Specific Populations report

Submitted by Dr. Terri Aldred

2017-18 Highlights

Dr. Terri Aldred (second from the left) with her UBC Indigenous Family Medicine Residents Photo: submitted

Indigenous Health / Practitioner Network – Dr. Aldred’s main focus has been on relationship building and doing informal needs assessments to determine what this network could look like. She has met with clinical faculty, current residents, and alumni in the UBC Indigenous Family Medicine Program. It was felt that an Indigenous Health Network would provide opportunities for people to connect and share what is new and good, and what individuals/groups have been struggling with – especially when using traditional sharing circle methods which are healing and rejuvenating. Dr. Aldred has met twice with First Nations Health Authority representatives including Drs. Evan Adams and Shannon McDonald. Most recently she met with the Undergraduate Indigenous Medical Program faculty and students and presented the idea of an Indigenous Health Network and collated some of their ideas on what this network could look like, who should be invited to attend, helpful formats to use for gatherings etc. She also met with the IPAC (Indigenous Physicians Association of Canada) president who is also interested in developing a BC chapter. The next steps are to set up an organizational meeting to formalize a vision for this network and articulate the nuts and bolts of how it would operate ideally.

Trauma Informed Care and Cultural Competency – Dr. Aldred has worked on developing her skills in trauma-informed care and cultural competency training as she is often asked to speak on these two topics. She took the Trauma Informed Care course last June and the online Alberta Family Wellness course this winter, and is researching topics of systemic racism and oppression and how best to tackle this. She presented on the former topic to the RCCbc Core group in December and plans to discuss systemic racism at a Core meeting later in 2018.

Advisory Role – Dr. Aldred is often asked to attend meetings or receive email requests to lend her thoughts on topics that pertain to Indigenous people, communities, or health.

Submitted by Dr. John Pawlovich

2017-18 Highlights

Virtual Critical Care Support Project – Dr. John Pawlovich and Dr. Don Burke have developed a virtual internist (intensivist) support system to assist physician/teams in select rural communities to access internist (intensivist) advice/consult/support using the online Medex platform and or a cell phone.

Five internists from across the province have developed an on-call roster which is distributed by RCCbc to the rural emergency departments of sites participating in the program. Seven rural sites are taking part in the initial phase of this program and the intent is to expand as requested. This work is another example of building networks between providers and the intent is to link this to other networks and build the scope of support as needed. Early feedback has been very positive.

Other work

Dr Pawlovich is collaborating with several rural health groups on technology enabled delivery of primary care services:

Dr. Jim Christenson (left) accompanied Dr. John Pawlovich to several Carrier Sekani communities Photo: BC Emergency Medicine Network

Northern Telederm Project – working with Drs. Nathan Teegee, Neil Kitson, and Craig Mitton to establish a rural dermatology service utilizing teleconference and secured mobile remote technology. Download the research poster now

Rural Surgical and Obstetrics Network (RSON) – consulting on the integration of videoconferencing technology into the Revelstoke operating room

Robson Valley Telehealth Project – facilitating evaluation of the project by Kendall Ho and Helen Novak Lauscher

Carrier Sekani Family Services – continuing to introduce learners and stakeholders to telehealth-enabled primary care in rural and remote Carrier communities. UBC Faculty of Medicine’s Dean Dermot Kelleher and UBC Emergency Medicine Department Head, Dr. Jim Christenson, recently accompanied Dr. Pawlovich on his monthly CSFS rounds.

Submitted by Drs. Jel Coward and Rebecca Lindley

2017-18 Highlights

The CARE Course delivered 15 courses in 2017-18, bringing the total number of courses delivered to 82, reaching over 1,900 rural healthcare providers. In the past year, the course equipment set and packing lists were revised, and a second set of equipment acquired in order to increase the capacity of The CARE Course team to deliver courses.

The CARE Course is taught by experienced rural faculty (physicians, nurses, first responders) Photo: The CARE Course

The CARE Course faculty development program was expanded, with five additional BC faculty completing the program. A Faculty Development Day was delivered in Alberta (Dec 2017). Mentoring and coaching of new faculty continues to be delivered in an ongoing manner.

