June 11, 2025 • 38 mins
Nova Scotia is on a journey to improve access to primary care for all Nova Scotians. This includes more providers, expanding the scope of practice for pharmacists and nurse practitioners, registered nurse prescribers, developing Health Homes so that care is collaborative with same-day/next-day appointment access, and creating the YourHealthNS app to put care directly in the hands of Nova Scotians.
Listen in as Karen chats with Bethany McCormick, vice president of operations for Northern Zone, and executive sponsor for Primary Healthcare and Madonna MacDonald. acting vice president of operations for Primary Healthcare in Central Zone. Their titles are long, but their impact on improving access to primary care will leave an even longer legacy.
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Interested in learning more about becoming a Health Ambassador? E-mail: podcasts@nshealth.ca
Editor's note: Since recording, the YourHealthNS app has now surpassed 700,000 downloads, and there are 91,423 Nova Scotians on the Need a Family Practice Registry (as of June 1, 2025).
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
Hello and welcome to Chats on Change, a Nova Scotia Health
podcast with your host, interim CEO Karen Oldfield.
Well, hi there folks. We we have two guests today.
We have Bethany McCormick and Madonna McDonald.
I'm going to introduce them bothto you, but I'll just say good
morning 1st. And did you guys have a good
weekend? Yes.
(00:22):
Yes, Good morning, Karen. Yeah, good.
Morning weekend. That's good.
Well, let me, let me start by introducing you both.
I mean, I, I've worked with you now for 3 1/2 years.
So I feel like I know you, but not everybody does.
So let's start Bethany under theBees, Bethany McCormick.
Bethany is the vice president ofoperations for Northern Zone.
(00:42):
She's she is the executive sponsor for Primary Healthcare.
She's recognized within Nova Scotia Health for achieving
goals through a shared vision and strategy development,
fostering highly productive working relationships, leading
effective teams, innovative thinking and managing multiple
and complex situations. I would say all of that and
(01:05):
certainly you're very data-driven and that's one of
the things that makes Bethany very good for this project and
and successful. So Bethany has a Bachelor of
Science in occupational therapy from Dalhousie and a master's of
in occupational therapy from theUniversity of Alberta.
I didn't know that. Bethany's a certified health
(01:25):
executive with the Canadian College of Health Leaders and
received the extra fellowship from the Canadian Federation of
Healthcare Improvement. So welcome Bethany.
And now to McDonough McDonald, aregistered nurse, acting Vice
President of Operations for Primary Healthcare in the
Central Zone, and along with Doctor Aaron Smith, leads the
(01:47):
implementation of the Health, Health, Home Health Neighborhood
Initiative that we will talk about today.
Living and working in rural NovaScotia for most of your 40 year
career really. So you were a child prodigy for
sure? Definitely, Madonna believes
that strengthening primary Healthcare is essential to
(02:08):
achieving a sustainable, high quality healthcare system.
Yes, kudos to that and a master's degree in epidemiology.
She has extensive experience planning and operating community
health services. Madonna was part of the proposal
team that brought the National Collaboration Center for Social
Determinants of Health to Saint Francis Xavier University,
(02:30):
supported Accreditation Canada'sleading practice for work with
Migmoggy Communities, and is an executive sponsor of the Health
System Leadership Academy. Well, the two of you are very
highly regarded and very well versed in the healthcare system
here in this province, certainlyin the acute care system.
(02:52):
And what you're doing in the primary system along with, you
know, a big team is really very interesting and quite
transformational, bordering on revolutionary actually.
So that's what we're here to talk about today.
So where, where should we start?So we had a list, it was a list.
(03:14):
Now it's not a list, it's something else.
So I would like to talk about that.
I'd certainly like to talk about, you know, that list went
as high as 165,000 people. It's now down to 94,000 and
continuing to go down. So I'd like to talk about how
we're doing that. We have started to use the
terminology of health, home health, neighborhood.
(03:37):
We certainly need to talk about that.
And what does that look like? So, so how about we start with
those three things and then we can go from there.
And so Bethany, I know you were very involved in the creation of
the list and also the conversionof the list to a usable piece of
data. So tell me what we had and tell
me what we have. Thanks, Karen.
(03:59):
So the need of family practice registry originally was really a
list or a tally of people who were looking for a doctor or
nurse practitioner. That's where we came from.
Where we are now is that list istransformed into a tool that we
can look at where the person lives, their health complexity
score, or how many health areas they're concerned about that
(04:22):
they self report to us. And then that helps us
understand how to connect them to the best care options and how
to match them to a health home, which we'll talk more about.
It's a tool now that allows us to proactively connect people to
the right care and services and also connect them to a health
home that's right for them in their community.
(04:42):
So I think the word proactively is one of the most important in
in your answer there. And you know, I say that because
with with a simple list there, there was not that ability, is
that correct? Yeah.
So so how does this really help the overall system?
So when we connect people or place them on the registry, it
(05:04):
gives us a signal that they're looking for a nurse practitioner
or family doctor near their home.
And now we can look at their health needs.
We can reach out to them and talk to them about what kind of
access they're looking for, whatother services they're using
while they wait to be connected to a health home, which is a
really important part of this. We can look at their health
concerns and suggest to them virtual care or our primary
(05:26):
healthcare clinics or a pharmacyclinic or other options while
they wait for a health home. So that allows them to have good
access in Nova Scotia, why they wait for a health home and then
we can connect them to the health home team that best meets
their needs and is close to their home in their
neighborhood. So what I hear in that is the
ability to have some back and forth and and I and I think that
(05:49):
was a missing piece from a simple list, a tally of names.
Yeah, and we're trying to make regular connections with folks
now. So we've been validating the
list or calling out to people tosee if they found a nurse
practitioner or a doctor yet, ifthey still need one and it and
what they're, you know, their health score is or their health
(06:10):
needs. But also checking in with them
regularly that they know the different ways they can access
services while they wait for a health home.
So that regular connection is important.
We haven't reached everyone yet,so I just want to reassure folks
that we're still reaching out. So if you hadn't had a call or
an e-mail yet, we've not forgotten.
We're working through the list. Now, Bethany, you'd made a
really important point about nothaving the complete list
(06:34):
validated. So I'm not really sure where you
are precisely, if you were able to share and what that means for
somebody who's been listening since July.
They're going to get a call, they're going to get an e-mail
and they haven't. And somehow I find those folks
find me and I would like to share with them what they what
they should anticipate. So I would say we're probably
(06:55):
about 2/3 of the way through thelist, which means that we've
either called or made an attemptto call or sent an e-mail to
someone to ask them do they still need a healthcare
provider. So when we call someone to do a
validation, we use the phone number that's listed on their
file in the registry. So it's important that that
information is up to date. We try them three times to reach
(07:18):
them. Sometimes folks are reluctant to
answer the phone or it's not a convenient time for them to
answer our call. So we haven't always reached
folks. So we've also switched to using
e-mail now. And we are seeing some higher
rate of kind of response with the e-mail.
But email's not also not right for everyone.
And the e-mail doesn't allow us to really have a good chat with
(07:39):
the person about the service options available to them, their
health concerns. So we're going to keep using
both methods to reach people. And if we haven't reached you
yet, hang on. We're working through the list
and we'll be reaching out to more and more people in the
coming months. And the other thing is folks can
always update their information on the registry themselves.
So you can contact 811 to do an update.
(08:01):
You can do it through our website, through the Need a
Family Practice Registry website, and you can also
complete your health questionnaire.
