91708 PCN Community Impact Report - Red Deer PCNreddeerpcn.com/About/Documents/FINAL PCN...

Community ImpactREPORT 2014 – 2015

91708 PCN Community Impact Report.indd 1 2015-06-03 1:01 PM

Red Deer Primary Care Network Impact on the Health of our Community

Primary Care Networks (PCNs) 1

Red Deer Primary Care Network (RDPCN) 2

Our Community 2

Our Organization 3

Impacting Lifestyle 8

Health Cafés 8

Health Basics: Lifestyle Group 9

Preventing Falls 10

Improving Sleep 11

Tobacco Free Life 12

Tools for Promoting a Healthy Lifestyle 13

A Healthier Community 14

A Healthy Workplace 17

Impacting Mental Health 18

Empowering People to Face Life’s Challenges 18

Managing Anxiety 19

Happier People 20

Strengthening Relationships 22

Reconnecting People 22

Improved Access to Psychiatry 23

Supporting Youth 24

Impacting Vulnerable People 26

Partnering with the RCMP to help people in time of crisis 26

Primary Care for Vulnerable People 27

Impacting Pregnancy and Babies 29

Pregnancy & Babies Program 29

Access for all Pregnant Women 29

Impacting People with Chronic Disease and Complex Conditions 30

Managing Diabetes and High Blood Pressure 30

Navigating the System 31

Assisting with Medication Concerns 32

Hospice Rounds 33

Testing Memory 33

Impacting Access to Continuous and Comprehensive Health Care 34

Supporting the Medical Home 34

Finding a Family Doctor 34

Educating the Public 35

Impacting the Future 41

2015 – 2018 Business Plan 41

2015 – 2016 Plan 41

Evaluation Tools Used 43

Connecting with the RDPCN 44

2 RED DEER PRIMARY CARE NETWORK


Primary Care Networks (PCNs)

Primary Care is the first point of contact a person has with the health system. Most

Albertans receive their primary care through PCNs. PCNs were established starting in

2005 to provide better access, greater health promotion and chronic disease management,

improved care co-ordination, and increased use of teams of health professionals. Since that

time 42 PCNs have been established. Alberta Health determines the overarching objectives

of PCNs. Alberta Health is the provincial government ministry that sets policy, legislation

and standards for the health system in Alberta. If your family doctor is a member of a PCN

you are a part of that PCN.

Each PCN is unique — developed by local family doctors with the local health region.

This allows and encourages the PCN to focus on the needs of the local patient population.

A joint venture agreement between the Doctors’ Not for Profit Corporation and Alberta

Health Services forms the PCN. For more information on Alberta Primary Care Networks

go to pcnpmo.ca.

Alberta Health introduced Alberta’s Primary Health Care Strategy in 2014. This strategy

sets out a long term plan for transformation of our primary care system to improve the

health of Albertans.

1 Alberta’s Primary Health Care Strategy Page 11.

“In Alberta, when we think about

healthcare, we often think of our

doctors and hospitals working to

help patients, who are ill, regain their

health. Working together, through

the RDPCN, doctors and staff

are working with citizens/patients

to address health issues before they

appear in the emergency room at the

hospital. The RDPCN is engaging

individuals in taking care of, and

responsibility for, their personal health

and wellness.”

– Cindy Jefferies, RDPCN Community Board Member“This transformation will make primary health care more efficient; by focusing on prevention

and health promotion, more people can receive care in the community rather than from

hospitals and emergency rooms. This reduces costs for the system, and for families and

individuals dealing with the personal costs of being ill.”1

COMMUNITY IMPACT REPORT 1


Red Deer Primary Care Network (RDPCN)

But we are aging: by 2040 one in four will be 65 and over

across Canada.

Our CommunityThe RDPCN serves a population of approximately 120,000 people living in

Red Deer, Blackfalds, Penhold, Delburne and Red Deer County.

Red Deer Primary Care Network (RDPCN), established in 2006, is the 8th largest of 42

Primary Care Networks in Alberta. Primary Care Networks range in size from serving a

population of 5000 people to over 300,000 people.

We have a young population: 29 is the median age

Median age is the age where half of the people are younger and half are older. In the

2014 Red Deer Municipal Census2 the median age in Red Deer was 29 years while the

median age was a litte higher in the surrounding communities. This compares to 36 years

of age for Alberta and 40 for Canada.3

Red Deer has fewer seniors than the rest of the country. Eleven percent, or approximately

1 in 10 people were 65 and over in 2011. This compares to 14% for Canada in 2011.

High Level

Fort MacMurray

Grande Prairie

Edmonton

Red Deer

Lake Louise

Banff

Calgary

Medicine HatLethbridge

Jasper

The community of Red Deer stands out for its community spirit. We would like to thank the

champions, The City of Red Deer, other organizations and volunteers who have collaborated

with RDPCN to create a culture of active and healthy living.

2 City of Red Deer (August 2014) Municipal Census.

3 Statistics Canada. Focus on Geography Series, 2011 Census.



This illustration is our visual identity that signifies a vital, healthy community. It encourages

people to be healthy using community assets such as the beautiful Red Deer pathways.

The RDPCN is known for:

People centred care.

Doctors who are committed to

improving the health of their

patients and the community.

Award winning workplace wellness.

Innovative and enthusiastic staff.

A holistic approach to

patient care.

Skills based leading edge

programs that achieve

significant results.

Sharing our programs locally,

provincially and nationally.

Health promotion activities in

the community.

Dynamic community partnerships.

Being a learning organization,

committed to quality

improvement.

Our Organization

Our Philosophy

We are in the business of health not illness. We empower people to be the healthiest they

can be. We use a positive approach and know that people can make the most progress by

focusing on what they are moving toward, not on what they are moving away from. Our

holistic approach considers the mental, physical and spiritual needs of an individual to

achieve their optimum level of wellness.

4 Alberta’s Primary Health Care Strategy, page 24.

“One of the necessary major cultural shifts is engaging individuals as active

participants in managing and making decisions about their own health.”4



Weaving a Web of Care

Patients are fi rst able to access the

services of the Primary Care Network

through their family doctor. Once a

person is referred to the team they are in

a web of care and can access the other

RDPCN services. Locating other health

care professionals such as family nurses

and mental health counsellors within the

RDPCN doctors’ offi ces enables direct

communication, collaborative practice,

and joint case management of patients.

Patients can access education and group

appointments in the centralized RDPCN

offi ce. Patients are linked with AHS

and other community organizations and

resources as needed in order to enhance

the delivery of primary care services.

In 2014 – 2015 there were 8,875

referrals to our programs. This

was a 2.6% increase from the

year before.

Pharmacist

Pregnancy

& Babies

Nurse

Mental

Health

Counsellor

PATIENTPATIENT

DoctorFamily

Nurse

AHS and

Community

Based Service

Programs

RDPCN

Community

Programs:

Street Clinic

PACT Team

RDPCN

Group

Programs

Multidisciplinary

Doctor’s Offi ce

Team



Our Accountability

Our vision: Innovative comprehensive and continuous

care for all patients in our community.

We receive our funding from Alberta Health. In the 2014 – 2015

year we received seven and one half million dollars to provide

Primary Health Care to our patients. We chose our priorities guided

by our vision, through a collaborative process that included RDPCN

patients, doctors, staff, Alberta Health Services representatives

and community organization representatives. Within the priorities

chosen, RDPCN considers innovative strategies to treat present

health issues and broader strategies to engage the community to

decrease future health risks. In the community we are a catalyst to

improve individual and community health.

We evaluate our programs and services using a continuous quality

improvement process to ensure they are effective, meeting the

needs of the community, and are using our resources wisely. Each

year we provide Alberta Health reports on these results. We also

will post this report on our website: reddeerpcn.com.