Drs Coward and Lindley worked with the Ontario College of Family Physicians to adapt The CARE Course for Ontario physicians. The entire team has coordinated and developed the course and program for delivery in rural Ontario settings.

The CARE Course continues to maintain a social media presence and engage in related networking around rural CPD and rural identity.

Academic development

During the last year, Drs. Coward and Lindley made several significant changes to the course:

  • • revision of main articles in the course material
  • • revision Critical Procedures on website, including addition of more ACLS algorithms
  • • update of four of the Point-of-CARE Cards
  • • refreshed web site interface
  • • renewal of Mainpro+ accreditation, including expansion/upgrade to new level of 3 Mainpro+ credits/hr. (The CARE Course now qualifies for 51 mainpro+ credits per course.)
  • • complete revision of the pre- and post-course integrated learning needs and barrier identification tools on website
  • • revision of the Faculty information process and website form to integrate course administration needs in parallel with meeting CCFP requirements for declarations of conflict of interest, etc
  • • engagement with community (FP resident and GP) around potential for making videos of procedures
  • • liaison work with other educators in BC regarding course content and material
  • • working with REAP committee to look at mechanisms for course delivery with the new funding secured for rural residents

Submitted by Dr. Kirk McCarroll

2017-18 Highlights

FPA Clinical Coaching for Excellence – Dr. McCarroll is part of the working group planning this program with Drs. Bob Bluman and Kirstie Overhill from UBC CPD and Dr. James Kim, Anesthesia Regional Dept Head for Vancouver Coastal Health. He is also planning and running program orientation sessions for participants.

See UBC Rural CPD report

FPA provincial privileging dictionary – working with Drs James Kim, John McAlpine, Andrea Geller, Ivan Scrooby, Jane Bishop, Brad Gulliford and Charlie Eckfelt on the panel to review and update this dictionary.

Rural Surgical and Obstetrics Network (RSON) – Dr. McCarroll is involved in the ongoing development of pillars, especially coaching. He is a member of the Interior Health working group.

See RSON report (tab below)

Rural GPA Locum Program – collaborating with Dr. Carl Whiteside to collect feedback from FPA network about this program

CME/CPD

Annual FPA conference – Dr. McCarroll is developing the planning committee and collaborating with other contributors to plan and develop the content for the Refresher Course for General Practice Anesthetists. He is actively recruiting and directing speakers for this conference.  The Refresher Course is a collaboration with UBC CPD, UBC Dept Anesthesia and UBC FPA residency program director, Dr John McAlpine.

FPA Online Journal Club – organization and development of accredited course with Dr Ray Markham, Allison MacBeth.

ESCAPE course development – collaboration with Dr Bruce McKnight FPA Golden, Dr Dilys Leung UBC CPD, Dr Jeff Plant, Dr Sean Ebert, Dr Tara Gill (IHA sim program).  Also collaboration with Lions Gate sim program and Dr John Pawlovich (REAP)

Submitted by Dr. Jeanette Boyd

2017-18 Highlights

Interprofessional Collaborative Practice Development Workshop for Maternity Care Providers – This workshop, co-chaired by Dr. Jeanette Boyd (RCCbc) and Lee Yeates, RM (PSBC), was held on May 26-27, 2017. More than 100 participants attended, representing all five pentagram partners with a full scope of health care providers involved in maternity care present, including midwives, family physicians and specialists. The workshop was a collaboration between Shared Care, Perinatal Services BC and RCCbc.

Objectives:

  • • Demonstrate how community-driven collaboration may support sustainability and resiliency of maternity care
  • • Identify barriers to and facilitators of collaborative maternity care
  • • Facilitate of culturally appropriate care within practices
  • • Identify knowledge gaps related to collaborative maternity care and contribute to the collection and development of resources to address the gaps
  • • Identify eterminants of effective collaborative practices
  • • Created foundations for an evolving Collaborative Maternity Care Community of Practice

 

Maternity Care Pathways aspect of the Rural Surgical and Obstetrics Network (Dec 2017) – this network seeks to map existing rural maternity care services and to gain an understanding of the important services, networks and relationships that are essential to support and sustain resilient maternity care in rural and remote areas. Key activities include:

