03-17-2020

Ongoing Primary Care in Family Practice

NSHA is rapidly adapting all aspects of its service delivery to align with the direction from our Chief Medical Officer of Health.

During this time, it is of particular importance that family physicians, nurse practitioners, and other primary care providers continue to provide essential primary health care services for Nova Scotians, with a focus on providing safe access to timely care for your patients’ urgent health concerns.

In keeping with the direction from the Chief Medical Officer of Health regarding social distancing, it’s a good time to consider which services must be provided face-to-face in the office and which can be provided through alternate methods.

Where patients must be seen in the office, please consider the arrangement of seating in your waiting room to limit contact between patients (2 meters). We recognize the challenges that this may pose in your environment. Careful attention to scheduling and effective use of the examination rooms will help to reduce the number of people in the waiting room, as will limiting the number of family members accompanying a patient for their appointment.

It is also important that we focus our health care resources on the care that needs to be done today, while ensuring the safety of health care providers, patients, and communities. Some practices are advising patients to defer routine and some aspects of adult preventative health care (i.e. pap smears).
COVID-19 Screening Tool for Family Practice

In order to reduce transmission of the COVID-19 infection, it’s important to ensure that patients with potential COVID-19 are seen in as few places as possible and in the most appropriate facility, where the staff have access to the necessary personal protective equipment and viral swabs. This will limit their exposure to health care providers, other patients, and the community.

Please refer to the COVID-19 Quick Reference for Primary Care Providers in Family Practice (March 16,2020). In this instance, it is particularly important to note that you and your staff can serve your patients best over the phone, referring those at risk to an assessment center, where they will have diagnostic testing and a clinical assessment.
Triaging Patients

Family Physicians and Nurse Practitioners are encouraged to triage all patients who call for an appointment to focus on providing care for urgent health concerns and to ensure that patients experiencing symptoms consistent with COVID-19 are directed to the appropriate place for health information and possible testing if applicable.

In order to support this, here are some considerations to think about in your practice:
  • Update your phone system message / voicemail message to provide helpful and timely information for patients. Consider including:
  1. COVID-19 Screening information – refer patients to the online assessment tool available at 811.novascotia.ca, and then to call 811 for further direction pending the results of their self-assessment using the screening tool.
  2. Available appointments - explain your interim appointment process and what types of appointments / needs are currently being prioritized, including options for phone appointments, and for patients to self-monitor and seek care as necessary.
  • Limit face-to-face visits for routine care.
  • Consider cohorting patients who may have contagious diseases in one part of the clinic, and/or limit their appointments to specific times of day.
  • Consider staggering office visits between phone and in person to minimize the number of people in the waiting room.
  • Consider updating your practice’s check-in procedure and intake process, to minimize congestion in the waiting room. If possible limit the number of family numbers attending.

If there are other measures you are taking in your practice that you would like to share, please send these to familypractice@nshealth.ca. These can be collated and shared with all primary care providers.
Personal Protective Equipment (PPE)

When seeing patients with any of a number of infectious diseases (including influenza, for example), personal protective equipment (PPE) is recommended. Refer to the College of Physicians and Surgeons of Nova Scotia’s Professional Standards Regarding Infection Prevention and Control in the Physician’s Office.

We recognize the challenges that you may be experiencing in obtaining PPE supplies at this time.

Information about the availability of masks and other PPE supplies for use in family practice, and the process for ordering these items, will be shared as soon as we have further details. The safety of health care providers, patients, and communities is, and will continue to be, a top priority.
Virtual Care

Please consider providing patient appointments by phone or participating in other virtual care options, including faxed or phone prescription renewals.

The Department of Health and Wellness is working with Doctors Nova Scotia to explore fee codes to better support this work. More information about this will be shared as more is known. We appreciate your patience while these options are being reviewed.

In the meantime, there is an existing fee code (03.03R) for telephone (or synchronous electronic verbal communication) between the family physician and the patient (or the patient’s parent, guardian or proxy as established by written consent). While this fee code is limited to patients 65+, those with mental illness, and/or those with one or more chronic conditions, this does include a large segment of the population. Refer to the July 2018 MSI Physician's Bulletin for additional information.

Examples of care that can be delivered by phone:
  • Discussion of results of investigations where there will be a resulting change in the management plan;
  • Prescription refills in the context of reassessing a chronic condition;
  • Discussion of status of a chronic illness and offering advice for self-management;
  • Telephone assessment and advice regarding an acute illness.
Ordering Lab Tests for Patients

NSHA laboratory services are requesting that health care providers defer ordering routine lab testing.
When ordering lab tests that are required for medical management and cannot be deferred, provide guidance to your patients so they know how long they can wait before proceeding with testing.
Planning in your Practice

All primary care providers are encouraged to consider developing a plan for your practice to ensure ongoing care for your patients if you and/or your colleague(s) are unable to practice for any reason, or if your practice staff are unable to work (i.e. are feeling unwell or need to self-isolate for 14 days). We have been hearing about a number of good examples of planning that is taking place around the province.

You may want to consider connecting with other practices and physicians in your community to discuss how you can ensure that your collective patients have access to urgent primary care, while further coordinating as a group to support your regular family medicine coverage responsibilities in the community (e.g. emergency department, inpatient, long term care, etc.).
Thank You

We understand that this is a stressful time for many of you and we appreciate the critical work you do to support Nova Scotians. A heartfelt thank you for continuing to be patient as this response rapidly evolves.
New information is being shared as quickly as possible, and we appreciate your efforts to focus on providing the best ongoing care for your patients.