SUCCESSShowcasing the power of Primary Care Networks in Calgary & area.

Network

SUCCESSShowcasing the power of primary care networks in Calgary & area

Network

Issue 1 / Publishing: March, July, and November 2012.

Issue 1PartnershiP with south

health camPusaiming for

enhancedoutcomes

fit test screening

Pan PCn Calgary & area OPeratiOns COmmittee

Bow Valley PCnYvette Penman Calgary Foothills PCnLaurie BrochuLorraine BucholtzDr. Bill HallDr. Rick Ward

Calgary rural PCnDr. Les Cunning Calgary West Central PCnDr. Jane BallantineDan Doll Highland PCnDr. Sheri Lupul mosaic PCnDr. Oliver DavidJason Shehner south Calgary PCnDr. Ernst GreyvensteinDr. Asha PaulMina Sisodiya

Message from Dr. Bill Hall

It is my honour to write the inaugural editorial for our new publication, Network Success, for the physician members of the seven primary care networks (PCNs) in the Calgary Zone. This magazine will highlight PCN activities and successes, as well as current initiatives to coordinate our programs to economize, evaluate and ease patient entry to the services we provide.

Network Success

It is clear from my vantage point as chair of the Pan PCN Calgary and Area Operations committee that all seven PCNs have responded to their local community needs with innovative and successful programs. It is also clear that we can reach some of our objectives by working together and sharing ideas, successes and even failures. It is the intent of this publication to inform you of these efforts.

The Pan PCN Calgary and Area Operations committee acts as the editorial board for this magazine and will not be influenced by those pro-viding financial support by way of advertising. Neither will the magazine attempt to contain content prevalent in the many journals crossing your desks. Articles will be of a PCN focus, written for health care providers and, as long as we are able to secure advertising, will be sent to you every four months free of charge. Each of the PCN medical directors will have the opportunity to provide editorial comment over the coming issues and highlight activities in their PCNs.

Primary care networks today

Currently PCNs are unable to make long term plans until there is more clarity in terms of budgets, business plans, governance structures, objectives and accountability. We hope that the current negotiations are settled quickly to allow us to move ahead once more. However, times like these are opportunities to re-evaluate and strengthen those aspects of our PCN activities which are helping us most in our day-to-day practice and providing a better community-based experience for patients.

It has been very satisfying to see the progress we have made in organizing community resources to fill gaps in primary care. While we require more resources, we aim to seek a balance between community and acute care funding. As we continue to demonstrate success, I believe we can make a more effective case to our funders for resources. While this will take time and effort, I am pleased to say the process is well underway.

Dr. Bill Hall Chair, Pan PCN Calgary and Area Operations committeeMedical Director, Calgary Foothills PCN

INTROINTRO

alberta Health servicesDr. Ted BraunSheena CliffordPeter RymkiewiczChris WoodDr. Paul Woods

editor Stephanie Baker

art DirectorAngela Bradley

PublisherJim Thornton

Contributing WritersMarilyn Duncan-WebbDr. Bill HallJulia MacGregorMeghan PrevostDr. Rick Ward

intro editorialDr. Bill Hall

Partnership with south Health CampusSCPCN

Fit testing screening CRPCN & SCPCN

aiming for enhancedOutcomesBVPCN atrial Fibrillation screeningCFPCN

tsuu t’ina ClinicCWCPCN

social WorkClinician ProgramMPCN

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CONTENTS

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Published for Pan PCN Calgary & Area Operations committee by:

Paragon Publishing inc.Calgary, Alberta403.287.9818ads@paragonpublish.comwww.paragonpublish.com All rights reserved ©2012. Printed in Canada.

Member of the Canadian Federation of Independent Business

The Pan PCN Calgary and Area Operations committee would like to thank Pfizer Canada for their assistance in printing this medical commu-nication publication.

PARTNERSHIP - SOUTH HEALTH CAMPUSPARTNERSHIP - SOUTH HEALTH CAMPUS

South Calgary PCN

lans for Calgary’s new South Health Campus (SHC) have created unique opportunities for PCN involvement to enhance both patient care and physi-cian engagement. Collaboration between acute care and primary care services help AHS achieve their vision of engaging all partners in building a campus that

inspires opportunities for health and healing.

