We know that, despite our best efforts as clinicians, patients with AFIB are not all receiving optimal, guideline-base care. Read about what we learned from a clinicians across the province regarding the challenges in managing AFIB patients in our white paper and take a look at Frank’s story.
Under the AFIB Innovation program we created a new model of care that aimed to bridge the gaps in the currently fragmented system of AFIB care in Ontario, and place the patient at its core. At the heart of the new model is the Atrial Fibrillation Quality Care Program (AFQCP). The AFQCP team includes an interdisciplinary care team led by a nurse practitioner and pharmacist, supported by a physician and fostered by partnerships to specialty care.
The philosophy of the AFQCP is to provide:
- Timely access from the ED to the first clinic visit – patients are given an appointment before they leave the ED
- Education about AFIB and its management, tailored to the needs of the patient
- Facilitation of access to necessary investigations or specialty care
- Comprehensive management of AFIB as well as other comorbidities that impact AFIB
- Seamless transition to the community care provider via clear, one-page guideline-based care plans within 24-48h of the visit
- Acute access to a clinician when needed via a 1-800 hotline
