Bella Coola

Joan Moira McIlwain – Individual Member moiramcilwain@hotmail.com
tel.: 250-799-5977
1030 McLellan Rd, Box 764
Bella Coola, BC. V0T 1C0

[Wikipedia] Bella Coola is a community in the Bella Coola Valley, in British Columbia, Canada.  Bella Coola usually refers to the entire valley, encompassing the settlements of Bella Coola proper (“the townsite”) (population approximately 148), Lower Bella Coola, Hagensborg, Salloompt, Nusatsum, Firvale and Stuie. It is also the location of the head offices of the Central Coast Regional District.

The entire Bella Coola Valley had a population of 2,010 as of the 2016 census. This was an increase of 5% from the 2011 census, when the population was 1,919.

Silverton

Silverton is a village about 5 kilometres south of New Denver in the West Kootenay region of southeastern British Columbia. The former steamboat landing is at the mouth of Silverton Creek on the eastern shore of Slocan Lake. Wikipedia

Name origin

Four Mile or Four Mile City, the former name, came from Four Mile Creek flowing through the town. In 1892, William Hunter and J. Fred Hume bought 160 acres of Crown land, upon which they founded the townsite the same year. By 1893, the creek was sometimes called Silverton Creek. The four miles likely measured the distance by trail from New Denver. That year, the new townsite was promoted as Silverton, probably after Silverton, Colorado. Over time, Silverton also became the predominant, then official, name for the creek.[4]

Present community

At 0.35 square kilometres (0.14 sq mi), Silverton is the smallest municipality in BC by area, and was the smallest by population 2002–2011. Zeballos has since held the latter title. When Silverton mayor Jason Clarke was asked to comment on the fact that the census population of 185 at 2016 was the same as 2011, he joked that no one is allowed to leave unless they find a replacement.[4]

The Memorial Hall (1919) once housed the second school, but is today used for exhibits by local artists, music and dance classes, concerts and social events. Within the grounds is the Interpretive Centre displaying historical photographs and a collection of artifacts salvaged from surrounding mines, with larger items in the Outdoor Mining Museum by the road. Opposite, two streets back, the Fingland Cabin is restored as a blacksmith shop.[15][16]

The Silverton Lakeshore Inn was the Selkirk Hotel (1897) prior to refurbishing.[17] The lakeshore campground has 15 sites, and along Silverton Creek are 20 further sites.[18]

Out-of-Pocket Costs for Rural Residents When Traveling for Health Care

Out-of-Pocket Costs for Rural Residents When Traveling for Health Care
Results from a province-wide survey in British Columbia

“This report presents findings from a rural citizen-patient survey on the out-of-pocket costs incurred while traveling to access health care in BC. To our knowledge, it is the first primary research study to systematically document the financial consequences of traveling for care for rural residents in BC and, as such, provides important information for health care planners.”

The results of this survey provide a starting place for discussions on the role of public support for rural residents who need to travel for health care. These discussions must involve key stakeholders from rural communities but also regional representatives and government ministries beyond the Ministry of Health (e.g., Transportation and Highways, the Ministry of Child and Family Development). Bringing the right group together will provided a starting place for developing a system response to ensure all residents have access to the health care they require, without financial barriers.

Respondents were asked to complete the survey for the most recent health care issue that required travel (e.g., a surgical procedure, cancer care). The most recent travel for this issue must have occurred within the last two years. Respondents were instructed to include travel for that one health issue and not to include separate travel for other health issues. However, responses indicate that a few respondents likely included trips for multiple issues in one survey response. Nonetheless, in this report, the use of the phrase ‘per person’ refers to the average cost per survey participant for one health condition. All costs are reported in Canadian Dollar as of 2020.

This study is co-funded by the Health Economics Simulation Modelling Methods Cluster, BC SUPPORT Unit and the Joint Standing Committee on Rural Issues, through the larger context of the Rural Surgical and Obstetrical Networks program, which works to stabilize and enhance surgical and obstetrical services in rural communities across BC.

Click the download to access the report.
 oopc-survey_report_7.16.20 Download

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A Pathway to Hope: A roadmap for making mental health and addictions care better for people in British Columbia

MESSAGE FROM THE MINISTER

As British Columbia’s first Minister of Mental Health and Addictions, I am honoured and excited to present A Pathway to Hope: A roadmap for making mental health and addictions care better for people in British Columbia.
Judy Darcy, Minister of Mental Health and Addictions

[Excerpts] At the heart of A Pathway to Hope is a powerful determination to make positive, lasting changes, so that B.C.’s system of mental health and addictions care works for everyone— no matter who they are, where they live, or how much money they make. Our vision is one where every one of us can live in a state of physical, spiritual, mental and emotional well-being.

This roadmap also represents a call to action to all British Columbians to work together, to contribute, to be part of the solutions moving forward. Integration — of government services and of all our external partners — is a key theme in this roadmap. This is a province-wide issue that touches the lives of so many people, and a ects our relationships, our work, our communities and so much more. Only by coming together, can we deliver the changes needed to support people in addressing their challenges and help us move forward in a proactive, progressive and supportive province.