The specific goals AHS established for the South Health Campus are:

1. Promote integration across the health continuum

2. Embed a culture of learning

3. Embody a wellness mindset

4. Enhance the citizen’s experience

5. Achieve operational, environmental and financial sustainability

According to South Calgary PCN’s co-medical director, Dr. Ernst Greyvenstein, South Calgary PCN has worked closely with AHS to develop initiatives that align with the goals for the new campus. “The partnership with AHS and the South Health Campus leadership team has been phenomenal and we value the input they have given us in developing certain programs for SHC.”

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Network Success Magazine 5

Key partnership initiatives include:

Establishing a rapid access model of careThis unit will enhance the health and well-being of acute, non-critical, complex medical patients through a proactive, efficient and sustain-able approach. Community and Emergency physicians can refer patients to an in-hospital Rapid Access Unit, where expedited access to assessment and treatment can be provided through a multidisci-plinary team.

Integrating a primary care physician lead into a tertiary care outpatient serviceThe PCN physician lead in this area will create linkages between physicians in the community and specialist ambulatory clinics. “By creating these linkages, establishing EMR compatible care pathways, and expanding community based patient and physician support, we would like to reduce referral wait times and hospital readmission rates through this partnership,” explains Dr. Greyvenstein.

Strategic collaboration opportunities exist with:

1. Calgary Headache Assessment and Management Program (CHAMP) 2. Cardiac services addressing congestive heart failure and vascular risk management

3. Psychiatry regarding depression management

Academic family medicine

South Calgary PCN is working with the University of Calgary Department of Family Medicine to recruit clinical preceptors for residents and establish additional family medicine teaching sites.

Low risk obstetrics

South Calgary PCN will continue to provide low risk prenatal and intrapartum care to all maternity patients in their catchment area. Discussions and collaboration with obstetrical partners at the South Health Campus are continuing.

Supporting the hospitalist program at SHC

Dr. Greyvenstein explains this on two levels. “The first is agreeing on an admission notification and a standardized discharge summary form in order to improve transition communication. The second involves the recruitment of physicians to the hospitalist program and assisting with placement of these physicians into community clinics if needed.”

Supporting the use of day medicine

South Calgary PCN is encouraging physicians to utilize day medi-cine services for selected patients. “PCNs are working on standardized order sets for common conditions in this area to facilitate confident patient care by the family doctor.” says Dr. Greyvenstein.

Raising awareness in the community

South Calgary PCN will assist in raising awareness of SHC’s wellness approach to patients through community outlets and events. Services supporting this wellness mindset include, but are not limited to a YMCA housed at SHC, demo/wellness kitchen and climbing wall.

For more information about projects and collaborations between South Calgary PCN and SHC, please contact South Calgary PCN at 403.256.3222.

~ Meghan Prevost

algary Rural and South Calgary Primary Care Networks (PCNs) have recently partnered with Alberta Colorectal Cancer Screening Program (ACRCSP) and Calgary Lab Services (CLS) to pilot a colorectal screening project in south Calgary and surrounding rural areas. According to Dr. Les Cunning, medical director for Calgary Rural PCN, screening initiatives are an ideal opportunity for PCNs to work with Alberta Health Services (AHS) to promote participation among physicians. “What particularly interests us are ways we can promote screening activity and improve standardized screening processes at the family practice level.”

F i t t e s t sCreening

6 Network Success Magazine

Promoting standardized screening processes in family practice.

This particular project aims to understand the use of a new entry level home stool test: Fecal Immunochemical Test (FIT). In contrast with guaiac fecal occult blood testing (gFOBT) currently used in Alberta’s screening program, FIT’s high specificity to human hemoglobin elim-inates any interference from diet or drugs and only detects bleeding from the large intestine.

The purpose of the project is to encourage use of FIT for average risked patients as a screening test and using screening colonoscopy as the diagnostic follow-up test for those with abnormal FIT results, those with symptoms or those at high risk for colorectal cancer. The pilot’s objectives include evaluating patient compliance and ease of test completion as well as establishing a standardized laboratory detection limit/threshold in Alberta. “The evidence and experience derived from this pilot will inform the implementation strategies of the population-based Alberta Colorectal Cancer Screening Program (ACRCSP),” says Dr. Huiming Yang, medical director for Screening with Alberta Health Services and a co-lead of the pilot project.

