Manitoba’s new standard of practice for episodic care sets out expectations for physicians

A new standard of practice from the College of Physicians and Surgeons of Manitoba (CPSM) outlines the responsibilities of physicians providing episodic care, including rules for follow-up and prescribing narcotics. The standard of practice is new for Manitoba, although other medical regulators have similar standards. “The reason this was done at this time is that we have a significant number of patients who do not have primary care physicians,” CPSM registrar Dr. Anna Ziomek told the Medical Post. “House calls and walk-ins have been increasing as part of the fundamental care delivery models in Manitoba.” “It was decided that we really did need to have a standard which outlined the expectations of this type of episodic care,” she said. The standard of care gives instructions on how to handle follow-up after a clinical encounter. All physicians must ask the patient if they have a primary care provider, but can use clinical judgement to decide if the primary care provider needs a report of the medical encounter. The initial draft standard stated all visits to episodic care providers must be reported to the patient’s family physician. But upon consultation with physicians providing episodic care, the CPSM working group decided a report isn’t necessary in all cases, just in those where the patient requires ongoing care, Dr. Ziomek said. For example, if a patient visits a walk-in clinic concerned about an ear infection and there’s no infection, the clinical encounter doesn’t need to be reported to the primary care physician. If a patient has returned two or three times with an acute ear infection, the physician should inform the primary care physician because it’s an ongoing problem. “We’re now leaving it to the discretion of the episodic care provider to decide if this is important to go back to the primary care provider or not,” Dr. Ziomek explained. Read: More MDs for Manitoba: Provincial association offers a prescription for doctors shortage Like all physicians, episodic care physicians must follow the CPSM’s Standard of Practice for Good Medical Care, which includes pursuing medical follow-up on tests results or treatments. “If you order a test, you need to follow-up that test. You can’t just assume that someone else is going to do that follow-up for you,” Dr. Ziomek said. “If you order a test and you want the primary care physician to follow that up, there needs to be direct communication and an agreement on the part of the primary care doctor that they will do that.” The transfer of care back to the primary care physician doesn’t have to be formal, but can be done via email, phone call or text, the standard of practice states. The lack of family physicians across the country means that patients sometimes assume that if they go to a walk-in clinic a number of times, that physician becomes their primary care provider by default. Episodic care providers are not required to become the patient’s primary care provider, the standard of practice reads. Dr. Ziomek said that patients need to understand that the episodic care provided is not part of a sustained, longitudinal, comprehensive relationship that defines good primary care. She said physicians may have to repeat the message a number of times if needed. “They need to make it clear to that patient that they can’t take them into their practice.” If the patient has a chronic condition and no primary care physician, the episodic care physician’s role is to “provide follow-up care for that particular medical condition and only until addressed or stable or another primary care provider assumes responsibility,” the standard of practice states. Read: Manitoba doctor warns of overwhelmed hospitals, calls for government help The new standard of practice outlines how physicians must look up what medications the patient is already taking before prescribing opioids of benzodiazepines. A similar review may be beneficial before prescribing other medications, the standard of practice notes. Physicians can review the patient’s medications on DPIN, eChart or consult with a pharmacist. The standard of practice relates to isolated primary care encounters provided in a walk-in clinic or as a house call. This includes: sports medicine clinics contraceptive care clinics sexual health clinics minor injury clinics virtual episodic care The standard of practice doesn’t apply to: care provided in a hospital emergency department care provided in a long-term care home specialist consultations travel medicine clinics palliative care or end-of-life care Episodic care is a necessary and important part of the Manitoba healthcare system, Dr. Ziomek said. While the Patient’s Medical Home is a better model of primary care, “we value the care that is being provided through walk-in clinics and this kind of episodic model,” she said. The standard of practice came into effect on Nov. 1. It can be found on the CPSM website. Read: Paying for plasma is the new normal: Why policy has changed decades after Canada's tainted blood scandal

Manitoba’s new standard of practice for episodic care sets out expectations for physicians

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