Pictou West uses QI collaborative to improve care for patients with high blood pressure

Across Nova Scotia, primary health care teams are working together in new ways to improve access to care and better support patients. One example is the health Home Quality Improvement (QI) Collaborative, a six-month program led by Nova Scotia Health’s Primary Health Care and Chronic Disease Management Network. This brought together nine clinic teams from across the province to test practical changes in their own settings, with structured learning sessions and hands-on support from practice facilitators. A practice facilitator is a Nova Scotia Health employee trained to work alongside primary health care teams to help improve how care is delivered and how teams efficiently work together.

Through the Collaborative, teams learned how to use data, redesign workflows and make better use of their full care team. Many teams shifted from solving problems as they arose, to taking a more planned team-based approach to improvement. Over time, teams indicated this helped make quality improvement part of their daily work.

At Pictou West Health Centre in the town of Pictou, the team focused on improving care for patients with uncontrolled hypertension (blood pressure above a healthy target).

“Hypertension can lead to serious complications like heart attack, stroke and kidney issues,” said Jennilee Parker, a family practice nurse. “The goal is to get patients under that target and keep them there.”

To better understand the problem, the team started reviewing patient data. What they found was a group of patients needing frequent follow-up visits.

“That creates a lot of demand on one provider and limits access for other patients,” said Charlotte Turnbull, a health services lead who was the practice facilitator involved at the time.

Instead of continuing with the same approach, the team used the Quality Improvement Collaborative’s dedicated time and resources to ask a question: Could they share this work differently?

The answer was to better use the full care team’s skills.

Rather than having all follow-ups booked with the nurse practitioner, patients were connected with the family practice nurse for regular blood pressure checks and education. The dietitian also became more involved, supporting patients with nutrition changes to help lower blood pressure.

“I would see them every two weeks, check their blood pressure and talk about lifestyle changes,” said Parker. “Then I’d connect with the nurse practitioner about medication changes if needed. Patients didn’t always have to see the nurse practitioner directly.”

Over six months, 18 per cent of visits were shifted to other team members, helping free up the nurse practitioner’s time for more complex care.

The team also introduced a loan program for blood pressure monitors, an idea brought forward by Parker after hearing directly from patients about the challenges they were facing. The clinic purchased three devices for patients to borrow, check their readings at home and bring the results back to the clinic.

“We had patients who were taking taxis to the clinic every two weeks just to check their blood pressure,” said Parker. “That’s a big burden, so this gave them another option.”

Checking blood pressure at home also gave a more accurate picture. “Often, blood pressure is lower at home because patients are more relaxed than they are in a clinic setting,” Parker said.

For the team, one of the biggest benefits of the Collaborative was having the time and structure to focus on change.

“Time is always a barrier,” said Turnbull. “This gave us the space to really dig into an issue like this in a way we normally wouldn’t.”

The Collaborative also helped teams look at their work differently.

“It gives you a chance to think about what’s not working and what we could do better,” said Haley Kirby, practice facilitator. “This was something that improved patient care without being a huge burden on staff.”

The changes made at the Pictou West Health Centre are continuing. The team sees opportunities to expand this approach to other areas of care. There has also been interest from other clinics in adopting similar ideas, particularly the blood pressure monitor loan program.

More broadly, the Collaborative showed that small, practical changes can make a real difference when teams are supported to work together, use data and test new approaches.

Photo of (L-R) Kelsey Sharpe, nurse practitioner; Jana Locke, secretary; Jenilee Parker, family practice nurse.