The board of the RDPCN consists of Family Doctors and Community

Members. Alberta Health Services (AHS) representatives sit on

our governance committee. AHS is the provincial health authority

responsible for overseeing the planning and delivery of health

supports and services to Albertans. We added community members

to our board at the beginning of this year to gain a broader

community perspective for RDPCN decisions and strategic planning.

2014 – 15 Board of Directors

Dr. Tony Williams BOARD CHAIR

Dr. Peter Bouch PAST CHAIR

Dr. Nav Rattan CHAIR ELECT

Dr. Peter Mah SECRETARY TREASURER

Dr. Morné Odendaal

Dr. Erin Thompson

Dr. Maureen McCall

Dr. James McIntyre

Dr. Jack Bromley

Dr. Charles Metcalfe

Cindy Jefferies COMMUNITY BOARD MEMBER

Mark Jones COMMUNITY BOARD MEMBER

Executive Director

Lorna Milkovich RN, BN, MBA

AHS Governance Representatives

Andrea Thain Liptak DIRECTOR, PRIMARY CARE AND CHRONIC DISEASE MANAGEMENT

Allan Sinclair EXECUTIVE DIRECTOR, RED DEER



Our People

The RDPCN teams include family doctors and other health care

professionals. Our people are encouraged to make healthy lifestyle

choices and act as role models. We all work together to help people

be as healthy as possible. Patient Care is our bottom line.

82 Family Doctors in 18 family medical clinics:

16 in Red Deer, 1 in Sylvan Lake and 1 in Blackfalds

42 Professional Staff including Registered Nurses,

Licensed Practical Nurses, Psychologists, Social Workers,

Pharmacists, Kinesiologists, Dietitian, Nurse Practitioner

and Recreation Therapist

16 Support Staff including Evaluation, Communication,

Management, Information Technology, Administration

Support, and Clinical Support Staff

“You must be the change you wish

to see in the world.” – Gandhi

Dr. Tony Williams

Board Chair

Lorna MilkovichLorna Milkovich

Executive Director



RDPCN staffRDPCN staff

COMMUNITY IMPACT REPORTCOMMUNITY IMPACT REPORT 77

Impacting Lifestyle

5 Statistics Canada. The Daily: Canadian Health Measures Survey, 2013.

6 2015 Alberta Survey on Physical Activity

The Facts

Overweight, physical inactivity and sedentary behavior are risk

factors for many chronic physical and mental health conditions,

such as heart disease, stroke, high blood pressure, colon cancer,

breast cancer, diabetes, depression and anxiety. Getting moving

and active is associated with as much as a 30% decrease in all

causes of death. Maintaining a healthy body weight can protect

people from up to 22 other illnesses.

Approximately two thirds of Canadian adult men (62%)

and almost half of women (45%) are classified as

overweight or obese.5

The average Albertan sits 9 hours per weekday and

8.25 hours on weekend days. Only 60% of Albertans

(self-reported) are physically active enough to get

health benefits.6

Health CafésWith so much health care information available from many different

sources people want to hear the basics and have an opportunity to

ask questions. Health Cafés are discussions of current and relevant

health topics for the public. Family doctors and other health

professionals provide key information and then open up the floor

to questions on topics such as The Best Diet for a Healthy Weight,

Exercise: the Fountain of Youth, The Hot Flash Bash, and Five

Ways of Creating More Comfort and Joy for the Holidays.

12 cafés with over 750 attendees were hosted over the

past two years.

Over 95% of the attendees found the cafés helpful and

would attend another.

“Casual and inviting atmosphere. Knowledgeable speaker.”

– Attendee



One year later, she is 36 pounds lighter!

Donna knew she was overweight and, when she saw a brochure

for the RDPCN’s Health Basics program in her Doctor’s offi ce, she

asked him about it. He referred her to the program and she started

in March 2013. Right from the start, she embraced Health Basics

and worked very hard at applying the information she learned in the

classes to her own life. One year later, she is 36 pounds lighter!

“The biggest thing for me has been the portion control,” says Donna.

She also stopped snacking in the evenings and started walking

every day. Her success has motivated her to maintain her

new healthy habits. “I’m

breathing much better and

can walk longer now,” says

Donna. Donna regularly

attends the follow up

sessions and says they have

helped keep her on track

through her ups and downs.

Donna’s advice to anyone

considering making a change

in their life:

Health Basics: Lifestyle GroupHealth Basics is an action based group for people who want to

embrace healthy living through mindset, nutrition and activity.

Participants learn simple and effective ways to make positive

lifestyle changes. One other Alberta PCN has received training on

the Health Basics program this year.

Small Steps Lead to Big Changes. Your choices reveal

your priorities.

In 2014 – 2015, 256 people participated in Health Basics.

At the end of the 8 week group results show:

Increased activity, healthy eating and positive mindset.

Increased quality of life – more vitality, less pain,

better mental health and increased ability to do

daily tasks.

Weight loss, decreased BMI and waist circumference.

“Through the encouragement and support I received, I lost

18 pounds and 3 inches in 8 weeks and most of all, I’m learning

to have a positive mindset on a daily basis. Health Basics has

taught me to make healthier choices. The cravings used to

control me and I now control the cravings.” – Health Basics participant

“Do it and don’t give up!

Every small step you take

makes a change.” – DonnaDonnaDonna



Preventing Falls

The Facts

According to the Alberta Injury Prevention Centre in 2011, falls

were the leading cause of hospital admission.

Strong and Steady

Strong and Steady is an exercise and falls prevention education

group (4 week) targeted to older adults who have a fear of falling,

may have problems getting out of a chair, are able to walk and are

able to participate in a group setting. The focus is on exercise,

safety in the home, and introduction to a community activity class.

146 people attended the group this year, double the

number from last year.

Participants reported over 80% improvement in:

Confidence in walking – malls, to the mailbox, gardening

Balance

“I feel better in my life and have more fun.” – Participant



Improving Sleep

The Facts

Insomnia is the most common sleep disorder across all stages of

adulthood. National Sleep Foundation surveys reveal that 60% of

adults report having sleep problems a few nights a week or more.

Sleep plays a vital role in every aspect of health and well being.

Return2Sleep

In order to address insomnia, RDPCN offers an online Return2Sleep

program developed at the University of Winnipeg.

In 2014 – 2015, 42 people completed the sleep

program. A sample of participants who completed the

program reported approximately 3 hours more sleep per

week; significantly improved sleep quality and efficiency;

adherence to sleep improvement techniques and that

they used sleeping pills significantly less often.

“Hey, Jonah, just wanted to again thank your organization

for running the sleep program. I was in the program a year

ago, and since taking it, I have been able to actually regain a

normal sleep routine, and regain back my life... There are very

few nights anymore that I am tossing and turning, and not

getting a fitful sleep. I tell everyone I meet who indicates

a sleep issue about my experience with the program and

that they should contact your organization and look into

participating, as it really could change their quality of life.

Never in a million years did I think an online program would

be so impactful, or that I would give a written endorsement

without being asked...amazing...” – MJ

“I gained knowledge about sleep that I wasn’t aware of

before, giving me a greater understanding of insomnia.

Some of my habits changed, but also my attitude towards

sleep shifted, which together have improved the quantity

and quality of sleep.” – Patient



Tobacco Free Life

The Facts

Quitting smoking is the single best thing

that you can do to improve your health

and quality of life. 21% of people in

Central Zone smoke, which compares to

17% for Alberta.

Tobacco Free Program

RDPCN’s Tobacco Free program, offered

by Family Nurses in clinics, is based

on the Mayo Clinic program and uses

motivational interviewing techniques.

In 2014 – 2015, there were

350 referrals. 51% of patients had

smoked over 30 years. The program

quit rate was 27% for the year.