If you haven't done that. It's voluntary, but we encourage
everyone to do that because the more we know about your health
concerns, the easier it is for us to match you to the right
service. That's great.
So I really appreciate that and thanks, Bethany.
The terms health home and healthneighborhood are being used not
(08:26):
just in Nova Scotia, but I notice other provinces,
including Ontario starting to gravitate to that kind of
terminology. And just to make things simple
for people, you know, when we use the terminology health home
or health neighborhood, what really are we talking about?
Karen, we're really talking about the primary care practice.
(08:49):
It may be a solo provider, it may be a collaborative team, it
may be a community of resources and supports that actually
support you as an individual, your family and your community
and their healthcare journey. So when we talk about Health,
Home and Nova Scotia, we're we're really talking about a
continuum of services. A primary solo provider doesn't
(09:13):
have the resources and supports wrapped around them as our
collaborative practice teams do.So we consider we're on a
journey to build and the the type of supports that we often
see in hospital around family physicians and nurse
practitioners in community. And we're also talking about
supporting long term care relationships as close to home
(09:35):
as possible and considering you as an individual, your family,
as partners in care. This is your health.
Health is a tremendous resource in ensuring you have a quality
of life. And so we want to build a
supportive care approach to thatin Nova Scotia.
So that's the vision. So we, we have on the one hand a
(10:00):
sole practitioner, if you like, a sole provider.
So a physician who's alone in their office other than their
admin perhaps. And so versus a collaborative
care set up. So I think I get the notion of a
sole provider, but when you talkabout a collaborative care, what
(10:21):
exactly might that entail? So a collaborative care team
usually has provided professional healthcare
providers in addition to either a nurse practitioner and or a
family doctor. So you may see practices across
the province and we have 115 collaborative care teams
underway right now in Nova Scotia.
(10:42):
You'll see dietitians, you may see social workers, you may see
psychologists, you may see pharmacists.
You'll hopefully see family practice nurses or registered
nurses, licensed practical nurses, and others to support
and work with that family doctorand nurse practitioner and the
patient themselves. What about a pharmacist?
Where might a pharmacist fit into that scenario?
(11:05):
So we see pharmacists fitting inin a lot of different ways.
They understand a lot about yourmedical health.
They understand a lot about medications, how medications
interplay with if you're someoneliving with diabetes, if you're
someone living with learning disabilities, with mental
illness. So they offer their special
knowledge to that care team and can give advice.
(11:27):
And also we're working in partnership with pharmacists and
pharmacies across the province to provide access to primary
care if you need some vaccines, if you need some diagnosis like
an urinary tract infection, thatexpanded care has happened as
part of this health home movement.
So we're going to come back to that.
(11:47):
So I, I guess just to extrapolate from what you've
described health home, then the next milestone along the journey
is a health neighborhood. And what is different about a
health neighborhood from what you've already mentioned?
So, Karen, and you know, I wouldsay in my experience, there are
many neighborhoods across Nova Scotia where health and social
(12:10):
care services are integrated and, and, and primarily I've
worked in rural communities. So we see that we help our
neighbors, hospitals help local pharmacists, we work with NGOs
like family resource centers to support young families and
caring for children. So really in the health
neighborhood, we're talking about a more organized, seamless
(12:36):
transition and relationship of supports to wrap around
individuals, families and communities.
Got it. So just so I have a clear
picture in my own head, then if we have on the one end of the
spectrum a soil provider, then the the aim is to connect the
sole provider to all of these other supports or vice versa,
(13:00):
right. OK, great.
So that's the vision. You know, in many ways how that
how I see that in my head is, isalmost like just an
interconnected chart where the boundaries have come, have come
down. So there's no artificial
boundary or or nothing that's preventing the connectivity of
(13:24):
all of the different providers, caregivers, resources in a
particular community. That's really what I see.
So part of the trick I think is to make sure that they are able
to easily talk to each other. So that is either through
technology or the data or both. So I guess that's the next big
(13:46):
step on the journey when we cometo talking about OPOR, which is
not really part of this, but maybe you could comment on it,
Bethany, because you're very familiar with it.
I think that in primary care, weleverage lots of different
technology opportunities where we can and we're continuing to
build forward on that. So the EMR or the electronic
medical record that we use in a primary healthcare practice is
(14:09):
really the repository for all that patient information.
Many practices are able to shareacross offices if they're on the
same kind of network, so to speak, which allows more
seamless care and connection to that information about the
patient. And we also have access to
information through provider portals or ways that we can look
(14:30):
in to see about a visit to an emergency department.
And that will become easier and easier with OPOR.
The other thing that's been verytransformational has been the
Your Health System app. Oh, yes, and, and you can
actually do the commercial, yeah.
The Your Health NS app, so this the new app that Nova Scotia has
(14:51):
brought into play, is a great place for folks to be able to
connect to their own health information if they set up an
account, but also to health services.
So you can use the virtual assistant to navigate yourself
to the right health service by answering a series of questions.
You can also access virtual careNova Scotia virtual basic care.
(15:12):
You can also connect to mental health and addiction services
and many other resources for Nova Scotians.
It's really a nice easy navigation tool.
You can use it on your phone or in your computer, and you can
still access 811 as well if you're someone that doesn't use
technology quite so easily. Perfect.
So I don't know if these will show up, but we did put the QR
codes there. So I've learned over time you
(15:34):
can actually even do that on a computer screen.
So anybody who's watching on YouTube or whatever can can
click on if they want to the. So I, I want to talk a little
bit more about that app as a point of access.
So let's just kind of back up. So now we've talked about the
list, we've talked about health,home health, neighborhood as as
(15:55):
perhaps a bit of a vision the Sonow if we come right back to the
94,000 people that are on the list and just the, the notion of
access in Nova Scotia generally.So you said, Bethany, that we
have so many more access points now.
So maybe between the both of you, we can actually start to
break that down because I find still just going out into
(16:20):
community. And in the past two weeks, I've
been in Shelburne at the Rose Way and had the opportunity to
meet with many of the local leaders, the mayors, the
wardens, the Caos, which was an excellent, really good
conversation. And, and one of the things that
we all acknowledged is that people do not know all of the
(16:44):
points of access. And secondly, you know, there is
still the stigma attached to technology.
Maybe people don't have a phone,maybe they don't have a
computer, or maybe they aren't savvy.
So so there's an education piece.
So that's one. And I also spent some time in
Cape Breton last week, got the regional.
(17:05):
I went to the north side, went to the new campus of of the CBU
medical school, and I also went to straight Richmond and to
Saint Martha's. So I've been on a little bit of
a tour, yes. And again, you know much as we
think we've over communicated and communicate, communicate,
it's never enough. So we do have some great points
(17:28):
of access now. So I'm going to toss it over to
the two of you and you can kind of split it up between you as to
some of the access points that have been developed.
So maybe I'll start with virtualcare.
So we have a lot of virtual options now available in Nova
Scotia across a spectrum actually.
So we have Virtual Care Nova Scotia, which is provided by
(17:50):
nurse practitioners are doctors who live and work in Nova Scotia
and they provide full access virtual care.
So they can order diagnostics, they can renew medications, they
can refer you on to specialists.And that one's available for
only those 9% of folks in Nova Scotia that aren't attached.
So it's a really great access point for those that are still
waiting to be connected to a health home, OK.
(18:11):
So let's just pause. So we have 9% of Nova Scotians
on that list, 94,000, and those individuals have full, whenever
they need it, access to Virtual Care Nova Scotia, which as you
say is the full range of diagnostics lab.
(18:32):
And then what if a person neededto be seen in person?