In her 2019 report, Taking the Pulse of the Population, B.C.’s provincial health officer, Dr. Bonnie Henry, reports that British Columbians rate their mental health as nearly the lowest in the country, despite being more physically active, eating more fruits and vegetables, and having generally healthier lifestyles. And the percentage of British Columbians reporting positive mental health is trending downward — an area where B.C. is falling behind at an international level.

Barriers to mental health and well-being
When it comes to delivering mental health and substance use programs on the ground, service demand exceeds service capacity. It’s as simple as that.
The results of the systematic barriers to care have huge implications for British Columbians. Too many people end up not getting the care they need until their condition is severe and requires more extensive and expensive treatment. Those treatments often tend to be fragmented, with people having difficulty navigating their way between primary, community and acute or emergency services.

Research suggests that stigma prevents 40% of people with anxiety or depression from seeking help — a trend that is magnified when put under a lens of cultural, gender, ethnicity, age, poverty, and sexual and gender identity factors. For example, women can face significant stigma when they experience depression before, during and after pregnancy, or the adoption of a child.

If care is sought, affordability of services becomes an additional factor, particularly for people accessing counselling or residential substance use facilities, or when additional service fees are required. These barriers are made even worse for people living in rural and remote areas.


The Barrier of Stigma
Stigma and affordability stand out as substantial systemic barriers to care. Fear and misunderstanding often lead to prejudice against people with mental illness, substance use and addiction challenges — and this discrimination comes far too often from health and social service providers themselves.
People with mental illness or addiction report that judgment by others is a significant barrier to recovery. Stigma can prevent people from asking for help for fear of what others might think or say.
According to the Canadian Mental Health Association, two out of three individuals with a mental health problem will not pursue treatment. These individuals will suffer longer, which could make the mental health issue worse. Recovery usually takes longer when mental health problems go undiagnosed for an extended period of time.
This is why reducing stigma has been a key part of government’s initial work on reducing opioid addictions and plays a key role in moving forward with this roadmap.

This roadmap also calls for a shift in funding priorities. Currently, across an array of ministries, the provincial government spends approximately $2.5 billion annually on mental health and substance use services with 95% of that spent on specialized, hospital-based or downstream services. This means only a small percentage is spent on early intervention, prevention and long-term recovery initiatives.

It’s clear that the time has come to devote more available dollars to upstream services that deliver services focused on health promotion, early intervention and keeping people supported and healthy when they achieve recovery.

Consistent with this government’s commitment to renewed team-based primary care overall, this approach to seamless and integrated care will increase system capacity through shared treatment planning and co-ordinated care options. It means tightening the links between physical and mental health care services; it means integrating schools and other community-based organizations; it means enhanced continuity of care and collaborative practice; and it means improved information sharing so that people won’t have to tell their stories over and over.

Key Outcomes:
– A full range of evidence-based services, treatments and supports are available when and where they are needed.
– People with lived experience inform and are leaders in mental health and addictions policy, planning and delivery of services and supports.

The Ministry of Social Development and Poverty Reduction’s TogetherBC poverty reduction strategy is critical to turning the tide on mental health and addictions in British Columbia. With a goal of cutting child poverty in half by 2024, we can reduce child vulnerability and help prevent people from becoming susceptible to mental health and addiction challenges throughout their lives.


Improved Access, Better Quality
People in every part of the province, in large communities and small, need to have access to
the full spectrum of evidence-based mental health and substance use care. Team-based care puts the patient at the centre of care, with all the team members working around them to ensure they receive appropriate care for their specific needs. This form of care makes the best use of each care provider, so we can serve more people more e ectively and in a way that better meets their needs. These teams offer collaborative care from physicians, nurse practitioners, nurses, pharmacists, occupational therapists, social workers, mental health clinicians and other health professionals.
The expansion of team-based care will improve access and quality for adults seeking mental health and substance use care. Co-ordinating care will create a network of services so that people can access the type and level of care they need, whether it be from a mental health or substance use worker, family physician or nurse, or through specialized services for more medically complex patients. Ultimately, this system will connect people proactively to culturally safe and effective care in a timely way.


Part of the challenge ahead is making sure that whatever supports are created, people and their care providers know what they are and where to find them. For most, that means searching the internet for information. That’s why an important part of improving mental health and substance use care is creating a more seamless online experience for people seeking these services from government, and boosting opportunities to access care directly online.
– Expand access to affordable community counselling
– Team-based primary care (with mental health and substance use professionals) and specialized services
– Enhanced provincial crisis lines network
– Implement peer support co-ordinators
– Develop peer support worker training resources
– Expand Bounce Back [an online program available for free throughout B.C., teaches effective skills to help individuals (ages 15+) overcome symptoms of mild to moderate depression or anxiety, and improve their mental health.]
– Create a web-based portal (focused on children and youth)

