Centre for Rural and Remote Mental Health (Australia)

THE CENTRE FOR RURAL AND REMOTE MENTAL HEALTH (CRRMH) IS A STATE-WIDE ORGANISATION THAT IS COMMITTED TO IMPROVING THE MENTAL HEALTH, WELLBEING AND RESILIENCE OF RURAL AND REMOTE RESIDENTS.

The Centre for Rural and Remote Mental Health works to promote and support community wellbeing collaboratives, recognising them as important pathways to mentally healthy communities and therefore reduced suicide rates.

A major rural initiative of The University of Newcastle’s Faculty of Health and Medicine and the NSW Ministry of Health, the CRRMH has a track record of conducting high-quality research and delivering evidence-based programs and services that improve mental health and wellbeing. Our staff are located across rural and remote New South Wales.

As the Australian Collaborating Centre for the International Foundation for Integrated Care, we promote patient-centred rather than provider-focused care that integrates mental and physical health concerns.

We work closely with local, national and international organisations to deliver the best outcomes. We value our partnerships and welcome new partners to join us in our work.

As part of the University of Newcastle, all of our activities are underpinned by research evidence and evaluated to ensure appropriateness and effectiveness.

CRRMH promotes patient-centred care rather than provider-focused care that integrates mental and physical concerns.

THE CRRMH FOCUSES ON:

  • the promotion of good mental health and the prevention of mental illness;
  • developing the mental health system to better meet the needs of people living in rural and remote regions; and
  • understanding and responding to rural suicide.

Find out more and sign up for the e-newsletter.
https://www.crrmh.com.au

WAIT TIMES

Thunder Bay’s Rapid Access Clinic for hip, knee conditions cuts wait times from years to weeks



Cathy Alex · CBC News – Oct 14, 2018

Patients are referred by their family doctor to the clinic, which then acts as a one-stop shop for consultations with orthopedic specialists and ultimately surgery if required.

Once enrolled in the program, the patient is assessed and then agrees to be cared for by the next available doctor from a pool of orthopedic surgeons, who also take turns working in Dryden, Fort Frances and Kenora.

Putting aside the natural competitive instinct between surgeons was key to developing the program, said Puskas. The program also brings together physiotherapists and doctors in a much more collaborative environment.

“We don’t always trust each other’s diagnoses, so we had to go through a period of time where we really got on the same page and used evidence from the literature to guide how we would deal with each different thing”, he said. 

That new respect is also translating into better service for patients, said Puskas, explaining he was able to see 30 patients in the fracture clinic, while his advanced practice therapist colleague cared for another 14, with the understanding he was always available if his expertise was required.

“So basically she was able to put 50 per cent more patients through and have them have the confidence that they had the attention of the surgeon if they’re needed.

“Quicker access to specialists and a shorter wait for surgery is having a dramatic effect on people’s quality of life, said Fanti, the program director.

To read more, click on: Thunder Bay’s Rapid Access Clinic for hip, knee conditions cuts wait times from years to weeks

SENIORS

China Caring for our Seniors
Colin Dacre – May 26, 2018
Local politicians are sounding the alarm about the level of care being provided to seniors at a care home in Summerland now owned by the Chinese government.
In addition to independent and assisted living, the facility provides complex care to residents with severe dementia.
Central Okanagan MP Dan Albas says he’s heard from family members of residents at the Summerland Seniors Village that care has degraded since the takeover.
Penticton MLA Dan Ashton pointed to a large wage disparity for staff between privately run care homes and the union-staffed facilities managed by Interior Health. With an existing shortage of care aides in the province, most new graduates are opting to work for IH for more money and benefits.
“The government requires 3.34 hours per individual in these homes, and it is my understanding the residents are not getting that because of the inability to find staff to provide that,” Ashton said.

We need to listen to voices of older patients
Katherine McGilton and John Muscedere – The Star
Jan 3, 2018
The Canadian Frailty Network embarked on a study to establish priority areas for researchers from the perspective of Canadians living with frailty, their caregivers and related stakeholders. This study asked older Canadians what they believe are the important questions related to the care, support and treatment they think would help maintain physical, mental and social well-being for older adults.
Older adults must have a voice in policy and program priority setting if we are to implement systems that are responsive to their needs. The need for patient involvement in setting both frailty research and policy priorities is particularly urgent since older adults have historically been underrepresented in decision-making in health and social care systems.
Key to the successful transformation of the health and social support landscape is evidence informed by persons living with frailty, their families and caregivers. Call it patient-centred care or a value agenda, we need to include the lived experiences of patients and families in how we do research, plan and care for them.
Their top priority concerned the organization of health systems. Older people told us they want integrated and better coordinated care that would meet both their health and social care needs and those of their families and caregivers.