So if you have a Virtual Care Nova Scotia appointment and they
feel that you need to be seen inperson, they can refer you to a
primary healthcare clinic in theprovince.
We have 19 of those and they cansay I'd really like Bethany to
be seen in person for an in person visit.
(18:52):
We make that referral and you get booked in.
Perfect. So who makes the referral?
Virtual Care Nova Scotia. Just does it.
Automatically can can make that appointment and the patient can
also reach out themselves. OK.
So this is a very important point of access and I think the
use is quite high. We've gotten up to close to 600
appointments a day from those onthe need of family practice
(19:16):
registry and another going from memory here, but it could be
another 300 ish for people who actually have a physician.
So maybe you could talk about that the way that works,
Bethany. So for every person in Nova
Scotia, if you have a provider or not, you can access what's
called basic virtual care. Versus full?
(19:37):
Full care. Yeah, basic care.
So a smaller suite of services, I put it that way.
So more basic health assessment,medication renewals, they cannot
order, diagnostic tests, those types of things.
That's the primary difference. So every Nova Scotia has two
appointments a year that we can use with basic care for a
(19:58):
healthcare need. So if you're lucky enough to,
you know, be connected to a health home, but you still need
access point, but you don't needto go into your office in person
or you don't really need that continuity of care from your
family doctor, you can use the basic virtual care.
Sometimes it's very convenient option.
For people to have a basic healthcare need met, great.
OK. So those are that's virtual care
(20:19):
and you said there were a numberof other virtual components.
So what? What are the others?
We have virtual urgent care and this is a slightly higher level
of service where we can see more, more ailments, minor
concerns, just maybe a touch higher than the primary
healthcare that you'd see in thevirtual care Nova Scotia.
You can access that through manyrural emergency department
(20:44):
locations. So for example, in my zone, we
offer that in Spring Hill and inPugwash and you go to that
hospital, you were seen by a nurse in person and then they
connect you to a virtual physician for your appointment.
It's a really nice opportunity for some of those rural
communities to continue their their urgent services when they
might be challenged with a health in.
(21:05):
Between, in between, almost in between primary and emergency,
So. That's right.
OK, great. So that's number two.
And then what's #3? Oh well, there's more than
three, but sorry. Sorry, I just go to three in my
own head. Yeah, yeah.
So the pharmacy clinics, so we have many pharmacies across the
(21:25):
province that offer expanded Primary Health care services and
they can, you know, diagnose andtreat minor ailments like UTI,
bladder infection. That's what UTI stands for, you
know, eye irritation, you know, other concerns.
So you can get testing for strepthroat, those kinds of things.
(21:46):
So that's a nice option for folks whether you have a
healthcare provider or not. Really timely access, easy to
book. You can do it through the app,
you can do it through your direct to your pharmacy.
You can pick an appointment anywhere in the province.
You can do them virtual or in person.
It's a great option. So I would do that through my
app, probably myself. Otherwise, how would I know
where to find these people? Well, you can.
(22:09):
Sometimes you know the pharmacy in your community that offers
the service and you have a relationship with them.
So you call and you book directly.
Actually when when I I did need this within the last couple of
months because I was developing a call source.
So this is like this is emergency for me.
Of course, it's not a true emergency, but if you don't
(22:29):
catch them early, it's a problem.
So, so I'm on the app, you know,where's the closest because my
pharmacy is not one of these pharmacies.
So I wasn't able to book an appointment per SE at my
pharmacy. But anyway, so I did it all
through the app, took me a little bit of took me a little
bit of finding out, but actuallyin the end it was pretty easy to
(22:51):
do. The the thing that I like to
remind folks is that many of thepharmacies can do the
appointment virtually. So I had the experience where I
had a bad bladder infection. I wanted to get in really
quickly. I looked for the first available
appointment in the province. When?
Was it? It happened to be in Picto, OH.
Well, that's good. But I didn't have to go, didn't
(23:13):
have to drive there. I did it by phone 3030 minutes
after I looked for it. Oh, that was good.
And got a prescription within anhour and got my care.
Didn't have to call my family doctor, didn't have to wait.
And I didn't have to buy the medication from the pharmacy
that did the appointment either.Well, that's just a great.
Yeah, a great experience. Yeah.
OK, so you've talked about threethings.
What else, Madonna? So I want to speak about mobile
(23:36):
clinics. My mobile clinics, I almost
forgot about those. How could I forget about mobile
clinics? We, we start at mobile clinics
during COVID and we really learned a lot about being
accessible in rural communities and in communities where they
may be facing a certain prevalence of illness.
(23:56):
And so those continued, both offered by public health and by
Primary Health care. We see them serving in times of
high respiratory illness in somecommunities.
I, like Bethany, had to use a mobile clinic.
I was taking my grandson from Hockey and Mabu.
I looked over at the community hall and there was a mobile
clinic. I knew I needed a flu shot.
(24:17):
I went in, I got my flu shot, had a good chat with nurses I
had worked with at Saint Martha's.
So I think it's about accessibility and also knowing
what's available in your communities and how to really
connect and be available. I mean, in rural communities,
you may, you may not be someone who's on an app, but you can, we
often talk about it. Ask at your provider, see at
(24:38):
your pharmacy signs, those kindsof things.
And so it is accessible. And I will say in talking with
some of the leaders in that public health and primary
healthcare space, public health says they're getting a lot of
questions about navigating our health system when they hold
those mobile clinics. So they're able to share about,
oh, look, if you're looking for this, this is where to find it
(24:58):
or these are the apps. So it's about being connected in
these communities and helping people understand the range of
resources that are now availablethat weren't 10 years ago.
But I think it's key as you juststated, help navigating the
system. It's complicated, it really is.
It shouldn't be, but because it's so desperate and it's
(25:21):
different in community to community to community, you do
need to sometimes get some help.So you know, what do you suggest
for people who are looking for help?
What's the best way to find out how to navigate?
I think there's different ways that work for different people.
So if you have a clinic that you're connected to, you know,
(25:43):
connecting with that clinic directly, asking them about your
specific concerns can be helpful.
The app of course has a wealth of information.
We also have information on our website, you know where to go in
Nova Scotia. 811 continues to beavailable for folks that are not
as technology inclined or don't have access to, to use that.
(26:05):
And then we do have, as Madonna said, you know, posters and
things up in local community areas and some of my very rural
areas that I work with, we actually post things on their
community boards, in their community halls, their churches
and so on. Here and also if folks are not
comfortable using computers, if you have a local library, often
(26:26):
you can get support through a a Community Center offered by
federal government. But 211, which like 811 can link
you to to a range of health services.
But 211 is available in Nova Scotia and they have a
navigation service for social and health access as well.
You know, I think just reflecting on what you've both
(26:47):
said and just, you know, what I know from my own travels around
the province, like we do need todo more around the education of
access. And the one of the things we did
last summer, which proved to be,you know, well received.
We had a number of summer students hired to act as health
ambassadors and going into whether it be nursing homes or a
(27:12):
curling club or, you know, a, a community event that was up to
them to figure out where the most people would be and to
share the information that we'retalking about today.
And I think we will be doing that again this summer.
But in addition, you know, it's great for students because it's
(27:33):
it's a learning experience for them and they're so good with
the technology. They can help folks.
But I think also there are a number of either retired
healthcare professionals or justvolunteers that want to help in
a different demographic that also know places where people
(27:55):
are who could use some help. So we're looking to broaden the
demographic of our health ambassadors too, beyond just
students. So I hope that that will help.
