Team roles and responsibilities

Calgary Health Region, Home Care Program

This home care program offers a range of services from nursing, therapy, rehabilitation to personal care. They are working on a Chronic Disease Management Initiative and have developed role algorithms and decision trees on areas such as diabetes, hypertension, COPD, etc. These were developed by the teams themselves as a team building exercise.

CDM Diabetes Algorithim May 31 04 CDM Hypertension Algorithim May 31 2004 Decision Tree

Collaboration in Primary Care - Family Doctors & Nurse Practitioners Delivering Shared Care: Discussion Paper

This paper is an initial paper or primer on collaborative models and describes a core model for establishing a successful collaborative practice. It consists of family physician and nurse practitioner questionnaires measuring collaborative experience).

ocfp paper handout

C.T. Lamont Primary Health Care Research Centre, Ottawa, IMPACT program (NOT RELEASED YET)

IMPACT began as a large-scale demonstration project supported by the Ontario Primary Health Care Transition Fund (2004-2006). It aims to improve drug therapy using a collaborative care model, integrating a pharmacist into family practice. These documents are draft. Two toolkits are included: one for site managers and physicians to integrate a physician into their practice and the other is for pharmacists. A physician information pamphlet is also included. They are available at the web site. http://www.impactteam.info/downloads.htm

Dr. Charles L. LeGrow Health Care Centre (site visit)

This is a multifunctional district health centre located in the town of Port aux Basques on Newfoundland's southwest coast. It is a 44-bed, fully accredited, nondenominational district health centre that provides inpatient and outpatient acute care and community services. This document outlines the process followed to redefine the roles of several team members after the introduction of nurse practitioners to the team.

NP Role Planning Day PHC weekend retreat 2

Family Health Teams Guide to Interdisciplinary Team Roles and Responsibilities

This is a resource for those that have been approved to form a family health team in Ontario to guide them in creating localized plans for service. This guide provides basic information to design and coordination of interdisciplinary primary health care teams. http://www.health.gov.on.ca/transformation/fht/fht_guides.html

Family Medicine Groups

The implementation of family medicine groups follows one of the main recommendations of the Clair Commission, a commission of inquiry into health and social services. The Ministère de la Santé et des Services Sociaux is establishing family medicine groups to increase access to family physicians for all, improve the quality of general medical care and enhance the role of family physicians. http://www.msss.gouv.qc.ca/en/sujets/organisation/gmf.html

Guidelines for the Development of a Regional Health Authority Plan for PHC Services

The purpose of the guidelines is to help with the implementation of a regional primary health care (PHC) plan. iscusses what PHC is, the planning steps required, action plan including team formation, and implementation. http://www.health.gov.sk.ca/ph_phs_publications/phs_pub_guidelines_%20for_dev.pdf

Increasing Support for Family Doctors in Primary Care

This will be a change management toolkit to assist family physicians to make changes in their practice. http://www.chsrf.ca/research_themes/pdf/Inventory_of_Projects.pdf

Data not available until 2006/07. College of Family Physicians of Canada – John Maxted jmaxted@cfpc.ca

Integration of Psychologists in Family Health Teams

The information contained in this document was taken, in part, from the grant application of the IPEM Study (Integration of Psychologists in Family Medicine Teams) funded by the Ontario Primary Health Care Transition Fund. It aims at providing general information concerning the rationale for including a psychologist in a Family Health Team.

IPEM FHT Toolkit NOV24th2005

Mid-Main Community Health Centre (site visit)

This is a non-profit community health centre located in central Vancouver. It started in 1988 with a group of people who wanted to make a difference. The physicians had a vision of, and believed in, community health care. Several documents are highlighted: a form that clarifies the job descriptions and relationships within the community, the transferring of function from one discipline to another; the pharmacist's prescriptive authority; and Warfarin monitoring physician authorization form that allows the pharmacists to manage a patient's therapy.

Clarifying Job Descriptions and Related Tasks Transfer of Function Pharmacist Prescriptive Authority Warfarin Authorization Form

National Home Care and Primary Health Care Partnership Initiative

The aim of this initiative is to improve patient care by developing partnerships that support and optimize the roles of primary health care providers and case managers and thereby improve the delivery of collaborative primary health care by enhancing provider partnerships. Contact: Marg McAlister, Project Manager, Tel: 519-473-0198, E-mail: mmcalister@cdnhomecare.on.ca PHCTF Project: Data not available until March 2006

Newfoundland Department of Health and Social Services

This province is moving rapidly forward on interdisciplinary collaboration and is doing interesting work on scopes of practice. Newfoundland has developed a scope of practice process for PHC team members. Each member does a 2 to 3 day summary of their work life and also identifies things they could have asked others to do. Information is then collated and a process is used by government to facilitate and identify gaps. The second stage of this initiative is that this will be done by discipline.

SOP-Draft-Sept-2004 visual revised sept 04 App B

Pan-Canadian Awareness Initiative on Occupational Therapy and Interdisciplinary Collaboration in Primary Health Care (KIT)

It contains resources to support the efforts of volunteer occupational therapists in collaboration with support personnel to position occupational therapy as an essential service in primary health care. http://www.caot.ca/pdfs/PanCan05.pdf

Report on the Integration of Primary Health Care Nurse Practitioners into the Province of Ontario

The primary focus of this study was to determine how best to integrate primary health care NPs into Ontario's health care system and specifically into various practice settings. http://www.health.gov.on.ca/english/public/pub/ministry_reports/nurseprac03/np_report.pdf

Social Work, Primary Care and Family Health Teams in Ontario: Delivering Comprehensive, Family-Centered Care

This document makes a case for including social workers on family health teams to improve coordination for patients. http://www.oasw.org/en/publicsite/swasacareer/default.asp