RURAL & REMOTE PRACTICE MANITOBA Physician Assistant Opportunities in Primary & Acute Care OBJECTIVES Why now? Challenges Demographic Issues Key Health Issues *DM, HTN, TB, ID, CKD NRHA Population and Community Demographics in the NRHA Local Health Care Resources and Breakdown Comparison What can we offer Considerations/Input/Discussions Highlights WHY NOW? 5 years of physician assistant presence Currently participating in roles including: Emergency Care
Acute Care (inpatient and outpatient) Surgical Assist Primary Care Rural/Remote Fill In Leaf Rapids, Lynn Lake, Flin Flon, Gillam, Snow Lake Administrative Process WHY NOW? Increasing familiarity Patients and staff are engaging in dialogues
more Recognizing that we can gather information and stream line communication and formulate treatment plans with less distraction Improved continuity Diagnostics, treatment plans, documentation are high calibre. CHALLENGES Health care is highly politicized internally Communities are highly politicized Social and historical context
Resource paucity materials, staff, skills and transience of staff and populations DEMOGRAPHIC ISSUES Remoteness and Isolation Jurisdictional Education Unemployment Income Inequality Government transfers Families Housing
Healthy foods Transportation and community infrastructure KEY HEALTH ISSUES Chronic disease prevention and treatment Disparity in Health Status Maternal Infant and Child Health Injury, Premature Death and Life Expectancy Youth Health
Communicable Disease Prevention Accessibility and Effectiveness Health System Utilization Social Determinants of Health HEALTH CARE CHALLENGES Chronic Disease DM HTN Vasc Dx CKD Infectious Disease MRSA TB Antibiotic overuse DIABETES, HTN, VASCULAR DISEASE Poor glycemic control & uncontrolled HTN very common Significant complications and end-organ disease associated with the above. Tremendous impact on quality of life. Poor access to primary care physicians allows disease states to evolve over years
Causes considerable stress for individuals, communities and those that care for them. Amplified by a disorganized approach to health care Confusion, frustration limits ability for self advocacy Often under estimate the value of care they get and could potentially access. INFECTIOUS DISEASE - MRSA Normalization of MRSA in northern communities Emergence early 2000s, by 2005-2007 rates 10x higher than southern MB By 2014 30x higher Heavily influenced by policies and practices that are racist Downstream = Access to timely & adequate care and relationships with health care works (accessibility, consistency, reliability) Upstream = water and sewage, over-crowding, ownership,
education Polices that have attempted to address these concerns: UNDRIP, TRC, Jordans Principle MRSA Limited studies about MRSA in northern communities with respect to HA and CA; colonization vs symptomatic Estimated that 1/30 are affected Strain of MRSA has specific virulence factors that contribute to tissue necrosis Predominant clinical presentation is with skin and soft tissue infections; secondary are sepsis and necrotizing pneumonia INFECTIOUS DISEASE - MRSA MRSA TB IN MANITOBA Twice the national average
Canada 4.9/100,000 & is improving; vs, MB 12.8/100,000 & getting worse First Nations are more affected, those in remote communities even more so; but.. this has been a more recent trend in 2000: rates of TB were almost equivocal between First Nations, Canadian-borne residents, and immigrants Since then, the latter two groups have both improved, while First Nations communities have not (from 41% in 2000 to 61% 2012) Remote communities are particularly affected within the NRHA - rates are 7 x higher 2007-2008 rate was 300/100,000 (from 10 communities in the NRHA) astronomical by epidemiological standards In Wpg the rate of pulmonary TB is higher than Calgary, Saskatoon, Regina and Edmonton combined
Wpg rates are 158 x higher than these cities NRHA 60% of Manitobas land mass 396,000 square kilometres Population of 74,983 Population density NRHA 0.19 Winnipeg 1047.26 POPULATION DEMOGRAPHICS 2016 - Census Population CITIES POP. COMMUNITIES POP. COMMUNITIES POP. Thompson 13,678 Norway House 5360 Wabowden
442 Flin Flon 5,185 Cross Lake 4643 Gods Lake Narrows 89 Nelson House 5089 Pikwitonei 64 TOWN The Pas 5369 Opaskwayak Cree Nation 3034 Thicket Portage 126 Gillam
1265 Split Lake 2945 South Indian Lake 981 Snow Lake 2662 Oxford House 2559 Ilford 106 Leaf Rapids 582 Pukatawagon 1724 Bakers Narrows Lynn Lake 494
York Landing 1239 Cranberry Portage Grand Rapids 268 Lac Brochet 1134 Wanless (RM) Kelsey (Flin Flon) 2492 Shamattawa 1425 Cormorant 244 Tadoule 772 Sherridon
