Primary Care in the North: Meeting the Challenge

Summary

The video script discusses the transformation of primary care in a Canadian province, emphasizing a shift from illness care to health care. It features Norwest Community Health Centers, which offer a comprehensive range of services under one roof, including mobile health services for remote areas. The script highlights the challenges of providing care in a vast region with an aging population and limited resources, focusing on innovative solutions like mobile units to reach seniors and maintain them in their homes. It underscores the importance of a population-based approach, interdisciplinary collaboration, and the need for innovative thinking to address healthcare disparities.

Takeaways

• 🏥 Traditional primary care is evolving, with a shift from 'illness care' to 'health care' to address the high costs of the former.
• 🌐 Norwest Community Health Centers is part of a network providing comprehensive care with a team including physicians, nurse practitioners, nurses, and other specialists.
• 👴 They primarily serve priority populations such as seniors and families, especially those with difficulty accessing primary care.
• 🚑 Mobile health services are crucial for reaching remote communities, with specialized units for primary care and diabetes services.
• 🌆 Geographic challenges are significant, with a large area to cover and a sparse population, necessitating innovative care delivery methods.
• 👣 The model aims to keep people, especially seniors, at home, reducing the need for travel and hospital visits, which can be a full-day affair.
• 👣 Foot care is highlighted as an essential service that helps maintain mobility and independence for seniors.
• 📊 Data and evidence are important, but the human element and context are crucial for providing tailored services to communities.
• 💡 Innovation is key, with the need to balance evidence-based decision-making with entrepreneurial thinking to meet community needs.
• 🏡 The approach focuses on the right care at the right time in the right place, emphasizing health promotion and preventive care over institutional care.

Q & A

What is the primary focus of traditional primary care in the province mentioned in the script?

Traditional primary care in the province has primarily focused on illness care rather than health care.

What is the significance of Norwest Community Health Centers in the province?

Norwest Community Health Centers are part of a network of community health centers that provide comprehensive care with various health professionals under one roof, serving priority populations including seniors and families with difficulty accessing primary care.

How does the geography of the province impact the delivery of primary care?

The province's vast geography, comparable to the size of France, poses a challenge for delivering primary care to its sparsely populated areas, particularly to an aging senior population.

What are the two types of mobile health services mentioned in the script?

The two types of mobile health services mentioned are primary care and specialized diabetes services.

Why are mobile units used in the region?

Mobile units are used because it doesn't make financial sense to allocate substantial resources to small communities with populations as low as 500 people.

What is the role of the foot care nurse in the community health services?

The foot care nurse plays a crucial role in keeping people mobile by providing foot care services, which are especially important for individuals with arthritis or limited visibility who cannot manage foot care on their own.

How does the mobile health service adapt to different environments to provide care?

The mobile health service can adapt to various environments, such as setting up behind a curtain in a library, to provide care, emphasizing the importance of service delivery and relationship with the people over the location.

What is the main challenge faced by seniors in small communities according to the script?

The main challenge faced by seniors in small communities is the lack of resources and support, leading to isolation and difficulty accessing necessary care.

Why is it cost-effective to use mobile units for providing services to remote communities?

Using mobile units is cost-effective because it allows for the provision of services to multiple remote communities at a fraction of the cost of building and maintaining individual facilities in each community.

What is the approach to decision-making in providing care to the population in the north?

The approach to decision-making involves a balance between evidence-based practices and innovative thinking, considering the unique challenges and needs of the population, and sometimes making decisions without complete data.

What is the philosophy behind the model of care provided by Norwest Community Health Centers?

The philosophy is to provide the right care by the right person, at the right place, and at the right time, focusing on health promotion and keeping people in their homes to reduce healthcare costs.

Outlines

00:00

🏥 Innovative Primary Care in Ontario

This paragraph discusses the evolution of primary care in a Canadian province, highlighting the shift from illness care to a more comprehensive approach that includes health care. Norwest Community Health Centers, part of a network of community health centers, provides a multidisciplinary team approach with physicians, nurse practitioners, nurses, and other health professionals under one roof. They focus on serving priority populations, including seniors and those with difficulty accessing primary care. The paragraph also addresses the challenge of delivering care across a vast geography with a sparse population, and how mobile health services are a solution. The importance of keeping people at home and the community's reliance on mobile units for primary and diabetes care are emphasized.

05:01

👨‍⚕️ Mobile Health Services for Remote Communities

The second paragraph delves into the innovative use of mobile health services to reach remote communities in Northern Ontario. It discusses the challenges faced by an aging population with limited access to healthcare due to geographical barriers and the lack of critical mass for full-spectrum senior care. The paragraph emphasizes the cost-effectiveness of mobile units compared to establishing permanent facilities in small communities. It also touches on the importance of data in decision-making, the need for a balance between evidence-based practices and innovative thinking, and the recognition of population health as a priority. The narrative includes personal experiences of clients who appreciate the convenience and comfort of receiving healthcare services in unconventional settings, such as libraries, and the overall goal of keeping people healthier and out of expensive healthcare institutions.

