Helping family health teams better care for older adults

It started with a shave and a conversation about the weather. That’s the moment Doug Oliver cites as the beginning of his career in health care. Now, he is focused on improving the health of older adults in his role as a respected physician researcher working in downtown Hamilton.

But his career has deep roots stretching back to his 20s when he was studying kinesiology at the University of Waterloo and volunteering at a nursing home, where he was assigned to spend time with isolated, older men.

“My first experience in health care was giving 90-year-old men a clean shave, helping them with their lunch, talking with them and playing the piano,” says Oliver. “Even though I didn’t have any medical training at the time, I felt the power of what spending time with someone can do.

“To this day, I’m more convinced than ever that those things I learned early on are the most important in people’s lives.”

Oliver is an associate professor with the Department of Family Medicine at McMaster University’s Michael G. DeGroote School of Medicine, and the medical director of McMaster Family Practice.

He’s also a co-lead of the team behind the Health TAPESTRY program, which is a multi-year, multi-site, primary-care based initiative. David Price, professor and chair of the Department of Family Medicine, is the executive lead; Dee Mangin, professor of family medicine, is the research lead, and Oliver is the implementation lead.

Health TAPESTRY sees trained volunteers visit adults aged 65 and older where they live. Volunteers ask questions related to their health and what matters most to them, recording the answers electronically. This information is then shared with the person’s health-care team so they may better understand how to work together to achieve these goals.

“The spirit of TAPESTRY is communities volunteering to help older adults, and primary care teams working together to empower older adults,” Oliver says.

“The ultimate goal is for people to age optimally and independently, and to be living where they want to, whether that is their home or hospice or retirement home.

“The focus is on that individual and what their goals are, rather than in a traditional medical model, which can be system-focused rather than individual-focused.”

The Hamilton-based randomized control trial from 2013 to 2016 saw a significant reduction in emergency department visits and hospitalizations for people who were in the intervention group in the TAPESTRY program compared to their counterparts. The TAPESTRY participants also spent less time than others sitting and were more physically active.

The data pushed the McMaster team to undertake the Health TAPESTRY Ontario three-year study, which is in its final year. Trained volunteers, now from the Canadian Red Cross, are collecting data and reporting back to family health teams in six different parts of the province. Oliver says the hope is that if they can replicate the findings, TAPESTRY could be rolled out to other communities across Canada.

Price says Oliver has been an essential part of the success of Health TAPESTRY.

“Doug has played a pivotal role in helping us to shape both the volunteer training and the volunteer home visits for the Health TAPESTRY program,” says Price. “His experience as a comprehensive family physician as part of an interprofessional team ensured that the work of the TAPESTRY volunteers made a significant contribution to the results of the study which showed better outcomes for older patients.”

Oliver is preparing to initiate a pilot project aimed at tackling hospital re-admission rates among patients at McMaster Family Practice. In this pilot, a team of primary care nurses will be looking at hospital discharge sheets every week, calling those patients aged 65 and older and offering a visit by a pair of Canadian Red Cross volunteers in the home within one week of hospital discharge. The goal is to see whether the Health TAPESTRY approach will work as an intervention to determine appropriate needs and prevent those older adults from returning to hospital. 

Oliver also recently collaborated with Ken Deal, professor of marketing at McMaster’s DeGroote School of Business, and Michelle Howard, associate professor of family medicine, on a research project focused on access to care. The initiative was designed to better understand how and why patients make the choices they do when calling in to book an appointment with their family doctor.

“As a result of that research, McMaster Family Practice was an early adopter of advanced access booking where the goal is to start our day with the majority of appointments wide open so patients can call in and be given an appointment that same day,” he says.

For Oliver, the failure to gain acceptance to medical school on his first attempt was turned into a positive as it fostered his pursuit of research. He successfully completed a master of science degree at McMaster thanks to a scholarship from the Natural Sciences and Engineering Research Council of Canada. 

As Oliver completed that degree, he applied the second time to medical school and was accepted to McMaster. He then went on to complete a family medicine residency at the university.

Today, Oliver balances research, health leadership, clinical practice and mentorship.

As a primary care physician, Oliver’s interests are home-based palliative care, primary mental health care and care of older adults. He is Dr. Oliver to more than 1,100 patients from newborns to those over the age of 100.

As medical director of the McMaster Family Practice, he and clinic director Jill Berridge manage a team of 20 family physicians, 45 residents and 60 staff members. McMaster Family Practice, located in the heart of downtown Hamilton at the David Braley Health Sciences Centre, sees more than 20,000 patients come in each year. 

There are always three family medicine residents on Oliver’s team for a period of two years at the McMaster Family Practice. He also mentors clinical clerks and medical students on rotations. His priority is patient communication. There is also frequent discussion about physician burnout.

“There was a time when I did burn out, and suffered a lot of loss in my personal life,” he says.

“Working in health care doesn’t always allow us to care for ourselves. If you don’t attend to yourself, nobody else will. Others won’t know we are struggling unless we tell them.” 

He says he managed to find balance again, crediting a new life partner and the love of his four children, including Stella, 18; Will, 16; Michael, 14, and Mia, 11. He also enjoys regular visits with his parents, who recently moved from his hometown of Whitby to his current community of Dundas.

“My number one way to prevent burnout is spending time with my kids and the people I love,” he says. “We love to play sports, watch sports and go to movies. I love to run, as well as play piano and guitar which I find relaxing. I am doing a better job taking care of myself, which helps me be better in every part of my life.”

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