The pilot enables two ways of distributing FIT screening packages to patients between the ages of 50 – 74 who are asymptomatic at aver-age risk for colorectal cancer. It began first in Calgary Rural PCN on March 23, 2011, where screening packages are sent to 108 physicians in rural communities. Participating physicians are asked to distrib-ute FIT screening packages directly to eligible patients. Patients then complete the test and return it to a designated laboratory drop-off location. The pilot expanded to include South Calgary PCN on July 7, 2011, where 129 physicians are provided with FIT project requisi-tions for ordering screening packages. Patients are asked to pick up their FIT package at one of four select lab sites, complete the test and return it to any laboratory drop off location close by.

One of the anticipated advantages to FIT is increased patient compli-ance due to its ease of use via a standardized tube-based collection device opposed to the test card. The collection device consists of a probe with spiral grooves on the tip, allowing up to 10 mgs of feces (depending on fecal consistency) to remain for testing. Hb stability is ensured for up to 15 days when refrigerated. In addition, automa-tion, closed-tube sampling and positive bar-coded samples allows for enhanced laboratory quality assurance and safety.

“While we’re seeing more research on the advantages of FIT, there are limitations and challenges surrounding its successful applica-tion in Alberta. This includes specimen stability and transport in climate extremes (winter/summer), as well as details pertaining to

ease of distribution to patients and ordering collection kits, partic-ularly in rural areas,” says Dr. Cunning. A potential disadvantage is the increased laboratory cost of the test. “While FIT is initially more expensive than the traditional gFOBT, the low-sensitivity guaiac resulting in dietary restrictions produces more false positives and the cost for those false positives is significant especially given the current bottleneck on colonoscopies,” says Dr. Cunning. However, accord-ing to research, FIT as a first-line screening test detects significantly more adenomas and cancers than gFOBT, and its analytical specific-ity eliminates dietary restrictions, resulting in less false positives and reducing the number of unneeded colonoscopies over time1.

The overarching goal of this and other screening projects from the PCN perspective is to continue engaging physicians in streamlining cancer screening activities within the clinic. “We’re always looking at ways we can have physicians participating with reporting at the prac-tice level, or be involved in the processes that would improve the way in which we conduct screening,” says Dr. Cunning. “As we continue to partner on screening initiatives of this kind, we’re asking, ‘what systems and processes could we change in our practices or at the PCN level to try and improve the standard screening pieces?’” In addition to colorectal screening, Calgary Rural and South Calgary PCNs are currently engaged in both cervical and breast cancer screening initiatives.

1Callum G. Fraser. Fecal Occult Blood Tests. Clinical Laboratory News 2011; Vol 37, Number 3.

Allison JE. FIT: A valuable but Underutilized Screening test for Colorectal Cancer – It’s time for a Change. American Journal of Gastroenterology 2010, 105:2026-2028.

FIT TEST SCREENINGFIT TEST SCREENING

Network Success Magazine 7

FIT Collection Bottle. After fecal sampling, probe is reinserted into the tube and pushed through a septum. Up to 10 mg of feces is dissolved in the 2 ml buffer.

Calgary Rural PCNSouth Calgary PCN

AIMING FOR ENHANCED OUTCOMESAIMING FOR ENHANCED OUTCOMES

8 Network Success Magazine 1

IM is changing the culture, norms and values surrounding the way we do business.” Christopher Wood, manager primary care, AHS Calgary Zone.

In the Bow Valley, an Alberta Access Improvement Measures (AIM) collabora-tive model of learning is reducing delays and advancing continuity of care. Almost 1,000 physicians across Alberta have committed to implementing AIM principles through 13 separate collaboratives. The formal AIM process in the Bow Valley wrapped up at a December learning session.

Initially teams identified performance bench-marks using custom-designed measurement tools - Dashboard and Octane – to search out opportunities to improve efficiencies. “[With these tools] we’ve been able to refine some of the work flows to eliminate extra work, free-ing up staff to do more important things for patients,” says Dr. Steve Mintsioulis, Siksika Health & Wellness Centre.

Small modifications – big gainsTeams found that even small modifications delivered big gains. For example, Bear Street Family Physicians in Banff added label printers in each exam room for easy access by physi-cians during patient consultations. Similarly, a lighting panel in the reception area of Three Sisters Obstetrics and Family Medicine Clinic helps streamline patient traffic flow by indi-cating to clinic staff which rooms are occupied and whether a physician is present. “[AIM] has made me as an admin person look at more details and to be more attentive to finding the fastest way for a patient to be seen,” explains Roxanne Desharnais, administrator, Bow Valley Mental Health.

