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Collaborative Community Health Care: Look At What’s Happening In Halifax’s North End (and elsewhere)

Nov 6, 2022 | Business, Politics

Opinion by Alison Strachan

In Saturday morning’s New York Times, Letter from Canada, journalist Ian Austen wrote an article titled: Alleviating Canada’s Acute Shortage of Doctors, The article discusses British Columbia’s new initiative aimed at attracting family doctors to that province. One aspect of that plan is to establish collaborative community healthcare clinics.

While in Halifax this week, Austen spoke to Dr. Katherine Stringer, head of the Department of Family Medicine at Dalhousie University, about the department’s efforts to increase the number of family doctors in Nova Scotia.

Among other initiatives to bring our numbers of family doctors up, Dr. Stringer pointed to collaborative health care practices saying this makes family medicine more attractive to family practitioners, in the article, she says that Dalhousie is in the process of converting its two Halifax clinics to collaborative practices that would be able to serve 3500 more patients.

Dr. Stringer is quoted as saying, “The future of family medicine in Canada has to be team-based,”  “We can realize efficiencies and focus the care so that patients receive the care from the right health care provider at the right time.”

That’s fine for those 3500 patients or clients, but what about the rest of Nova Scotia that is reeling under the weight of a practitioner shortage? And why, oh why, are collaborative “clinics” only now being looked at as viable when they’ve existed in Nova Scotia for more than 50 years and been recognized over the years as a game changer?

This “new” initiative reminded me that the North End Community Health Centre has been a collaborative practice for over 50 years and 30+ years ago, while I served on its Board, Premier John Savage, himself an MD, dubbed it the way of the future. It is and always has been a thriving and constantly growing community-based center for health care.

The North End Community Health Centre, on its webpage, is supporting over 7000 patients or clients in its outreach and brick-and-mortar offices.

Yet here we are in 2022 still making overtures and not embracing the model as a proactive healthcare solution because we focus so strongly on the bricks and mortar of reactive healthcare, hospitals.

After experiencing the Infirmary emergency room (the Charles V. Keating Emergency and Trauma Centre) with a son needing outpatient IV antibiotics for a week last month for a serious cellulitis infection, I can only shake my head. Firstly, because there was no other outlet capable of providing him with this service (i.e., a collaborative clinic) and secondly because I kept glancing up at Charlie Keating’s portrait and wondering to myself whether that packed room on that day was what he had in mind when he made his donation enabling emergency and trauma cases.

The following is an Opinion written in August 2021, prior to the last provincial election in Nova Scotia on the 50th anniversary of the opening of the North End Community Health Centre and prior to Saturday’s Letter From Canada published by the New York Times.

My point is now as it was then, we have the model. Let’s make more.

Collaborative Community Health Care: Look At What’s Happening In Halifax’s North End (and elsewhere)

By Alison Strachan

In 1971, access to primary health care and general health services in the North End of Halifax was next to impossible to find due to the lack of primary health care physicians and health services.

Sound familiar?

Three women took on the task of convincing a team of Dalhousie Medical School physicians to establish the first-ever primary health clinic on Gottingen Street in the heart of the community. What became the North End Community Health Care Centre is a non-profit organization funded through various grants and charitable donations, and it partners with the Department of Health and Wellness and the Nova Scotia Health Authority.

Fifteen years or so later, I was asked to be a member of the community centre’s board. Due to some volunteering, I was doing at the centre back then, director Johanna Oosterveld would not take ‘no’ for an answer when she asked me to join the board.

John Savage was premier at the time and took office facing big operating debts from the previous governments, along with declining equalization payments from the federal government. Savage successfully balanced the provincial budget in 1996, for the first time since 1978, but faced big criticism for cutting social spending. Many of those cuts took place in health care.

One day he visited the North End Community Health Care Centre and I recall Oosterveld was nervous. But as I said, she did not take ‘no’ for an answer and Premier Savage left his visit describing the centre collaborative health care model as a worthy goal for the delivery of health care in Nova Scotia.

Today, the centre continues as a successful model for collaborative health care services and there are reportedly close to 50 similar models now open in Nova Scotia overseen by a top-drawer board of governors. The centre’s website is https://nechc.com/board-of-directors/

What goes on in a collaborative health care centre?

If you’ve worked in a medium to large law or accounting firm, it’s a similar model. Associates, clerks, paralegals, and legal assistants all play a role in freeing up time for the Partner managing a file who can then spend time at the strategic level.

In health care, it brings together a number of practice professionals: a family doctor, nurse, nurse practitioner, dietician, psychologist or social worker, and others. The idea is to provide better holistic care and allow physicians to spend more time with patients who need to see them.

For example, if a client needs routine blood work done, a nurse practitioner typically puts in the order for the client and within a few weeks, the client’s in a chair at the clinic having blood drawn by a phlebotomist and getting a call a few days later from the nurse practitioner with the results and whether follow up care is needed.

A client with a chronic condition who needs regular care would rarely see a physician so long as that care can be managed by a nurse practitioner or another collaborator such as a dietician or psychologist. A physician would be available if there are changes or concerns that cannot be addressed by the nurse practitioner.

But let’s be clear, the important thing about collaborative healthcare is the knowledge that goes into serving its immediate community.

Currently, the North End Community Health Care Centre model is addressing the crisis of homelessness by assisting clients to find housing or temporary shelter, getting services delivered where they are needed through the Mobile Outreach Street Health unit, running community programs from nutrition awareness to exercise programs, and a dental clinic.

During COVID-19, the mobile unit found itself doing testing and providing vaccines at shelters and otherwise. Global-TV Halifax discussed the importance of this with executive director Marie-France LeBlanc in this interview.

The community centre also ran a successful harm-reduction program for dependent clients during COVID and will continue this program by hiring additional harm-reduction workers for an ongoing program. You can read more about this in this CBC clip.

My thought is that investing more in community health through collaborative centers in this province is critical to our overall health and ability to deliver primary health care services to the population. Investment in centers that share the work so that wellness for all parties can be achieved makes the most sense when it comes to attracting healthcare professionals who can shine their skills in a meaningful community, collaborative, and healthy way.

Premier Savage and I may have disagreed on many things but his take on the collaborative care community health care model is one that won’t get disagreement from me. It’s been a long haul from getting that first model established in the North End to the handful of centers now existing — some only in the early development stages.

Make sure you know where the leaders stand on the ongoing development of this model of care.

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