In its most recent national newsletter, the College of Family Physicians of Canada highlights the innovative work of North Vancouver’s HealthConnection Clinic and how it cares for vulnerable patients.
It was one of six sites from across the country to make it into the second issue of the College’s series on Innovation in Primary Care: Caring for Unattached and Marginalized Patients.
Its appearance in the newsletter is timely as HealthConnection celebrates its fifth anniversary this year.
Established in 2013, the clinic is a unique partnership between VCH and the North Shore Division of Family Practice. Its goal when it opened was to improve the care for high-needs, medically complex and vulnerable clients who were unattached, difficult to serve and who had high rates of hospital admissions by providing team-based primary care.
The clinic serves more than 900 patients a year who struggle with multiple health and social issues including mental health, chronic disease and a lack of housing and have served more than 1,200 patients since opening its doors.
The variety of health care professionals from GPs, nurse practitioners to social workers at the clinic are actively involved in the ongoing care of clients to help them manage complex conditions and access social supports such as housing. The clinic also works closely with community agencies on behalf of mutual clients.
Since opening, the clinic has provided access for at least half of the North Shore’s estimated 735 homeless people, reduced the number of ED visits and admissions, and decreased the length of stays.
Highlighted in the College’s article was the clinic’s addition of a team-based learning site for all associated disciplines and the creation of the Complexity Assessment Tool, also known as AMPS (Attachment, Medical, Psychiatric, Social determinants), which is helping improve patient care.
AMPS is an innovative resource that guides primary care clinicians in assessing patients with complex needs and identifying disease-related and other barriers to improved health. Care teams can use this tool to develop a care plan tailored to an individual’s needs, highlighting any additional medical and/or community services required.
For Sujata Connors, Director, Community & Family Health, what is key about HealthConnection is that it has low barrier access, a welcoming, non-judgmental environment and a team approach to care where all who visit feel welcome and safe.
To read the CFPC’s latest newsletter, click here.
Read more about HealthConnection Clinic