KEY PILLARS:
– Prevention, early intervention and wellness promotion
– Seamless and integrated care
– Promoting wellness, prevention and intervening early in life can reduce problems as people grow and develop. It’s estimated that 70% of mental health and substance use problems have their onset during childhood or adolescence. These illnesses cause significant long-term disability and are arguably the leading health problem children and youth in B.C. face. Expanding treatment services is important, but treatment alone cannot meet the mental health and substance use needs of children and youth. We must also focus on prevention, screening and early intervention to reduce the number of children and youth affected.
– Reduced costs for care: The Mental Health Commission of Canada estimated that if Canada reduced the number of people experiencing a new mental illness in a given year by 10%, at least $4 billion could be saved after 10 years.
– Evidence-based and culturally safe programs and supports that focus on prevention and promotion activities will be delivered in K-12 schools province wide.
– School-based staff  and integrated team members will proactively identify children early who are experiencing social or emotional challenges and/or early signs of mental health and substance use challenges. These students will continue to receive initial supports in schools through school counsellors, curriculum, and mental wellness promotion and prevention programs. Students with higher mental health and substance use needs will be connected to integrated delivery teams.

Work is underway to develop a virtual mental health counselling and referral service for post-secondary students of all ages throughout British Columbia: • This service will include telephone and online chat capabilities. • The launch of this service is planned within the coming year.

Integrated service delivery is a new and innovative model that has been successfully implemented in other jurisdictions and has been adapted for the unique context of British Columbia.
In five school districts over two years, multi-disciplinary teams will be established with existing providers and new positions, each being connected to a cluster of schools and delivering services to children, youth and young adults whose needs are higher than can be met within a school or through primary care.


Within government, a multi-ministry approach is underway. For example:
– The Ministry of Mental Health and Addictions will be building on the new direction within the Ministry of Health to focus on improving primary care services and integrating an array of services around the individual.
– The Ministry of Social Development and Poverty Reduction’s TogetherBC poverty reduction strategy is critical to turning the tide on mental health and addictions in British Columbia. With a goal of cutting child poverty in half by 2024, we can reduce child vulnerability and help prevent people from becoming susceptible to mental health and addiction challenges throughout their lives.
– Over a year ago, government launched the most ambitious housing plan in B.C.’s history. Since then, in partnership with an array of community organizations, 20,000 new homes have either been completed or are underway — including housing dedicated for those who are homeless, for women and children eeing violence, for Indigenous peoples (both on-and o -reserve), and other types of supportive housing.
– Similarly, government’s new Childcare BC will help reduce nancial stress for families and give more kids access to quality care, making life more a ordable, balanced and healthy for children and their families.

Substance use: Better care, saving lives
The overdose emergency has revealed the deep connections between mental health, medical care needs (e.g. pain care, chronic disease management, like HIV and viral hepatitis), and substance use care. While continuing to escalate the response to the overdose emergency, the Province must also broaden its focus to include other harmful substance use. In its review of opioid deaths in its health authority, Vancouver Coastal Health, for example, found that most deaths (60%) had not met the criteria for an opioid-use disorder and the vast majority used multiple substances, many of whom were dependent on substances other than opioids.
Complicating the situation, many individuals struggling with addiction are accessing ineffective, rather than evidence-based services. For instance, in their review of overdose deaths, the B.C. Coroner found that more than half of those who died in the crisis had accessed some form of mental health or primary care service, but had not been able to access effective addiction care.
Services need to be ready when people are. Rapid access to the right treatment is critical to giving people the help they need to heal. The current patchwork of waitlists and referrals is leaving most adults without any help for mental health and substance use problems until they become much worse or reach a crisis.
People need access to appropriate addictions care on a continuum from team based primary care, withdrawal management and counselling to hospital outpatient services and treatment beds.
We need to better support people earlier, and we need to bring services together so families aren’t struggling to get their loved ones the care they need.

The Ministry of Mental Health and Addictions and the Ministry of Health are working together to ensure the Primary Care Strategy addresses mental health and substance use needs. This will be accomplished by:
– Expanding hours of primary care to enhance access.
– Adding mental health and substance use workers to primary care teams.
– Co-ordinating referrals for patients to and from other services (emergency and hospital system, specialists, community services), and providing individuals and families with support to navigate the system.
– Addressing and supporting families’ needs and involving them in the care team as appropriate.
– Ensuring services meet the diverse and unique needs of individuals including for: race, ethnicity, gender, sexual orientation, socio-economic status, age, physical abilities, religious or political beliefs and people living in rural and remote communities.

Provincial Health Services Authority will lead the development of an enhanced, e cient provincial crisis line network, which will reduce duplication and provide emotional support, information, referral, crisis and suicide prevention/ intervention services.

Implement peer support co-ordinators
Full-time co-ordinator/navigator positions will be established in each regional health authority to work with people with lived experience. Coordinator/ navigators will conduct a gaps/needs analysis at the regional level and work with lived experience and lived experience support organizations to ensure that services are delivered in a culturally appropriate and e ective manner where and when people need them, including during life and care transition points.

Develop peer support worker training resources

Create a web-based portal (focused on children and youth)

Shifting from: Uniform programs and services
To: Programs and services that meet the unique needs of targeted population groups and local communities.
From: Government policy and initiatives centred around ministry mandates
To: Policy initiatives developed in partnership with other stakeholders, designed to support the holistic needs of British Columbians.
From: Inconsistent, output-based performance measurement and reporting
To: Consistent and transparent performance measurement and reporting based on long-term benefits for British Columbians.