Karen smoked for 45 years. In March

2014, she celebrated her one year smoke

free anniversary. She had thought about

quitting smoking before, but it was

her doctor, suspecting she might have

hypertension, who really encouraged

her to go for it. Karen signed a quitting

contract with the RDPCN nurse she worked

with to stay accountable. The contract

reinforced her commitment to quit, but

there were still struggles including some

weight gain. Fortunately, Karen did not

have hypertension and now her health is

better than ever. She is able to take a deep

breath without coughing, has noticed her

skin has regained a healthy colour, and is

working to return to her previous weight.

She cites many other positives that have

come as a result of her accomplishment.

“The new me doesn’t have to go outside

after meals, or break away from social

situations to smoke. My clothes don’t smell

bad and I’ve saved a lot of money, too!”

she says. The combined support of the Red

Deer Primary Care Network, her husband

and her own determination were the keys

to her success.“The future looks good because my

health is good.” – Karen

KarenKaren



Lifestyle Planner

A lifestyle planner has been produced since 2010.

The planner provides

tools to record

information such

as blood pressure,

exercise type and

times as well as set

health goals. It is

designed to motivate

and engage people

in self-management. Patients use it to set their goals, monitor

their progress and review it at appointments with their health

care providers. The template has been shared with three other

PCNs in Alberta.

Educational Television in 10 Doctors’ Offices

Televisions in clinic waiting rooms provide patients with interesting

health focused programs as well as information on RDPCN

programs and activities such as the trek or upcoming Health Cafés

therefore using the opportunity to engage people in healthier living

while they wait.

Treks in virtual locations

Having a goal doubles the

chance of making successful

changes. RDPCN treks are one

resource to encourage people

to participate in regular activity

in a fun way. To date 11

treks have been sponsored

by the RDPCN with over

6200 participants including

individuals, groups, corporations

and schools.These included treks at virtual locations such as the

Hawaiian Islands and Mount Everest. People register and join the

trek on the website rdpcn.com. Activity is converted to steps by the

online program. In order to complete a trek on schedule one needs

to take approximately 10,000 to 11,000 steps every day. Studies

indicate 10,000 steps/day is necessary for health benefits.7

my lifestyle planner 22010155

Annual

Checks and

Screening Tests

See pages

19 and 20

7 10,000 Steps a Day to Health, American Public Health Association

“I got your brochure, got a pedometer – started a week late

but kept going. I got to 728,242 steps. I even walked while

I leaned on the cupboard to read the newspaper! Finally got in

two fitness classes. I try to park as far away as I can in parking

lots. I walk faster! The trek did motivate me.” – Participant

Tools for Promoting a Healthy Lifestyle

Start

50,000

150,000

250,000

350,000

450,000

550,000

750,000

700,000

600,000

650,000

850,000

500,000400,000

300,000

200,000

100,000

800,000

900,000

Paauilo

Hilo

Volcano

KahaluuKealakekua

Puako

Honokaa

Alenu

ihah

a Cha

nnel

Hana

HaikuKahuluiHonokowaiKaiw

i Cha

nnel

Waipahu

Makaha

Pacific

Ocean

Hawaii

Pacific Ocean

Hawi

Kahoolawe

MauiLanai

Molokai

Oahu

Honolulu

Lihue

Lanai City

Pahala

Naalehu

Kauai

Hawaiian Islands

Hawaiian Island TrekSTARTS February 23, 2015

ENDS May 23, 2015

Track your steps and activity on this map or

sign up online by visiting www.redeerpcn.com.

You can register as an individual or create a team!

Aim for 10,000 steps a day for good health and

to tour the islands in 90 days!

Mark your trail

Use your pedometer to keep track of your steps or

convert 1 and ½ hours of any moderate physical

activity to 10,000 steps.

HawaiianIslands

Trek



A Healthier Community

The Built Environment

Canadians of all ages aren’t moving their bodies enough to reap

all of the good things that come from being active: reduced risk

of disease like type 2 diabetes and some cancers, better scores in

reading and math, better fitness, more fun, healthy body weight,

self-confidence, new skills, better mental health.8

The RDPCN worked with the City of Red Deer to build

10 outdoor gyms in Red Deer communities in 2009

and 2010 making workouts free and convenient while

offering people an opportunity to build community

by getting to know their neighbors. Red Deer has the

highest number of outdoor gyms per capita in Canada.

People like the multiple locations as they can choose a different gym

while walking or biking. A grandmother over the age of 80 brought

her daughters and grandchildren to try it. People were eager to share

their gym experience with their spouses, family and friends.

8 Participaction. Moving Canadians to Move More. Impact Report 2014.

“It is easy, fun, convenient and affordable; provides a great

workout for circuit and strength training.”

– Community member who uses the outdoor gym

Ten gyms are located within Red Deer communities:

• Barrett Park – 4725 – 43 St. (next to Kinex Arena)

• Bower Place – 460 Barrett Dr.

• Glendale Park – Glendale Blvd. at Greig Dr.

• Johnstone Crossing Community Health Centre –

105 Jennings Cres.

• Mountainview Sunnybrook Community Activity Centre –

4316 – 32 St.

• Oriole Park – 5204 Kerrywood Dr.

• Red Deer Primary Care Network – 5130 – 47 St.

• Riverside Meadows Community Activity Centre –

5616 Kerry Wood Dr.

• Rosedale Community Activity Centre – 2 Rowland St.

• Victoria Park – Allan St. at Ayers Dr.



Disc Golf

Two disc golf courses, a 9-hole beginner course in Kentwood and an intermediate

course in Victoria Park were built in partnership with the City of Red Deer for

the use by the general public in 2011 and 2012. Over 1,000 people of all

ages have attended community disc golf coaching sessions since that time.

Portable disc golf sets can be borrowed from the RDPCN for local events.

RDPCN also offers outdoor gym and disc golf training for small groups on

request. Score cards can be printed off at reddeerpcn.com or picked up at

the central RDPCN office.

Comments from the community:

In April 2014 RDPCN’s Executive Director presented on RDPCN’s involvement in Bike

Lanes, Outdoor Gyms and Disc Golf courses at the Chronic Disease Prevention Alliance of

Canada (CDPAC) Conference in Ottawa. She spoke about the RDPCN partnership with the

City of Red Deer for creating shared built and supportive environments (bike lanes, disc

golf and outdoor gyms) to promote health and prevent disease. The conference organizers

noted that this was the only place in Canada where they found doctors involved in the

built environment.

“Amazing game and one everybody can do. Just as addictive as real golf.”

“Disc golf is awesome and you don’t even know you are exercising.”

“Great family fun. Great fun for all ages.”

Disc Golf courses are located at:

Victoria Park (along Allan St.): a 9 hole,

2500 foot course in Central Red Deer.

The course is rated at par 28 and par 25

for professionals.

Kentwood (along Kent St. and Kendrew Dr.):

a 9 hole, 2226 foot course in North Red

Deer. The course is rated as par 37.



RDPCN also supports biking to many City events by providing personnel to supervise bike racks.

In support of active living the RDPCN provided sponsorship, volunteers, the bike corral

staff and first aid to support Red Deer in hosting the Tour of Alberta for 2013 and 2014.

Farmer’s Market Bike Corral

Bike Corrals are hosted by RDPCN each Saturday from May through October at no charge

to the user. The Bike Corral has been available since 2012.

An average of 35 people use the bike corral each week.

“I went to the Market yesterday and it was the first time I actually enjoyed going

on my bike. The bike corral was a great idea. It was the first time I didn’t have

security or the Market Coordinator chasing after me or didn’t have to worry

about my bike being stolen. Cheers to those who came up with the idea!” – Cyclist

The City of Red Deer

Recreation Passes

RDPCN provides City of Red Deer recreation

passes to patients who are currently facing

some financial challenges and want to use

City-operated recreation facilities or take

part in City offered Recreation, Parks or

Culture programs or activities.

