Panel discussion – BC Health Coalition Conference 2017

November 3, 2017

BCHC Friday 100_preview-Colleen Fuller

From left to right: Marcy Cohen – moderator (health and social policy researcher), Colleen Fuller (health policy analyst,Board of Directors of REACH Community Health Centre in Vancouver), Edward Staples (President of SOHC (Support Our Health Care), member of the BCHC Steering Committee, member of the Princeton Health Care Steeringng Committee, and the South Okanagan Similkameen Community Healthcare Coalition), Dr. Margaret McGregor (Family Physician, Director of the UBC Dep. of Family Practice, Community Geriatrics, a research assciate with the VCHRI’s centre for Clinical Epidemiology & Evaluation and the UBC Centre for Health Services and Policy), Anita Shen (student of nursing and a former youth in government care), Kerrie Watt (Youth Mental Health & Substance Use Prevention Educator with Vancouver Coastal Health)

Questions to Ed Staples, President of SOHC, are in Italic
1. Can you describe the role of the community in advocating for and working with local health professionals to address the gaps/challenges in health services in your and other rural communities, and can you explain why and how primary care reform is seen as key in addressing these problems?

To address the first part, the role of the community, quite simply, is to identify what’s needed and to establish a collaborative and cooperative relationship with all community stakeholders to make change happen.

It is critically important for there to be a “community” voice.  Otherwise, the professionals – the doctors, administrators, and bureaucrats – will view the world as the aggregate of their specific, unique patients, and the formal funding and legal structures surrounding them – mostly government and especially provincial government supported and directed.

Without a community voice, those “forgotten” or structurally denied services will continue to be part of the huge “blind spot”, the gaps/challenges that exist in our communities.

Community organizations such as Support Our Health Care provide a more adequate view of need and priority for service, providing they talk directly to the providers and funders using persuasive public processes of research and community consultation.

The second part of this question, the importance of primary care reform, is harder to answer. The myriad healthcare models that exist in rural communities across the province are the result of communities doing the best they can with what they have. Each community healthcare model, no matter what you call it, is born of necessity rather than design. However, if you were to examine the various models, I think you’d find some common determinants:

1. personnel – service delivery is wholly dependent on the healthcare personnel available at any given time – and that can change monthly, weekly, daily
– range of specialties – knowledge of each other’s skill set is critical to the
delivery of a team based, multi-disciplinary primary care model
– expertise, experience, and character
– living location

2. healthcare infrastructure
– location of physical facilities – spread over the community or all under one roof
– size and layout

3. community infrastructure
– size of local health area
– transportation services
– distance and time

4. population health profile
– average life expectancy
– chronic disease prevalence rate
– health behaviour indicators – diet, exercise, alcohol consumption
– perceived health

2. What are some of the ways that the provincial government, health authorities and Divisions of Family Practice could be providing more support for primary care reform initiatives in rural communities across the province?

First, it is important to understand that there’s no single path, no single model that will work for all communities. The model of healthcare that works best for each community is born out of necessity rather than design. The available services determine the model.

some initiatives that could use support:
– initiate weekly team meetings – critically important to the successful operation of a primary care team – Princeton is unique in this regard – not aware of any other community that does this.

Princeton’s team
– four General Practitioners (with a fifth on the way in August)
– two Nurse Practitioners (sharing 1.0 FTE)
– visiting specialists-12 specialists coming to Princeton providing clinics-win, win, win
– Community Care Worker
– Nurses (RNs, LPNs)
– Nurse Manager
– home & community care nurse
– occupational therapist
– physio-therapist
– Community Paramedicine
– long term residential care worker
– Mental Health and Substance Use counsellor
– medical students

– agenda set by each specialist (all care givers are viewed as specialists in one form or another)
– discharge planning
– problem solving – barriers to discharge

– include patient navigators as the entry level to the primary care model – the general practitioner becomes a member of the healthcare team rather than having the sole responsibility for determining patient care and wellness

– look at communities where primary care initiatives have worked – share best practices – Princeton is one model, Ashcroft another (some info on this)
recognize that the community has a role to play in determining the services that are needed

– establish community action plans with measurable outcomes, implemented by community healthcare steering committees

– develop patient file sharing protocols – allow transition to one common EMR system – cross community exchange of information

– physical infrastructure is a strong determinant in the formation of the local primary care model – does the space define the service or the service define the space? should be the latter but too often the former – provide financial assistance to communities that need to change/upgrade their physical space in order to implement an effective primary care model

3. Can you describe the role of the community in advocating for and working with local health professionals to address the gaps/challenges in health services in your and other rural communities, and can you explain why and how primary care reform is seen as key in addressing these problems?
 
It is important for there to be a “community” voice.  Otherwise, the professionals will view the world as the aggregate of their specific, unique patients (those who make it there) and the formal funding and legal structures surrounding them – mostly government and especially provincial government supported and directed.
 
Therefore, those “forgotten” or structurally denied access to service(s) will continue to be part of the huge “blind spot” that is the focus of the question.
 
Community organizations of all types provide a more adequate view of need and priority for service providing they talk directly to the providers and funders using persuasive public processes of research and community consultation.
 
4. What are some of the ways that the provincial government, health authorities and Divisions of Family Practice could be providing more support for primary care reform initiatives in rural communities across the province?
 
Pro-actively seek out organizations that are interacting with the public, or segments of the public, and solicit their input on a routine basis.  This might imply the creation of interface bodies on which deliverers, funders and community organizations are represented.

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SOHC Discussion Paper

Developing an Improved and Sustainable Health Care Model for Princeton, B.C
Support Our Health Care has released a discussion paper in order to get feedback from the community, politicians and professionals about the state of local healthcare and what the long term solutions should be.
Download PDF Here