Heart Failure: Practice Support Program

Submitted by: Dr. Sean A. Virani and Bonnie Catlin

The Practice Support Program (PSP) was
launched in 2007 with two objectives: to
improve care for patients throughout the
province and to increase job satisfaction
among BC’s general practitioners (GPs).

 Specifically the PSP was also designed to improve
clinical and practice management for family
physicians (FPs) and GPs and support physicians
to implement tools and resources in their
daily practice that can increase efficiency and
capacity, improve patient care and professional
satisfaction, and reduce costs to the health care
The PSP began as an initiative of the General
Practice Services Committee (GPSC) and now
receives additional direction, support, and
funding from the Shared Care Committee and the
Specialist Services Committee (also partnerships
between the BCMA and Ministry of Health).
The MAINPRO-C accredited program offers
focused training sessions (learning modules) for
physicians and their medical office assistants
(MOAs) in three domains:

  • Clinical improvement.
  • Practice management.
  • Information technology.

Module learning sessions are organized in
communities throughout BC by health authority
PSP coordinators and are delivered by local health
authority regional support teams. Currently
the PSP offers seven condition specific learning
modules and three are in development. As of
March 2012, nearly 70% of all practicing family
physicians in B.C. and more than 1000 MOAs have
participated in a PSP. Physicians reported that
participating in a PSP has had a positive impact
on their practice, enabling them to better support
patients, increase professional satisfaction,
improve patient care and lower costs.

Under the leadership of Dr Sean Virani, Dr Bruce
Hobson and the Provincial Heart Failure (HF)
CNS Bonnie Catlin, BC’s Heart Failure Strategy/
Network has partnered with HF experts in each                                                                                        of the 5 health authorities and the PSP team
to create a PSP learning module focused on HF.
The intent of the HF module is to provide HF
education, practice resources and infrastructure
for GPs to improve the care of their HF patients
and improve efficiencies within their office
work flow. The HF module also emphasizes the
importance of and engagement in a collaborative
shared approach to HF patient care between
specialists and GPs.                                                                                    

The HF module is intended to align with the PSP/
Shared Care Committee COPD learning module
and to start the process for consideration of
a module focused on HF/COPD co-morbidity.
Utilizing the HF practice tools and patient
education resources created by the Provincial HF
Resource Development working group, the HF
module came to fruition quickly. The HF module
working group also created subsequent GP
practice resources that could be utilized within
the context of GP practice.

The first prototype session for the HF learning
module was May 7, 2012 with over 200 attendees,
including representation from GPs, specialists
and MOAs. The session also included the
introduction of the co-morbid conditions of HF
and COPD. Dr Sean Virani presented the latest
in HF research, diagnosis and treatment, as well
as outlining the importance of sharing the care.
He also showcased the current HF tools and
resources available to GPs (accessible from BC’s
HF Network website). Dr Bruce Hobson also
introduced the GP HF algorithms and challenged
his colleagues to develop strategies to integrate
them into their office workflow to improve
patient care. Evaluations from the presentation
showed 100% of the GP’s, clinicians and MOA’s
rated the session good or very good.

In the afternoon action planning session there
was enthusiastic interest in the HF module
tools and resources and formal planning was
established on how to incorporate them into the
GP office. Some GPs committed to establishing
a HF registry for all their current patients. We
gathered meaningful feedback on the HF referral
form and key elements that should be included in
a consultation letter.

The second prototyping session will occur in early
2013 and each of the GPs will report back on their
successes and challenges of implementing their
action plans.
The following HF tools and resources set the
foundation for the HF learning module and are
also available on BC’s HF Network website www.

Resources to Assist Primary Care Physicians in
Referring a Patient to a Heart Function Clinic

Indications For Referral to a HFC

 Heart Function Clinic Referral Form

Resources to Assist the Primary Care Physician
to Assess Their HF Patients Based on the Latest
Evidence Based Literature

Heart Failure Patient Questionnaire

GP Patient Assessment Form

Snap Shot of Patient Visit

Heart Failure Patient Education Self
Management Resources

• HF 101
• Heart failure zones*
• Daily weight
• Sodium restriction
• Fluid Restriction
• Activity

HF Practice Algorithms 3 Options:

These resources are intended to give the health
care professional the tools, resources and
information they need to diagnose, treat and care
for their heart failure patients. Each algorithm
has labeled boxes and when the GP clicks on the
box the information pops up.

     Start treatment                             Symptomatic Care




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