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  • Friday, June 17, 2016
  • 0706-000238 ADAPTING THE CHRONIC CARE MODEL TO BUILD PRIMARY HEALTH CARE FOR TRANS AND GENDER DIVERSE PEOPLE IN A SMALL, RURAL CANADIAN CITY: EVERY DOOR IS THE RIGHT DOOR WHEN AN ACTIVATED COMMUNITY MEETS A PREPARED TEAM

    June 20, 2016 10:09 AM - June 20, 2016 10:21 AM

    Water Studio

    • Vanita Lokanathan, MD ;
    • Sheena Howard, BSN, RN ;
    • Jan Tkachuk, MA, RP

    Purpose

    This presentation describes and analyzes the development of comprehensive primary services for trans* and gender diverse people (TGD) in the small city of Peterborough, Ontario, Canada using the Chronic Care Model (CCM) as a framework to understand the elements of systemic change needed to improve healthcare delivery to this underserviced population. 


    Materials and Methods

    Until 2008, all TGD individuals in the Peterborough area who wished to transition with medical support required a referral to a large urban Gender Clinic, with wait times of up to 2 years for assessment.  From December 2008 to December 2015, 165 clients were able to access assessments and hormone management through a primary care provider (Family Physician and Family Practice nurse team).  This included clients from the community and catchment, as well as from other communities, including some from larger urban areas who were not able to access services in their home communities.  The Chronic Care Model (CCM) was developed by Dr. Edward Wagner, Director of The MacColl Institute for Healthcare Innovation, to offer a comprehensive approach to improving outcomes for people with chronic illness by restructuring elements of the health system and targeting community interventions needed to leverage more productive interactions between activated clients and prepared health care teams.  Having had experience with the application of the CCM to effect improvements in healthcare for other healthy populations (prenatal patients), the presenters were able to use the model as a lens to understand and implement key improvements in delivery system design, decision support, and self-management support which improved outcomes for the TGD population in access to comprehensive health services.

    Results

    The critical intervention that has driven the improvements has been the creation of an active, ongoing self-management support program for clients, partners, and families in the form of regular Gender Journeys groups.  The success of these groups in increasing clients' skills for self care and informed and activated decision-making, as well as enhanced visibility of the community's needs, has been recognized with the awarding of a three-year governmental grant of $225,000.  Delivery system design changes have included increasing capacity by developing an expanded role for the Family Practice Nurse working with the lead Physician, so that 165 clients have now accessed comprehensive primary care services.  A multidisciplinary steering committee has been created to support the community programs and develop plans for spread of primary care access to other providers in the community.  Decision support interventions such as promotion of existing guidelines and educational sessions have led to clinical capacity building to expand assessments from the current two clinicians to other local providers, to the availability of some local surgeries (hysterectomies), and to the support of clinician champions in other communities.  Further, two local health care organizations are planning to undertake cultural competency training for all front-line workers.

    Conclusion

    Adaptation of the CCM is a helpful template for developing a systematic approach to targeting the elements of improvement needed to develop effective primary services for TGD people, and other populations which struggle with inequitable access in traditional health care settings.


    Category: Primary Care