Our collaborative partners have been supportive in helping us make the CHANGE Program one of the cornerstones as we develop our Primary Care Network (PCN) model. The CHANGE Program can be a socially responsible, culturally appropriate, scalable program for the entire province, starting right here in the Pacific Northwest. CHANGE BC is a bold step towards delivery of a pro-active healthcare program which is the first of its kind across the country.
Prescribing the CHANGE Program has changed the lives for so many of our patients and we are excited to make it available to even the most vulnerable people across the northwest.
Referring patients into the CHANGE Program?
ELIGIBILITY
To be eligible for the CHANGE Program, participants must meet at least two out of the four following criteria:
- BP: ≥130/85 mmHg or receiving pharmacotherapy
- HbA1c: ≥5.7% or fasting blood glucose ≥ 5.6 mmol/L or receiving pharmacotherapy
- Triglycerides: ≥ 1.7 mmol/L or receiving pharmacotherapy
- HDL-C: < 1.0 mmol/L males and < 1.3 mmol/L females or receiving pharmacotherapy
*the CHANGE Program is proud to be size and weight inclusive.
THE REFERRAL PROCESS
CHANGE BC referrals are made by the patient’s Primary Care Provider. If the patient is attached to a Family Physician or Nurse Practitioner, please connect with their Primary Care Provider and ask for the referral to come internally through them. This allows the CHANGE BC team to collaboratively practice and support each patient, and to ensure patient progress is documented within each provider’s respective EMR.
Unattached patients who may be interested in the CHANGE BC Program must have a Family Physician or Nurse Practitioner in order to be referred, and should be directed to the Health Connect Registry to help to connect to a most responsible provider at: https://www.healthlinkbc.ca/find-care/health-connect-registry. The Health Connect Registry Team may also be reached by phone at 250-877-8979.
- Are you practicing in Terrace, Houston, or Nisga’a Valley? Please send an internal referral for your patient to the CHANGE Program.
- Are you practicing elsewhere? Please talk to your Primary Care Network or Division of Family Practice team on bringing the CHANGE Program to your region. Details on available supports can be found on our Primary Care Network/Division of Family Practice Team.
What is the role of the referring most responsible provider with the CHANGE Program?
Referring providers are the anchor of the CHANGE Program, leading the interprofessional team to support patients. They are responsible for determining patient suitability for the program based on the referral criteria. This includes assessing patient readiness, providing a Physical Activity Readiness Questionnaire (PAR-Q) screening to confirm the patient is able to exercise, as well as any exercise restrictions, ordering and reviewing bloodwork, adjusting pharmacotherapy, assessing changes as needed, encouraging and supporting patients as they participate in the CHANGE Program throughout the 12-month program, and coordinating/communicating with the clinical team to optimize patient care.
CHANGE BC, developed by the Pacific Northwest Division of Family Practice in 2018, is an outstanding, collegial community of practice that offers ongoing Physician and Nurse Practitioner orientation supports, as well as opportunities for professional development. The CHANGE BC team meets weekly to advance care supports, and is actively linked with UBC, as well as other CHANGE groups provincially and nationally. More information on the CHANGE Program is available on the Metabolic Syndrome Canada website.
For more information on the CHANGE program, please contact Colleen Enns.