Now, I think we're kind of coming up to time, if you can
believe it. So what I would like to ask both
of you from your perspective is,you know, do you I'd like to
(28:18):
understand what part of the workthat we've just talked about you
consider to be transformational.So we're kind of talking about
change here today. But you know, as a newcomer to
healthcare, I don't always know what was, so I don't always
fully appreciate the change thatis.
So I'd like both of you to reflect and comment.
(28:42):
Well, I've been thinking about what has made it possible for us
to bring the need a family practice registry down and it's
many things. And the one thing that we
haven't really talked about yet that I think has been one thing
that I wanted to highlight is the transformation within the
teams and the clinics that are accepting new patients from the
list. So we're working differently
with healthcare providers and teams to really create
(29:04):
efficiency, to change the mindset around shared care and
that health home, as Madonna described, bringing patients
into the clinics more quickly and efficiently.
So really just changing the how we do the work has created a lot
more capacity to serve more NovaScotians in a really effective
(29:24):
and connected way. So with managing the the native
family practice registry from a list to a tool has been one part
of it. But we had to have clinics and
teams willing to accept those patients in a new way.
And it's been really transformational to on board the
patients or connect the patientsin a different way to manage the
(29:46):
way we have hours in the clinicsorganized.
Like having more same day, next day access even in a primary in
a health home is a really big deal for folks.
Even when you're connected to a clinic, if you can't get in for
six or eight weeks, then you're looking for other options.
So we've changed so many things,how we pay the family doctors as
impacted same day, next day access, for example, we've
(30:08):
recently changed their payment model.
So all of these things together have really created a multi
pronged strategy that have really created momentum that's
just building and building. And as we connect more people,
bring in new providers, create more efficiencies with the
teams, I'm really excited about getting the number lower and
lower so that more Nova Scotiansare connected to a health home
(30:29):
well. You're, you're singing my song
on that one, Bethany, so I appreciate your reflection.
And what about you? Madonna So what I would say
Karen is one of the things unintended impacts of of working
through COVID was we saw a lot of folks didn't access
healthcare regularly or at a time when they really needed it.
And so following that, we saw really an overburdening and
(30:52):
almost a reaction where more folks needed more complicated
care because they hadn't received it at the right time in
the right place during COVID. And so transformationally that
really I think made us reflect on what are the important
supports and services to help the public access care in
(31:13):
community long before they need a hospitalization.
Or COVID or not COVID? Absolutely.
More about diabetes, chronic conditions so that they're
managed appropriately, that we have emphasis on preventive
work, you know, all kinds of things.
Not only the social supports that are available, but how to
prepare meals. There's a whole range of
(31:33):
supports and services that we see, but most importantly that
if folks need to have an intervention by their primary
care team, those nurses, doctors, nurse practitioners,
dietitians, social workers, thatwe really have a strong
foundational network in community that can help respect
(31:54):
the individual's time. So they're not in a hospital
waiting for care, but the care is provided in a much more
timely fashion in community. So as Bethany described, we're
working to support the WRAP around supports for physicians
and nurse practitioners in Nova Scotia so that we're better able
to support individuals, familiesand their communities at home
(32:17):
because their time is just as precious as healthcare
providers. Absolutely.
So, you know, that's a really great reflection.
I've got three more really quickpoints.
I know that you, Bethany, do a lot on the mental health and
addictions, and I just wonder ifyou could just briefly elaborate
on the kinds of tools that are also available in your Health
(32:37):
Nova Scotia app or or in other places.
So the mental health and addiction service is available
across the province. There's a centralized intake
phone line where people can selfrefer or be referred by a mental
or a primary care provider or orsomeone else to have an
assessment by a clinician and then they determine the services
that you might need. Services could range from
(33:00):
anything from like a community based group, any mental health
tool or a tool that you can use online self-directed.
I've used one of those. I loved it just around like
mindfulness and, and staying well all the way up to being
connected to an outpatient clinician for therapy or a
crisis team or an inpatient stay.
(33:20):
And so that intake line is a really key point.
We also have a 24/7 crisis line where people can call at any
time and speak to someone if they're feeling they're in a
mental health crisis. And we also nationally now have
the 988 suicide prevention line that also people can dial the
988 number and be connected to someone in that they have a
collaborative relationship with our local crisis team here.
(33:44):
And then in the app, there's also numerous links to our our
mental health tools and resources that folks can use
self-directed and there's there's a whole plenitude of
things there. We also have recovery support
centers which are a walk in service, low barrier access for
folks dealing with substance use, gambling or addictions
concerns. Great.
Thanks, Bethany. And just a final note on the
(34:07):
app, I looked at the numbers last week and I was actually
quite astounded. We're over.
We're 626,000 Nova Scotian, so well more than half like, which
is astounding and really good, you know, validation that that
people want their healthcare in their hands.
(34:29):
And so you know, we're going to keep going on that.
Now Madonna, I know you are verymuch a people person and it
would be incorrect to assume that Madonna, MacDonald and
Bethany McCormick are carrying everything we've talked about by
themselves. So I'd like you to maybe comment
(34:49):
on the teams, Madonna and give agive a thumbs up to the work of
the teams. Thanks, Karen.
Really this is a work of many partnerships, Nova Scotia
Health, the IWK working in partnership with our government,
Department of Health leaders whoare involved in really setting
the vision for where we want to go in terms of health home
(35:11):
health neighborhood. Most importantly, the providers.
Bethany spoke earlier about the providers who really readily
accepted our our calls, our support who are asking us what
do you mean by health home. And in Nova Scotia we're
building on the College of Physicians medical health home
model and expanding it to the health home model to recognize
(35:34):
and and really place a value on the breadth of providers that
contribute to someone's individual care.
And so they're key because if healthcare providers, the
doctors, nurses, nurse practitioners, dietitians,
social workers, pharmacists and others who are not part of the
care don't want to take part, we're not going to be
(35:55):
successful. No, if they don't see themselves
as part of the solution, pretty hard to to get.
There they're key and and we have and also importantly, as
we've said, you as individuals to be partners in this.
I, you know, Karen knows I call it a social movement and we were
joking because she referred to sort of some of the, the Cody
(36:15):
and Tompkins movements way back in the day.
We're there. We're, we're, we're put well,
well, not only are we there, butwe are actually putting D2, you
know, D2 concept. Exactly, This is really about
working differently. Perhaps it happened in the past.
We see great examples in First of First Nation communities in
(36:36):
Nova Scotia where they build on a neighborhood concept in terms
of their collaborative care teams and and you become part of
their practices. So we have a lot to learn by the
many community health centers, the practices like the Mentor
Clinic, lots of family physicians who've taken on other
providers in their practice and collaborative team to move this
(36:57):
forward and also our history of social movement.
And don't forget Noella Whalen and Dr. Maria Alexiadis.
Have they helped you? Oh my gosh, yes.
Doctor Maria Alexiadis, Noella Whalen have been instrumental.
They work with a whole group of folks who.
(37:18):
Right across the province, all. Across the province, the
practice support teams, the leaders who have been
strengthening our primary care clinic model, the our academic
learning partners. When we see Cape Breton
University, Dalhousie St. of X in terms of nursing and others,
the colleges, they're all critically important in terms of
(37:40):
looking at how do we shift policy to enable these changes?
How do we practice differently? We've seen an investment in the
PACE clinic in but with the College of Physicians Dr. doctor
well with and how that can help us prepare and learn differently
in terms of shifting practitioners into practice who
come from other countries. So there's a wealth of work
(38:04):
foundational to this movement inNova Scotia, and I think we can
learn a lot from people who are already championing it.
