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Patients Collaborating with Teams

Overview

Patients Collaborating with Teams (PaCT) takes a proactive, systematic approach to enable patient to manage their care when they have, or are at risk for having, multiple chronic diseases or other complex health needs. PaCT takes the next step in the patient’s medical home by furthering the panel and chronic disease management work already underway in PCNs and primary care clinics.

Panel and Continuity

Continuity of care is about improving Albertans’ health though stronger ongoing relationships with their family physician or nurse practitioner and team, increased information sharing, and enhancing care coordination. The first step to improving continuity is identifying and maintaining a panel of unduplicated patients.

Patient Centred Interactions

Patients and healthcare providers are partners that work together to achieve the patient’s goals. This helps patients to better understand their health condition or treatment, leading to increased shared decision-making and confidence for self-management.

At the heart of PaCT, providers and their teams are supported to reach those patients that keep them up at night by shifting the conversation from, “What’s the matter?” to “What matters to you?”
  • Advances in evidence-based medicine create opportunities to improve care for patients with complex health needs
  • Practice-level collaborative care-planning approaches are effective in supporting patients with complex health needs
  • Research tells us that using team-based care improves patient outcomes
  • ‘Many hands make light work’: when teams share skills and knowledge to care for those with complex health needs, the work is not as challenging for any one person
  • Alberta data indicates that many practices have a significant number of patients with complex health needs who do not seek adequate care
  • PaCT will build on panel identification and maintenance processes already embedded in practices and facilitate the spread of excellent care processes to all primary care practices.

Read PaCT's one pager or FAQ for more information. Or watch the following videos to learn more about PaCT: