Family doctors now proactively help groups of patients to improve the health of all

Improving the life of just one patient is a true success story for any treating physician and team. Radically transforming the care of almost 20 is a major achievement. Over the past year, the lives of many of Dr. Ted Jablonski’s patients got a whole lot better, thanks to an innovative practice enrichment project. The drug-switching initiative took 4 months initially and involved at least 6 staff. But patients such as retiree Gillian Bottomley say it was time well spent.

BEFORE THE CHANGE

Diagnosed with atrial fibrillation six years ago, Gillian had endured almost weekly trips to a lab to check that her blood coagulation INR (international normalized ratio) was in the correct range. When it was not, she would go more often. “My husband used to drive me,” she says. “I’d have blood running down my arm because my blood didn’t clot very well. If the count was too high, I’d go back four days later. I never really knew if my blood was too thin and if I was at risk of bleeding internally.”

NEW DRUGS

The drug Gillian had been taking was the gold standard treatment for atrial fibrillation for many years. For some patients, however, it was often ineffective. New oral anticoagulants were released several years ago, but were prohibitively expensive. So when Alberta Blue Cross announced last year that it would cover the cost of the new drugs in certain cases, Dr. Jablonski realized a huge group of his patients could benefit from the change. Together with his Calgary Foothills PCN liaison, the proactive care coordinator, in-clinic nurses and clinical pharmacists, Dr. Jablonski reviewed his electronic medical record for patients who might qualify and benefit from the switch. Staff contacted patients and clinical pharmacists offered counselling sessions.

BENEFITS FOR ALL

“I knew this would be a life-changer for these patients and it would save us a lot of time in the long run,” Dr. Jablonski says. The drug patients previously used had been a day-to-day issue for the clinic. Staff were constantly playing phone tag with patients who needed to adjust their dosage. It was time consuming. “If you can take all of that away and have a medication that is foolproof, it is easy to get buy-in,” Dr. Jablonski says. “It was a very satisfying process.” Dr. Jablonski estimates the drug switch has saved him at least a few hours a week, with about the same amount of time saved by health management nurses and clinical pharmacists at his clinic. “With even modest time savings from this initiative, our clinic is able to manage increased patient numbers,” Dr. Jablonski says. “Our whole team has more time to deal more completely with other patients’ issues. Was it time well spent? Absolutely, yes.”

For her part, Gillian says she has more peace of mind. Today she is less worried about the risk of blood clots causing a stroke because her new drug controls her blood better. “I am very grateful Dr. Jablonski has done this, that he thinks about his patients and what is best for them,” she says. “It has been terrific for my husband and amazing for me. I’m much happier.”