Keywords

💡Primary Care

Primary care refers to the first point of contact for patients within the healthcare system, typically provided by general practitioners or family doctors. In the video, primary care is discussed as a critical component of community health, with a focus on addressing not just illness but overall health. The script mentions that traditional primary care has been illness-focused, which is costly and needs to evolve to a more health-centric approach.

💡Community Health Centers

Community Health Centers are facilities that provide a range of healthcare services to the local community, often including preventive care, health education, and treatment for common illnesses. The video emphasizes the role of these centers in bringing together various healthcare professionals under one roof to serve priority populations, such as seniors and families with limited access to primary care.

💡Mobile Health Services

Mobile Health Services are healthcare services that are delivered to patients in locations other than traditional healthcare facilities, often using vehicles equipped with medical equipment. The script describes how mobile units in the video serve remote communities, providing primary care and diabetes services, which is crucial given the vast geography and sparse population distribution in the region.

💡Geography and Accessibility

Geography and Accessibility are key concepts in the video, highlighting the challenges of delivering healthcare services in a region as large as France but with a much smaller population. The script discusses how the vast size of the service area and the aging population create significant barriers to accessing care, which mobile health services help to overcome.

💡Interdisciplinary Models

Interdisciplinary Models refer to healthcare approaches that involve multiple healthcare professionals working together to provide comprehensive care. The video script mentions how community health centers bring together physicians, nurse practitioners, nurses, and other specialists to provide a holistic approach to healthcare, emphasizing the importance of collaboration in addressing the complex needs of patients.

💡Health Promotion

Health Promotion is the process of enabling people to increase control over and improve their health. The video script discusses the importance of health promotion in keeping people healthier and reducing the burden on the healthcare system. It suggests that by focusing on health promotion, the community can prevent illnesses and keep people out of expensive healthcare institutions.

💡Population Health

Population Health is a concept that focuses on the health outcomes of a group of individuals, including the distribution of such outcomes within the group. The video script highlights the shift from treating specific illnesses to considering the health of the entire population, aiming to improve overall health and well-being through preventive measures and health promotion.

💡Aging Population

An Aging Population refers to the demographic trend where the proportion of older individuals in a population is increasing. The video script discusses the challenges this poses for healthcare delivery, particularly in remote areas where the population is already older than the rest of the province, and the need for innovative solutions to provide care to this vulnerable group.

💡Isolation

Isolation in the context of the video refers to the social and geographical separation of individuals, particularly seniors, from healthcare services and community support. The script describes how isolation can lead to seniors being left without necessary supports, emphasizing the importance of mobile health services in bridging this gap and maintaining social connections.

💡Cost-effectiveness

Cost-effectiveness in healthcare is the measure of the relationship between the cost of a healthcare intervention and its effect on health outcomes. The video script argues for the cost-effectiveness of mobile health services, suggesting that they provide a more affordable way to deliver care to remote communities compared to establishing permanent healthcare facilities.

💡Innovation in Healthcare

Innovation in Healthcare refers to the introduction of new ideas, methods, or devices to improve patient care. The video script discusses the need for innovative approaches to healthcare delivery in remote and underserved areas, such as the use of mobile units and interdisciplinary care models, to meet the unique challenges of the region.

Highlights

The traditional focus on illness care is shifting towards health care due to its high cost.

Norwest community health centers provide a comprehensive range of services under one roof.

Priority is given to serving hard-to-reach populations including seniors and families.

Mobile health services are crucial for providing primary care and diabetes care in remote areas.

Geographical challenges in delivering care are addressed by mobile units due to the vast size of the region.

The aging senior population presents unique challenges in accessing care.

Mobile units are cost-effective alternatives to building multiple health centers in remote communities.

Clients appreciate the convenience and comfort of receiving care in non-traditional settings.

The importance of starting with population needs and building networks and partnerships to meet those needs.

Innovation is key in addressing the unique challenges of providing care in the north.

Transportation is a significant barrier for seniors, especially those who have lost their licenses.

The lack of assisted living and supportive housing outside of Thunder Bay exacerbates senior care challenges.

Mobile units provide primary care and health promotion services efficiently to remote communities.

Data alone can be misleading without context, and the human element is crucial in service provision.

The model of care provided has been recognized as viable for the whole population after over 30 years.

The philosophy of the right person at the right place at the right time is central to their approach.

Population health and interdisciplinary models are gaining recognition for their potential to reduce healthcare costs.

Transcripts

[Music]