Yes, I totally agree. And you know, the proof's in the
pudding. We're taking the list down.
We know where we're going. We've put the pieces in place to
take us there. So now it's just head down doing
(38:24):
the work. So as two of the people who
really lead much of the work andall of the folks that you
mentioned, I'd like to say thankyou.
You guys are doing a great job. You know, we need to do it
faster, but but we're doing it. So I appreciate what you folks
do everyday for Nova Scotians and thanks for sharing.
Hello and welcome to Chats on Change, a Nova Scotia Health
podcast with your host, interim CEO Karen Oldfield.
Well, hi there folks. We we have two guests today.
We have Bethany McCormick and Madonna McDonald.
I'm going to introduce them bothto you, but I'll just say good
morning 1st. And did you guys have a good
weekend? Yes.
(00:22):
Yes, Good morning, Karen. Yeah, good.
Morning weekend. That's good.
Well, let me, let me start by introducing you both.
I mean, I, I've worked with you now for 3 1/2 years.
So I feel like I know you, but not everybody does.
So let's start Bethany under theBees, Bethany McCormick.
Bethany is the vice president ofoperations for Northern Zone.
(00:42):
She's she is the executive sponsor for Primary Healthcare.
She's recognized within Nova Scotia Health for achieving
goals through a shared vision and strategy development,
fostering highly productive working relationships, leading
effective teams, innovative thinking and managing multiple
and complex situations. I would say all of that and
(01:05):
certainly you're very data-driven and that's one of
the things that makes Bethany very good for this project and
and successful. So Bethany has a Bachelor of
Science in occupational therapy from Dalhousie and a master's of
in occupational therapy from theUniversity of Alberta.
I didn't know that. Bethany's a certified health
(01:25):
executive with the Canadian College of Health Leaders and
received the extra fellowship from the Canadian Federation of
Healthcare Improvement. So welcome Bethany.
And now to McDonough McDonald, aregistered nurse, acting Vice
President of Operations for Primary Healthcare in the
Central Zone, and along with Doctor Aaron Smith, leads the
(01:47):
implementation of the Health, Health, Home Health Neighborhood
Initiative that we will talk about today.
Living and working in rural NovaScotia for most of your 40 year
career really. So you were a child prodigy for
sure? Definitely, Madonna believes
that strengthening primary Healthcare is essential to
(02:08):
achieving a sustainable, high quality healthcare system.
Yes, kudos to that and a master's degree in epidemiology.
She has extensive experience planning and operating community
health services. Madonna was part of the proposal
team that brought the National Collaboration Center for Social
Determinants of Health to Saint Francis Xavier University,
(02:30):
supported Accreditation Canada'sleading practice for work with
Migmoggy Communities, and is an executive sponsor of the Health
System Leadership Academy. Well, the two of you are very
highly regarded and very well versed in the healthcare system
here in this province, certainlyin the acute care system.
(02:52):
And what you're doing in the primary system along with, you
know, a big team is really very interesting and quite
transformational, bordering on revolutionary actually.
So that's what we're here to talk about today.
So where, where should we start?So we had a list, it was a list.
(03:14):
Now it's not a list, it's something else.
So I would like to talk about that.
I'd certainly like to talk about, you know, that list went
as high as 165,000 people. It's now down to 94,000 and
continuing to go down. So I'd like to talk about how
we're doing that. We have started to use the
terminology of health, home health, neighborhood.
(03:37):
We certainly need to talk about that.
And what does that look like? So, so how about we start with
those three things and then we can go from there.
And so Bethany, I know you were very involved in the creation of
the list and also the conversionof the list to a usable piece of
data. So tell me what we had and tell
me what we have. Thanks, Karen.
(03:59):
So the need of family practice registry originally was really a
list or a tally of people who were looking for a doctor or
nurse practitioner. That's where we came from.
Where we are now is that list istransformed into a tool that we
can look at where the person lives, their health complexity
score, or how many health areas they're concerned about that
(04:22):
they self report to us. And then that helps us
understand how to connect them to the best care options and how
to match them to a health home, which we'll talk more about.
It's a tool now that allows us to proactively connect people to
the right care and services and also connect them to a health
home that's right for them in their community.
(04:42):
So I think the word proactively is one of the most important in
in your answer there. And you know, I say that because
with with a simple list there, there was not that ability, is
that correct? Yeah.
So so how does this really help the overall system?
So when we connect people or place them on the registry, it
(05:04):
gives us a signal that they're looking for a nurse practitioner
or family doctor near their home.
And now we can look at their health needs.
We can reach out to them and talk to them about what kind of
access they're looking for, whatother services they're using
while they wait to be connected to a health home, which is a
really important part of this. We can look at their health
concerns and suggest to them virtual care or our primary
(05:26):
healthcare clinics or a pharmacyclinic or other options while
they wait for a health home. So that allows them to have good
access in Nova Scotia, why they wait for a health home and then
we can connect them to the health home team that best meets
their needs and is close to their home in their
neighborhood. So what I hear in that is the
ability to have some back and forth and and I and I think that
(05:49):
was a missing piece from a simple list, a tally of names.
Yeah, and we're trying to make regular connections with folks
now. So we've been validating the
list or calling out to people tosee if they found a nurse
practitioner or a doctor yet, ifthey still need one and it and
what they're, you know, their health score is or their health
(06:10):
needs. But also checking in with them
regularly that they know the different ways they can access
services while they wait for a health home.
So that regular connection is important.
We haven't reached everyone yet,so I just want to reassure folks
that we're still reaching out. So if you hadn't had a call or
an e-mail yet, we've not forgotten.
We're working through the list. Now, Bethany, you'd made a
really important point about nothaving the complete list
(06:34):
validated. So I'm not really sure where you
are precisely, if you were able to share and what that means for
somebody who's been listening since July.
They're going to get a call, they're going to get an e-mail
and they haven't. And somehow I find those folks
find me and I would like to share with them what they what
they should anticipate. So I would say we're probably
(06:55):
about 2/3 of the way through thelist, which means that we've
either called or made an attemptto call or sent an e-mail to
someone to ask them do they still need a healthcare
provider. So when we call someone to do a
validation, we use the phone number that's listed on their
file in the registry. So it's important that that
information is up to date. We try them three times to reach
(07:18):
them. Sometimes folks are reluctant to
answer the phone or it's not a convenient time for them to
answer our call. So we haven't always reached
folks. So we've also switched to using
e-mail now. And we are seeing some higher
rate of kind of response with the e-mail.
But email's not also not right for everyone.
And the e-mail doesn't allow us to really have a good chat with
(07:39):
the person about the service options available to them, their
health concerns. So we're going to keep using
both methods to reach people. And if we haven't reached you
yet, hang on. We're working through the list
and we'll be reaching out to more and more people in the
coming months. And the other thing is folks can
always update their information on the registry themselves.
So you can contact 811 to do an update.
(08:01):
You can do it through our website, through the Need a
Family Practice Registry website, and you can also
complete your health questionnaire.
If you haven't done that. It's voluntary, but we encourage
everyone to do that because the more we know about your health
concerns, the easier it is for us to match you to the right
service. That's great.
So I really appreciate that and thanks, Bethany.
The terms health home and healthneighborhood are being used not
(08:26):
just in Nova Scotia, but I notice other provinces,
including Ontario starting to gravitate to that kind of
terminology. And just to make things simple
for people, you know, when we use the terminology health home
or health neighborhood, what really are we talking about?
Karen, we're really talking about the primary care practice.
