A research team from the Rural Coordination Centre of BC (RCCbc) and the University of Northern British Columbia’s (UNBC) Division of Medical Sciences have been looking at how hybrid care could be used to improve health care workforce sustainability and health equity.
Most medical care is conducted in person. Patients go to see a doctor or other health care provider. But recently, the concept of virtual care has been taking hold. The team is looking at how these two streams of health care can be used in locations like Tumbler Ridge where getting specialized care is quite difficult.
Principal investigator for the project, UBC Northern Medical program’s Dr. Anurag Singh (also affiliated with UNBC), was in Tumbler Ridge for the Health Fair on September 27.
“This project will promote health equity in rural communities by building trust between communities and health providers and co-creating and implementing virtual care solutions,” he says. The hope is that the learnings will be able to be applied to developing service delivery guidelines and hybrid care policy scalable across Canada.
He and the rest of the team are looking at how hybrid care programs:
- link health professionals through technology to treat patients (virtual care) alongside local providers (in-person care);
- bridge service gaps when providers are unavailable and;
- support local providers.
Because not all communities have embraced such programs, the researchers are seeking to understand the complexities of implementing ‘hybrid care’ and how to make this approach culturally safe and adaptable to unique community needs, while improving health care workforce sustainability.
“What we’re researching is thinking about the innovation that comes—usually from big cities, like Vancouver or Toronto. You see things develop, and they might come to Tumbler Ridge, but they come later on. They’re not innovated in the community setting. So the theme of our work is to turn that around. We want innovation to come from the needs of the community, so that it comes tailored to your needs and your situation, so that it really works for you.
He says not a lot of health care professionals want to go and talk to communities and understand what their needs are, then develop tools that might work for them. “Nobody wants to do it,” he says. “So being in the north, the researchers at UNBC, at UBC North and UBC Okanagan, we felt this was a gap. So we’ve been talking to Dr. Helm and the District of Tumbler Ridge and recognizing how innovative this place is. What you guys are already doing is amazing.”
Singh is a kidney doctor—a nephrologist—based in Prince George for the last 12 years. He says in that time, he realized there were complications beyond his control. “So I started looking at the other problem people are having, because just saving their kidneys was not working.”
He says that brought him to the current project, which is looking at how can health care professionals improve and standardize what people receive as virtual health: on the phone, on a video, or on a screen. “What does that look like? Because in some communities, the reality is that they don’t have a doctor. The only care they get is through the phone. Is that optimal? Is it good enough? It’s a big question, and we don’t think it is. But given the situation right now, that’s where it’s heading, and we would like to stop that. We’re looking to fill the gaps and support the service using the existing health workforce. We want to find a different solution.”
He says each community is different, so the goal is to find solutions that work for each community. “Each community gets to choose what is implemented in their community, and that’s important. This is community driven. And of course, the goal is to promote continuity of care, relationships with the providers. What makes your community special is your providers who function as your advocate.”
He says this is not common in all communities and he wants to see that attitude more from Tumbler Ridge to other communities. “We want to want more providers like that. Doctors, nurses, occupational therapists, physical therapists…all these providers who can speak for patients and advocate for them. That’s very important.
He says in the north, it is a given that not everyone will be able to access health care easily. “We accept that there will be times when you will have virtual health care: maybe on the phone, maybe on a video call. But the goal is for that call to go to somebody that you know, who knows your community and your context. You’re not talking to a bot or someone who’s sitting in Toronto. You’re talking to somebody who visits your community, who has a relationships there and knows the context. Someone who knows what supports you have, what things are accessible to you.
“It’s also about supporting the providers who are there on the ground in your community. If you get a third party person and your own providers are feeling like, ‘what’s this?’ That’s not the point. There’s no point of having health care that is actually taking away the what you have right now. So we don’t want that, and we want to promote the opposite. We want the care to be team based. We want people talking to each other, working as a team for you.”
He shares an example of how a doctor in Chetwynd is able to call a specialist colleague outside of the community. This, he says, allows the doctor to provide care for a patient so that patient doesn’t need to travel outside the community. “There are supports right now available in different areas that are currently not available to Tumbler Ridge that we can explore, what might fit in this community. That includes covering emergency virtually, that includes maternity newborn services, pediatric, critical care, specialist services like internal medicine, virtual emergency, and so on. So there are options out there right now that can be tailored to the needs of Tumbler Ridge.”
The team is in town, he says, to explore the needs of the community. “What are your priorities? What do you really need in health care delivery? How can we align it to what we have available, and if we don’t have available, how do we promote that innovation? How do we say ‘hey, Tumbler Ridge really needs this?’ How can we bring in the researchers—people who do that innovation?”
He says that everything boils down to money in the end, but he’s hoping the research will show that a hybrid care model works, and to convince the government to support it. “We are worried that it is only a matter of time until virtual care will be imposed or left as the only option for communities who don’t have regular care. But we feel that you cannot do virtual only. That is important, yes but you also need someone local.
He says private companies, are already selling apps and subscriptions and have no choice but to work with these because there’s nothing else available. “We want to stop that from happening.”
He says the researchers want to hear from the community. “We’re here to learn from you,” says Singh. “We had a session this morning with the providers, with the doctors, with the nurses, and the leaders of Northern Health and the division. Now we want to hear from you, which is very important. Your voice is really critical in this. So how can you participate? You can share your personal experiences, stories of what has happened.”
Or, for the people who are really excited about hybrid care, they can join the project as part of the community board. “This is almost like activism, what you would be doing. We need members of the community who are invested in this with us. Because we really don’t want to do this on our own. This is very important for everybody. We want to hear what is working well in the community. That is one important thing. We want to start with your strengths. You have so much leadership support. You are innovative. You’re doing amazing work. So we want to hear from you what role do you see hybrid care play here? This is not a one-time show that we’re doing, we want to understand how you see hybrid care playing a role in this development.”
People who are interested in participating in the project can contact Lauren Currie at lauren.currie@unbc.ca .
Above photo: Dr. Anurag Singh
Trent is the publisher of Tumbler RidgeLines.
