GiiC General

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GIIC Project Overview

Population aging presents significant challenges to the health care system in Ontario. Not the least of these is the fact that 82% of seniors have one or more chronic health conditions and 43% have three or more conditions. This later group of seniors is at risk of becoming frail. Frailty, characterized by complex bio-psycho-social and functional problems, is associated with increased health system usage and puts seniors at risk of loss of the capacity for independent living and lowered quality of life (Wolff et al, 2002). Within the aging demographic, frailty may be the fastest growing segment across the province and particularly in northern regions and outside high-density urban areas (Manuel & Schultz, 2001)   

Ageing demographics will have a significant impact on human resource planning and development in all professions working in many health care contexts across the circle of care (McKnight et al. 2003). Providing care to the expanding population of frail seniors requires an both an increase in the numbers of care providers and development of our skill sets. Our skill sets require expertise in three broad competencies  - geriatrics, inter-professional practice and inter-organizational collaboration. Competence in geriatrics is required because the clinical presentations of frail seniors are unique and include the ‘geriatric giants’ of dementia, delirium, falls, continence and poly-pharmacy often co-occurring in complex ways.  Competence in inter-professional practice is required because the complexities of these clinical presentations are such that optimal care requires an interdisciplinary team. Inter-professional teamwork, as outlined in the recently published Health Force Ontario, Inter-professional Care: Blueprint for Action (Oandasan & Closson, 2007), is the care delivery method of choice in caring for frail seniors (Geriatrics Interdisciplinary Advisory Group, 2006).  Finally, competence in inter-organizational collaboration is required because the management of frail seniors requires the sharing of care across many organizational boundaries from primary and community based care to emergency and hospital-based services. Table 1 provides an overview of these competencies.

On the need for training in the core competencies

Repeated surveys demonstrate that curriculum time devoted to geriatrics in the academic preparation of health professionals is insufficient. In our own surveys, for example, frailty-focused service ‘specialists’ in all disciplines tell us that they when they graduated they lacked the confidence and skill sets to care for frail seniors. They tell us that they required extensive continuing education that was acquired through informal ‘on the job’ processes, specific time-limited educational events and pilot projects though groups such as the RGPs of Ontario.  These findings from the inter-professional geriatric ‘specialists’ appear independent of year of graduation (Ryan & Kirst, 2005). Limitations on geriatrics training are a challenge to the health systems capacity to meet the needs of an aging population.

The need for renewed focus on preparing health professionals for inter-professional practice has recently been documented in the Health Force Ontario, Inter-professional Care: Blueprint for Action (Oandasan & Closson, 2007). The blueprint argues that because inter-professional practice is an essential characteristic of health care delivery in the real world, preparation for inter-professional practice must be formally incorporated into the academic and continuingeducation of health professionals. Simply putting people together to work does not necessarily create effective teamwork. In formative academic training health professionals must build attitudes and expectations supportive of inter-professional practice that with appropriate support can be refined in the workplace to improve the quality of services to patients (Barr, 2000). 

The Inter-professional Care: Blueprint for Action and the emergence of Local Health Integration Networks in Ontario also guide us towards the importance of inter-organizational collaboration in the delivery of effective health care. But, just as simply putting people together to work does not necessarily create effective teamwork, so simply requiring organizations to work together does not necessarily lead to effective shared care. Inter-professional practice and inter-organizational collaboration require ongoing coaching, support and facilitation. Resources to meet this ongoing need are seldom available in the workplace.

Between Specialized Geriatric Service providers affiliated with the Regional Geriatric Programs of Ontario, Community Health Centres and Family Health Teams who are and will increasingly be the primary source of care for the growing population of frail seniors, there exits a combination of skill sets and needs that can respond to the issues of human resource scarcity for geriatric care and the need to provide practice based training in inter-professional practice and inter-organizational collaboration as outlined in the Blueprint for Action.