(08:49):
It may be a solo provider, it may be a collaborative team, it
may be a community of resources and supports that actually
support you as an individual, your family and your community
and their healthcare journey. So when we talk about Health,
Home and Nova Scotia, we're we're really talking about a
continuum of services. A primary solo provider doesn't
(09:13):
have the resources and supports wrapped around them as our
collaborative practice teams do.So we consider we're on a
journey to build and the the type of supports that we often
see in hospital around family physicians and nurse
practitioners in community. And we're also talking about
supporting long term care relationships as close to home
(09:35):
as possible and considering you as an individual, your family,
as partners in care. This is your health.
Health is a tremendous resource in ensuring you have a quality
of life. And so we want to build a
supportive care approach to thatin Nova Scotia.
So that's the vision. So we, we have on the one hand a
(10:00):
sole practitioner, if you like, a sole provider.
So a physician who's alone in their office other than their
admin perhaps. And so versus a collaborative
care set up. So I think I get the notion of a
sole provider, but when you talkabout a collaborative care, what
(10:21):
exactly might that entail? So a collaborative care team
usually has provided professional healthcare
providers in addition to either a nurse practitioner and or a
family doctor. So you may see practices across
the province and we have 115 collaborative care teams
underway right now in Nova Scotia.
(10:42):
You'll see dietitians, you may see social workers, you may see
psychologists, you may see pharmacists.
You'll hopefully see family practice nurses or registered
nurses, licensed practical nurses, and others to support
and work with that family doctorand nurse practitioner and the
patient themselves. What about a pharmacist?
Where might a pharmacist fit into that scenario?
(11:05):
So we see pharmacists fitting inin a lot of different ways.
They understand a lot about yourmedical health.
They understand a lot about medications, how medications
interplay with if you're someoneliving with diabetes, if you're
someone living with learning disabilities, with mental
illness. So they offer their special
knowledge to that care team and can give advice.
(11:27):
And also we're working in partnership with pharmacists and
pharmacies across the province to provide access to primary
care if you need some vaccines, if you need some diagnosis like
an urinary tract infection, thatexpanded care has happened as
part of this health home movement.
So we're going to come back to that.
(11:47):
So I, I guess just to extrapolate from what you've
described health home, then the next milestone along the journey
is a health neighborhood. And what is different about a
health neighborhood from what you've already mentioned?
So, Karen, and you know, I wouldsay in my experience, there are
many neighborhoods across Nova Scotia where health and social
(12:10):
care services are integrated and, and, and primarily I've
worked in rural communities. So we see that we help our
neighbors, hospitals help local pharmacists, we work with NGOs
like family resource centers to support young families and
caring for children. So really in the health
neighborhood, we're talking about a more organized, seamless
(12:36):
transition and relationship of supports to wrap around
individuals, families and communities.
Got it. So just so I have a clear
picture in my own head, then if we have on the one end of the
spectrum a soil provider, then the the aim is to connect the
sole provider to all of these other supports or vice versa,
(13:00):
right. OK, great.
So that's the vision. You know, in many ways how that
how I see that in my head is, isalmost like just an
interconnected chart where the boundaries have come, have come
down. So there's no artificial
boundary or or nothing that's preventing the connectivity of
(13:24):
all of the different providers, caregivers, resources in a
particular community. That's really what I see.
So part of the trick I think is to make sure that they are able
to easily talk to each other. So that is either through
technology or the data or both. So I guess that's the next big
(13:46):
step on the journey when we cometo talking about OPOR, which is
not really part of this, but maybe you could comment on it,
Bethany, because you're very familiar with it.
I think that in primary care, weleverage lots of different
technology opportunities where we can and we're continuing to
build forward on that. So the EMR or the electronic
medical record that we use in a primary healthcare practice is
(14:09):
really the repository for all that patient information.
Many practices are able to shareacross offices if they're on the
same kind of network, so to speak, which allows more
seamless care and connection to that information about the
patient. And we also have access to
information through provider portals or ways that we can look
(14:30):
in to see about a visit to an emergency department.
And that will become easier and easier with OPOR.
The other thing that's been verytransformational has been the
Your Health System app. Oh, yes, and, and you can
actually do the commercial, yeah.
The Your Health NS app, so this the new app that Nova Scotia has
(14:51):
brought into play, is a great place for folks to be able to
connect to their own health information if they set up an
account, but also to health services.
So you can use the virtual assistant to navigate yourself
to the right health service by answering a series of questions.
You can also access virtual careNova Scotia virtual basic care.
(15:12):
You can also connect to mental health and addiction services
and many other resources for Nova Scotians.
It's really a nice easy navigation tool.
You can use it on your phone or in your computer, and you can
still access 811 as well if you're someone that doesn't use
technology quite so easily. Perfect.
So I don't know if these will show up, but we did put the QR
codes there. So I've learned over time you
(15:34):
can actually even do that on a computer screen.
So anybody who's watching on YouTube or whatever can can
click on if they want to the. So I, I want to talk a little
bit more about that app as a point of access.
So let's just kind of back up. So now we've talked about the
list, we've talked about health,home health, neighborhood as as
(15:55):
perhaps a bit of a vision the Sonow if we come right back to the
94,000 people that are on the list and just the, the notion of
access in Nova Scotia generally.So you said, Bethany, that we
have so many more access points now.
So maybe between the both of you, we can actually start to
break that down because I find still just going out into
(16:20):
community. And in the past two weeks, I've
been in Shelburne at the Rose Way and had the opportunity to
meet with many of the local leaders, the mayors, the
wardens, the Caos, which was an excellent, really good
conversation. And, and one of the things that
we all acknowledged is that people do not know all of the
(16:44):
points of access. And secondly, you know, there is
still the stigma attached to technology.
Maybe people don't have a phone,maybe they don't have a
computer, or maybe they aren't savvy.
So so there's an education piece.
So that's one. And I also spent some time in
Cape Breton last week, got the regional.
(17:05):
I went to the north side, went to the new campus of of the CBU
medical school, and I also went to straight Richmond and to
Saint Martha's. So I've been on a little bit of
a tour, yes. And again, you know much as we
think we've over communicated and communicate, communicate,
it's never enough. So we do have some great points
(17:28):
of access now. So I'm going to toss it over to
the two of you and you can kind of split it up between you as to
some of the access points that have been developed.
So maybe I'll start with virtualcare.
So we have a lot of virtual options now available in Nova
Scotia across a spectrum actually.
So we have Virtual Care Nova Scotia, which is provided by
(17:50):
nurse practitioners are doctors who live and work in Nova Scotia
and they provide full access virtual care.
So they can order diagnostics, they can renew medications, they
can refer you on to specialists.And that one's available for
only those 9% of folks in Nova Scotia that aren't attached.
So it's a really great access point for those that are still
waiting to be connected to a health home, OK.
(18:11):
So let's just pause. So we have 9% of Nova Scotians
on that list, 94,000, and those individuals have full, whenever
they need it, access to Virtual Care Nova Scotia, which as you
say is the full range of diagnostics lab.
(18:32):
And then what if a person neededto be seen in person?
So if you have a Virtual Care Nova Scotia appointment and they
feel that you need to be seen inperson, they can refer you to a
primary healthcare clinic in theprovince.
We have 19 of those and they cansay I'd really like Bethany to
be seen in person for an in person visit.
(18:52):
We make that referral and you get booked in.
Perfect. So who makes the referral?
Virtual Care Nova Scotia. Just does it.
Automatically can can make that appointment and the patient can
also reach out themselves. OK.
