The important role of nurse practitioners

Fred*, a man in his [late] twenties, had been relying on local walk-in clinics for his medical care for over a decade – until he connected with a nurse practitioner (NP) through TELUS Health Virtual Care. When Fred first used Virtual Care, he had been suffering from asthma and environmental allergies that had lasted for years, each time feeling like he was waiting for his next flare of symptoms.

But with the support of this NP, Fred began a daily inhaler and prescription-strength antihistamines, and — at his three-week follow up initiated by the clinician — he said his allergy symptoms were better controlled than they had been in years. Fred continues to be seen regularly by the same NP, who also supported him in finding a local family practice, and feels grateful for the consistent care and attention he has received.

Nurse practitioners model of care

Fred has clearly benefited from the nurse practitioner-led model that TELUS Health Virtual Care has adopted since its inception.

Although many people may not be aware of the full scope of nurse practitioners’ training, it is rooted in high quality primary care. They can diagnose, treat a wide range of medical issues,¹ write prescriptions, refer patients for imaging, lab work and to specialists, and help people navigate an increasingly complex health system.

“The main issues our nurse practitioners deal with are infectious diseases (like coughs, colds and — more recently — COVID-related symptoms), mental health concerns (like depression and anxiety) and skin concerns (like rashes, eczema, acnes, ticks and insect bites) as well as pediatric fevers or concerns,” says Camille Lalonde, Head of Clinical Services for TELUS Health Virtual Care.  Most users are working parents between the ages of about 25 to 45 and their children. 

Accessibility and removing barriers to care

“There’s no replacement for a person’s family doctor or comprehensive primary care professional,” says Dr. Dominik Nowak. “But one person can’t be everything at all times, and we need to build a system that supports people in a way that is more human-friendly, including beyond the office, after hours, and with other barriers to care in mind.” And with about five million² Canadians without a family doctor, many people don’t have that essential link to medical care. Services provided by the Virtual Care team are there to complement the care the patients already do have and helping fill health system gaps, while removing pressure on overcrowded urgent clinics and helping people avoid visits to the emergency department.

“What we are doing is helping to remove barriers to getting help,” Nowak says. “Caring for people virtually means that we can support people who would otherwise need to think about time off work, transportation, mobility, parking or caregiving and child care responsibilities, and they can be seen at a time that makes sense to them. Within 75 minutes of calling, people reaching out to the Virtual Care team will usually have been assessed by a registered nurse, who acts as the Care Manager, and have met either with a care advocate — if they need a virtual employee assistance program for issues like legal, financial, dietary support or crisis management — or be seen by an NP, if they need primary care.”

“The first point of contact and assessment is always done by a nurse, to ensure people receive care with a human connection every step of the journey,” says Lalonde.

Unlike registration processes that happen through an automated service, a conversation with a nurse may help to pick up additional problems a person may be experiencing. For example, they might begin by describing difficulty sleeping or a skin rash or a cough that won’t quit, but then describe to the nurse that they have lower energy and had barely left home since a loved one’s recent passing. When collected by a human, these important details are respected and help shape the approach to care. Then — in addition to their primary health care concern — the assessment may bring out their need to also get mental health and social support.

Available 24/7

By having access to a service that is available 24/7, people seeking care can avoid long wait times at walk-in clinics or emergency departments, and are able to get professional advice on care and the urgency of the issue – even if they do not have a regular primary care professional. “Virtual care also means that you able to speak with a person at a time that is convenient for them, in the private place of their choice, on demand. That often means seeing them in their home environments, without external stressors and at times, even surrounded by loved ones who can add their observations and voice their concerns,” says Lalonde.

As well, the TELUS Health Virtual Care team can relay medical information back to the person’s primary care professional so everyone in the circle of care is kept in the loop. And with their unique “bridge to specialty program”, the TELUS Health nurse practitioners have access to a network of psychologists, dermatologists and pharmacists to support them with more complex cases, helping to support people during their long wait times for in-person assessments with specialists.

The nurse practitioners can also support continuity of care by arranging regular follow-up appointments, including with the same clinician if the person requests it. As well, the 260 nurse practitioners on the Virtual Care team work collaboratively with other medical experts on the team if they need to discuss a treatment plan or consult with another healthcare professional.

Of course, there are times when an in-person visit is necessary. “It’s about finding a way to best support people seeking care, respecting when and how they wish to be seen, while also balancing the importance of the in-person visit and connection to a family practice,” Nowak says, in what he refers to as his hope for a “kind and careful health system.”

What is for sure is that the virtual care provided by nurse practitioners on TELUS Health reflects an empathetic and holistic approach to health and wellness. Nurse practitioners help people to become well when they are sick, and stay well when they are healthy.

“The approach of the nurse practitioner is grounded in both the art of caring for the patient holistically, taking into account their bio-psycho-social context, and the science of providing medical care supported by best practice guidelines,” says Lalonde. “Patients continue to be tremendously grateful for our approach and this is evidenced by our steadily high patient satisfaction rate in the App stores.”

*Any of the stories shared in this column are rooted in clinical practice but fictitious composites.
1. NPs cannot prescribe controlled substances virtually or provide referrals for CT scans

2. https://nationalpost.com/opinion/why-five-million-canadians-have-no-hope-of-getting-a-family-doctor