Volume 13 - December 2018
Whatever our customs, many seem to come together in December. The days are short, the nights are long, and it’s cold outside. Our traditions – big and small, universal and very personal – often revolve around getting together with family and friends to share food, music and light on a dark winter night.
It also can be extra busy time of year for physicians working in rural communities.
If you’re celebrating, we at the Rural and Remote Division of Family Practice wish you, your colleagues and your families a holiday season filled with peace and contentment.
Bella Bella: Building connections
Bella Bella is a small but mighty medical community. There are 4.45 FTE, part-time and locum family physicians, and the Bella Bella Medical Clinic provides outpatient medical care, including walk-in and same-day access clinics. The RW Large Memorial Hospital has five acute and seven long-term care beds, full-time lab/x-ray and an emergency department, and the Hailika’as Heiltsuk Health Centre provides community health, home care, fitness, youth programs, counselling and a maternal-child health program.
Despite these resources, longtime rural physician Dr. Stuart Iglesias says Bella Bella still faces two key challenges: responding effectively to the growing burden of chronic disease, especially diabetes, and providing continuity of care where physicians are most often short term and/or locum.
“Specialists have always provided preferred access to rural and remote communities by coming here to meet patients in the community, or treating patients who travel to their offices in Vancouver,” he explained. “Elevating this service from a one-off acute intervention towards a continuity of care model always relied on the stable presence of a family physician, which this remote community has not seen for quite some time.”
“We needed to find a way to leverage the interest and commitment of specialists into something more effective,” said Dr. Lauri Ann Shearer, the Medical Director of RW Large Memorial Hospital and the Bella Bella Medical Clinic. “We believed that if we could increase the face-to-face contact between the community and the specialists, and support patients with a strong telehealth program between visits, the specialists could directly provide ongoing continuing care to residents with chronic diseases.”
That belief is paying off. By 2017-18, 18 specialists were providing a wide range of services from the hospital and medical clinic. This included a cardiologist (with echocardiogram and exercise stress test technicians), a diabetes specialist, a nephrologist and a rheumatologist. Both the cardiologist and diabetes specialist offer comprehensive telehealth follow-up between visits to support patients and provide continuity of care. The Heiltsuk Health Centre offers its own active program of visiting professionals, coordinating more than 15 clinics with therapists, a dietician, acupuncturist, on-site dental clinic, ophthalmologist and opticians.
Last year (2017-18), there were more than 1,300 specialist appointments and telehealth follow-up appointments booked through the hospital and medical clinic – an impressive number, considering that the population of Bella Bella, Klemtu, Denny Island and Ocean Falls is 1,500.
There are two reasons why this continuous care model for chronic disease is succeeding. First, the RW Large Memorial Hospital, the Bella Bella Medical Clinic and the Hailika’as Heiltsuk Health Centre are working together closely and cooperatively. Second, the medical community has created two positions dedicated to keep the system running smoothly.
Two new positions
In 2014, the Joint Standing Committee (JSC) on Rural Issues provided two-year funding for a chronic disease nurse. Since 2016, the nurse has been coordinating specialist clinics and telehealth sessions for patients, providing monitoring and follow-up of chronic patients, liaising with specialists and other allied health professionals, and developing streamlined systems for the clinic's chronic disease management.
“The response was great, but we were somewhat a victim of our rapid and early success,” said Dr. Iglesias. “It quickly became evident that the new chronic disease nurse’s position needed a robust admin platform from which to work effectively. So we asked the Rural and Remote Division of Family Practice to provide funding for an MOA to support the nurse, and to coordinate the outreach clinics."
By August 2018, the Hailika’as Heiltsuk Health Centre offered to provide an MOA to fill the position, with funding provided by the JSC.
The MOA has been coordinating and scheduling clinics, documenting and solidifying the workflow. Along with organizing clinics and notifying patients, the MOA makes sure all of the supports are ready: that the documents are up-to-date, the processes are clear, patients have had the tests they need, and the physician has the results. The clinics are more streamlined, and there has been a noticeable decrease in the workload of the Medical Clinic’s regular staff.
Evaluating the results
The division evaluated the CDM position in 2017, and concluded it met all three goals: greater continuity of care to chronic disease patients, decreased physician workload, and greater practice efficiencies. Patients also appreciate the CDM: 95 percent surveyed said the nurse had helped by sending reminders for lab work and specialist appointments. The next step is to formally evaluate the impact of the MOA’s position. So far, there is strong support for the MOA position, and keen interest in expanding the services to include more specialists.
Rural Retention Program Review: What’s your view?
The Joint Standing Committee on Rural issues is looking for input from rural physician for its Rural Retention Program Review process. The Rural Coordination Centre of BC is facilitating the review and would like to hear suggestions from physicians in rural communities about stabilizing and/or improving the program. Dr. Ed Marquis and Doug Blackie are traveling to rural communities and hosting webinars to speak face-to-face with rural physicians.
