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Newfoundland and Labrador

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Provincial/Territorial Envelope

Lead and Partner Organization(s) :

Newfoundland and Labrador Department of Health and Community Services

Background and Goals :

This initiative is part of Newfoundland and Labrador’s (NL’s) ongoing efforts to reform its primary health care (PHC) system. It follows on the heels of Healthier Together: A Strategic Plan for Newfoundland and Labrador (2002); the establishment of the Office of Primary Health Care and a Provincial PHC Advisory Committee (2002); and the provincial PHC framework, Moving Forward Together: Mobilizing PHC (2003). Based on this framework, PHC includes a range and balance of services that promote health, prevent illness and injury, diagnose and treat episodic and chronic illness and injury, and encourage individuals, families and communities to achieve and maintain health. The new direction promoted a team-based interdisciplinary approach to services provision, with the aim of having PHC teams provide PHC services to at least 50 per cent of the province’s population by 2010. This province-wide initiative continues that approach, with the specific goals of enhancing accessible, sustainable PHC services; supporting comprehensive, integrated and evidence-based services; promoting self-reliant healthy citizens and communities; and enhancing the accountability and satisfaction of health professionals.

Activities :

During the four years of this initiative (2002–06), it undertook a wide range of activities.

To increase the proportion of the population having access to PHC organizations accountable for the planned provision of a defined set of comprehensive services to a defined population, activities focused on:

  • Developing, implementing and evaluating a provincial framework for PHC;
  • Integrating all services across the continuum (from primary prevention to acute and episodic illness) at the PHC service delivery level; and
  • Supporting PHC teams (serving populations ranging from 6,000 to 25,000 persons) to provide interdisciplinary services, based on the needs of the population served.

To increase emphasis on health promotion, disease and injury prevention, and management of chronic diseases, all PHC team areas worked on, and succeeded in:

  • Initiating Community Advisory Committees;
  • Enhancing wellness activities; and
  • Initiating the Diabetes Collaborative.

To expand 24/7 access to essential services, activities focused on:

  • Enhancing emergency transportation in some areas; and
  • Implementing a provincial 24/7 nurse phone line.

To establish interdisciplinary PHC teams of providers, so that the most appropriate care is provided by the most appropriate provider, activities focused on:

  • Securing provincial leadership support for implementation of PHC changes;
  • Establishing eight PHC teams, with ongoing evaluation, and assisting with their development as teams (in the areas of scopes of practice, chronic disease management collaboratives, Building a Better Tomorrow [BBT] initiative training modules, professional development, as well as partnerships with the inter-professional health education system for inter-professional development at the pre- and post-licensure levels); and
  • Opening up discussion on physician funding and contracts.

To facilitate coordination and integration with other health services, activities focused on:

  • Supporting providers to work together;
  • Establishing formal linkages through chronic disease management (CDM) collaboratives with secondary and tertiary services;
  • Electronically sharing health information through institutional, community and medical records, as well as through telehealth and Selfcare/Telecare (a teletriage and health information system in both official languages for all of Atlantic Canada); and
  • Forging partnerships—which have aided the development and approval of a provincial framework with the support of a Provincial Advisory Council; Working Groups; Family Practice and Inter-Professional Collaboration Department at Memorial University—and ongoing linkages and communications with associations, unions, etc.

Resources :

Key Learnings :

Despite some rather formidable challenges (majority of physicians being paid on a fee-for-service basis, NL’s large geography and small population, maintaining an Aboriginal health system along with the provincial one), NL has managed to advance its PHC reform agenda through this initiative. Eight PHC teams have been initiated, with three more team areas in the early stages of proposal implementation, and three more finalizing proposals. Proposals were based on population needs. Large numbers of professionals participated in team development and worked on scopes of practice processes, and early evaluation results show positive shifts towards increased teamwork. All PHC team areas established Community Advisory Committees, and all PHC teams, in cooperation with the provincial Wellness Strategy and Regional Wellness Coalition, increased support for wellness initiatives. The CDM Collaborative was implemented in the seven rural PHC team areas, and is in the early implementation stage in urban settings. The evaluation processes were formalized for all PHC team areas and for special projects (such as enhanced sharing of information). Partnerships were forged with academic institutions for professional education and development, as well as with the Newfoundland and Labrador Centre for Health Information to move forward with a number of information management initiatives for evaluation and future direction (sharing of electronic health information, telehealth, electronic medical record [EMR], and the PHC classification system ICPC2).

The provincial framework and the infrastructure that was developed supported PHC renewal activities in the province and will continue to provide support for future PHC team areas. These will also support implementation of all provincial health strategies at the service delivery level. PHC renewal will also be sustained by collaboration with stakeholders, capacity building for providers/leaders, seeking opportunities to integrate the BBT modules and standards of practice processes into professional practice; self-paced learning and web-based adaptations of some of the tools; leadership for PHC at the executive level of the Regional Integrated Health Authorities (RIHAs); exploring opportunities to continue with Memorial University of Newfoundland and the College of North Atlantic for professional education and development; and integrating the provincial leadership for PHC into the current Department of Health and Community Services structure.

The initiative’s organizers believe that much of what has been developed—proposals, scopes of practice, BBT modules, CDM Collaborative—will be useful to other departments and divisions within the Department of Health and Community Services, to the RIHAs, as well as to other jurisdictions and organizations.

Approved Contribution :

$9,705,620.00

Contact Information :

Sheila Miller
Director, Planning and Evaluation
Department of Health and Community Services Government of Newfoundland and Labrador
Phone: 709-729-7075
E-mail: millers@gov.nl.ca

This initiative was supported by the Primary Health Care Transition Fund. The views expressed herein do not necessarily represent those of the federal government. The above information was prepared on the basis of the initiative’s final report, in consultation with its author.