Managing the accuracy of physicians’ patient panels - including analyzing panel size and pro-file - is fundamental to balancing supply and demand, improving care and making sound business decisions. Adjustments to scheduling have also brought about efficiencies. Teams

implemented changes to their booking sys-tems and shared strategies for reducing the impact of no-shows, physicians’ holidays, staff changes and historical backlogs. “Patients can’t believe they can get in so quickly, espe-cially for routine appointments like annual medicals,” says Mary Melzer, medical office assistant at Ridgeview Medical Centre in Canmore.

Dr. Lynne Marriott from Bear Street Family Physicians was skeptical going into the AIM sessions, but now she says, “… I changed my appointments to 15 minutes each with the immediate effect of reducing my stress. Financially I haven’t noticed a negative effect and it is worth a lot to not feel constantly pres-sured for time.” AIM faculty member Arvelle Balon-Lyon advises, “The key to cycle time is finding the right rhythm for each physician.” For some physicians ten minutes works well; others work better with longer times.

Backpack of skill setsAnother benefit of the AIM project is increased recognition of the diverse skill sets within all participating clinics. This has maxi-mized the scope of practice for staff members who have identified “backpacks” of skills they “carry” all the time. “We’re doing more nurse-managed consultations… patients don’t always have to see a physician.” says Beth O’Toole, primary care and chronic disease management registered nurse, Ridgeview Medical Clinic.

Matching supply and demandAs the formal AIM process in the Bow Valley wraps up, teams now have the clinical access goals and strategies to continue incorporating AIM principles and practices. Ultimately, the detection of process ‘hot spots’ and oppor-tunities for further improvements focuses on better access and continuity of care, lead-ing to superior clinical outcomes. For more information about AIM, contact Christopher Wood at: christopher.wood@albertahealthservices.ca

~ Marilyn Duncan -Webb

Bow Valley PCN

Quick tips to improve efficiency.

Keep everyone in-the-Know

Dedicate the first few minutes each morning for a team huddle. Review the day sheet and think about information other team members may need to know.

2

Standardize exam roomS

Organize all exam rooms to carry the same supplies and

equipment in the same location. Keep an inventory list as a quick

way to restock.

3

manage frequent “no-ShowS”

Instruct staff to double-book patients who often miss their

appointments. This prevents you from losing an appointment slot

if the patient fails to show up.

1

30 second patient intervention could prevent 19 strokes a year.

That is the projected benefit from a new screening program initiated by Calgary Foothills Primary Care Network (PCN). The Integration of Care in Atrial Fibrillation (ICAF) project is a multi-phased program centered on enhanced activities by multi-disciplinary team (MDT) members seeing high-risk patients. The program’s overall objective is to identify patients with atrial fibrillation (AF) and ensure they are receiving evidence-based care. Stroke - the most dev-astating condition associated with AF - can be significantly reduced through appropriate management.

In many patients, AF is asymptomatic. As many as 40 percent of those who have AF are not identified or managed. Given the high stroke risk to this population, they are the focus of Phase 1. Following a three-hour training session, Calgary Foothills PCN’s health management nurses and pharmacists are performing 30-second pulse checks on high-risk patients they see in physician mem-bers’ offices. The literature supports that this is sensitive and specific screening intervention for AF. The simplicity of the screening activ-ity as well as inexpensive and non-invasive diagnostic follow up (a simple ECG) makes this an ideal project for population-based intervention.

In Phase 2 of the project, patients with known AF will be reviewed to ensure they are receiving appropriate evidence-based anti-thrombotic therapy. The new Canadian Cardiovascular Society guidelines have lowered the thresh-old for anti-thrombotic therapy. Patients

with known AF will be assessed through the CHADS2 tool (to assess stroke risk) and the HASBLED tool (to assess bleeding risk). When current management does not reflect guideline recommendations, the family physi-cian will be notified for action.

Why the focus on AF and this project? New therapies and new guidelines prompted a review of what was currently happening within Calgary Foothills PCN. A needs assessment of physician members identified some gaps and opportunities. With over one third of our members responding, the follow-ing insights were gleaned:

1. A majority of members (77.2%) risk strati-fied and initiated anti-thrombotic therapy to patients newly diagnosed with AF.