Thank you for taking the time to read this document. At its core, it is a call for all hands on deck. Mental health and substance use issues are a problem across every part of this province; all of us can and must be part of the solutions. It’s a challenge that our government is ready to lead on. We look forward to working with all of you in the months and years ahead.
All the best,
Judy Darcy, Minister of Mental Health and Addictions

To access, click on: A Pathway to Hope: A roadmap for making mental health and addictions care better for people in British Columbia










Are you the Victim of a Prescribing Cascade?

Canadian Deprescribing Network website: https://www.deprescribingnetwork.ca/patients-and-public

By Camille Gagnon, Janet Currie and Johanna Trimble

Click here to download a printable version of this article

[Excerpts] A prescribing cascade can happen when you and/or your health providers do not realize new symptoms are actually the side effects of one of your medications. When this happens, you may be diagnosed with a new medical condition. As a result, often your health provider will prescribe a new medication to treat the side effects of the first medication. 

Your new medication may also have side effects. When you and/or your health provider interpret these side effects as yet another new health condition, this can lead to more prescriptions. What happens next? Too often, you can end up taking a cascade of new medications which are not needed and which can cause harm. 

Whenever you take a medication, there is a risk you will experience a side effect. The more medications you take, the greater your risk of side effects. Whenever you experience new symptoms, you and your health providers should always first consider whether they could be caused by medications you are currently taking. This will help avoid a common preventable problem called a “prescribing cascade”.

At 75, Mrs. Reynolds started having trouble falling asleep. She felt like she was spending hours tossing and turning. Her daily routine hadn’t changed: she visited with friends, went for her daily walk, and made sure to keep her coffee consumption low. Her medications hadn’t changed either. She’d been taking medications regularly for depression, high cholesterol and high blood pressure for years.

Hoping it would help her get a good night’s sleep, Mrs. Reynolds bought a box of sleeping pills (Sleep-Eze®) at the pharmacy and took one that evening. Although it didn’t help, she thought it would be worth trying them a little longer. But over the next few days, Mrs. Reynolds noticed her mouth started feeling dry, which forced her to keep a glass of water on her bedside table. In the mornings, she woke up feeling groggy and constipated. Meanwhile, her sleep hadn’t improved. Feeling frustrated, she decided to go see her pharmacist Nadia about these new symptoms as well as about her sleep problem. 

Nadia listened carefully to Mrs. Reynolds’ story. Then, she explained that the most likely cause of her dry mouth, constipation and daytime grogginess was the sleeping pill she’d been taking. Nadia then took a close look at Mrs. Reynolds’ file. She told Mrs. Reynolds her antidepressant (bupropion) could be causing her insomnia in the first place. 

“Your sleep problem is likely a side effect of the antidepressant medication you are taking. When you took another medication for your sleep problem, this created what we call a prescribing cascade.” Mrs. Reynolds was puzzled. She had been taking bupropion for over two years. Was it possible new side effects could appear after so much time had passed? The pharmacist’s response was clear: “Yes. You can get a new side effect at any time.”

A few other examples of common prescribing cascades:

When a new symptom may be a medication side effect, you and your health provider should consider deprescribing. Deprescribing means reducing or stopping medications that may not be beneficial or that may be causing harm. 

Deprescribing should always be done in a planned and supervised manner, in partnership with your health provider. The goal of deprescribing is to improve your quality of life without compromising your health.

How can you help prevent prescribing cascades?
It is not always easy to identify prescribing cascades, as they may go on for years, and involve many medical conditions, symptoms and medications. Many symptoms, such as fatigue, confusion, dizziness and falls, may actually be side effects of medications, not old age or a new medical condition. These side effects can lead to hospitalizations and changes to your life and well-being. Here are five things you can do to help prevent prescribing cascades:

Ask questions. Have you noticed a new symptom? Ask a health provider this question: “Could this symptom be a side effect of one of my medications?” Do not assume your doctor, pharmacist or nurse is always looking out for side effects of the medications you are taking. If you have a doubt about a medication, ask about it.

Don’t forget your non-prescription medications. Non-prescription medications (also known as over-the-counter or OTC medications) and natural health products can also cause side effects and prescribing cascades. The sleeping pill Mrs. Reynolds started taking is just one example. Be sure to include all non-prescription medications on your list, and share this information with your health provider(s).

Stay informed. Educate yourself about the possible side effects of your medications. New side effects can appear months or even years after taking the same medication, even at the same dose. Remember that even if your medications or dosage hasn’t changed, over time your body, life situation and health change. This can affect the way your body processes medications. Be sure to review all your medications with a health provider at least once a year. This will help ensure you are taking only medications you still need. Each time you add a new prescription, ask for a full review of your medications to ensure it won’t interact with those you already take.

Consider deprescribing. When you and your health provider identify a prescribing cascade, it’s important to discuss whether stopping a medication or reducing the dose would be a good option for you. You may decide to put a tapering plan in place to stop a medication gradually.

Are there alternatives? Could other, safer treatments (medication or non-medication) help with this health condition?