So this is a very important point of access and I think the
use is quite high. We've gotten up to close to 600
appointments a day from those onthe need of family practice
(19:16):
registry and another going from memory here, but it could be
another 300 ish for people who actually have a physician.
So maybe you could talk about that the way that works,
Bethany. So for every person in Nova
Scotia, if you have a provider or not, you can access what's
called basic virtual care. Versus full?
(19:37):
Full care. Yeah, basic care.
So a smaller suite of services, I put it that way.
So more basic health assessment,medication renewals, they cannot
order, diagnostic tests, those types of things.
That's the primary difference. So every Nova Scotia has two
appointments a year that we can use with basic care for a
(19:58):
healthcare need. So if you're lucky enough to,
you know, be connected to a health home, but you still need
access point, but you don't needto go into your office in person
or you don't really need that continuity of care from your
family doctor, you can use the basic virtual care.
Sometimes it's very convenient option.
For people to have a basic healthcare need met, great.
OK. So those are that's virtual care
(20:19):
and you said there were a numberof other virtual components.
So what? What are the others?
We have virtual urgent care and this is a slightly higher level
of service where we can see more, more ailments, minor
concerns, just maybe a touch higher than the primary
healthcare that you'd see in thevirtual care Nova Scotia.
You can access that through manyrural emergency department
(20:44):
locations. So for example, in my zone, we
offer that in Spring Hill and inPugwash and you go to that
hospital, you were seen by a nurse in person and then they
connect you to a virtual physician for your appointment.
It's a really nice opportunity for some of those rural
communities to continue their their urgent services when they
might be challenged with a health in.
(21:05):
Between, in between, almost in between primary and emergency,
So. That's right.
OK, great. So that's number two.
And then what's #3? Oh well, there's more than
three, but sorry. Sorry, I just go to three in my
own head. Yeah, yeah.
So the pharmacy clinics, so we have many pharmacies across the
(21:25):
province that offer expanded Primary Health care services and
they can, you know, diagnose andtreat minor ailments like UTI,
bladder infection. That's what UTI stands for, you
know, eye irritation, you know, other concerns.
So you can get testing for strepthroat, those kinds of things.
(21:46):
So that's a nice option for folks whether you have a
healthcare provider or not. Really timely access, easy to
book. You can do it through the app,
you can do it through your direct to your pharmacy.
You can pick an appointment anywhere in the province.
You can do them virtual or in person.
It's a great option. So I would do that through my
app, probably myself. Otherwise, how would I know
where to find these people? Well, you can.
(22:09):
Sometimes you know the pharmacy in your community that offers
the service and you have a relationship with them.
So you call and you book directly.
Actually when when I I did need this within the last couple of
months because I was developing a call source.
So this is like this is emergency for me.
Of course, it's not a true emergency, but if you don't
(22:29):
catch them early, it's a problem.
So, so I'm on the app, you know,where's the closest because my
pharmacy is not one of these pharmacies.
So I wasn't able to book an appointment per SE at my
pharmacy. But anyway, so I did it all
through the app, took me a little bit of took me a little
bit of finding out, but actuallyin the end it was pretty easy to
(22:51):
do. The the thing that I like to
remind folks is that many of thepharmacies can do the
appointment virtually. So I had the experience where I
had a bad bladder infection. I wanted to get in really
quickly. I looked for the first available
appointment in the province. When?
Was it? It happened to be in Picto, OH.
Well, that's good. But I didn't have to go, didn't
(23:13):
have to drive there. I did it by phone 3030 minutes
after I looked for it. Oh, that was good.
And got a prescription within anhour and got my care.
Didn't have to call my family doctor, didn't have to wait.
And I didn't have to buy the medication from the pharmacy
that did the appointment either.Well, that's just a great.
Yeah, a great experience. Yeah.
OK, so you've talked about threethings.
What else, Madonna? So I want to speak about mobile
(23:36):
clinics. My mobile clinics, I almost
forgot about those. How could I forget about mobile
clinics? We, we start at mobile clinics
during COVID and we really learned a lot about being
accessible in rural communities and in communities where they
may be facing a certain prevalence of illness.
(23:56):
And so those continued, both offered by public health and by
Primary Health care. We see them serving in times of
high respiratory illness in somecommunities.
I, like Bethany, had to use a mobile clinic.
I was taking my grandson from Hockey and Mabu.
I looked over at the community hall and there was a mobile
clinic. I knew I needed a flu shot.
(24:17):
I went in, I got my flu shot, had a good chat with nurses I
had worked with at Saint Martha's.
So I think it's about accessibility and also knowing
what's available in your communities and how to really
connect and be available. I mean, in rural communities,
you may, you may not be someone who's on an app, but you can, we
often talk about it. Ask at your provider, see at
(24:38):
your pharmacy signs, those kindsof things.
And so it is accessible. And I will say in talking with
some of the leaders in that public health and primary
healthcare space, public health says they're getting a lot of
questions about navigating our health system when they hold
those mobile clinics. So they're able to share about,
oh, look, if you're looking for this, this is where to find it
(24:58):
or these are the apps. So it's about being connected in
these communities and helping people understand the range of
resources that are now availablethat weren't 10 years ago.
But I think it's key as you juststated, help navigating the
system. It's complicated, it really is.
It shouldn't be, but because it's so desperate and it's
(25:21):
different in community to community to community, you do
need to sometimes get some help.So you know, what do you suggest
for people who are looking for help?
What's the best way to find out how to navigate?
I think there's different ways that work for different people.
So if you have a clinic that you're connected to, you know,
(25:43):
connecting with that clinic directly, asking them about your
specific concerns can be helpful.
The app of course has a wealth of information.
We also have information on our website, you know where to go in
Nova Scotia. 811 continues to beavailable for folks that are not
as technology inclined or don't have access to, to use that.
(26:05):
And then we do have, as Madonna said, you know, posters and
things up in local community areas and some of my very rural
areas that I work with, we actually post things on their
community boards, in their community halls, their churches
and so on. Here and also if folks are not
comfortable using computers, if you have a local library, often
(26:26):
you can get support through a a Community Center offered by
federal government. But 211, which like 811 can link
you to to a range of health services.
But 211 is available in Nova Scotia and they have a
navigation service for social and health access as well.
You know, I think just reflecting on what you've both
(26:47):
said and just, you know, what I know from my own travels around
the province, like we do need todo more around the education of
access. And the one of the things we did
last summer, which proved to be,you know, well received.
We had a number of summer students hired to act as health
ambassadors and going into whether it be nursing homes or a
(27:12):
curling club or, you know, a, a community event that was up to
them to figure out where the most people would be and to
share the information that we'retalking about today.
And I think we will be doing that again this summer.
But in addition, you know, it's great for students because it's
(27:33):
it's a learning experience for them and they're so good with
the technology. They can help folks.
But I think also there are a number of either retired
healthcare professionals or justvolunteers that want to help in
a different demographic that also know places where people
(27:55):
are who could use some help. So we're looking to broaden the
demographic of our health ambassadors too, beyond just
students. So I hope that that will help.
Now, I think we're kind of coming up to time, if you can
believe it. So what I would like to ask both
of you from your perspective is,you know, do you I'd like to
(28:18):
understand what part of the workthat we've just talked about you
consider to be transformational.So we're kind of talking about
change here today. But you know, as a newcomer to
healthcare, I don't always know what was, so I don't always
fully appreciate the change thatis.
So I'd like both of you to reflect and comment.
