vancouver as his “three-in-one.”

Albert Hammill likes to refer to his medical appointment at the new integrated care clinic at St. Paul’s Hospital in Vancouver as his “three-in-one.”

Facing heart disease, Type 2 diabetes and severely diminished kidney function, Hammill no longer needs to make separate appointments with the multiple specialists he needs to see — his conditions can now all be dealt with during one visit.

“It got to be a little bit of a pain. You know, you’re running around and have to go and see a doctor here and a doctor there,” says Hammill of the traditional health-care system.

“They would all want different blood tests at different times.”

But that all changed with the opening of the integrated care clinic in Vancouver in January.

“If you needed to see a cardiologist, there was one there every time you went to the clinic,” says the 81-year-old, who has had two cardiac bypasses since 1983. “If you need to see a diabetes specialist, there was one there every time you went. Occasionally I would see them, but I always saw the kidney doctors.”

The clinic takes a team approach: with the doctors — a cardiologist, endocrinologist and kidney specialist — a nurse co-ordinator, dietitian, pharmacist and social worker provide a kind of one-stop visit for patients with complex and chronic problems.

So far, says kidney specialist Dr. Monica Beaulieu, the clinic sees about 200 patients, most with a “package of illnesses.”

“Traditionally, you’d be referred to a diabetes clinic and then you’d be referred to our kidney function clinic and you may or may not be referred for a healthy heart clinic,” she says. “This time, you’re just referred to our integrated care clinic.”

Beaulieu says the set-up benefits patients because it has eliminated the often months-long wait for referrals to specialists and trips for multiple appointments.

“The most important thing they noticed first,” she says, “is the ability to do it at one place and not have to go back and forth.”

It also saves times for “middle-aged children who are taking time off work often to take their parents to all these different appointments.”

“So we get a lot, a lot of thank yous from the family members, in terms of this just makes more sense.”

Another bonus is that X-rays, blood tests and other lab analyses are arranged by a single care co-ordinator, thus avoiding duplication of orders from more than one specialist.

“It’s hard on their body and the health-care system,” Beaulieu says of patients undergoing repeated and often unnecessary tests, which are estimated to waste about $4.5 million a year for the chronic-care population alone.

Integrating care also means specialists can consult to avoid giving conflicting advice or medications.

“What it does is avoid the ping-pong with the patient and with the family doctor in the middle,” says clinic cardiologist Dr. Christopher Thompson.

For instance, a drug commonly prescribed as a boon for heart failure patients can be a bust when it comes to failing kidneys, he explains.

“So you could end up in this scenario where the cardiologist is saying, ‘Increase the ACE-inhibitor to improve heart function’ and the nephrologist is saying, ‘Oh, I don’t want to increase the ACE-inhibitor. I’m worried about decreasing kidney function.”’

By having specialists collaborate about an individual patient’s overall health profile, they can come up with a treatment plan that confers more benefit than harm, he says.

That co-operative strategy also prevents a patient receiving mixed messages and getting confused about whose advice to follow, says Beaulieu.

“Dietary’s a big one. We find that people do a lot of restriction of their diet … more than they have to, to the point of being malnourished, because they have the list from diabetes and the list from kidney and the list from heart.”

“And they say: ‘I can’t eat anything.”’

Beaulieu believes simple changes such as those being made by the clinic can make a huge difference both in patients’ health outcomes and their quality of life.

The long-term goal is to expand services to treat more diseases, among them lung disorders, arthritis and mental health issues like depression — and perhaps provide a model for other jurisdictions across the country.