Back to Mrs. Reynolds 

Following their discussion, Nadia offered to contact Mrs. Reynolds’ family doctor to recommend they reduce the dose of her antidepressant (bupropion). Mrs. Reynolds’ family doctor agreed to the change and asked her to follow up with him in a few weeks to check on her mood. Mrs. Reynolds was relieved that the side effects from the sleeping pill disappeared a few days after she stopped taking them. 

About two weeks after reducing the dose of her antidepressant, Mrs. Reynolds noticed a definite improvement in her sleep. She also found several of the techniques explained in a brochure her pharmacist gave her on how to get a good night’s sleep to be helpful. Waking up at the same time every day and limiting naps helped improve her sleep at night. Mrs. Reynolds was satisfied. Her conclusion? To avoid taking medications unnecessarily, when new symptoms appeared in future she would make sure to always ask her doctor or pharmacist this question first: “Could this symptom be a medication side effect?”. 

ALWAYS TALK TO YOUR DOCTOR, PHARMACIST OR NURSE BEFORE STOPPING OR CHANGING ANY MEDICATION.

The authors

Camille Gagnon is the Assistant Director of the Canadian Deprescribing Network. Camille is a clinical pharmacist and works in a primary care clinic. She has experience in clinical program management, community pharmacy, teaching and pharmacogeriatry. She is a passionate medication safety advocate.

Janet Currie is a social worker who has been involved with patient and medication safety issues for over 17 years. She is particularly concerned about the safety and efficacy of psychiatric drugs and their impacts on seniors. She is a member of the core Executive of the Canadian Deprescribing Network, the past co-chair of the Canadian Women’s Health Network and was a two-term member of Health Canada’s Expert Advisory Committee on the Vigilance of Health Products. She owns and manages a website on psychiatric drug safety and has frequently testified to the Canadian Senate and the Parliamentary Standing Committee on Health on prescription drug surveillance and adverse drug effects.  She is completing a Ph.D. on medication safety and off-label prescribing at UBC. Janet is Chair of the Patient Awareness Committee of the Canadian Deprescribing Network.

Johanna Trimble is a patient safety advocate and member of the BC Patient Voices Network. She is a member of the Geriatrics and Palliative Care Subcommittee of the Council on Health Promotion for Doctors of BC. As an honourary lecturer, she co-teaches first-year medical students at UBC in Community Geriatrics as well as pharmacy students on medication issues in Long Term Care. Johanna is an active member of the Patient Awareness Committee of the Canadian Deprescribing Network.

To download the article, click on: Are You the Victim of a Prescribing Cascade?

https://www.deprescribingnetwork.ca/patients-and-public

HEiDi – Virtual Physician COVID-19 Deployment

From https://dsi.ubc.ca/news/visual-analytics-support-heidi-virtual-physician-covid-19-deployment:

June 22, 2020 | Drs. Tamara Munzner and Kendall Ho were award DSI funding for their project, “Visual Analytics Support for the HEiDi Virtual PHysician COVID-19 Deployment.” This project will leverage advances in data visualization and analytics to optimize the delivery of telehealth care to patients stricken with COVID-19. The outcomes will help health system experts to gain a holistic snapshot of the current care system and expedite analysis and decision-making. Ultimately, this will allow the health care system to respond rapidly and deftly to current and future health-related scenarios such as a pandemic outbreak. Summary of project follows below.

In the current extreme situation of the COVID-19 pandemic, health systems face unprecedented medical and social challenges that data science can help address. Dr. Kendall Ho’s group in Emergency Medicine has spearheaded the HealthLink BC Emergency iDoctor-in-assistance (HEiDi) project to augment the 811 service delivering health care guidance to the public through telephone access to nursing advice by integrating virtual physicians (VPs) into the triage process, to help balance the enormous increase in load due to this crisis. This project is being deployed in extreme haste, rolling out within only three weeks what would normally take many months or even years, with operational and strategic concerns being addressed simultaneously. The new data being gathered through this project needs to be analyzed in the context of existing health system data including
a) service utilization and call data including follow-up call-backs,
b) patient metadata and health system usage outcome data,
c) VP and nurse shift scheduling data, d) other system and administrative data, and
e) health economics data.
Even as the project is being deployed, Ho’s group is developing assessment criteria to establish its efficacy considering the dual goals of high-quality patient outcomes and satisfaction, and sustainable cost to the health care system of delivering care.

Dr. Tamara Munzner’s group has extensive experience in visual analytics (VA), building tools for human-in-the-loop decision-making in complex and heterogeneous data environments. Visual analytics approaches allow human analysts to comprehend the rich and nuanced nature of the full data landscape beyond the bare-bones descriptive statistics that summarize only the largest-scale trends. Her group has extensive experience in the methodology of conducting design studies, a user-centered and problem-driven design methodology in visual analytics, and in collaboration with experts in the genomics, biology, and medical domains.

