Because women with substance use, mental health and/or gambling issues have significant difficulty accessing traditional, office-based primary health care, the Jean Tweed Centre offers services (including direct care and referral services) to clients through videoconference (Ontario Telemedicine Network) in a number of its programs. While the outcomes of this service have been positive, broader uptake in the agency’s Pathways outreach program, which serves a particularly vulnerable and marginalized population, has been less than anticipated.
By June 30, 2017, 100 percent of clients in the Pathways outreach program, who have been identified as having an unmet primary health care need, will be offered person centered primary health care services, either in person or through the Ontario Telemedicine Network (OTN).
EQIP Support to the Project:
- QI coach: Laura Daly-Trottier
- Data Coach: Nicole Adkin
The Jean Tweed Centre (JTC) in Toronto is a community-based organization that provides a safe and supportive environment for women with substance use, mental health, and/or gambling issues. The JTC recognizes that women and their families have unique needs when seeking support, and offers a range of services that are responsive to the context of women’s lives. This includes primary health care services offered through OTN, which can help reduce the barriers women experience when trying to access services in person.
Despite the availability of this primary care service across the agency, use of OTN was limited in the Pathways program – an outreach program that supports pregnant and parenting women with substance use issues.
The opportunity to explore this challenge through the EQIP initiative was a welcome opportunity for JTC.
Application of the Fishbone exercise revealed that not all staff knew when a referral to the program was appropriate, and, when they did, most preferred not to use OTN to connect clients to the agency’s Nurse Practitioner. A number of root causes were unveiled with the use of the 5 Why analysis, including the need for training, support and resources.
Using the PDSA – Plan, Do, Study, Act – process, a number of change ideas were tested to tackle root causes, including creating resources to support staff to refer to this service, and training and resources to support effective use of OTN.
As April Furlong, EQIP Co-Lead, explains, “The process helped us get past the assumption that the technology was always the main problem. With new assessment guidelines in place we are starting to support staff to identify the need for this service.”
Chelsea Kirkby, EQIP Co-Lead, adds, “The E-QIP tools and templates, as well as the support of our coach, encouraged us to be concrete, focused and comprehensive.”
The Jean Tweed Centre has evidence that primary health services offered though OTN has reduced barriers to accessing treatment and that clients are highly satisfied with the program. Through the E-QIP initiative, the agency now has the tools to increase the reach of this service to clients served in its outreach program. This is a great example of how a focus on Quality Improvement can increase access to services for those who need them most.