There are several ways to participate in the review.
- The Doctors of BC sent an email to rural physicians on Nov. 29. It includes a link to an online survey, which they ask all physicians to complete (about 15-20 minutes).
- If you would like to join the webinar or provide input via by phone or email, please contact Anne Lesack, Project and Research Assistant, RCCbc by phone (1 877 908-8222) or email (firstname.lastname@example.org). “We’re completely happy to accommodate rural physicians if they aren’t able to fill out the survey and/or participate in our webinars – we know they have insane schedules.”
Building connections with the community
A team of 16 physicians in Revelstoke are opening the curtains and showing the community what they do. “We have decided to release a series of health care articles in the Revelstoke Mountaineer as part of our community engagement work,” said Katherine Brown, Revelstoke’s Chapter Coordinator and new Health Care Development Project Manager. “This first article is an introduction to the work we do, and future articles will focus on specific projects. So far, we have received very positive feedback from the community.”
- Read the first story here. We’ll include the link for each new story as it’s published and post it to our own News and Events webpage.
Our new Board of Directors: depth and breadth of experience
The Rural and Remote Division’s new Board of Directors has been confirmed, and we are excited to put them to work as quickly as possible. This diverse board brings additional expertise to complement that of our general membership. Their focus will be on governance and strategy.
Each board member is committed to engaging with physician members at the community level to shape the strategy of our Division. Physician Leads will have the opportunity to meet the new board members at our Division retreat this spring. Their individual backgrounds are evidence of their suitability to serve the Rural & Remote Division, and together, they are a powerhouse!
Here is a brief introduction. Full bios are posted on the website.
David Butcher is a rural family physician on Salt Spring Island. He has been a Board member for the past six years and Treasurer for the past five. He has been involved with the Rural and Remote Division since its early days and has helped develop the current policy frameworks.
Danette Dawkin is a GP in Fort St John, Vice Chair of the NPDOFP, and board member of the RCCBC. Danette was asked to join the board by “the illustrious Rebecca Lindley.” She said “Yes” because she wants to help develop true patient and community centred healthcare built from the ground up. “This may sound naïve and somewhat ridiculous, but it is so.”
Travis Holyk is the Executive Director of Research, Primary Care and Strategic Services at Carrier Sekani Family Services, and Adjunct Professor at the University of Northern British Columbia. He is a leader in developing and administering innovative health and social programs that continue to have a positive and lasting impact in First Nations communities.
John Soles is the Chief of Staff, Dr. Helmcken Memorial Hospital, Clearwater. His vision is to enhance rural medicine to have adequate numbers of physicians, training for rural physicians and support of rural physicians in practice.
Lori Verigin is a Family Nurse Practitioner at Waneta Primary Care in Trail. Lori hopes to see greater inclusiveness in team-based care and would like to encourage more involvement of other primary care providers (such as NPs) who serve complex populations in rural and remote locations.
Laurie Walters holds a contract position with the Central Interior Rural Division as Recruitment & Retention Manager, and leads the Physician in Transition project, an online tool to assist country physicians transitioning into the communities of 100 Mile House and Williams Lake. Laurie also coordinated Tick Tock Find Us A Doc – a one-of-a-kind campaign to involve the residents of the region in physician recruitment. Laurie and her team secured a physician, several locums, and raised $30,000 in community sponsorship.
Dave Whittaker has been the staff physician in Port McNeil for the last six years. Dave has been with the Division since the beginning. Currently, he is the Chair of the Rural and Remote Division of Family Practice and a member of the Telehealth Working Group. His greatest professional accomplishment is collaborating with his fellow physicians to develop a team-based care approach to ensure that patients receive excellent primary care from as many individuals as possible.
Introducing Cheryl, Jeremy and Pat
Cheryl Drewitz has joined the Rural and Remote Division of Family practice as Chapter Coordinator for Pemberton. Cheryl has a Masters of Public Health and has worked as both a registered nurse and a paramedic. She is based in Kamloops and will be travelling to Pemberton on a bi-monthly basis.
Jeremy McElroy is our new Interim Director of Operations. Jeremy has a Bachelor’s degree in Political Science and International Relations and has a Chartered Professional in Human Resources designation. He spent six years as Executive Director of the Kwantlen Student Association, and 15 years serving on various non-profit society boards. His strong background in governance, policy development and human resources will be a great asset to our Division. Jeremy will work alongside our Director of Operations, Leanne Morgan, until December 21st to ensure a smooth transition.
Pat Lenci is our new Chapter Coordinator for Bella Coola. Pat will be Bella Coola’s first Chapter Coordinator. Pat has a BSC in Nursing and completed her Nurse Practitioner certification and has over 30 years’ of healthcare experience in the Bella Coola Valley. Pat’s strong healthcare background and community development skills will be a great asset to our Division.