The RDPCN distributed 169

Recreation Passes as Fee Assistance

Program Approvers in 2014 – 2015.



A Healthy WorkplaceRDPCN is a leader in healthy workplace. The policies and

operations of the RDPCN support staff work life balance and

physical and emotional wellbeing. RDPCN received the Alberta

Premier’s Award for Healthy Workplaces three years in a row.

Workplace Highlights:

Activity recess reduces sedentary activity and

boosts energy.

Community participation is supported: Tour of Alberta,

Ronald MacDonald House suppers, Berry Architecture

Wellness Ride.

Staff participated in the Canadian Commuter

Challenge at the beginning of June by walking or riding

to work rather than driving. 11 staff participating

travelled 517 km, saved 17 litres of fuel and 39 kg

of CO2 were avoided through active transportation.

Staff education contributed to our continuous

quality improvement process.

“The March Staff meeting review revealed how impressive our

Workplace Wellness plans are and how well they are implemented.

So many opportunities to engage and to be proud of being

an organization that walks the talk.” – RDPCN Staff

“RDPCN is a great place to work and have a career.” – RDPCN Staff

Ronald McDonald House dinner volunteers

RDPCN softball team



9 Mental Health Commission of Canada (2012). Changing Directions, Changing Lives: The Mental Health Strategy for Canada.

10 Alberta Health 2009 Billings

11 Institute of Health Economics 2008

Impacting Mental Health

Empowering People to Face Life’s Challenges

Mental Health Counsellors

Mental health counsellors provide brief counselling for patients referred in every RDPCN

doctor’s clinic. Patients who require longer term counselling, specialized counselling, or

who are urgently in need of services are referred to AHS or community services.

Patients reported a 42% decrease in distress level after counselling sessions

in an evaluation done in 2013.

A Journey Back to Health

As a member of the Fire Department, Peter was used to dealing with extremely stressful

situations on a daily basis. After 35 years he retired and was surprised to find that the

anxiety and depression he had been experiencing for years was actually worsening. He was

retreating from life and his health and personal relationships were suffering. Peter was

aware of Post Traumatic Stress Disorder (PTSD) and he recognized that he needed help.

Peter reached out to his doctor who referred him to a Red Deer Primary Care Network

Mental Health Counsellor. Over the next three months, he began his journey back to health.

“One of the strategies I learned, that I continue to implement, is practicing mindfulness. Really

being aware of what’s happening and how it’s affecting me,” says Peter. Staying active, both

physically and mentally, is another important part of Peter’s life now. He has even picked up

old hobbies. “I started woodworking again,” he says. Peter encourages anyone dealing with

anxiety and/or depression to ask for help. “You can’t do it alone. It’s a good time to lean on your

friends,” he says. “The more I share with people, the more they share and they want to help.

I’ve been surprised how many people I know who are dealing with the same issues I have been.”

Today, he describes his future as looking very good!

“1 in 5 people in Canada live with a mental

illness each year.”9

At least 40% of visits to family doctors in

Alberta are mental health related.10 Every

day, 500,000 Canadians are absent from

work due to mental illness.11

In 2014 – 2015, there were

2,331 referrals to the Mental

Health Program. The top four

reasons for RDPCN mental health

referrals in 2014 – 2015 were

anxiety, depression, relationship

issues, and grief.

The Facts



Managing Anxiety

The Facts

Anxiety can stop people from living their best life. Anxiety is the

most common mental health reason for patients seeing a family

doctor.12 Anxiety is also the most common reason for referral to

the RDPCN mental health program.

Anxiety to Calm Group

In 2014 – 2015, 159 people participated in the

anxiety group.

The RDPCN 8 week group program, Anxiety to Calm, is focused

on people learning more about anxiety, learning skills to manage

and reduce anxiety, and experiencing more calmness.

People attending this group had a 48% reduction in

anxiety symptoms on completion of the group.

People improved their ability to do daily tasks and work; had more

energy; better mental health and increased their likelihood of

socializing with family and friends.

The most helpful components of the group were reported as:

Knowing that one is not alone in dealing with anxiety.

Tools and techniques to deal with anxiety.

Understanding how anxiety works.

Learning from other group members.

12 Alberta Health Services website: http://www.albertahealthservices.ca/2774.asp

“I feel a high sense of

relief that my anxiety is

something I can conquer.

I have the tools and

knowledge. It doesn’t need

to take over my life. I’m

excited for the future and

what it holds for me.”

– Katarina, class participant

KatarinaKatarina



Happier People

The Facts

Approximately 10% or one in ten Canadians have a

depressive disorder.

Depression was the second most common reason of all

referrals to RDPCN mental health in 2014 – 2015.

Happiness Basics

RDPCN offers a 7 week Happiness Basics group based in positive

psychology. Positive psychology focuses on the creation of positive

states of mind, positive emotions and positive experiences. It

focuses on what is going well with people, what is right, and what

is good. It studies why and how we excel and what makes us

great. Participants learn skills such as savoring and gratefulness.

RDPCN stands out as a leader in Alberta for using this fresh and

scientifically proven approach.

241 people participated in the

Happiness Group in 2014 – 2015.

Participants reported an average

26% increase in their happiness

after completing the group.

48 health care professionals working in various Alberta PCNs and

AHS were trained to deliver the Happiness Basics group. This

knowledge transfer shared an effective well-developed group.

Classes are running in several communities across the province.

One to two hour slices (workshops) of this program have been

offered to 23 organizations, schools and workplaces through

the community. The slices provide an introduction to positive

psychology and teach a few skills.

“Happiness Basics opened my mind and I am much less

angry and negative; I have new tools and goals to experience

happiness; I felt invigorated by the information and the

challenges; instructors were very personable with lots of

energy; I became more aware of what I have to be grateful

about; I think looking forward to Happiness class was the

best part of all – I was just happy thinking about class.”

– Happiness Basics participant

FLOURISHING/POSITIVE

LANGUISHING/NEUTRAL

DEPRESSED/NEGATIVE



Vi

Recently I took the Happiness Course. The day after the

happiness class was fi nished I was in a car accident. The

happiness class helped me put things in perspective. Instead

of dwelling in self-pity or getting caught up in the stress of the

unknown future I have learned it is what it is and am dealing

with things one day at a time knowing things could’ve been a lot

worse. I have minor whiplash which I am being treated for with

daily physio and my van is a write off. I am seeing things as an

opportunity for learning and personal development as well as an

adventure (rather than a drudgery poor me syndrome).

I can’t change the circumstance but can change how I react to it.

I’ve always known this to be true but now I am practising it. The

course has helped me immensely and I highly recommend it to

everyone and anyone! It’s true that attitude really is everything. It’s

interesting how other things in my life lately have also related to

changing thought patterns and other skills I learned in the course.

Kathleen

Kathleen has battled depression throughout her life and now

experiences Seasonal Affective Disorder (SAD), a type of depression

that occurs in the fall and winter months. This past winter was

especially hard and Kathleen’s doctor recommended the Red Deer

Primary Care Network program Happiness.

Mindfulness was only one of the strategies

Kathleen learned during the six week

program where she felt a sense of

community. “It was uplifting on the dull gray

days and provided tools to use to stay out of

depression,” she says. In addition, Kathleen

knew she had to get active. Through the

encouragement of the Red Deer Primary Care

Network, she started taking yoga classes and

has discovered a real love for it. Her advice

for anyone considering trying the program is

to keep an open mind and try to be available

to change. “It has been awesome for me.”

“I came to the group with no real expectations, or idea of how

Happiness classes would help me; however, after a couple weeks,

I did begin to practice mindfulness and it was quite a surprise to

see how important it is to be present and in the moment.”

“Thank you so much for an awesome learning experience.

