BC’s After Hours Care program is making a difference for people and physicians, by connecting people to the care they need when their family physician is not available and removing a top burden experienced by physicians.
The After Hours Care program saw 584 family physicians and nurse practitioners sign up to use the program with their patients in its first year.
The numbers represent an estimated 597,000 patients who now have a family doctor across the five regions included in the program pilot: Greater Victoria, Langley, Shuswap North Okanagan, South Okanagan Similkameen, and the Thompson Region.
“Colleagues who do call shifts, and longitudinal physicians, consider this a win-win project,” says Dr Sarah Chritchley, family physician with the Victoria Division of Family Practice.
The Family Practice Services Committee (FPSC), in partnership with HealthLink BC at the Ministry of Health, launched the program as a six-month pilot in September 2023 to provide people with access to after hours care, that supports work-life balance for longitudinal family physicians and nurse practitioners. In January 2024 the pilot was expanded to include the Shuswap North Okanagan Division of Family Practice to help address the after hours care challenges in Vernon. Partners are continuing to work towards the expansion of the program in BC.
After hours care was one of the top burdens that family doctors identified during Doctors of BC’s primary care engagement in summer 2022. The new program meets the College of Physicians and Surgeons of BC’s Practice Standard for Care Coverage Outside Regular Office Hours.
Attached patients of family physicians and nurse practitioners participating in the program receive access to after hours medical care and advice from 5 p.m. to 9 a.m. during the week and 24 hours on weekends and holidays.
“It is so rewarding when groups come together in partnership to design and launch a pilot service. It’s even more rewarding when the impacts and benefits of the pilot result in support to continue with the pilot while we concurrently plan on how to scale the service for provincial launch,” says Sandra Sundhu, executive director, HealthLink BC with the Ministry of Health. “The power of the collective is energizing and motivating. Thanks to everyone who has and will continue to work with us to make this a reality for all family physicians, nurse practitioners, and attached patients.”
“We are extremely pleased with the high uptake by family doctors and nurse practitioners in the pilot,” says Dr Jaron Easterbrook, the program’s co-medical director and a family physician representative to the (FPSC). “We would like to see the expansion of this program throughout the province to meet the needs of all communities.”
Dr Chritchley agrees, “I strongly support it continuing and being offered across the province.”
An evaluation of the program found that the virtual care service can resolve urgent patient complaints and reduce unnecessary visits to the emergency department, walk-in clinics and Urgent and Primary Care Centres (UPCC).
The evaluation was a mixed method study anchored in the quintuple aim for high quality health care that includes patient experience, patient outcome, provider experience, health equity and cost of care. Although these are preliminary results, the long-term evaluation looking at the quintuple aims is still ongoing.
The pilot demonstrated the ability to reduce patients’ plans to attend the emergency department by 81% and lower the number of UPCC or walk-in clinic visits by 58%. The pilot was also able to resolve patients’ urgent issues in 34% of all calls and accelerate 16% of callers who had originally planned to wait and see if their symptoms resolved to be appropriately re-directed to emergency following their after hours care encounter.
“It is rewarding to see the ability to reduce the demand on our ER for those we can manage with urgent phone calls,” says Dr Jennifer Begin, a family physician with the Ponderosa Primary Care Centre in Penticton and a member of the South Okanagan Similkameen Division of Family Practice.
The program is meant to extend, not replace, a patient’s family doctor or nurse practitioner by focusing on handling urgent issues that could not wait until the medical office reopens.
Family physicians filled every shift during the pilot, resulting in waits of less than an hour to speak with a physician. Fever and cough were among the most common reasons for patients to call the After Hours Care program.
The service provided 2,788 virtual physician encounters between September 18, 2023, and February 29, 2024. Most patients surveyed welcomed after hours care, citing its positive role in improving access to care and meeting their informational needs. Physicians reported they saw 39% more work-life balance and 61% reported a reduction in burden.
While the program can remove barriers to accessing after hours care, there are concerns that patients may face barriers related to the limitations of virtual care. Some family physicians and nurse practitioners also expressed concerns about increasing the demand for health care resources, as well as equitable access.
Recommendations for scaling up the program include strengthening inter-provider information exchange and open communication channels among patients, providers, and administrators and tailoring the program to work with electronic medical record systems in community practices.
“Most primary care providers appreciated the After Hours Care program in supporting the after hours needs of their patients and helping improve the provider’s ability to deliver longitudinal primary care,” says Dr Kendall Ho, the program’s co-medical director, HealthLink BC medical director, and a practicing emergency physician. “Not only did patients get the help they needed, but it ensured the appropriate use of the health care system.”
Discussions are underway between Doctors of BC and the BC Ministry of Health to expand the program throughout the province.