Primary Palliative Care Navigation Program 

The remote care program is a new initiative through The Owen Sound Family Health Team and Partners

Your  care team feels you and your caregiver would benefit from participating in this new program.

This program will give you more timely support from a palliative care nurse and your primary care provider during your palliative care journey. 

Purpose of the program:

• Reduce avoidable Emergency Room visits
• Increase access to primary care providers

• Increase access to communication between primary care providers and nursing agencies, home care, and community paramedics.
• Reduce strain on the home care system by streamlining communication and escalation pathways between community and primary care providers.
• Increase early identification of patients who would benefit from a palliative approach to care.
• Increased timely equitable access to high-quality palliative care 24/7 as close to home as possible.
• Increase support for family member and caregiver burnout.
• Patients, families, and caregivers benefit from the early engagement of a palliative approach to care.
• To put the patient at the center of their care experience, with services focused on supporting their evolving needs.

How the program works: 

• The primary care provider refers you to the remote care program.
• The palliative care nurse meets with you in person or by phone and collects intake information.
• You are given a tablet with a simple, easy-to-use monitoring survey loaded on it.
• You submit the survey weekly (or as needed) from the tablet within your home.
• If the nurse has concerns about your comfort level or medical condition, they will call you or your caregiver.
• The nurse will assess your needs and then consult your main care provider.
• The nurse will coordinate the next steps with the palliative care team – this could be services such as home care or community paramedics.

How the tablet works: 

• You will receive a tablet from a doctor, nurse, or community paramedic.
• You will receive a phone call from the Technical support team (clouddx) to help you set up your tablet & connect to your Wi-Fi.
• The customer support tech will help you fill out your first survey.
• The survey is a series of questions that tells the palliative care nurse your current comfort level, need for medication changes, and overall needs.
• You will receive a weekly survey on your tablet. You will have 24 hrs to fill out the survey.
• The survey is sent directly to the palliative care nurse for review.
• If you have technical issues with the tablet, you can contact the Clouddx Customer Care support team.

Primary Palliative Care Navigation Program Team

Owen Sound Family Health Team Palliative care nurse:  Amorei Sohl –  510.470.3030 
Cloud DX Tablet Patient Support Specialist Phone: 1-888-543-0944 ext.232
Palliative Care Medicine Group
Grey  & Bruce Community Paramedics
Grey Bruce Ontario Health Team

Brochure