Wish I took this course years ago!” – Vi

KathleenKathleen



Strengthening Relationships

The Facts

Unhealthy relationships can take a toll on mental

health and quality of life. Relationship concerns are the

third most common reason for referral to the mental

health program.

Relationships that Work

The RDPCN 4 week Relationships that Work group

enhances personal, work and family relationships.

The group focuses on what the participant can change

as a person cannot change others.

In 2014 – 2015, 64 people participated in

the program.

Participants reported an average 72% increase in

relationship satisfaction scores after the group.

“I am more aware of myself and my contribution

or lack of in my relationship and I want to change

what I can to be more positive, less condemning

of the person. I will use the words I feel when

discussing issues.” – Participant

Reconnecting People People who attend the Recreation Therapy program have issues such as

finances, confidence, mental health, physical health, and awareness of

leisure activities that hold them back from being active and engaged in

the community. The Recreation Therapist works with the person in the

community to develop skills to increase their engagement in activities.

This leading edge program has moved recreation therapy out of the hospital

into the community. It is one of the only programs in Canada that is health

promotion based.

There were 133 new patients seen in the Recreation Therapy

program 2014 – 2015. There were 551 encounters with patients.

6 months after attending the program patients were 16% better

able to develop and maintain social relationships with family

and friends; experienced 20% better mental health; were less

downhearted and depressed and their risk of becoming depressed

decreased by 23%.

“My health has improved, both physical and mental health.

I look at activity in a different way; what was once a chore

is now an enjoyable experience.” – Patient

“I started going out and doing different things like going shopping

and dancing more.” – Patient

“I found new activities and became more comfortable in a group.” – Patient



Improved Access to Psychiatry In addition to the 1 in 5 people with a mental illness each year,

Alberta’s Creating Connections: Addiction and Mental Health

Strategy (2011) noted that as many as 10% of the people

over age 15 may be dependent on alcohol or drugs13 and some

are experiencing both mental disorders and substance abuse

problems. When individuals have mental health and/or substance

abuse concerns, they often approach their family doctors fi rst.

Family doctors play a major role in the delivery of mental health

and/or substance abuse care. They may also need to consult

with specialists such as psychiatrists to help with diagnosis and

treatment plans for their patients. Referral to other community

agencies such as AHS Community Addiction & Mental Health

Services may also occur.

RDPCN has partnered with community psychiatrists by supporting

a psychiatric clinic located at the RDPCN offi ce three afternoons

a week. By doing so, psychiatrists without private offi ces of their

own now have a venue to direct referrals from the family doctors.

There were 213 referrals to a Psychiatrist at RDPCN in

2014 – 2015.

13 Centre for Addiction & Mental Health; Mental Health and Addiction Statistics 2010

Dr. Anton ValmanaDr. Anton Valmana

Psychiatrist



Supporting Youth

Empathy Pilot Project

14 Mental Health Commission, May 2012.

15 Dr. Peter Silverstone, Medical Director, AHS Mental Health Strategic Clinical Network. Empathy Program Proposal

Approximately 5,000 students were screened for mental

health concerns in 2014 – 2015.

119 students were seen for mental health concerns by

RDPCN counsellors in 2014 – 2015.

Results after the online intervention:

Depression and Anxiety scores were significantly

decreased after the online intervention.

Rates of reported suicidality were significantly

decreased.

Students who participated in the program showed

significantly more improvement.

“Reducing the impact of mental health problems and illnesses and

improving the mental health of the population require promotion

and prevention efforts in everyday settings where the potential

impact is greatest.”14

“More specifically, there is strong evidence that appropriate

interventions in schools can have a dramatic impact on reducing

the frequency of youth addictions and mental health problems.”15

The Empathy Pilot Project (also known as the Resiliency Program)

is a partnership between Red Deer Public Schools, Alberta Health

Services, RDPCN and the University of Alberta. Grant funding is

provided by Alberta Health. Schools offer resiliency education

for students in grades 6 – 8. Students from grades 6 – 12 are

screened in the areas of emotional health and addiction issues.

Students identified at risk are then offered an online intervention

supported by Resiliency Coaches. If they need further assistance

RDPCN Mental Health counsellors assess risk, teach coping skills

and provide counselling. If the student is at higher risk they are

transferred to AHS counselling.

“In our school alone, the screening has identified a

significant number of students who were not on our radar

for having mental health issues. What’s really important to

me is students are recognizing they are not alone. That

others are also dealing with many of the challenges and

struggles associate with mental health and wellness.”

– Mark Jones, Central Middle School Principal and RDPCN Community Board Member



“Very relevant to what our students are

going through at this age. Students

were entertained and focused –

humourous. I realized the pressure

adults put on kids without noticing

how it makes them feel – it’s too

much to handle at times (perfection).

I’m hoping after watching this play

that the kids reach out to others

who are struggling, that they’re more

understanding.” – Teacher

Under My Skin

Under My Skin uses social action drama to provide grade seven students with important

messages and information on body image promotion, healthy active living and positive

perspectives. Grade seven is a crucial time to deal with many of the issues associated

with body image including media messages, self-talk, risky behaviours, well being, and

positive choices. This is a project of the Foundation for Red Deer Public Schools which

has been supported by the Red Deer Primary Care Network for four years.

This year’s production ran for six days in November 2014 and was seen

by 1,164 grade seven students from eleven schools representing four area

school jurisdictions.

Students reported:

Positive self-talk was the biggest take away from the play – to accept

themselves for who they are and to be respectful and kind to others.

Students later thought about how their comments affect their peers.

Happiness Skills

Happiness skills were taught to 4 groups of elementary and middle school children

and to teachers at 2 progressional development days. Examples of skills the students

experienced in partners and small groups include thinking and writing about a positive

experience, savouring, good deeds and positive self-talk.

The goal was to have fun, experience positivity, interact with each other and experience

the benefits of these activities. They explored how they could use the skills moving

forward at school and at home.



The Facts

The RCMP received approximately 1500 mental health related 911 calls in

2014 – 2015.

PACT

Red Deer’s Police and Crisis Team (PACT) is a two-person outreach team consisting of

a Registered Psychiatric Nurse (RPN) and a RCMP officer. PACT responds to incidents

involving individuals/families experiencing mental health, addiction, or psychosocial

crisis, especially when danger to the public is present. The team provides assessment,

street level intervention and connection to community resources. PACT diverts service

delivery away from the Emergency Room and the Criminal Justice system where possible.

PACT responded to 805 mental health crisis calls in 2014 – 2015 and

diverted 92% of the cases from Red Deer Regional Hospital – Emergency

Room. Social Return on Investment (SROI) of 6:1 was realized for this

program. For every dollar spent, 6 dollars of social value were created.

SROI is a tool for measuring value, taking into account social, economic and environmental

factors. For every dollar invested, social value is created and higher cost health care

services such as ER visits and hospitalization are avoided.

“They were really nice people and

treated me well and took me to get

the help I needed . . . I was really

grateful for them.” – PACT client

Impacting Vulnerable People

Partnering with the RCMP to help people in time of crisis



Street Clinic

The Street Clinic provides primary care for vulnerable people.

A storefront Street Clinic has been operational for three years

to provide medical services and connect people to agencies for

further help and resources to support them becoming healthier.

The Nurse Practitioner works in consultation with a family doctor,

as needed. Based on the prevalence of mental health and addiction

concerns of many Street Clinic patients, a dedicated mental health

counsellor is assigned to the Street Clinic.

In 2014 – 2015, 131 new patients attended the clinic.

New and follow up patients had a total of 732 visits.

The Social Return on Investment is 3:1.

