Alone we can do so little; together we can do so much. Helen Keller
By: Annamarie Fuchs, Creator. Partners in Health | Conversations.
November 20, 2020.
Living in a relatively small community offers tremendous appeal to many of us. My husband and I and our family have lived in a modest sized town for more than 20 years and we appreciate both the pace and the proximity to other services found in a nearby city. As a community volunteer, I’m the chair of a committee working to attract and retain health professionals including physicians, nurse practitioners, and others. It’s been an interesting experience to step back and view the health system in Alberta from the lens of my own community’s needs. Most of my work in the last 20 years has occurred at a more macro level so this opportunity has been both enlightening and satisfying as I have begun to consider the topic of health care in more local and inclusive terms.
We live in a moderate sized rural community near a city of 100,000 people. That city has a regional referral center, a cancer center, lab and diagnostics, palliative and hospice care. There are also Primary Care Networks situated across the region where dozens of family physicians work together with other professionals in team-based environments. Because we are in a bedroom community, there has been less emphasis until recently on bringing more health professionals directly to the town to establish practices. After all, citizens can drive 10 minutes to a city of 100,000 people or to another smaller city with a hospital and other basic services. So why go through the trouble of strengthening the health care provider community locally? It’s because we believe that health, healthcare, and wellness are nonlinear. Creating a focus on wellness requires a far broader perspective than ensuring health services can be accessed from a cause and effect point of view. It’s about acknowledging the values and expectations of our citizens to enable them to access the services and information they need to support the decisions that they make day-to-day whether they are in the grocery store, on the walking trails, or experiencing illness, injury, or disability.
When you begin to view health care from that perspective, then our local health system suddenly appears relatively robust. Citizens in our community have the opportunity to shape their health by taking advantage of our field house or the network of trails that connect us. The field house is a beautiful facility with a large pool, state of the art gym with instructors and courses, an open gymnasium for team sports, a walking track, and meeting facilities. The walking trails connect the entire community and link to another town approximately 13 km away. In fact, the Great Trail https://thegreattrail.ca/ (formerly known as the Trans Canada Trail) runs right through the town and the Field House. We also have pharmacists and dentists, chiropractors, physiotherapists, massage therapists, food stores, a community garden, a food bank, and other recreational facilities. And we have nearby farmers where we can purchase vegetables, fruit, and locally raised meat if we choose. The town has evolved beautifully in the nearly 25 years I’ve been here and as a result we are growing rapidly and thriving.
So, it’s time to fill the gap. In other words, while we recognize that we have a beautiful and growing community with services that attract young families, retirees, and commuters, citizens deserve consistent and reliable access to local family physician practices based on a patient’s medical home https://patientsmedicalhome.ca/. This model has been endorsed by the College of Family Physicians of Canada, the Canadian Family Practice Nurses Association, the Canadian Association of Social Workers, Canada Health Infoway, The Canadian Public Health Association, and others. The literature is clear. Family practice teams with family physicians, nurse practitioners, and others working with in team-based environments[1] play a vital role in delivering uninterrupted support at the community level – where we all live and play! And, what some people may not be aware of is that there are 41 Primary Care Networks across Alberta, staffed by nearly 4,000 family physicians and more than 1,400 other health professionals. https://pcnpmo.ca/alberta-pcns/Pages/default.aspx. If you have a regular family physician, you very likely belong to a PCN.[2] In fact, more than 80% of all Albertans belong to a PCN.
In our community and despite the fact that we have two nearby Primary Care Networks, we still don’t have reliable, full time locally based physicians or nurse practitioners. However, coupled with the services we already have in place, the physicians and/or nurse practitioners we soon hope to attract will enable citizens to choose whether to build relationships with local health professionals that can be maintained through the life span. A long-term relationship with a family physician or a nurse practitioner is at the core of a medical home.
There are tools that can enable community leaders to understand how to best meet the needs of their citizens. The Rural Health Professions Action Plan https://rhpap.ca/ provide strategies and offer supports that can enable rural Albertans to attract and retain high quality health professionals close to home. The Alberta Quality Matrix for Health (www.hqca.ca) offers a common language and approach by talking about acceptability, accessibility, appropriateness, effectiveness, efficiency, and safety. Health services must be respectful and responsive. They must be optimally and safely delivered in the most suitable setting in a reasonable time and distance and relevant to our needs while based in evidence so that if we are positively engaged, we can expect to achieve the most appropriate outcomes.
In the Quality Matrix, the areas of need are expressed through “the actions Albertans take” to access the care that they require. It talks about the “care and support needed in order for patients to manage chronic illness or disability” and support for “best possible functioning and preparation for eventual death for those with terminal illness.” What it doesn’t say is that you specifically need a hospital, a physician, or a nurse practitioner to enable you to achieve optimal health in any circumstance. It recognizes the variation in what health means to all of us and how communities and citizens can design their own community-based health systems. Access to services should be reliable and appropriate for that community and integrated with all the dimensions of care which are influenced at any given time by the areas of need. Have a look at the Quality Matrix for Health and the user guide which can be found at www.hqca.ca. It’s a great resource.
None of us will experience uninterrupted good health throughout our lifetimes. There will be lapses in function, mobility, or wellness through aging, illness, or injury. And in some cases, some of us will experience profound disability or even a life limiting diagnosis. As our lives unfold, we will all respond to periods where we focus on efforts to ‘be healthy, get better from illness or injury, live with disability or illness, and when we face end of life’. We can choose to respond by reaching out to our local community services, to our social networks, and to our medical homes. But we can only benefit from the services and supports available to us if we educate ourselves and reach out. For the most part, communities across Alberta are doing their part. The rest is up to you!
[1] https://patientsmedicalhome.ca/vision/physicians/
[2] https://actt.albertadoctors.org/file/1.2-PrimaryCareTransformationStructures.pdf#search=number%20of%20Albertans%20in%20PCNs
