The NWT’s health authority says it is working to identify the best approaches to primary care in small communities from a patchwork of regional solutions currently in place.
Nine years ago, the territorial health authority was formed from the amalgamation of the majority of regional authorities that served areas like the Dehcho, Sahtu and Fort Smith.
Most smaller NWT communities have no resident physician. Care comes from health centres or health cabins staffed by nurses, who can then refer patients to physicians elsewhere.
However, health authority bosses say that can look different from community to community.
Asked by Cabin Radio how the authority is approaching primary care in small communities right now, territorial medical director Dr Claudia Kraft said a key question managers want to settle is whether patients in small communities are getting the same care they could expect if they were in a larger centre like Yellowknife or Inuvik, or if they lived down south.
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The health authority is in the middle of what it calls primary care reform: reshaping how primary care is delivered across NWT communities, including in Yellowknife.
Outside the territorial capital, Kraft said, a “key piece” of that work is understanding whether nurses in smaller communities have access to the right support when they need it.
“Does a patient who’s presenting in a health centre have the same chance of getting on the doctor’s list – if they need to be on the doctor’s list – as they would if they were in Yellowknife?” Kraft asked, offering an example of what the authority is studying.
“We’re really looking at how we make sure we have a model of virtual support, visiting primary care doctor visits, nurse practitioner inputs and health teams to make sure we are properly supporting primary care needs.”
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Kraft said even almost a decade after various regional authorities came together, separate approaches persist.
“We have a lot of different models, and we’re really trying to understand what our strengths and weaknesses are in those approaches,” she said.
“We come from regional roots, right? Different health authorities, different ways to solve that question in different regions.
“We’re quite close to understanding what are our best practices are and the areas where the community health nurse – or the community themselves – would say, ‘Look, we think this isn’t meeting the mark.'”
One concern staff and residents have also raised is consistency of care.
Even in Yellowknife, gaining access to the same healthcare workers – who already know your file and understand your health concerns – can be difficult.
Getting care from the same faces if you need virtual assistance in a smaller community can be tricky.
Jennifer Torode, the chief operating officer for the health authority’s Yellowknife region, said the authority is trying to promote a model where even if there’s no resident doctor, “recurrent long-term locums” – people subbing in from the south who keep returning to the same position – can be “effectively attached to a community.”
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“They provide remote support to the same community health centre and in-person visits when those are scheduled. That is absolutely one of the models that’s working really well, but we’re trying to formally understand the pros and cons,” Torode said.
“One physician can’t necessarily support all of the visits for the entire year or all the remote care, because they need to have their holidays and their leaves or they have other tasks to attend to. We have successful models of integrating locums into that.”
Torode said the health authority is in the process of using population health data to better understand the needs in each community.
“How are we dealing with diabetes in that community? How are we dealing with cancer in that community? How are things going with mental health?” Torode said, offering examples.
“There are a whole host of things that tell us whether or not a community is healthy, and those are the things – above and beyond the notion of just simply physician practice – that need to be considered right across the Territories.”
“Once that work is done,” said Kraft, “we’ll be in a better position to say, ‘What’s the gap?’ What else do we need to do?”
She added: “My hope is that part of this means we stop thinking of, say, the family doctors in Yellowknife as exclusively Yellowknife’s resource, and start thinking about family doctors for the territory.
“How do they support all of the nurses delivering all of the care and all the patients needing that care across the territory?”