The top 4 reasons for a visit were:

1. Non-urgent medical care

2. Prescriptions

3. Lab tests

4. Wound care

16 Alberta Primary Health Care Strategy, page 8.

Primary Care for Vulnerable People

The Facts

Vulnerable populations are groups that are not well integrated into

the health care system because of ethnic, cultural, economic,

geographic, or health characteristics. This isolation puts members

of these groups at risk for not obtaining necessary medical care,

and thus constitutes a potential threat to their health.

Although the overall standard of living is high, nearly 10%

of Albertans still live below the poverty line.16

The Point in Time Homeless count for the City of

Red Deer revealed a total of 137 people experiencing

homelessness on October 16, 2014. This result shows a

decrease of 51% from 2012 when the count was 279.



Homeless but Hopeful

Garry had been homeless for a decade. When he came back

to Red Deer, friends on the street told him to go to the Red

Deer Primary Care Network’s Street Clinic where he could get

connected with the services and organizations he needed. He

was suffering with the skin condition psoriasis and battling panic

attacks. Through the Street Clinic, he found a family doctor to

treat his skin and the Canadian Mental Health Association, who

connected Garry with

a psychiatrist and

counsellor. “The street

nurse works with

you as an individual

and connects you to

others that can help

in areas she can’t,”

says Garry. Today,

Garry’s psoriasis is

under control, he

has found a place to

live and is working

with Employment

Placement & Support

Services to get back

into the work force.

“Getting my toe nails done, in a very gentle and painless manner,

has gotten me to a point where I can again walk and exercise

in comfort. The fact it is provided at no cost to me, as I’m

now on a fi xed pension income, is very much appreciated.” – Ray

Foot Care

As we grow older, three out of four Canadians will develop foot

problems that require medical attention. A Family Nurse provides

foot and nail care at the Street Clinic for those who can’t afford

such services. This is also an opportunity for the Nurse to identify

and address other health concerns.

In 2014 – 2015, there were 34 new patients with a total

of 246 patient encounters.

GarryGarry



The Facts

The health and wellbeing of the mother during pregnancy and postpartum directly impacts

the long term health of her child.

There were 1,743 births in Red Deer in 2014. This is up 5% from 1,667 in

the previous year.

28 RDPCN Family Doctors deliver babies.

Pregnancy & Babies ProgramRegistered nurses meet with low medical risk women in pregnancy and following birth at 11

medical clinics. They facilitate discussion about prenatal care, nutrition, weight gain, activity,

tobacco and alcohol use, breastfeeding, emotional and social needs and postpartum adjustment.

Women in need of extra support are connected to community agencies. Some of these

agencies include the Family Services of Central Alberta Building Incredible Babies,

Central Alberta Women’s Outreach, Red Deer Housing Authority, AHS Mental Health,

Central Alberta Pregnancy Care Centre, as well as other RDPCN programs.

Impacting Pregnancy and Babies

“You have really been a help to me. I am a lot less anxious now than when I walked

in the door. You answered so many questions and I have been able to talk to you

about things that were worrying me.” – Patient

“Pregnancy can be so stressful and even though I am a googler I don’t know what to

do with some of the information I read or how to use it in my own situation.” – Patient

Access for all

Pregnant WomenPregnant women without a family doctor

can find one through the RDPCN website

where clinics accepting obstetrical patients

are listed. Connecting to a family doctor is

important for consistent prenatal care.

There were 684 patients seen in the Pregnancy & Babies program in 2014 – 2015.



Impacting People with Chronic Disease and Complex Conditions

17 Report of the Auditor General of Alberta Chronic Disease Management September 2014

18 Report of the Auditor General of Alberta Chronic Disease Management September 2014

Managing Diabetes and High Blood Pressure

Family Nurse and self-management

This program provides information on medical and lifestyle choices to help manage blood

pressure, blood sugar and/or cholesterol. Learning to better manage chronic disease or

complex conditions can prevent and/or delay complications that can negatively affect

health. Lifestyle practices have consistently been shown to slash rates of chronic disease

and premature death by 80%.

There were over 1,292 new patients in 2014 – 2015 in the Diabetes,

Hypertension, Navigation, and Complex Care Planning programs.

The Facts

Chronic diseases are considered the largest

challenge facing our healthcare system.17

More than any other health problem,

chronic diseases shorten people’s lives and

make their lives more difficult.

30% of Albertans have at least one

chronic health condition and this

increases to 75% for those over 65 years.

About 25% of Albertans will develop

diabetes. More than 90% will have high

blood pressure by age 80.18

Insulin Start is a group provided by a Family Nurse who is a Certified Diabetes Educator (CDE).

The group provides information for diabetics on the early management and administration of

both mealtime and long acting insulin. All patients are encouraged to follow-up with their family

nurse for adjustment to reach target. The PCN CDE nurse provides consultation support to the

family nurses. AHS also provides a phone support service. Previously patients were referred to

AHS Diabetes specialty services, but moving it to the primary care level provided better access

and continuity of care, while freeing up AHS to see more complex patients.

In 2014 – 2015, 80 people attended this group.

“With the nurse’s help, my life has become so much better. I am rarely sick anymore, my

blood pressure and blood sugar levels are normal, and my liver enzymes have become normal

as well. I have started exercising almost every day and I’ve lost 30 pounds!” – Patient



Navigating the SystemWe help to connect people to some of the excellent resources Alberta has to offer. It is

easy to get lost in the health system today, especially for seniors and those who fi nd it

hard to cope anyway.19

Navigation is the connection of patients to AHS or other community agencies for services

or resources such as fi nancial aid, housing, food and counselling. Navigation is a critical

component of complex care management in chronic conditions and pregnancy. Patients

with chronic conditions and their families have multiple health and social needs that are

not easily handled in a traditional doctor offi ce visit.

Barbara’s doctor referred her to Linda, a RDPCN family

nurse for help with her diabetes. Linda navigated her to

AHS Diabetes the Basics education class and then followed

up with her on making changes in her lifestyle. Barbara

noted that Linda gave her lots of information on managing

diabetes and “was persistent in pointing out how important

exercise is.” Barbara’s shoulder pain from a biking accident

limited her mobility. Linda helped her to make a plan to

increase her exercise, which included using an indoor

fi tness facility in bad weather. Barbara says, “I now have

good control of diabetes and am enjoying my life more and

meeting challenges a bit more easily. Linda had a way of

making be feel better about myself. I’m better and happier.

I’m looking forward to healthy 80’s and 90’s and beyond.”

19 Putting People First, Recommendations for an Alberta Health Act, Page 20.

Connections to

Community Resources –

All Programs 2014 – 2015

(Total Navigations = 1,749)

■ Canadian Diabetic Association, 6%

■ Employment/Housing 3%

■ Website/References: 19%

■ Alberta Health Services Chronic

Disease Management: 17%

■ Specialists (dentist, optometrist,

specialist physicians: 7%

■ Addictions and Mental Health: 18%

■ Community services: 11%

■ Other: 19%

BarbaraBarbara



The Pharmacy program provides detailed

medication reviews for patients prescribed

fi ve or more medications and makes

recommendations to their doctors regarding

changes, if required. The pharmacist works

with patients and their doctors to ensure

optimal management of medications with

a common goal of good health.

30% of patients were on more

than 10 medications per day in

a 2013 survey.

Chronic pain, arthritis and elevated

cholesterol comprised the top three

chronic conditions for patients seen

by pharmacist.

In 2014 – 2015, 127 patients were

seen by a pharmacist.

The pharmacists also provide

unbiased education based on a

current literature review to the

doctors. They presented 46 education

sessions in doctors’ offi ces. The small

group setting facilitates discussion.

I didn’t realize how much a Pharmacist could do for me!

Two months ago Alma felt terrible. Her blood pressure was high and she thought she

might have a stroke. Her constant coughing was interfering with her sleep and she was

exhausted. In addition, she learned the pain medication she was taking for a separate

issue, wasn’t working with her blood pressure medication. Alma stopped taking the pain

meds, but then controlling her pain became a problem.