now does this go front or back yeah

that'll go in the front is it

heavy is this

coming I don't know if there is such a

thing as regular primary care anymore in

this province

there's so many different um iterations

and variations in terms of how we

provide Primary

Care traditionally we have looked at

illness we have not looked at healthc

care we've looked at illness care that

needs to change because illness care is

way too

expensive Norwest community health

centers is part of a network of

Community Health centers across the

province we will have Physicians nurse

practitioners nurses food care nurses

dietitians counselors all Under One Roof

we serve priority populations a lot of

seniors families uh a lot of individuals

that have difficulty accessing primary

care we're really the only one that goes

out in the region on a regular rotation

we have two mobile Health Services one

is primary care the other one

specializes in diabetes services and

some communities are serve twice a month

when we're thinking about the needs of

our population access to care is a huge

need we have the geography the size of

France yet only

234,000 people that live in that

geography how do you actually deliver

care to a senior's population that's

aging that's uh the distribution is

older than the rest of Ontario and you

just don't have have the critical mass

in the publicly funded model or in the

privately funded channels how do you

deliver service from end to end across

the Continuum to this

population things in there a lot of

people in this province don't realize

how big the north is we serve actually

the District of

thunderbay my staff will travel for 3

hours in a vehicle to get from site to

site our seniors have a special

challenge especially seniors in some of

the small communities um and part of the

problem is the lack of resources in

these communities and it quite frankly

doesn't make sense to put a lot of

resources in these communities because

we're looking at in some situations a

population of 500

people which is why we use the mobile

units

Perfect all right just turn the heat up

it's

freezing

behind that table we deal with all the

issues so somebody might be coming to me

for foot care but um talking to them I

might realize they have other issues and

then I can direct them to the nurse

practitioner or I can direct them to the

to the Community Health

worker one of the biggest things we keep

people at home where they belong instead

of having to go into town

Drive 2 hours you know when you're

thinking about it then wait for their

appointment it's a whole entire day no

cuz you actually have to coat it then

wash it and then you to me it feels just

like an old friend when you come to see

these girls all the time she oh what

have you been doing or what haven't you

been doing and you better do some more

walking and and don't wear those wet

socks anymore you know so they do my ac1

test and they check my little book with

all my sugars I've been for the last 3

weeks a month whatever and then with my

feet Deborah checks that all the time

check make sure the nails are cut right

I don't even cut my nails anymore I get

it done here cuz then it's done right

there you go I'm Deborah I'm the foot

care nurse it's really keeping people

moving by having Foot Care Service there

are are you good oh I'll be able to see

what you're doing that's right people

have arthritis or stiff joints and they

can

manage they couldn't manage a Clipper

and they can't see what they're doing

sometimes just a little Nick can um be a

very dangerous thing for a

diabetic as long as we have uh an area

where we can set up then we can provide

care it's amazing what um people will

adjust to some of the feedback that

we've had from clients has been

outstanding we had one woman who had a

full physical exam behind a curtain and

basically said that you know this is the

best most comfortable physical that I've

ever had um sitting in a lawn chair with

a nurse practitioner behind a curtain in

a

library it's not about the location so

much it's more about how you present the

services and how you adapt them and the

relationship with the

people we start with the needs first we

start with the population

characteristics first and we then try to

figure out what are the networks that

are required what are the Partnerships

that we can use to meet those

needs this is a population that we

really um need to focus on up in the

north and we really need to uh to be

Innovative in how we approach these

individuals they don't want to leave

their homes and quite frankly I don't

blame them transportation is a big

problem especially with seniors when

they get into their 80s they lose their

license if their children are living in

Thunder Bay um you know their children

can support support them but if they

don't have children if they don't have

family they're pretty isolated so they

rely on their neighbors for support that

can be spotty it can be non-existent in

places that leaves seniors Alone um it

leaves them isolated uh and quite often

leaves them in a situation where they

have no supports we don't have um hardly

any or uh at all uh assisted living or

Supportive Housing outside of the city

of Thunder Bay

if you combine an aging population

without the critical mass for the full

spectrum of senior care it's resulting

in a lot of care being delivered in

hospitals where uh there may be better

settings thank

you yeah in terms of being coste

effective we provide uh service via our

mobile units um to to 10 remote

communities so if you thought about

putting 10 buildings up in those

communities and even if the staff

weren't there full-time that's a

significant amount of money we can take

a van and provide service for roughly

500,000 to all those communities that's

that's with you know full compliment of

Staff all the equipment uh we're

providing primary care and health

promotion for that so it's extremely

coste

effective when you're trying to make an

investment decision or an allocation

decision how do you control for all

those

variables especially when many of them

have to do with income levels education

levels housing availability and so on

and so forth sometimes we have to make

those decisions with uh maybe not having

all the data that we would

like d data can be tricky data in and of

itself and alone without the other

context I think can be

um misleading I think it doesn't tell

the true picture and you miss the human

piece and once you do that I don't

believe you're going to be providing the

services you need to particular

individuals and communities so if I have

a community of 500 people and we're

seeing X number of visits per per year

per day those numbers are really going

to look a whole lot different than a

downtown uh Community um in in Toronto

and how do you compare that it's it's

not comparing Apples to

Apples we walk that fine line between

evidencebased decision making and

entrepreneurial Innovative thinking we

have to use professional judgment we

have to weigh out what are the risks of

moving forward without maybe uh not

having all the perfect evidence and data

that we

want this model of care has been around

for over 30 years I think it's now being

recognized as a viable model of care for

the whole

population our philosophy is the right

person at the right place in the right

time well it's interesting all of a

sudden population health is on the radar

and it has a name

now we're looking at at people we're not

looking at specific

[Music]

illnesses if we can keep people

healthier if we can look at

interdisciplinary models if we look at

health promotion if we can look at ways

of keeping people in their home it will

cost less to the Health Care system

because we'll keep them out of the

expensive

[Music]

institutions