Working Towards Better Care and Better Health in Newfoundland and Labrador

When it comes to research in health care, engaging with patients and the public, users of the health care system, is crucial; particularly if that research leads to the implementation of some sort of change for the better within the system. However, the concepts of patient-oriented research and patient engagement are not always top of mind for researchers, at least not in the beginning. That’s where NL SUPPORT – Newfoundland and Labrador’s Strategy for Patient-Oriented Research (SPOR) SUPPORT Unit – comes in. NL SUPPORT has been working to help integrate patient-oriented research into the culture of health research at Memorial University. Leading by example, patient engagement is built into the core of the work conducted by NL SUPPORT and its associates.

NL SUPPORT has fostered a strong working relationship with its Patient Advisory Council (PAC). Members of the PAC are invested in the work they are contributing to and believe in the goal of a better health care system for NL. In fact, the PAC has even begun generating research ideas and is currently exploring the concept of patient-initiated research for the first time.

Like other jurisdictions across Canada, NL SUPPORT will soon be transitioning from Phase I to Phase II of the SPOR SUPPORT Units. With this will come a new governance structure that has even more patient representation throughout. Patients will sit at the table of the Unit’s Oversight Committee, and a minimum of two patient representatives will join each of its four core component committees.

“By having them involved with our work at various levels, we are seeing more meaningful engagement from our patient partners,” says Catherine Street, Director of NL SUPPORT. “Their input is truly helping guide our approach to setting health system research priorities and we are able to lead by example within our local research community when it comes to patient-oriented research and patient engagement.”

Right Treatment, for the Right Patient, at the Right Time

Quality of Care NL is the applied health systems research platform of NL SUPPORT whose goal is improving the quality of care in the province by facilitating change and working to ensure the right treatment gets to the right patient at the right time. They also partner with Choosing Wisely Canada in supporting the reduction of low-value health care through the promotion of national guidelines and recommendations. Much of the work of Quality of Care NL is centered around the evaluation of interventions to change behaviour in the use of health care resources and identifying the lessons learned from those interventions.

Such interventions have included audit, feedback and academic detailing, eOrdering and technology, implementation of process change, system change, and public engagement. The results of which are released and updated bi-annually in their publication, Practice Points. Volume 6 of Practice Points was just released this past August and is a tool widely used amongst stakeholders in the province to help drive decision-making in health care.

In most every evaluation of clinicians’ use of various health care resources, there is a group of ‘over-users’. Quality of Care NL found that auditing and sharing feedback and best practice guidelines directly with clinicians (a process known as academic detailing) has been associated with improvement in some areas – such as reducing instances of potentially unnecessary testing by family physicians – but not in others. This has led to an understanding that more aggressive interventions may be needed, such as technology solutions or process or system change.

Various partners in health care, including the Quality of Care NL and NL SUPPORT team, have collaborated to find more efficient processes, with better outcomes, using technology. For example, the Newfoundland and Labrador Centre for Health Information (NLCHI) led an initiative to implement an eOrdering system for the province’s only vascular lab earlier this year. Within the province’s Eastern Regional Health Authority, an app called Spectrum is being used as a decision support tool to help clinicians determine the appropriateness of antibiotic prescriptions and ultimately aid in the global fight against antimicrobial resistance. Of course, we must acknowledge that the global pandemic has led to the more widespread adoption of virtual care tools that, although not without some challenges, has been a positive change in health care.

“These interventions have all seen various levels of success and we learn more with every analysis about how to reduce low-value care in our province,” says Dr. Patrick Parfrey, Clinical Lead for Quality of Care NL. “By incorporating the patients’ perspectives and working with the health care professionals and decision-makers, we hope to be a catalyst for meaningful change that leads to better health outcomes for people in Newfoundland and Labrador.”

Building Better Health Together

Health professionals and patient partners participate in a panel discussion at the 2019 Antibiotics FutureForum in St. John’s, NL, a public event hosted as part of World Antibiotic Awareness Week.

Key components of the work undertaken by NL SUPPORT and Quality of Care NL are outreach and engagement – connecting with the people on whom the work has an impact, and engaging them in meaningful dialogue about the outcomes on the provincial health care system. Health care stakeholders include not only clinicians, nurses and other health care providers, but also the public, government, regional health authorities and other entities whose work is centered in health care.

As part of World Antibiotic Awareness Week 2019, Quality of Care NL hosted the Antibiotics FutureForum. Open to the public, this event featured presentations from Canada’s Chief Public Health Officer, Dr. Theresa Tam, specialists, economists, and a panel discussion with patients and various providers of health care services. The forum helped spread the message that we all have a role to play when it comes to combatting antibiotic resistance. Read about some of the other 2019 outreach activities

Heading into Phase II of SPOR, NL SUPPORT and Quality of Care NL will continue efforts to enhance a culture of patient-oriented research and evaluation of health care interventions. Everyone has a vested interest in health care and working together to share information and resources, and develop new, innovative solutions to existing issues will lead to better health outcomes for all.

Visit us online at NL SUPPORT and Quality of Care NL.

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