A Red Deer Primary Care Network pharmacist suggested an alternate form of her pain

medication, which worked as effectively and caused no contraindications. The Pharmacist

worked with Alma to explain all of her medications, answer her questions, and even saved

her money with generic alternatives. Today, Alma is feeling great. Her blood pressure and

pain are under control, she is sleeping through the night and she’s exercising daily. “I would

tell anyone to get a referral to see the Pharmacist immediately. There were a lot of things

I didn’t know!” says Alma.

AlmaAlma

Assisting with Medication Concerns



Hospice RoundsA pilot project integrated family doctors into the weekly rounds at the Red Deer Hospice.

Rounds are the weekly meeting at the hospice where the Hospice Care Team reviews palliative

patients’ care plans. Since the program was found to be very valuable the program will continue.

12 RDPCN Doctors and 1 RDPCN Pharmacist participate in this program.

“Overall better symptom management and comfort care for all residents. Bedside

rounds demonstrate individual attention to residents.” – Hospice Staff Member

“Interdisciplinary team dialogue around end of life care that otherwise wouldn’t happen.

This has contributed to: increased staff learning and better patient care; better

communication between doctors and staff; increased understanding and appreciation

of different staff roles at hospice which contribute to end of life care; open, thoughtful

and insightful discussions among staff and doctors regarding care.” – RDPCN Doctor

Testing MemoryPeople often go to see their family doctor

when they are concerned about their

memory. The doctor might refer the

patient to the family nurse to carry out

memory testing to help to sort out whether

this is normal aging or whether there is a

cognitive impairment such as dementia.

The Family Nurse uses 3 screening tests

(MoCA, MMSE, SIMARD MD) to assess

changes in memory, reasoning, perception

or functioning. Patients and caregivers

are given resources and navigated to

appropriate community supports.

188 patients were seen for cognitive

screening. 19 of those patients

were connected to First Link for

help with dementia.



Supporting the Medical HomeThe Patient’s Medical Home (PMH), or Health Home, is a family practice where a person

feels most at home to discuss their personal and family health and medical concerns.

People who have a family doctor have been shown to have fewer hospitalizations and

better health outcomes. The most cost effective care and best outcomes for patients

with chronic diseases occur when family doctors provide and coordinate their care.20

The community of family doctors provide cradle to grave care. RDPCN helped

19 doctors to identify their patient panels with the support of Towards

Optimized Practice.

A panel is a list of patients that have an established relationship with a family doctor. Evidence

shows that patients who consistently see the same doctor or medical home use signifi cantly

fewer health care services, have better outcomes and save the healthcare system money.

Health screening was promoted through

posters in clinics, clinic educational

TV and in our Lifestyle Planner.

20 College of Family Physicians of Canada. September 2011 A Vision for Canada Family Practice – The Patient’s Medical Home

Impacting Access to Continuous and Comprehensive Health Care

Finding a

Family Doctor

RDPCN Website

People who need a family doctor can visit

the RDPCN website for a list of clinics in

Red Deer.

There were over 13,000 hits on this

part of the website in 2014 – 2015.

We do not have a record of the number of

people attached through the website.

Attachment Lists

Attachment Lists were available for

people in Long Term Care, with Mental

Health disorders or requiring Palliative

care. They ensure that these people have

a dedicated family doctor.

About 100 patients were attached in

the past year through this process.



Educating the Public

Attaching to a family doctor

A slide show by the Towards Optimized

Practice group of Alberta Medical

Association explains the benefits of being

attached to a family doctor and is available

on the RDPCN website and on clinic TVs.

… aspartof

your

Shows…



Catchesproblems

And,helps

keep youout of

the

Looks at the

Helpsyou

Horizon Family

Medical Clinic



Is someoneyou can

Who

about you …

… and a

friends andfamily…



For goodhealth, see

yourregular



RDPCN Website

RDPCN has a user friendly Website that

informs people of the various programs

and activities of the RDPCN.

The website had over 117,000 hits

this year.

RDPCN Pamphlets and Posters

Pamphlets are given to each patient

to explain programs. Starting in 2015,

the pamphlets and posters added the

following text to explain patients are a

part of RDPCN:

Your Family Doctor is a member of

the Red Deer Primary Care Network

(RDPCN). This means you are a part

of the RDPCN, and these Programs

are for You.

In the RDPCN,

local family

doctors work with

other health

professionals and

Alberta Health

Services to

coordinate the

delivery of primary

health services for

their patients.

Posters are displayed in waiting rooms and

exam rooms. People can ask their Family

Doctor to be referred to the programs.

ProgramsYour Family Doctor is a member of the

Red Deer Primary Care Network (RDPCN).

This means you are a part of the RDPCN,

and these Programs are for You.

In the RDPCN, local family doctors work with other health

professionals and Alberta Health Services to coordinate

the delivery of primary health services for their patients.

Your Family Doctor is a member of the Red Deer Primary Care Network (RDPCN). This means you are part of the RDPCN, and these Programs are for You.

One-on-One in your Doctor’s Office

If you need help with Program Description

Mental Health

Concerns

Mental Health

Counsellor

Brief therapy on effective ways to cope with prolonged stress, relationship issues, grief and loss

and maintaining mental health. Find solutions that are right for you and build on your strengths.

Quitting Smoking or

other tobacco products

Family Nurse Individual support to help you to reduce tobacco use or be tobacco free.

Diabetes, High Blood

Pressure, Cholesterol

Family Nurse Individualized support to help you manage your blood pressure, blood sugar, and cholesterol.

Housing, Finances or

Meals

Family Nurse Help with finding community agencies that best support your needs or concerns such as

housing, finances or meals.

Pregnancy and Babies Family Nurse An opportunity to meet with a registered nurse to discuss your questions and concerns. Learn

about having a healthy pregnancy and baby.

Identifying your interests

and getting active

Recreation

Therapist

Receive education and support to get active in your home and in the community.

Medication Concerns Pharmacist The pharmacist will review your medications, explain how they work, and answer your

questions. The pharmacist will also provide recommendations to your family doctor.

Sleep Health Basics

Coach

This program is for you if poor sleep is affecting your quality of life; you have a persistent

inability to get to sleep, stay asleep or experience refreshing sleep. 1 hour information session

and 6 week online program.

Memory Concerns Family Nurse Screening for significant changes in memory, reasoning, perception or ability to perform tasks.

Nail Care Family Nurse Basic toenail trimming for those with chronic conditions, and/or limited financial resources.

Groups to Empower You


Choosing healthy living,

losing weight and

becoming more active

Health Basics

Group

Health Basics is an action based program where you will practice making small steps that lead

to big changes. You will learn simple and effective skills to make positive lifestyle choices. The

program holistically includes mindset, activity and nutrition.

Being Happier Happiness

Basics Group

A group for people who want to be happier. Learn skills to make positive changes in your

thoughts, actions, relationships and health, and create more happiness for yourself. Learn what

happy people do, how they think, and purposefully create happiness for themselves.

Reducing Anxiety Anxiety to

Calm Group

This group may be for you if anxiety has stopped you from doing your usual activities and living

your best life. Learn skills to find calm, challenge yourself and live well.

Relationships Relationships

that Work Group

This group may be for you if you are ready to take personal responsibility and learn strategies to

enhance relationships in your life. This includes personal, work and family relationships. Learn

skills to increase communication, better yourself, focus on the positive and take responsibility

for your role in the relationship.

Becoming steadier on

your feet

Strong & Steady

Group

A group for older people who want to become more active, stronger and steadier on their feet.

You will learn 10 exercises to increase your strength, flexibility and balance.

Managing Insulin Insulin Class Learn how different types of insulin work, how to manage insulin and tips on the proper way to

give insulin.