(28:42):
Well, I've been thinking about what has made it possible for us
to bring the need a family practice registry down and it's
many things. And the one thing that we
haven't really talked about yet that I think has been one thing
that I wanted to highlight is the transformation within the
teams and the clinics that are accepting new patients from the
list. So we're working differently
with healthcare providers and teams to really create
(29:04):
efficiency, to change the mindset around shared care and
that health home, as Madonna described, bringing patients
into the clinics more quickly and efficiently.
So really just changing the how we do the work has created a lot
more capacity to serve more NovaScotians in a really effective
(29:24):
and connected way. So with managing the the native
family practice registry from a list to a tool has been one part
of it. But we had to have clinics and
teams willing to accept those patients in a new way.
And it's been really transformational to on board the
patients or connect the patientsin a different way to manage the
(29:46):
way we have hours in the clinicsorganized.
Like having more same day, next day access even in a primary in
a health home is a really big deal for folks.
Even when you're connected to a clinic, if you can't get in for
six or eight weeks, then you're looking for other options.
So we've changed so many things,how we pay the family doctors as
impacted same day, next day access, for example, we've
(30:08):
recently changed their payment model.
So all of these things together have really created a multi
pronged strategy that have really created momentum that's
just building and building. And as we connect more people,
bring in new providers, create more efficiencies with the
teams, I'm really excited about getting the number lower and
lower so that more Nova Scotiansare connected to a health home
(30:29):
well. You're, you're singing my song
on that one, Bethany, so I appreciate your reflection.
And what about you? Madonna So what I would say
Karen is one of the things unintended impacts of of working
through COVID was we saw a lot of folks didn't access
healthcare regularly or at a time when they really needed it.
And so following that, we saw really an overburdening and
(30:52):
almost a reaction where more folks needed more complicated
care because they hadn't received it at the right time in
the right place during COVID. And so transformationally that
really I think made us reflect on what are the important
supports and services to help the public access care in
(31:13):
community long before they need a hospitalization.
Or COVID or not COVID? Absolutely.
More about diabetes, chronic conditions so that they're
managed appropriately, that we have emphasis on preventive
work, you know, all kinds of things.
Not only the social supports that are available, but how to
prepare meals. There's a whole range of
(31:33):
supports and services that we see, but most importantly that
if folks need to have an intervention by their primary
care team, those nurses, doctors, nurse practitioners,
dietitians, social workers, thatwe really have a strong
foundational network in community that can help respect
(31:54):
the individual's time. So they're not in a hospital
waiting for care, but the care is provided in a much more
timely fashion in community. So as Bethany described, we're
working to support the WRAP around supports for physicians
and nurse practitioners in Nova Scotia so that we're better able
to support individuals, familiesand their communities at home
(32:17):
because their time is just as precious as healthcare
providers. Absolutely.
So, you know, that's a really great reflection.
I've got three more really quickpoints.
I know that you, Bethany, do a lot on the mental health and
addictions, and I just wonder ifyou could just briefly elaborate
on the kinds of tools that are also available in your Health
(32:37):
Nova Scotia app or or in other places.
So the mental health and addiction service is available
across the province. There's a centralized intake
phone line where people can selfrefer or be referred by a mental
or a primary care provider or orsomeone else to have an
assessment by a clinician and then they determine the services
that you might need. Services could range from
(33:00):
anything from like a community based group, any mental health
tool or a tool that you can use online self-directed.
I've used one of those. I loved it just around like
mindfulness and, and staying well all the way up to being
connected to an outpatient clinician for therapy or a
crisis team or an inpatient stay.
(33:20):
And so that intake line is a really key point.
We also have a 24/7 crisis line where people can call at any
time and speak to someone if they're feeling they're in a
mental health crisis. And we also nationally now have
the 988 suicide prevention line that also people can dial the
988 number and be connected to someone in that they have a
collaborative relationship with our local crisis team here.
(33:44):
And then in the app, there's also numerous links to our our
mental health tools and resources that folks can use
self-directed and there's there's a whole plenitude of
things there. We also have recovery support
centers which are a walk in service, low barrier access for
folks dealing with substance use, gambling or addictions
concerns. Great.
Thanks, Bethany. And just a final note on the
(34:07):
app, I looked at the numbers last week and I was actually
quite astounded. We're over.
We're 626,000 Nova Scotian, so well more than half like, which
is astounding and really good, you know, validation that that
people want their healthcare in their hands.
(34:29):
And so you know, we're going to keep going on that.
Now Madonna, I know you are verymuch a people person and it
would be incorrect to assume that Madonna, MacDonald and
Bethany McCormick are carrying everything we've talked about by
themselves. So I'd like you to maybe comment
(34:49):
on the teams, Madonna and give agive a thumbs up to the work of
the teams. Thanks, Karen.
Really this is a work of many partnerships, Nova Scotia
Health, the IWK working in partnership with our government,
Department of Health leaders whoare involved in really setting
the vision for where we want to go in terms of health home
(35:11):
health neighborhood. Most importantly, the providers.
Bethany spoke earlier about the providers who really readily
accepted our our calls, our support who are asking us what
do you mean by health home. And in Nova Scotia we're
building on the College of Physicians medical health home
model and expanding it to the health home model to recognize
(35:34):
and and really place a value on the breadth of providers that
contribute to someone's individual care.
And so they're key because if healthcare providers, the
doctors, nurses, nurse practitioners, dietitians,
social workers, pharmacists and others who are not part of the
care don't want to take part, we're not going to be
(35:55):
successful. No, if they don't see themselves
as part of the solution, pretty hard to to get.
There they're key and and we have and also importantly, as
we've said, you as individuals to be partners in this.
I, you know, Karen knows I call it a social movement and we were
joking because she referred to sort of some of the, the Cody
(36:15):
and Tompkins movements way back in the day.
We're there. We're, we're, we're put well,
well, not only are we there, butwe are actually putting D2, you
know, D2 concept. Exactly, This is really about
working differently. Perhaps it happened in the past.
We see great examples in First of First Nation communities in
(36:36):
Nova Scotia where they build on a neighborhood concept in terms
of their collaborative care teams and and you become part of
their practices. So we have a lot to learn by the
many community health centers, the practices like the Mentor
Clinic, lots of family physicians who've taken on other
providers in their practice and collaborative team to move this
(36:57):
forward and also our history of social movement.
And don't forget Noella Whalen and Dr. Maria Alexiadis.
Have they helped you? Oh my gosh, yes.
Doctor Maria Alexiadis, Noella Whalen have been instrumental.
They work with a whole group of folks who.
(37:18):
Right across the province, all. Across the province, the
practice support teams, the leaders who have been
strengthening our primary care clinic model, the our academic
learning partners. When we see Cape Breton
University, Dalhousie St. of X in terms of nursing and others,
the colleges, they're all critically important in terms of
(37:40):
looking at how do we shift policy to enable these changes?
How do we practice differently? We've seen an investment in the
PACE clinic in but with the College of Physicians Dr. doctor
well with and how that can help us prepare and learn differently
in terms of shifting practitioners into practice who
come from other countries. So there's a wealth of work
(38:04):
foundational to this movement inNova Scotia, and I think we can
learn a lot from people who are already championing it.
Yes, I totally agree. And you know, the proof's in the
pudding. We're taking the list down.
We know where we're going. We've put the pieces in place to
take us there. So now it's just head down doing
(38:24):
the work. So as two of the people who
really lead much of the work andall of the folks that you
mentioned, I'd like to say thankyou.
You guys are doing a great job. You know, we need to do it
faster, but but we're doing it. So I appreciate what you folks
do everyday for Nova Scotians and thanks for sharing.
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