Confirming Patient Attachment to a Family Physician/Consent if No Family Physician

For those patients identified in the initial list of “unattached” patients, the next step is to confirm that the information in the Clinic’s EMR is up-to-date; and if unattached status is confirmed, ask the patient if they would like assistance with finding a family doctor. The suggested steps in this process and possible script ideas follow for MS Clinic staff.

1. Introduction to patient
   1. “This is __[name]______ from the Edmonton/Calgary MS Clinic. We are updating information in our records and want to confirm some details with you.” [If you wish at this point, you can update address and phone numbers if needed. If not, proceed to question on family doctor.]
2. Confirming attachment/unattached to a family doctor
   1. “We do not have a family doctor noted in your chart; is that correct, or do you have a family doctor who you see regularly and as needed?”
   2. If have a family doctor, record name given (whether doctor is at a walk-in clinic or not), thank patient, perhaps remind them of their next scheduled visit to MS clinic, sign off.
   3. If not sure, clarify…if sounds like a particular doctor or clinic is regularly consulted by the patient, record that doctor and/or clinic. If not, consider as “c”.
   4. If do not have a family doctor, proceed to step #3.
   5. If either a walk-in physician or clinic without a specific doc is mentioned, consider patient attached at this point (although may be a loose attachment).
3. Offering to assist with finding a family doctor
   1. “We are working closely with some family doctors to help people with MS find a family doctor when they don’t have one. Would you like us to include you in the plans to find a family doctor?”
   2. If “yes”, go to step #4; if the person indicates that they don’t think they need a family doctor, prompt them to consider this.
   3. “It’s true that the MS clinic sees you regularly to manage your symptoms and disease progression, however we know that there are other health conditions that can arise from time to time, and we all benefit from regular screening and prevention. Having a family doctor who knows you well, and works with us and you to manage any health conditions is really important. When you see the same family doctor over a long period of time, you are more likely to have better health outcomes. We would encourage you to have a family doctor and keep seeing us [the MS clinic] for your regular visits to manage MS.”
4. Confirming location for family doctor (applies more to the Cochrane postal codes)
   1. “I see that you live in Cochrane and we are working with a family doctor there who is willing to accept more patients. Would you prefer to see a family doctor in Cochrane or is Calgary more convenient?”
5. Obtaining Consent for a follow-up phone call from Primary Care
   1. “I will pass your name and phone number on to ____[specific name]___, the nurse/clinic assistant {customize] who will phone you in the next couple weeks and offer to connect you with a family doctor. Is that okay with you?”
6. Thanks, and sign off
   1. "Thanks so much…"

What to say if you get an answering machine or another family member; patient not 
available?

“This is _____ from the MS clinic calling for ____[name of patient] to update our records. Would you please call me back at _____ [number]. This is not urgent, so if you can just call me when it is convenient for you. Many thanks…again my name is ____ and the number is ______.”

Best to use a similar approach if a family member answers, asking the patient to call when convenient.

The Guide to Panel Identification Suggests the Following Tips for Clinic Staff

Identify Relationship with Each Patient

Each patient visit to the clinic is an opportunity to confirm patient information, including the name of his/her physicians, both specialists and primary. Best practice is to make this a routine part of the patient check-in process. This simple step builds a reliable panel list. Electronic medical records (EMRs) have a field that allows front office staff to mark when the patient’s status and attachment have been verified or updated. This action stamps the chart with the date. Scanning over this field at patient check-in tells the receptionist or medical office assistant when this was last done.

Patient information should be validated at minimum every six to 12 months.

Document Consistently in Each Patient Chart

Assigning a patient to a physician should be documented on the chart in a standardized manner and in an agreed upon location. EMRs have a location assigned for this information and a standard location can be agreed upon and established in paper charts. It is imperative that ALL individuals responsible for recording the specialist and primary physicians within the EMR follow standard processes and procedures for data entry. This should be adopted clinic-wide and not vary by individual physician preference. Only when information has been recorded consistently within an EMR can the information be searched reliably.