Windsor Star article published on November 23, 2015.
Article in full pasted below. Brian Cross, Windsor Star
They don’t rush you, is the first thing that struck Essex retiree Jean St. Pierre when she began getting her primary care from a nurse practitioner instead of a doctor.
She and her husband Edward had a family doctor in Windsor, whom they liked very much, but the drive back and forth from their home in Essex was increasingly inconvenient as they became older and needed to visit more often. So when the Essex County Nurse Practitioner Led Clinic opened five years ago to address the town’s physician shortage, they switched. “And I really, really like it here,” said St. Pierre, who says that the nurse practitioners are all “wonderful,” and most of her health-care needs are met in the same office — by a dietitian, massage therapist, physiotherapist, social worker and a family doctor, who drops in once a week. “We have everything here and for older people it’s a convenience, you don’t have to drive into the city.”
Many agree with her. The clinic on Victoria Avenue started slowly but has gradually grown to 2,200 patients served by three nurse practitioners, an RN and about nine other staff. And while more doctors have moved into town — including two in the same plaza — the caseload continues to grow.
The situation’s similar at the VON’s nurse practitioner-led clinic in Belle River, which has almost 2,300 patients served by a team including three NPs. While the doctor shortage — the main reason it was created in 2010 — has improved, the clinic continues to grow by 16 to 20 patients a month. Lead nurse practitioner Lisa Ekblad said patient satisfaction surveys consistently score in the high 90s
“We’re not working alone, and if you can provide that kind of service to them they tend to stay,” she said, describing these clinics, not as a quick fix for a doctor shortage, but as a successful new way to access the health-care system. Essex widow Isabelle Ferguson, 86, said she wouldn’t trade her Essex NP-led clinic for a new doctor. “Because of the excellence of the treatment, and the time they spend and the (extra services) they have,” she said, citing how the previous night she attended a cooking class put on by the dietitian. “Everything I need is right there in that one little plaza.”
The initial perception in Essex was the NP clinic was brought in to “fill in” for the physicians. People didn’t have a good understanding of what a nurse practitioner is. They thought it’s the same as an RN or perhaps an RPN, so the clinic spent time educating people that NPs can do almost everything a family doctor can, except for ordering diagnostic tests like MRIs and CTs and prescribing narcotics. Once some people began trying the clinic, more followed.
“Essex is a small town — the seniors talk, everybody talks,” said nurse practitioner Tresa Hagell. What residents learned was the clinic offered so much more than the NPs. In addition to the dietitian, the counselling, the health education, and access to a chiropractor, there was a lab, so people can walk down the hall for a blood test. There’s also a physiotherapist at the clinic, which is a big bonus for people without employee benefits since it’s very difficult to access free (government-paid) physio.
And each NP regularly does housecalls for elderly, frail people unable to make it into the clinic. It’s a service that’s especially popular when the weather gets cold and miserable. “As long as you’re rostered here, you don’t pay for any of these services,” said Hagell.
“Once they understand our role, they love us, because we have the time to spend with them (about a half-hour per consultation) and our approach to care is more holistic,” said clinical lead NP Shelley Raymond, a former ICU nurse in the U.S., who upgraded her education to become a NP and has been at the clinic since it opened.
That means when a patient has high blood pressure, their initial reaction isn’t to prescribe a pill, she explained. Instead, they look at why the patient has high blood pressure, and hook them up with health professionals who can provide advice on modifying their lives through exercise and diet.
Raymond said now that she’s been at the clinic five years, she’s seen pregnant moms come in for prenatal care, and now she’s seeing their children. She’s happy that her patients no longer have to rely on walk-in clinics for their care and she loves doing the home visits — a throwback to another era that the elderly appreciate. “They’re very, very thankful and it’s just nice that we can do that here — you get lots of hugs,” she said.
Nurse practitioners are expected to carry a caseload of 800 patients and are paid a government salary that tops out at around $89,000. The clinic’s budget, for both its Essex site and its more recently opened site on Windsor’s Drouillard Road (where there’s one NP with about 400 patients), is $1.5 million.
While the clinics in Belle River and Essex are close to capacity, future expansion is up in the air, as is the future of all primary care. The health ministry is currently in the midst of a major review of how to deliver primary care.
In a statement to the Star, Health Minister Eric Hoskins said the 25 NP-led clinics were established in Ontario “to provide comprehensive, accessible and co-ordinated family health-care services by targeting Ontarians who have difficulty accessing primary care.” Currently, they service more than 49,000 patients.
“Ontario is the first jurisdiction to formally adopt this model and it is an example of the sort of innovation that will help to continue to improve care for Ontarians,” Hoskins said.
Pauline Gemmell, the administrator at the Essex clinic, said the patients don’t call it the Nurse Practitioner-Led Clinic. “They call it OUR nurse practitioner clinic,” she said. “I want this to be here when I retire and I’m older.”
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