108 Brochet 789 Moose Lake 1124 Gods River 643 771 LOCAL HEALTH RESOURCES CITIES POP. COMMUNITIES POP. COMMUNITIES POP. Thompson (13678) H Norway House (5369) H
Wabowden (442) HC Flin Flon (5185) H Cross Lake (4643) NS Gods Lake Narrows (89) NS Nelson House (5089) NS Pikwitonei (64) HC TOWN The Pas (5369) H Opaskwayak Cree Nation (3034) NS Thicket Portage (126)
HC Gillam (1265) H Split Lake (2945) NS South Indian Lake (981) NS Snow Lake (2662) H Oxford House (2559) NS Ilford (106) HC Leaf Rapids (582) HC Pukatawagon (1724) NS Bakers Narrows
Lynn Lake (494) HC York Landing (1239) NS Cranberry Portage (771) Grand Rapids (268) NS Lac Brochet (1134) NS Wanless (RM) Kelsey (Flin Flon) (2492) NOT RHA Shamattawa (1425) NS Cormorant (244) HC Tadoule (772) NS
Sherridon (108) HC Brochet (789) NS Moose Lake (1124) NS Gods River (643) NS HOSPITALS (H) - 5 NURSING STATIONS (NS) - 17+ HEALTH CENTERS (HC) - 8 NS BREAKDOWN OF LOCAL RESOURCES HOSPITALS THOMPSON
FLIN FLON/THE PAS Gillam Lynn Lake COMMUNITY HOSPITALS NORWAY HOUSE NURSING STATIONS (23) HEALTH CENTERS (9) BREAKDOWN OF LOCAL RESOURCES/ BARRIERS ysician presence (potentially only 1 week/month) riers to referrals, acceptance to tertiary care mited onsite pharmaceuticals from pain management, anti-microbial ltiple jurisdictions and organizations involved in policies ICC management
ong term antibiotics (e.g. Vancomycin) excessive displacement for patients from home communities ephone consultation (volume in ED) COMPARISON (UPDATED NUMBERS STILL PENDING) THOMPSON/FLIN FLON/PAS SEVEN OAKS CATCHEMENT 74983 75553 ED VOLUME ~35000 45000 ED BED 9/~7/5 (21) No special areas e.g. clinics for IV/Cast INPATIENT BED 40/42/21 (103) SCU/ICU
3/1 OBS 18/#/1 PACU 10/0/8 36 304 19 WHAT CAN WE OFFER? Improve access to primary care services that has more financial sustainability. Help promote effective utilization of services and formulate an organized approach to healthcare. Acute care and interventions. Infant, child, youth, maternal and elder health issues. Chronic disease prevention and management. Improve referral process and specialist care. CONSIDERATIONS PGY TRAINING CURRICULUMS Interventions/specialization
Familiarization with available technology - e.g. XR Contact points (onsite physicians/remote physician contact) Financial sustainability INPUT? DISCUSSION? IDEAS? INTERESTS? HIGHLIGHTS Health Care across the lifespan Infants, children, adolescents, adults, seniors Interdisciplinary Complex Case Management Fishing, kayaking, hiking, endless boreal forests
Complete 4 monthly EMRAPs simply by driving to Winnipeg and back. FURTHER INFORMATION 5th Estate - This is where I live - Mental Health Crisis in Cross Lake Nwe Jinan - nonprofit organization that brings a mobile recording studio into schools and community centres across North America. Youth are able to express themselves musically and creatively under the guidance of a professional music producer. Night Spirits - Book about the survival of the Sayisi Dene following the forced relocation to Churchill and their subsequent personally initiated move to Tadoule Lake in the 1970s told by survivors
REFERENCES Northern Regional Health Authority. (2017). Annual Report 2016/2017. Retrieved from http://www.northernhealthregion.ca/data/1/rec_docs/4536_2016-17_NRHA_Annual_Report_(Final).pdf Northern Regional Health Authority. (2014). Community Health Assessment 2014. Retrieved from http://www.northernhealthregion.ca/data/1/rec_docs/1279_nhr_2014_cha_report_final.pdf Welch, M. A. (2014). TB rates of aboriginals soar. Chiefs contend provincial report fails to capture the extent of the problem. Retrieved from https://www.winnipegfreepress.com/local/tb-rates-for-aboriginals-soar-261347381.html Winnipeg Regional Health Authority. (2015). Seven Oaks Community Area Profile, 2015. Retrieved from http://www.wrha.mb.ca/research/cha2014/files/SevenOaks.pdf Statistics Canada. (2016.) Census Profile, 2016 Census. Retrieved from https://www12.statcan.gc.ca/census-recensement/2016/dp-pd/prof/index.cfm?Lang=E Walkty, A. & Hoban, D. (2009). DSM Micronotes Clinical Microbiology Discipline Publication: Methicillin Resistant Staphylococcus aureus (MRSA) Retrieved from http://dsmanitoba.ca/wp-content/uploads/2014/09/Micronewsletter11-13-0.pdf Alfa, M., Mhanickam, K. & Simner, P. (2011). DSM Micronotes Clinical Microbiology Discipline Publication: TB in Manitoba. Retrieved from http://dsmanitoba.ca/wp-content/uploads/2014/09/MicroNotes06-07-1.pdf Northern Health Region TB program and partners. (2015). Tuberculosis cases diagnosed in persons using a northern MB shelter. [PowerPoint slides]. Received 06 June 2018. Isaac, M. & Waruk, J. (2017). MRSA in Northern MB. [PowerPoint slides]. Received 10 October 2017.
