Regional Integrated Care
Regional Integrated Care: Putting patients with complex needs at the centre of their care
Coordinating all the services and supports that a person with multiple health conditions requires. That’s the idea behind integrated care.
The primary care provider, home and community care organizations, specialists and other community partners – as well as the patient and caregivers – work with the identified Integrated Care coordinator. Together, they develop one coordinated care plan that focuses on the client’s goals and what is important to them.
The goal is to improve the quality of care and the health care experience for those who use the health system the most.
Who is Eligible?
The following is the full criteria:
- 4+ complex health conditions (at least one being a physical health condition)
- At least 1 social determinant of health issue
- High cost (frequent users of health services)
Exceptions are programs and services adopting the approach for all clients/patients (i.e. Assisted Living Services, Primary Care Outreach for Seniors).
How do I access Integrated Care?
Anyone – a family doctor, care provider, friend, family, caregiver or even a client - can identify someone who fits the criteria.
Providers: Complete the Integrated Care Identification Form and fax it to the central number.
A care coordinator in your area will follow-up with you.
Patients & Families: Talk to your family doctor, nurse practitioner or other health care provider to see if this approach is right for you or your loved one.
For more information, please call the South East Ottawa Community Health Centre at 613-737-5115 ext 2559.
Information for Primary Care Providers
Want to learn more?
Read our Frequently Asked Questions for Clients and Families
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