This collaborative effort between Munzner and Ho will help the HEiDi project answer their driving data-centric questions including which information is needed for daily reports, how many doctors are needed in what optimal daily shift coverage for upcoming service days and follow-ups, which system usage outcomes change when virtual physicians interact with patients and with advising nurses, and which overload and triage issues remain severe. They will develop visual analytics workflows to represent as much information as possible visually in a way that expedites analysis and decision-making by health system experts, and their communication with many other stakeholders including clinicians, patients, and policymakers. The overall goal of this new collaboration is to provide visual analytics support for the HEiDi system, to help health system experts observe and improve the system even as it is built, in terms of virtual physician impact on patient experience, while adapting to the specific requirements of the current COVID-19 crisis.

In summary, this project will help health system experts to observe and improve the clinical pathway of 811 service on a strategic and operational level, to foster the effectiveness and efficiency of VPs, and to improve patient experience. It will also gain an initial understanding of stakeholders and this very interesting ecosystem, as a basis for a systematic and methodology-driven data science research multi-year project. Data science support for the 811 ecosystem will both address today’s urgent problems and serve to develop methods and tools that can be used in future extreme situations.

Learn more about Real-Time Virtual Support Services in BC

Data Science Institute
Vancouver Campus
EOS Main Building
6339 Stores Road, Room 113C
Vancouver, British Columbia, Canada V6T 1Z4

Virtual Care Guide for Patients

VIRTUAL CARE Guide for Patients

In collaboration with patients and their families, the Canadian Medical Association, the College of Family Physicians of Canada and the Royal College of Physicians and Surgeons of Canada have created this guide to help patients prepare for “virtual visits” with their doctor. It focuses on video visits, although it is also possible to receive virtual care through phone calls, text messaging and email. We recommend that you read the entire guide to gain the best possible results. 09a300

Many patients are enthusiastic about virtual care’s potential but are also understandably concerned about some key issues, such as:

  • Is virtual care safe and effective?
  • Can I manage the technology to connect with my doctor?
  • Will the system be secure enough to ensure my privacy?
  • How will virtual care affect my relationship with my doctor?

    Fortunately, the answer to the first three questions is usually yes. And both patients and doctors who have experience with virtual care report that it has a positive effect on their relationship.With those reassurances, let’s look at what you need to know to take advantage of virtual care, and particularly video visits.

WHO PAYS FOR VIRTUAL CARE?

THERE ARE THREE WAYS TO COMPENSATE DOCTORS FOR PROVIDING VIRTUAL CARE:

Publicly funded medical coverage: In most provinces and territories, virtual care is not covered by government health insurance programs. But there are exceptions, particularly during infectious outbreaks, and there is growing interest in broadening public insurance coverage for virtual visits.

Employer-paid insurance: Many employers now offer free virtual health care to employees and their dependents.

Patient paying out of pocket: For patients who are willing to pay for virtual care, there are private companies who sell individual visits or subscriptions for virtual care with physicians.

Check to see whether your provincial/territorial government covers it (contact your doctor or your provincial/territorial medical insurance plan) or whether your employer covers it.

WHAT IS AND ISN’T SUITABLE FOR VIRTUAL CARE

While many medical problems can be assessed and treated via virtual care, there are others that cannot be safely managed without an in-person physical examination.

YOU CAN SAFELY USE VIRTUAL VISITS FOR:

mental health issues

many skin problems (photos that you take in advance provide better images than video)

urinary, sinus and minor skin infections

sore throats, if your doctor can arrange a throat swab to test for strep

eye redness without pain or change in vision

sexual health, including screening and treatment of sexually transmitted infections, and hormonal contraception

travel-related health care

conditions monitored with home devices and/or lab tests (e.g., blood pressure, cholesterol, thyroid and some parts of diabetes care)

review of lab tests, imaging (e.g., x-rays and ultrasounds) and specialist reports.

Some problems are not appropriate for virtual care because a doctor would need to physically examine you. This includes:

new emergency symptoms such as chest pain, shortness of breath, loss of vision, loss of hearing, sudden weakness or numbness (you’d need to go to a hospital emergency department)

ear pain (your doctor would need to look inside your ear, which can’t be done via video)

cough (your doctor would need to listen to your chest with a stethoscope);abdominal or digestive problems (your doctor would need to feel your belly) 

muscle and joint injuries (your doctor would need to feel the affected area for tenderness, warmth, etc.)

Although you may need to see a doctor in person for your first appointment for these types of problems, follow-up visits may be well suited to virtual care.

As time passes, we expect new innovations and research will increase the range of problems that doctors can assess safely via virtual visits.

Click: VIRTUAL CARE  
to access more informations, such as:

ARRANGING A VISIT

REGARDLESS OF WHERE YOU OBTAIN A VIRTUAL VIDEO OR PHONE VISIT, YOU NEED TO MAKE SOME ARRANGEMENTS IN ADVANCE

PREPARING YOUR COMMUNICATIONS DEVICE AND CONNECTION FOR A VIDEO VISIT

CHOOSING AN APPROPRIATE LOCATION FOR A VIDEO VISIT

THINGS TO HAVE WITH YOU AT THE START OF THE VISIT

DURING THE VIDEO VISIT

This Virtual Care Guide for Patients was co-created with members of the CMA Patient Voice, a group of patient representatives that advise the CMA on key health issues from a patient’s perspective.