2. Despite this high level of intervention, most (61.9%) were not using the CHADS2 risk assessment tool recommended by the guidelines.

3. Only 9.1% of respondents declared high familiarity with the new guidelines, which ideally, would be guiding their management.

4. There was a strong willingness of most phy-sicians (90.6%) to have their MDT members be active in AF management – from screening alone to initiation of protocol-based anti-thrombotic therapy. Based on this, we feel that the program hits the ‘sweet spot’ of what PCNs are all about: working alongside family physicians and maxi-mizing the skills of MDT members to provide quality care to patients resulting in improved health outcomes. The vision and details of

this project came from Calgary Foothills PCN physician members and MDT leader-ship working with the Libin Heart Institute. Special thanks to Dr. Russell Quinn, director of Atrial Fibrillation Clinic, for his support, leadership, wisdom and enthusiasm in this project.

Support for this program – data collection and analysis, training for MDT staff and CME for physician members and their staff – was obtained through a grant from Bohringer-Ingleheim following College of Physicians and Surgeons guidelines and PCN policy.

Is the ICAF program making a difference? The projected prevention of 19 strokes per year is based on the demographics and epi-demiology that could be impacted by this intervention. Calgary Foothills PCN aims to validate this projection by analysis of health data – stay tuned for an analysis later this year. However, while the program has only been running for a few months, 45 screen positive patients have been identified, of which 17 had no known atrial fibrillation. Confirmation through ECG is pending. This simple 30 second screen is already paying positive health dividends for patients in our community; another example of PCN inno-vation and leadership.

~ Dr. Rick Ward

Network Success Magazine 9

ATRIAL FIBATRIAL FIB

Preventing 19 stokes a year through a 30 second patient intervention.

Calgary Foothills PCN

suu T’ina translates to mean ‘a great number of people’. The Tsuu T’ina Nation, located along the edge of southwest Calgar y, is populated by

strong, proud and independent people who possess a remarkable cultural heritage. In 2008, Calgary West Central PCN physicians collaborated with the other health profes-sionals at the Tsuu T’ina Dr. Thomas Murray Health and Wellness Centre to serve patients living on the Tsuu T’ina reserve.

Over half of First Nations people within the Calgary area are living with one or more chronic conditions (Stats Canada, 2006). After building relationships with patients at the health centre, it became apparent to the Calgary West Central PCN physicians and the Tsuu T’ina Nation leaders that there was a need for the provision of additional compre-hensive primary care services.

Moving from the initial primary care ser-vices offered to residents three days a week in 2008, Calgary West Central PCN physicians

and other health professionals have expanded the services and are now on the reserve five days a week. These services include screening and comprehensive care for chronic diseases such as diabetes, high blood pressure and obe-sity; a comprehensive women’s health clinic dedicated to early intervention, screening, prevention and pediatric services, including ongoing care for children of patients who have been seen at the clinic.

Last year, Calgary West Central PCN phy-sicians helped their patients to welcome 62 new infant nation members. In 2011 alone there were over 3,800 patient encounters with Calgary West Central PCN physicians at the Tsuu T’ina Dr. Thomas Murray Health and Wellness Centre. According to Calgary West Central PCN physician Dr. Ross MacDonald, new patients are being seen almost daily.

In addition to expanding primary care ser-vices, physicians Ross MacDonald, Sonya Regehr and Christin Hilbert focused on the unique opportunity to learn about the resi-dents’ social, cultural and spiritual beliefs and

practices. Through this deepened understand-ing and respect for traditional Tsuu T’ina values and culture, Calgary West Central PCN physicians and staff have established a relationship of trust with the patients they see.

“It is a real privilege to work so closely with these residents,” says Dr. MacDonald. “The Tsuu T’ina Nation has allowed us to come on their land and work with their people to pro-vide improved access to primary care.” Now patients feel more comfortable approach-ing the physicians they know for healthcare advice for themselves and their families.

As the Tsuu T’ina residents continue to see a family physician and access the primary care services available to them, there will be more opportunities for Calgary West Central PCN physicians and staff to work with - and learn from – the Tsuu T’ina Nation.

~ Julia MacGregor

DELIVERING PRIMARY CARE TO A NATIONDELIVERING PRIMARY CARE TO A NATION

10 Network Success Magazine 1

Calgary West Central PCN

It is a real privilege to work so closely with these residents.