Other Services


Medical Services for

Vulnerable People

Street Clinic

at Bay 160,

5017 –

49 Street

No Alberta Health care number needed. This program is for vulnerable people in Red Deer’s

downtown core. Services include: prescriptions, birth control planning and medication, blood

work, wound care, high blood pressure and diabetes care, sexually transmitted infection testing

and treatment, mental health counselling and referral to specialists.

Mental Health Crisis Police & Crisis

Team

403.406.2505

Red Deer’s Police and Crisis Team is a two person outreach team of a Registered Psychiatric

Nurse (RPN) and a RCMP Officer. The team responds to calls involving individuals/families

experiencing a mental health, addiction, or psychosocial crisis, especially when danger to

themselves or the public is present. PACT helps people in time of crisis. It connects them with

resources for the longer term. PACT follows up to see that people are doing okay and connected

to resources.

Speak to your family doctor, visit www.reddeerpcn.com or call 403.343.9100 for details about any of these programs.

In the RDPCN, local family doctors work with other health professionals and Alberta Health Services to coordinate the delivery of primary health services for their patients.

March 2015

reddeerpcn.com



Real People.

Real Success.

Real People Real success is a

public education campaign using

billboards throughout the city and

the RDPCN website to showcase

real people who have made

signifi cant health improvements

and shared their story in order to

inspire others.

I lost 50 pounds and gained a whole new attitude

I attended the Red Deer Primary Care Network’s Health Basics program in the fall of 2011.

I attended all 8 weeks faithfully but it wasn’t my time. My defi ning moment came almost a year

after taking Health Basics. “Mom, come down the slide with me”. My youngest is pulling on my

hand. I am frozen with fear. Fear that I will get stuck on the slide. I knew I couldn’t carry on

the way I had been. I went home that day and I knew my life needed to change, but how?

The next day at work, a co-worker challenged me to sign up for a Spartan Race. I watched

a video and agreed...reluctantly. All the things that I had learned in Health Basics played in

my head and started to click. I started making small changes. I stopped making the morning

muffi n stop and I slowly stopped eating out so much. I began journaling my food. This was a

huge eye opener for me to actually see how easily I could eat double what I should. I started

making larger meals and packing leftovers for lunch. The crock pot became my best friend. I

also started running and those fi rst few weeks nearly killed me, but I kept on going. I surrounded

myself with likeminded people who encouraged me to meet my goals, and made me accountable

for the activity I was, or wasn’t doing. Setting small realistic goals kept me accountable and

motivated. Whether it was to do 5 push-ups or run for 20 minutes, I kept moving forward. I

found focusing on fi tness goals worked and the scale just naturally followed suit. So almost

a year later, I ran the 5km Spartan race that I had signed up for 50 lbs lighter. It was the

most amazing feeling in the world to cross the fi nish line. Within weeks of the fi rst race, I

also completed a 13 km Spartan race and 21 km Spartan race called ‘The Beast’. And yes,

the name says it all! I really did feel, and still do now, that I can do anything I set my mind

to. I can easily say this is a way for life for me now and it’s defi nitely for the better. – Melanie

MelanieMelanie



2015 – 2016 Plan

Engaging Patients and the Community

• Implement program prescriptions to highlight the importance of RDPCN program referrals.

• Expand community engagement through community partnerships, community board

members and community activities.

• Improve integration with local partners and develop other partnerships as appropriate.

Impacting Lifestyle

• Continue with programs available in 2014 – 2015.

• Community partnerships with the City of Red Deer and community groups will

continue to leverage local resources and champions in creating a sustainable culture

of active living.

• Our Community Plan will build toward the 2019 Canada Winter Games.

• We plan to offer group programs and Health Cafés to organizations in the community.

• Initiate exercise prescriptions for RDPCN, City of Red Deer and community resources.

Impacting Mental Health


• The Empathy Pilot Program will continue if funding is secured.

• Offer Anxiety to Calm facilitation training for other organizations in the province.

• Develop a Grief program for people coping with loss.

21 Significant references include:

• PCN Evolution Vision and Framework: Report to the

Minister of Health

• The Expanded Chronic Care Model

• AHW philosophy “Recognize that health is

a partnership among individuals, families,

communities, health professionals and organizations

that deliver health care and services – things need to

be seamless to patients.”

• Alberta’s Primary Health Care Strategy

2015 – 2018

Business PlanThis year we developed our 2015 to 2018

business plan21 through a collaborative

process that included RDPCN patients,

doctors, staff, AHS representatives and

community organization representatives.

We are guided by Alberta Health’s

Provincial Objectives for PCNs, Alberta’s

Primary Health Care Strategy and the PCN

Evolution Vision and Framework: Report

to the Minister of Health. The plan builds

on the work done in the previous plans

and the continuous quality improvement

process which is shaped by our evaluation.

Impacting the Future



Impacting people with Chronic and

Complex Conditions


• A dementia strategy will be developed through collaboration

with the AHS Seniors Health Strategic Clinical Network.

• A Chronic Pain Program will launch in September 2015 to

help people who experience chronic pain to live a better

quality life.

Impacting Pregnancy and Babies


Impacting Vulnerable People


Impacting Access to Continuous and

Comprehensive Care


• Provide support for the health home.

• Educate the public on the importance of attaching to a family

doctor and health home.

• Establish and manage patient panels or rosters. A panel is a

list of patients that have an established relationship with a

doctor. Once a doctor has a list of his/her patients they can

better manage their care for example with screening.

• PCN Support Nurses will be placed into the clinics to

establish panel management including the development of

disease registries and establishing new clinical operational

processes for prevention and treatment.

• Improve timely access to a family doctor and team.

• Improve patient experience.



Evaluation Tools Used

SF12-v2®

The SF12-v2® tool is utilized to assess

health and wellbeing, including physical

and mental health. It is used for evaluation

in a variety of programs in the RDPCN.

Social Return on

Investment (SROI)SROI is a tool that measures the social,

environmental and economic value of

an activity or program.22 It calculates

the cost savings for avoiding higher

cost systems such as the Emergency

Department, Hospital Inpatient and

Justice System. It is used in the Street

Clinic and PACT programs.

Happiness ScaleThis instrument is used in the Happiness

Basics Program. Patients determine their

level of happiness on a scale of -10 to

+10 at the beginning and at the end of

the program.

Burns Anxiety

InventoryA 33 question tool that assesses

anxious feelings, thoughts and physical

symptoms. It is used in the Anxiety to

Calm programs.23

Burns Relationship

Satisfaction Test®

This is a tool based on seven relationship

indicators which measure a person’s

relationship satisfaction.24 It is used in

the Relationships That Work program.

22 SROI Canada Network, 2011

23 David Burns (1993). Ten Days to Self-Esteem.

New York, NY: Harper Collins.

24 David Burns (1993). Ten Days to Self-Esteem.

New York, NY: Harper Collins.

Donna ThompsonDonna Thompson

Program Evaluator



Connecting with the RDPCNIf you are looking for a family doctor

• Go to our website to see the list of family doctors: reddeerpcn.com

If you are a patient of an RDPCN family doctor and would like to get

connected with our programs

• Ask your family doctor for a referral

If you would like more information about RDPCN programs:

• Go to our website: reddeerpcn.com

• Pick up a RDPCN pamphlet at your doctor’s office

• Read the RDPCN poster at your doctor’s office

If you would like to give us feedback or ideas you can:

• Go to the discussion board on the Home Page of our website: reddeerpcn.com

• Call Lorna Milkovich, Executive Director at 403.343.9100

• Email us at [email protected]

• Visit us at 5120 – 47 Street, Red Deer

Real People. Real People.

Real Successes.Real Successes.

Read their stories

at reddeerpcn.com.

Thank you for

inspiring others!



www.reddeerpcn.com


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