Case Example

Case Example #1

Example IconA primary health care centre was established in a far northern community with a large percentage of Inuit people. The community health centre is staffed by a team of primary care and public health providers. The team decides to offer a chronic disease management clinic to better support the growing number of people in this population with diabetes.

NunavutIn the planning phase, primary care providers highlighted the extent of specific chronic conditions that they were seeing and noted a high incidence of diabetes among the Inuit clients and patterns of non-compliance with their therapy. The public health providers shared information that would help to shape how the clinic would operate and what roles team members would play.

Public health staff were aware from having made newborn home visits in the community that the Inuit family homes were multigenerational. Few aging people in this culture were receiving any outside assistance as the families tended to care for one another and they all lived together. Many of the older generation were unilingual using only Inuktitut language. Use of traditional remedies was common but not readily talked about because of fear of non-acceptance by western medicine.

To best meet the needs, the team decided to hire a medical interpreter, to invite family caregivers to attend appointments, to inquire about specific traditional practices which might interact with prescribed medications, and explore alternative traditional therapies that could be safely used with clients and their families.

The primary health care team applied for a grant to expand the support component of their program and services. They are successful in getting the necessary funding for a volunteer family visitor program coordinated by public health. Upon their agreement to participate in the family visitor program, each family was assigned a trained public health visitor. The family visitor checked regularly and was able to report back to the public health-primary care team on how the family was coping and any signs that might have indicated that a follow-up appointment was needed.

 

Case Example #2

Example IconA primary care, public health, mental health, and addictions services collaboration has supported the development of a Rural Women’s Health Centre providing programs and services that are open to women and adolescent girls. The centre is particularly sensitive to those who experienced difficulties in accessing appropriate health services.

An equity lens is applied: Welcoming aboriginal, immigrant, visible and language minority women, women with disabilities, and lesbian, bisexual, and queer women. The centre shares a commitment to facilitating empowerment of women, individually and collectively.

Rural Women’s Health Centre Programs and Services

Medical ServicesSupport ProgramsEducation Programs
Sexually Transmitted Infections Screening Tobacco CessationManaging Stress
Sexual Assault Care Sexual Health for YouthTalking with your Kids
Women’s Health Services Crisis and Problem-Solving SupportMenopause
Teen’s Health ServicesWell Woman CareHealthy Food Choices
Healthy Aging
Substance Abuse, Sexuality, Depression

Strong Communication and Coordination Mechanisms
This case has exceptionally strong communication and coordination mechanisms that have contributed to the collaboration’s success. Partners in the collaboration set up several committees composed of health teams and community members. They held numerous committee meetings over time and reached several milestones.

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Partners in this collaboration focused on a vulnerable population this one good way for public health and primary care to find common ground for strategic planning. Communication is an important aspect of the success with these collaborations.

Achievements
Various committees’ achievements related to coordination and communication mechanisms included the development of, and agreement on:

  • The mission and vision;
  • Collaboration goals and objectives;
  • A philosophy, definitions, and a model of care (who would provide which services and how);
  • Guiding principles and a collaborative approach to providing programs and service;
  • An evaluation framework;
  • Policies and procedures to support day to day operations of the collaboration.

In particular, collaboration partners determined how record sharing process would occur including the details.  Decisions were entered into the policy and procedure as well as into the formal collaboration agreement. Parts of the client data sharing agreement that was developed by the committee are in the attached PDF.

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