Access to primary health care is fundamental to the health of the province’s populations – populations of communities, regions and the province itself.
With that in mind, in the past couple of years, Eastern Health has embarked on an innovative community partnership with a joint goal: to explore new and improved approaches to the delivery of primary health care in rural areas and among vulnerable populations. Eastern Health staff and community members have been busy identifying primary health needs, and working collaboratively to come up with solutions and improvements.
The Bonavista region is currently seen as a leader in creative business innovation, entrepreneurship, arts, family attraction and retention, and the protection of place; and Bonavista residents indicated they desired the same kind of forward movement with respect to the delivery of primary health care.
In 2016, through a unique partnership between Eastern Health and community representatives, the Bonavista Primary Health Care Community Advisory Committee (CAC) was formed to find innovative and cost-effective ways to improve the quality and delivery of health-care services in the region.
“Primary health care is about providing the right care at the right time in the right place,” says Debbie Walsh, co-chair of the Community Advisory Committee and regional director of Eastern Health’s Medicine Program. “It focuses on healthy living by prevention, health promotion and support for self-management, along with improved coordination and continuity of care.”
In the fall of 2016, the Newfoundland Centre for Health Information (NLCHI), in partnership with Eastern Health, conducted an in-depth health status study on current health-care trends within the Bonavista region.
It revealed, for example, that in 2015-2016, the majority of emergency room visits were for non-urgent conditions such as prescription requests, cough/congestion, and sore throat – leading to an overcrowded emergency room and long waiting periods.
Community residents were relying on the ER for non-emergency care because of a shortage of family physicians or nurse practitioners.
So Eastern Health held efficiency exercises at the hospital in the fall of 2015 and spring of 2016. Patients who showed up in the emergency department were assessed and re-directed to other health-care professionals, as needed – appropriate to their specific needs at that time.
As a result – the majority of patients now visit the Emergency Department only for urgent and emergent care, while others avail of a nurse practitioner at the adjacent walk-in clinic.
Eastern Health also gave considerable focus to recruitment and retention of primary health-care providers. In January 2016, a nurse practitioner was hired and integrated into the primary health-care service in the Bonavista area.
In February 2016, Dr. Mohammed Al-Byaty was contracted in a full-time capacity, and Dr. Brenda Penney began a full-time position in September 2016, combining general practitioner clinic with work in both acute and long-term care. In October 2016, Dr. Rosemary Hanna was contracted for full-time work. The three new physicians joined three other physicians already practising in Bonavista.
As a result, the area now has a full complement of physicians and nurse practitioners within the Bonavista Peninsula Health Centre – with Dr. Brenda Penney also serving as on-site chief of staff.
Primary Access: Technology and Improved Health Outcomes
Many improvements to health-care technology have also been made in Bonavista.
Online tools and resources ensure that people have access to health-care service to keep them well and empowered – and that their health-care providers have access to all the information they need to provide timely and targeted care. These include:
Electronic Medical Record
The Bonavista Peninsula Health Centre is one of the first in the province to have a fully-functioning electronic medical health record (EMR), which provides access to all a patient’s health information, including laboratory results, diagnostic imaging reports, and consultation reports.
“Access to up-to-date information gives the health-care team a more complete understanding of patients’ health care needs, at any given time,” says Dena Trask, project lead for the Bonavista Primary Health Care Initiative. “Accurate and timely information-sharing about things like current medications, allergies and test results, along with a coordinated, team-based approach to health care – all lead to better diagnoses, treatment and management of health issues.”
Remote Patient Monitoring
The RPM program is an at-home monitoring program, available to patients in the Eastern Health region who live with diabetes, chronic obstructive pulmonary disease (COPD), and congestive heart failure.
Patients are monitored by a highly-skilled registered nurse who educates and equips patients with the skills to manage their own care and improve their quality of life. For patients with chronic diseases, it helps keeps them well at home, and prevents unnecessary hospital admissions.
This interactive video and voice-conferencing technology connects patients with various specialists, increasing access to care from health-care centres in or near their own community. The Bonavista Peninsula Health Centre currently uses Telehealth for oncology, dialysis, long-term care, methadone treatment and psychiatry.
Primary Focus: Moving Forward
As Eastern Health continues to work with residents of the Bonavista Peninsula, it has also begun a similar primary health care initiative on the Burin Peninsula.
In May 2017, Eastern Health partnered with the Government of Newfoundland and Labrador’s Office of Communication and Public Engagement to host a series of community consultations sessions in Grand Bank, St. Lawrence, Burin and St. Bernard’s.
The purpose of the sessions was to share information about health status of residents in the area; to engage participants in a discussion regarding health; and together to search for concrete solutions to help transform the delivery of primary health care.
A total of 171 residents participated in the process. They included representatives from community groups and organizations such as ambulance operators, municipalities, fire departments, schools, churches and clergy, youth and seniors’ groups, sports and recreation committees and Eastern Health employees.
The top three concerns in the communities/region identified by participants during the consultation process were mental health, cancer and addictions.
“Eastern Health takes the concerns raised by the residents of the Burin Peninsula very seriously, and is developing an action plan to address the issues that have been identified,” said Judy O’Keefe, vice president with responsibility for primary health care. “In the coming months, we will establish a Community Advisory Committee and we look forward to working with community representatives to find solutions aimed at transforming primary health care on the Burin Peninsula.”
In the meantime, residents have requested a list of services currently provided on the Burin Peninsula, and with that in mind, Eastern Health developed a Health Services Directory (PDF) for easy access.
Access to primary health care can also be a concern for vulnerable populations, and with this in mind, Eastern Health has established a partnership with community groups in the capital city.
It joined forces with The Gathering Place, Choices for Youth, the Salvation Army, Memorial University and the Department of Health and Community Services for an initiative known as the Downtown Health Care Collaborative, targeting vulnerable people in downtown St. John’s.
The purpose of the collaborative is to provide primary health care with a mental health focus, by interdisciplinary teams including nurses and social workers, physicians and nurse practitioners.
Eastern Health remains committed to improving access to quality primary health care, to ensure the best possible outcomes for men, women and children throughout the eastern region.
A sustained approach is key to empowering both individuals and communities to take responsibility for their health-care needs, in partnership with their health-care providers.
This article was written by Deborah Collins, a communications manager with Eastern health, based in St. John’s.