RURAL/REMOTE

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DRUGS/ADDICTION

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URGENT PRIMARY CARE CENTRES (UPCCs)

Opinion: Community health centres needed to improve primary care in B.C.

Survey data show the percentage of British Columbians who have a regular health care provider is significantly lower than the Canadian average

Dr. Rita McCracken, Dr. Mei-ling Wiedmeyer, Ruth Lavergne Publishing date:Apr 01, 2019  •  April 1, 2019 

B.C. Premier John Horgan and Minister of Health Adrian Dix check out the facilities at the Westshore Urgent Primary Care Centre in Victoria at the time of its opening in October 2018. [PNG Merlin Archive] PHOTO BY DARREN STONE, VICTORIA TIMES COLONIST /PNG

For many British Columbians who don’t have a regular doctor or can’t see their doctor when they need to, getting day-to-day primary care means waiting at a walk-in clinic. Often this means telling your whole medical story in a short appointment focused on a single problem. Yet, lacking continuity of care can lead to worse health outcomes and more trips to hospital. Strong evidence shows investing in primary care leads to better health for patients. Primary care provides a first point of access, a continuous relationship over time, and, importantly, co-ordination as patients move through the health system.

Since last summer, the Ministry of Health has announced six new urgent primary care centres and promised at least four more. UPCCs offer same-day visits for patients who aren’t experiencing emergencies but should be seen within 24 hours, much like walk-in clinics. UPCCs do not offer relationship-based care over time or play a co-ordinating role for patients needing to navigate the system. More than $20 million has already been invested in building centres in Vancouver, Surrey and the West Shore and running them for the first year. An extra $2.9 million is projected for a centre in Burnaby announced last month.

When a new UPCC opened in Langford last fall, patients lined up outside. While some were looking for an urgent appointment, many hoped to find a regular place to go for primary care. Survey data show that the percentage of British Columbians who have a regular health care provider is significantly lower than the Canadian average. While the number of family doctors per person in B.C. is higher than ever, an increasing number of family doctors working in private walk-in clinics — and now UPCCs — are not providing continuous care.

In B.C., the main option for new family doctors to provide continuous care is to set up and manage their own fee-for-service practices. Fee-for-service payment can be a barrier to team-based, preventative care since it only pays doctors and does not encourage the prevention of illness. It also means doctors have to spend time running a business. For some doctors this model works, but research tells us that most new family medicine graduates want to work in team-based practices that do not require running a business.

Community health centres is a team-based primary care model that the B.C. government included in its May 2018 primary care strategy. These non-profit centres provide team-based care, offering access to social workers, family physicians, nurse practitioners, dieticians, counsellors and others and connect patients to other resources.

Importantly, CHCs are governed by a board that ensures they are responsive to the communities they serve. In Ontario, these centres have helped reduce hospital emergency department use by improving access to care — a B.C. government priority. While UPCCs also might seem like a good way to take pressure off emergency departments, studies show that it’s not patients who could visit UPCCs who contribute to delays and crowding but rather patients with more complex medical conditions who need a hospital bed.

We are concerned that UPCCs are diverting funding and health care providers away from models like community health centres and primary care networks with the greatest potential to provide the quality primary care patients need.

Urgent care services have a place in our system but it’s the wrong prescription for B.C.’s primary care ailments. Primary care reform takes time and we need to be thoughtful to ensure policies align with the evidence. What we need are attractive new community-based practice opportunities, like those found in community health centres for the new generation of family doctors.

Drs. Rita McCracken and Mei-ling Wiedmeyer are family physicians; Ruth Lavergne is an assistant professor in the faculty of health sciences at Simon Fraser University.

https://theprovince.com/opinion/op-ed/opinion-community-health-centres-needed-to-improve-primary-care-in-b-c

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Overview

What is an Urgent and Primary Care Centre?