VIRTUAL CARE

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Restoring Trust: COVID-19 and The Future of Long-Term Care


Established by the President of the Royal Society of Canada in April 2020, the RSC Task Force on COVID-19 was mandated to provide evidence-informed perspectives on major societal challenges in response to and recovery from COVID-19. 

Executive Summary

Why do we need urgent action to reform and redesign long-term care in Canada?

For 50 years, Canada and many other countries have generated inquiries, panels, task forces, commissioned reports, media reporting and clarion calls for action to reform conditions in nursing homes and create a higher standard of care. We have ample sound evidence produced by social and health scientists globally on how to achieve this.

But Canada is experiencing a far higher proportion of total country COVID-19 deaths in nursing homes than other comparable countries—81% in Canada, compared to 28% in Australia, 31% in the US and 66% in Spain, based on current reports.1 Many of those older Canadians in nursing homes are dying without family, anxious and afraid, surrounded by people in frightening protective equipment. Why?

Our long-term care sector, particularly nursing homes, is in crisis now from far more than COVID-19.The pandemic just exposed long-standing, wide-spread and pervasive de ciencies in the sector.These deep operational cracks arise from failures in:
– addressing the consequences of well-known population trends in aging, dementia and caregiving by family members
– listening to the voices of our older adults, especially those living with dementia and their families
– acknowledging profound inequities faced by older Canadians, foremost among them poverty
– maintaining adequate levels of properly oriented dietary, laundry and housekeeping staff, and recognizing their roles in creating a quality environment
– developing and supporting management and leadership on the ground
– building and supporting resilience of the long-term care workforce
– listening to the voices of the workers at the point of direct care
– establishing standards for appropriate levels of regulated health workers
– adequately educating, regulating and supporting the unregulated care workers who provide upwards of 90% of direct care
– regulating the sector in a balanced, whole systems way
– using data to act on improving the sector and evaluating results
– collecting, verifying and analyzing crucial data to manage the sector
– financing a sturdy long-term care sector

Canada’s long-term care (LTC) sector, pre-pandemic Canada’s LTC sector has its roots in the Elizabethan Poor Law of 1601, not in the healthcare system. Provincial and territorial plans are disparate and piece-meal. The Canada Health Act does not protect or ensure universal LTC. Today, the characteristics before the pandemic of the people living in nursing homes, the workforce that looks after them, and the physical environment that surrounds them are all key contributors to Canada’s long-term care crisis.

Canada’s older adults are entering nursing homes later in life. As Canada ages and older adults live longer, we have worked toward more capacity for those people to age in community. At the same time, prevalence of chronic diseases—foremost dementia—and the social challenges of living into one’s 80s, 90s and 100’s have increased. The consequence is that residents enter nursing homes—commonly their final home—with much more complex and higher social and medical needs. This has dramatically raised the complexity of care that nursing homes are faced with providing, even compared to the care required a decade ago.

The workforce mix in Canada’s nursing homes has changed, but has not evolved to align with the needs of older adults who need complex health and social care. Hands-on care is now almost entirely given by unregulated workers—care aides and personal support workers. They receive the lowest wages in the healthcare sector, are given variable and minimal formal training in LTC, and are rarely part of decision-making about care for residents. Studies have shown that they often have insufficient time to complete essential care and are at high risk for burnout and injury. Despite these severe challenges, most report feeling that their work has meaning.

Over the past two decades, ratios of regulated nurses to care aides have dropped steadily to contain costs and in the belief that richer staffing mixes were not required. Canadians in nursing homes may also have little access to comprehensive care including medical, health and social services and therapies. Such comprehensive care requires staffing and resources such as physicians,mental health care, palliative resources, physical therapists, occupational therapists, speech/ language therapists, recreation therapists, dieticians, pharmacists, pastoral care, psychologists, and social workers.

Canadians in nursing homes may also have little access to uninsured services such as podiatry, dental, hearing and vision care. In some cases residents must pay for specific medications. Residents with family and friends close at hand may be able to rely on them to help fill some of these gaps in services. However, fewer and fewer of these unpaid caregivers are available due to continuing changes in family size and geographic distance.

Finally, many nursing homes in Canada are old and not designed for the complex needs of today’s residents—or for containing or preventing the communicable disease now sweeping through them. When infections such as COVID-19 arrive, too often quality of life and quality of care must take second place to handle the surge. Today’s paradigm of nursing homes as a public social place, inviting in the community, has clashed sharply with nursing homes as a safe space for residents and staff under COVID-19.

A preferred future for the LTC sector in Canada
In this Policy Briefing Report commissioned by the Royal Society of Canada, we describe a preferred future for the LTC sector in Canada, with a specific focus on COVID-19 and the LTC workforce. Nursing homes are an essential part of our social and health system. For the many older Canadians who will need this high level of care, a nursing home is a good choice if we do it right. However, in nursing homes we must be able to consistently deliver high-quality and holistic care and support a good quality of life, a good end of life and a good death. Canadians expect no less. Canada certainly has the capacity and knowledge to achieve this goal.

