Dr. Basran: “We can’t fix chronic disease. But we can provide better care.”
Saskatchewan’s only Royal College-certified geriatrician gained an affinity for older adults early in life. Growing up in the tiny community of Cabri, Sask., Jenny Basran, MD, FRCPC, and her family lived above their Chinese restaurant where seniors often gathered to share stories and opinions — and young Jenny spent a lot of time.
“I just really liked being around them,” she recalls. “I was really comfortable with older adults from an early age.”
Her decision to pursue a medical career in Geriatrics took root during Dr. Basran’s pre-med years at the University of Alberta, where she had an opportunity to do research with physicians caring for geriatric patients. She was attracted to the complexity of geriatric care and the specialty’s team approach to meeting the needs of older adults.
After completing her medical education and Internal Medicine residency at the University of Saskatchewan and a Geriatric Medicine Fellowship at the University of Calgary, Dr. Basran initially pursued an academic path in teaching and research. Being the only geriatrician, she soon found the heavy load of teaching, research and clinical work unsustainable and decided to focus her efforts where she saw the most urgent need: bringing the Geriatric lens to care across the health care system. That meant more time spent training and working with stakeholders across the province to modernize a health care system that was built around acute illness and not the continuing care needs of many complex patients, particularly older ones.
Her efforts contributed to Saskatchewan’s new Connected Care Strategy, which launched over a year ago.
“It’s about how health professionals work together in interdisciplinary teams and how to support patients as they transition between teams,” she says. The challenge was to build a system that can manage complexity, recognizing that “often patient needs are longitudinal, not episodic, and therefore need everyone to work together.”
Dr. Basran explains that while complexity is prevalent in older adults and those with multiple chronic conditions, it also applies to all patients with complexity — regardless of age or cause of complexity.
“We looked for the root cause of system flow problems like long ER waits,” she says. “The problem was not in the ER per se. Acute care beds were often occupied with complex individuals who are no longer acutely ill but still need care by a range of health professionals. There is a lack of options for them to transition to intermediate bed-based or home-based care, so they are stuck in an acute care bed. While this impacts the flow of patients from the ER, more importantly, many of these complex patients become further deconditioned.”
Dr. Basran adds that the term often used for these “stuck” patients is Alternate Level of Care patients — an operational term, rather than a clinical one. The lack of intermediate care also leads to primary care defaulting to the ER and usually an admission because they are unable to meet the needs in the community.
Aside from ensuring appropriate care options are developed, one goal of the Connected Care strategy is to make sure that teams from acute care and community care are working with each other, and with the patients and their families.
“Connected care also means the patients are connected to their care. This means being patient-centered and focusing on what matters to patients, their goals, and ensuring they truly understand their health situation,” says Dr. Basran. That includes “real-time discussions” with everyone involved in the individual’s care.
This is where Dr. Basran’s interest in technology comes in. Her current role as the Saskatchewan Health Authority’s Senior Medical Information Officer is focused on digital health. This includes an exploration of virtual care and making sure the right electronic information is collected and shared to support Connected Care.
“The current data we collect and how we share clinical information is not adequate,” she says. “We need to structure the information so it can be a digital companion to patients’ care, providing a better understanding of the complexity while also making it easier for health professionals to work together to do the right thing.”
Better data, particularly when linked to show the longitudinal picture, also improves understanding of the system and supports administrative decision-making, whether at the unit-, executive- or policy-level.
“We can’t fix chronic disease. But we can provide better care.”
October 1 was National Seniors Day. Earlier this year, the Royal College released a comprehensive report on physician care for seniors. Read the report: Health Care for an Aging Population: A Study of how Physicians Care for Seniors in Canada [PDF].