Urgent and Primary Care Centres (UPCCs) are an important piece of our primary and community care strategy. They were first introduced to the province in 2018, with the creation of five new UPCCs in the West Shore (Langford), Vancouver, Quesnel, Surrey and Kamloops.

The goal of UPCCs is to provide a flexible resource to meet both the urgent and ongoing primary care needs of people in communities (primarily in larger urban centres) across the province. UPCCs will work to address several key problems currently faced by patients and health care providers:

  1. Many people do not have a regular family physician (GP) or nurse practitioner (NP), and as a result they must consistently visit walk-in clinics or the emergency department when they need primary care.
  2. People go to the emergency department when they have a regular provider, but are not able to get a same-day or next day appointment when unexpected urgent medical issues arise.
  3. Physicians and health care providers are unable to add team-based capacity to their clinics (such as a nurse or other allied health care provider) because their current space or lease arrangements do not allow for expansion.

UPCCs will help to address all these challenges by serving three main purposes. They will provide urgent care to patients who have health needs that should be attended to within 12 to 24 hours, but do not need the level of service found in an emergency department. They will have net new capacity for attaching patients to a GP/NP for their longitudinal primary care needs. They will be a team-based care clinic with interdisciplinary professionals who will support the urgent and ongoing care needs of all patients in the community, whether unattached, attached at the UPCC or attached elsewhere in the community.

They will provide an alternative to going to the emergency department by offering urgent care services, specifically:

  • Basic in-office emergency services for sprains or simple fractures, minor cuts requiring stitches, mild to moderate breathing difficulties, minor burns or rapid access to mental health and substance use crisis intervention services;
  • Assessment and treatment for minor illnesses, such as respiratory infections, eye irritation, fever or flu, skin rashes, urinary tract infections or abdominal pain; and
  • On-site or close proximity access to diagnostic imaging and lab services that maintain the same hours as the clinic, such as x-rays, point of care testing and blood tests.

    To read more, click on the link below.
https://www.pcnbc.ca/media/pcn/PCN_UPCC_What_is_an_Urgent_and_Primary_Care_Centre_10012019.pdf

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AARON DERFEL, Updated: January 27, 2020
Andrea Mendell, nursing an infected cut on her lower lip, arrived 20 minutes before the Queen Elizabeth Urgent Care Clinic opened its doors at 8 a.m. to make sure she wouldn’t have to wait too long to see a doctor.

But Mendell, a high school teacher from Côte-St-Luc, was stunned to discover that there were already 21 people ahead of her in line, with the first patient having arrived at 5:50 a.m. on a recent Wednesday.

Mendell is one of those patients who heeded the advice of Health Minister Danielle McCann: don’t go to a hospital emergency room unless you have a major problem. Knowing that her infected lower lip didn’t qualify as a major problem, Mendell turned instead to one of the winter clinics that McCann pledged would ease the burden on the province’s overcrowded ERs.

Yet at the same time that Mendell was waiting in the packed winter clinic on Marlowe Ave., the ER at the nearby Royal Victoria Hospital was filled to almost double its capacity, with five patients languishing on gurneys in its hallways.

This is precisely the scenario that the winter clinics were intended to avoid, prompting one ER doctor in the Laurentians to call them a fiasco. Other critics suggest that the failure of winter clinics to solve Quebec’s perennial ER crisis is a symptom of a much deeper dilemma: the chronic shortage of family doctors in Montreal as well as a lack of nurses in hospitals.

To read more, click on:
Quebec’s winter clinics far from the panacea promised by health minister.

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New, privatized health clinic will weaken public system: analyst

Seymour Health Centre given $7 million contract by Vancouver Coastal Health to operate care centre
May 23, 2019 By:  Graeme Wood

[Excerpt] The privatization of a new health clinic by Vancouver Coastal Health (VCH) is “deeply concerning on a number of levels,” according to government policy analyst Alex Hemingway of the Canadian Centre for Policy Alternatives.

A $7 million contract provided by the health authority to for-profit company Seymour Health Centre to operate the recently opened City Centre Urgent Primary Care Centre is unlikely to produce better care – while costing more money in the long term, contends a report from Hemingway.

Furthermore, Hemingway sees the VCH model as being a Trojan Horse of sorts for a more powerful private medical lobbying industry in B.C.

“Canada’s largely private (and highly inefficient) system of pharmaceutical drug coverage is a prime example of this lobbying power in action, as is the privatized and staggeringly inefficient U.S. health care system,” said Hemingway.

