Twin Bridges Nurse Practitioner-Led Clinic

Case Study Submitted by: Valerie Winberg
Country: Canada

The Twin Bridges Nurse Practitioner-Led Clinic in Ontario, Canada, is an interdisciplinary primary care clinic that provides people-centred care to 3,200 patients. Nurse Practitioner-Led Clinics (NPLC) are an innovative model for delivery of comprehensive health care, designed to improve access to care for thousands of individuals and families who currently do not have a primary healthcare provider.

Ontario has struggled with a shortage of primary care providers for over 10 years with many regions being severely underserviced. The shortage has led to communities with large numbers of “unattached” or “orphaned” patients (i.e. with no primary provider) whose only access to care was local emergency departments.  This has caused overcrowding in emergency departments and long wait times. Furthermore, lack of access to preventative care and regular monitoring and maintenance of chronic disease conditions results in even greater hospital utilization.

These nurse-led clinics provide services to people throughout the lifespan. Services include periodic health exams, episodic illness care, immunisations, injury prevention, advanced wound assessment and management of chronic diseases. It also includes individual and group programmes aimed at physical and mental wellness such as mindfulness, meditation, anxiety management, physical fitness through exercise and yoga, tobacco use cessation, healthy eating and food preparation skills. The clinic also has a collaborative partnership with the Aamjiwnaang First Nation to provide primary care services to individuals of this First Nations community.

As a result of this service, Twin Bridges has:

  • provided a new access point for patients into health care
  • very high patient satisfaction scores on survey responses that rank NPLC in the 98-100% satisfaction range on all areas surveyed
  • greatly reduced the number of unattached patients across the province of Ontario
  • provided access to patients to comprehensive services in one location where the circle of care is easy to access
  • enabled the services to remain highly affordable
  • empowered the patients so that they feel heard and can openly interact with staff
  • implemented a shared care model between Nurse Practitioners which enables access to same day appointments and ensures that all patients have a primary provider
  • enabled improved shared care experience to assist in the care of complex patients

The model of care at Twin Bridges is exceptionally innovative within its context. A truly unique aspect of the model is the incorporation of nursing leadership within an interprofessional team. It challenges the long-held paradigm in Canada that physicians alone must manage a person’s health. With Nurse Practitioners partnering with individuals and communities to improve health and wellbeing, patients are at the centre of the service and are fully engaged in the services provided by team based carers.

The success of the clinic has led the Ministry of Health and Long-term Care to fund an additional 25 clinics across the province of Ontario.

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