Our key message looking ahead: Solve the workforce crisis in LTC
As a first step, and if we do nothing else right now, we must solve the workforce crisis in LTC. It is the pivotal challenge. Workforce reform and redesign will result in immediate benefit to older Canadians living in nursing homes and is necessary for sustained change. It will also improve, at a minimum, quality of care so that nursing homes are able to reduce unnecessary transfers to hospitals, reduce workforce injury claims, and interface more effectively with home and community care.

Solving the LTC workforce crisis is intimately linked with securing robust and sustainable funding and strong governance for LTC going forward. New federal and provincial dollars are urgently needed to tackle the LTC workforce crisis so that we can face and manage COVID-19 pandemic conditions and improve quality of care, quality of life and quality of end of life for people living in nursing homes.

We recommend 9 steps to solving the workforce crisis in nursing homes, all of which require strong and coordinated leadership at the federal and provincial/territorial levels to implement.

  1. The federal government must immediately commission and act on a comprehensive, pan-Canadian, data-based assessment of national standards for necessary staffing and staffing mix in nursing homes. National standards must encompass the care team that is needed to deliver quality care and should be achieved by tying new federal dollars to those national standards.
  2. The federal government must establish and implement national standards for nursing homes that ensure (a) training and resources for infectious disease control, including optimal use of personal protective equipment and (b) protocols for expanding staff and restricting visitors during outbreaks.
  3. The provincial and territorial governments, with the support of new funding from the federal government, must immediately implement appropriate pay and benefits, including sick leave, for the large and critical unregulated workforce of direct care aides and personal support workers. Appropriate pay and benefits must be permanent and not limited to the timespan of COVID-19. Pay and benefits must be equitable across the country and equitable both across the LTC sector and between the LTC and acute care sectors for regulated and unregulated staff.
  4. Provincial and territorial governments must make available full-time employment with benefits to all unregulated staff and regulated nursing staff. They should also evaluate the impact on nursing homes of “one workplace” policies now in effect in many nursing homes and the further impact on adequate care in other LTC setting such as retirement homes, hospitals and home care. Provincial and territorial governments must assess the mechanisms of infection spread from multi-site work practices and implement a robust tracking system.
  5. Provincial and territorial governments must establish and implement (a) minimum education standards for the unregulated direct care workforce in nursing homes, (b) continuing education for both the unregulated and regulated direct care workforce in nursing homes and (c) proper training and orientation for anyone assigned to work at nursing homes through external, private staffing agencies.
  6. To achieve these education and training objectives, provincial and territorial governments must support educational reforms for specializations in LTC for all providers of direct care in nursing homes, care aides, health and social care professionals, managers and directors of care.
  7. Provincial and territorial governments, with the support of federal funds, must provide mental health supports for all nursing home staff. In addition to extraordinarily stressful pandemic working conditions, these staff are experiencing significant deaths among the older adults they have known for months and years, and among colleagues. They are grieving now, and this will continue.
  8. Federal support of the LTC sector must be tied to requirements for data collection in all appropriate spheres that are needed to effectively manage and support nursing homes and their staff. Data collected must include resident quality of care, resident quality of life, resident and family experiences, and quality of work life for staff. Data must be collected using validated, appropriate tools, such as tools suitable for residents with moderate to severe dementia. Captured data must address disparities and compounding vulnerabilities among both residents and staff, such as race, ethnicity, language, gender identity, guardianship status, socioeconomic status, religion, physical or intellectual disability status, and trauma history screening.
  9. Data collection must be transparent and at arm’s length from the LTC sector and governments. Provincial and territorial governments must evaluate and use data to appropriately revisit regulation and accreditation in nursing homes. They must take an evidence-based and balanced approach to mandatory accreditation, as well as to regulation and inspection of nursing homes. They must engage the LTC sector in this process, particularly the people receiving care, their families, managers and care providers.

    Canada’s choice
    Canadian nursing homes have generally been able to “just manage.” However, just managing is not adequate. Then came COVID-19, a shock wave that cracked wide all the fractures in our nursing home system. It precipitated, in the worst circumstances, high levels of physical, mental and emotional suffering for our older adults. Those lives lost unnecessarily had value. Those older adults deserved a good closing phase of their lives and a good death. We failed them. We have a duty to care and to fix this—not just to fix the current communicable disease crisis, but to fix the sector that enabled that crisis to wreak such avoidable and tragic havoc. We have the capacity, the knowledge and the resources to take immediate steps toward restoring the trust we have broken.

    This is our choice.

    1. Canadian Institute for Health Information. “New analysis paints international picture of COVID-19’s long-term care impacts”: CIHI; June 25, 2020. Available from: http://emktg.cihi.ca/ViewEmail.aspx?em_key=08jafBPP2lXCQzTRLz6rSCxyfUk+dfkDpRY- QwdGchCoOfLXGIWW6Y6UWEMHRnIQqp03BjiwW7pQ5bqfdhCmHXL3vARe3YTEE&em_source=html

Executive Summary: https://rsc-src.ca/sites/default/files/LTC%20PB%20ES_EN.pdf

Full report: https://rsc-src.ca/en/restoring-trust-covid-19-and-future-long-term-care

https://www.youtube.com/watch?v=hfg1EkO_u3Y&feature=emb_logo

Virtual Care

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