The idea of a UPCC is to alleviate emergency rooms from patients in need of non-emergency medical care, such as treatment for minor wounds, fever or dehydration.

And, last November, B.C. Minister of Health Adrian Dix touted UPCCs as able to “better connect local residents with the primary care they need.”

Dix didn’t respond to Glacier Media’s request for comment on Hemingway’s report.

Hemingway raised the fact the health authority spent $2 million on facility upgrades in addition to the centre’s lease payments through to April 1, 2020.

To read more, click on https://www.burnabynow.com/local-news/new-privatized-health-clinic-will-weaken-public-system-analyst-3100320

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Why are we letting corporate medicine take hold in Vancouver’s new urgent care centres?
[Excerpt] May 23, 2019 – By Alex Hemingway
Seymour Health received nearly $2 million from Vancouver Coastal Health to renovate their UPCC property. The health authority appears to have used public dollars to enhance a privately owned real estate asset.
Instead of inviting in these for-profit firms, why isn’t Vancouver Coastal Health running the UPCCs and other proposed health care services themselves or by partnering with community non-profits?
The health authority’s moves towards corporate health care delivery take us in the opposite direction of the impressive range of reforms taking place in BC’s public health care system. A swift change of policy is in order here.

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Patients searching for family doctor at new Langford Urgent Primary Care Centre leave disappointed

There was confusion on opening day of a new urgent primary care facility on the West Shore Monday morning.

More than a dozen people waited in line before the Westshore Urgent Primary Care Centre opened its doors for the first time at 8 a.m.

But some of those people were frustrated to learn that they would not be able to find a new family doctor at the centre – at least for now.

Wilson said she was hoping to find a family doctor for her three-year-old grandson as well as herself.

“I had a brain tumour taken out a year ago June, and I’m getting older. I need care,” she said.

When it was announced early last week, the province said the new urgent primary care facility in Langford would better connect locals with health care providers.

Click the bold text on top to access the full article

Related Stories
B.C. expected to announce new urgent primary care centre on West Shore

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Nanaimo

Jane Osborne

Jane is an individual member, working for the BC Association of Community Response Networks.

From the  www.bccrns.ca website:”A CRN is a diverse group of concerned community members who come together to create a coordinated community response to adult abuse, neglect and self-neglect.”
and:
CRNs around the province are reaching out to the community to establish a network of community agencies, local businesses, government agencies, (Health Authorities, Community Living BC) to provide help for adults experiencing or at risk of experiencing abuse, neglect and self neglect. Working together as a CRN, people and their communities are making a difference.

The area Jane covers on Vancouver Island spreads from the Malahat to the north tip of the island, to the west coast (the Uclulet – Tofino corridor), and the islands off the coast.
Her region includes the Coast Salish, Nuu-cha-nulth and Kwakwaka’wakw territories.

Jane is also associated with the following Community Health Networks: 
Cowichan Communities Health Network
Alberni/Clayoquot Health Network
Oceanside Health & Wellness Network
Comox Valley Community Health Network
Strathcona Community Health Network,
and 
Mount Waddington Health Network


Jane is a member of the Community Based Seniors’ Services Leadership Council, and co-leads the Rural and Remote Communities Provincial Working Group. Much of her work is in rural communities on Vancouver Island.

E. Jane Osborne (she/her/hers)
Regional Mentor, Central & North Vancouver Island, BC Community Response Networks/ Volunteer Facilitator, Restorative Justice Victoria
Living and working with gratitude on unceded Coast Salish, Nuu-chah-nulth and Kwakwa̱ka̱’wakw Territories
Phone: 250-751-2588 / Mobile: 604-363-5370
jane.osborne@bccrns.ca / www.bccrns.ca

Entrepreneurial Activities of Rural Coalitions in Advancing Access to Healthcare

https://equityhealthj.biomedcentral.com/articles/10.1186/s12939-019-1021-3
The principal investigators of the study were Kathy Rush, PhD, RN Associate Professor at the School of Nursing UBC Okanagan and Dr. Mike Chiasson, Professor, Faculty of Management, University of British Columbia Okanagan.
Note: it was at this meeting in Kelowna, on April 27, 2017 that discussion began that led to the formation of the BC Rural Health Network, officially launched seven months later on December 1, 2017.