SOCIAL WORK CLINICIAN PROGRAMSOCIAL WORK CLINICIAN PROGRAM

11

he area encompassing northeast and part of southeast Calgary is made up of a population that houses the majority of Calgary’s new immigrant and low income residents. In response to the prevalence of socio-eco-nomic and mental health issues associated with this

vulnerable group, Mosaic PCN began offering physicians access to social work clinicians as part of their mental health program.

The initiative began in 2010 to provide patients of member physicians with counselling support and resource navigation. Claudia Canales, one of the program’s four social work clini-cians, says the social work model meets the needs of Mosaic PCN’s population well. “We needed social workers trained to do psycho-social assessments and also provide counselling,” she says.

For this reason, Mosaic PCN’s panel of social workers are qualified to provide high-level mental health counselling , psychologi-cal assessments and resource navigation. “Patients we see often have complex situa-tions which may require assistance from a number of resources and programs. A lot of the time they also present with mental health issues that are related to the psycho-social needs they have,” Canales continues.

The program has produced many benefits for both physicians and patients. “The main benefit for physicians, in my experience, is time management with the complexity of the clients,” explains Diana McCarron, another social work clinician with Mosaic PCN. “From what I’ve heard, the physicians are relieved to be able to say ‘I have someone who can spend time and help you with these types of things. Let’s focus on your diabetes for this visit.’”

For patients, McCarron says “flexibility and accessibility are the main benefits. We can see patients quickly and on an as-needed basis.” This is especially helpful for patients who are in crisis, or have suicidal ten-dencies. Once referred, patients can attend as many visits with the

social work clinician as needed. In addition, appointments take place right at the family doctor’s office for ease of access. After each session a detailed report is sent back to the physician for follow-up.

One of the advantages of the program is the social work clinicians’ ability and willingness to campaign for their patients. “We spend a lot of time advocating for our patients,” says McCarron. “We write letters to EI, income support, or services like access mental health on behalf of our patients in order to help them secure funding or access to a support program.” This is another unique characteristic of Mosaic

PCN’s complex patient population, Canales explains. “People in this area are not often aware of resources. They often come in to see us and we introduce them to a program or service that could have been alleviating a lot of their stress months ago, but they just were not aware of it.”

Fundamental to the success of the social work clinician program has been a solid knowledge and understanding of the popu-lation Mosaic PCN serves. “Knowing what types of socio-economic and mental health issues are out there… and being prepared to know where to point them and what ser-vices are available to help them is key,” says Canales.

Mosaic PCN’s social work clinician program demonstrates primary care networks’ unique ability to tailor their programs and services to meet the needs of their specific populations. In just over a year, the program has grown from one social work clinician to four, with plans to hire a fifth. From April to September 2011, the social work clini-cians received 412 referrals for a total of 611 visits. The social work clinicians are currently working in six physician offices and the Mosaic PCN Refugee clinic. “Without this service,” says McCarron, “we’re unsure where patients would turn for help.” Canales agrees. “To date there is no comparable alternative to what Mosaic PCN is offering this population.”

~ Meghan Prevost

Mosaic PCN

Calgary Foothills Primary Care networkServing north Calgary and Cochrane.

P: 403.284.3726F: 403.284.9518www.cfpcn.ca

mosaic Primary Care networkServing northeast Calgary.

P: 403.250.5059F: 403.250.5227www.mosaicpcn.ca

Calgary West Central Primary Care networkServing central Calgary.

P: 403.258.2745F: 403.258.2746www.makinghealthhappen.com

south Calgary Primary Care networkServing south Calgary.

P: 403.256.3222F: 403.256.3223www.scpcn.ca

Calgary rural Primary Care networkServing Black Diamond, Bragg Creek, Chestermere, Eden Valley, Claresholm, DeWinton, High River, Nanton, Okotoks, Siksika First Na-tion, Strathmore, Vulcan and surrounding areas.

P: 403.999.1587F: 403.206.7027www.crpcn.ca

Highland Primary Care networkServing Airdrie, Carstairs, Crossfield, Didsbury and surrounding areas.

P: 403.999.1587F: 403.206.7027www.hpcn.ca

Bow Valley Primary Care networkServing Banff, Canmore, Exshaw, Morley, Lake Louise and surrounding areas.

P: 403.675.3000F: 403.675.3002www.bowvalleypcn.ca

Calgary and area Primary Care networks

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