  • • identification and exploration of key strong maternity care communities of practice
  • • patient journey mapping
  • • mapping of existing rural maternity care pathways
  • • appreciative inquiry process

Perinatal Services, RCCbc, and Shared Care partnered to host the Interprofessional Collaborative Practice Development Workshop for Maternity Care Providers in May 2017. The toolkit developed from this meeting is now available

Submitted by Dr. Stu Iglesias

2017-18 Highlights

ESS family practice involves a wide range of procedures. Photo: Vicky Vogt Haines

ESS Dictionary Review – The ESS Dictionary was successfully revised in the Spring 2017. All references to numbers of procedures required either to achieve or maintain competence were successfully eliminated, instead embedding them in a local CQI process.

Prince Albert Program: Invitational Meeting – This meeting – held September 29-30, 2017 –  brought together all of the stakeholders whose support is needed to elevate ESS to a Category 1 training program. There was a broad consensus and considerable enthusiasm that this goal is both necessary and achievable. The engagement of the Royal College, the College of Family Physicians of Canada, and the College of Medicine at the University of Saskatchewan represented significant progress. A research project led by Dr. Jude Kornelson involving interviews of graduates of the Prince Albert Program was completed and presented at the Invitational Meeting and is currently awaiting publication.

Surrey Caesarian Section training program – RCCbc is supporting a 24 month collaboration between UBC Department of Family Medicine and the Surrey OB program to develop this training program, including a CPD component, to a Category 1 level. Dr Nicole Ebert has committed to be the co-lead for Rural Family Medicine. The journal for the Society of Obstetricians and Gynecologists of Canada published the ESS-OB curriculum, a document that will be foundational for the development of the Surrey program.

Trauma ESS surgery – Dr. Vikki Vogt Haines was awarded the trauma mini-fellowship and will begin April 2018

RhPAP (formerly RPAP) engagement – Dr. Iglesias presented to the Alberta Health Professional Action Plan (RPAP) in Spring 2017. RhPAP has since hired two ESS family physicians – Drs. Bebard (Peace River, AB) and VanBussel (Pincher Creek, AB) – to advocate for rural ESS physicians and small rural surgery and maternity care programs.

Events and Conferences

Banff ESS CME Program – this event – held in January 2018 – was attended by approximately 40 ESS family physicians and 30 rural OR Nurses. As an outcome, Dr. Ryan Falk formed an ESS CPD Committee, which will be housed within the Society of Rural Physicians of Canada.

Laparoscopic Salpingectomy program – a second course was hosted March 26-27, 2018.

Rural Surgery Summit – this meeting was hosted as part of the Canadian Surgery Forum held in Victoria during September 2017. Faculty included both specialist surgeons and ESS family physicians. A summary will be published in the Canadian Journal of Surgery.

Rural Surgical and Obstetrics Network (RSON)

Dr. Vikki Vogt Haines is now Medical Lead, Coaching Pillar

Dr Bret Batchelor is now Lead, Remote Presence Pillar

Dr. Sean Ebert is now Clinical Lead, Quality pillar

See RSON report (next tab)

Submitted by Dr. Nancy Humber and Kim Williams

2017-18 Highlights

Parents cuddling their baby during a C-section Photo: Jeremy Reding

The Rural Surgical and Obstetrical Networks (RSON) has had a great year. The initiative is co-led by Dr. Nancy Humber and Kim Williams who, with a hard working team, have begun to build the infrastructure necessary for such a project. The team has worked closely with Interior Health in engaging communities to develop readiness assessments and build relationships between the smaller community providers and the specialists at the regional centres. The engagement with Northern Health has grown to include members of the perinatal leadership team and relationships continue to strengthen. The team has also been approached by Vancouver Coastal Health and Island Health and will have further engagement in the future.

During the past year, leadership teams for each of the five RSON pillars were developed and integrated into the overall provincial leadership. Each team is tasked with working on its individual mandate while communicating with the other pillar teams to create the flexible capacity required to move this work forward while staying accountable and keeping the funding aligned with the overall RSON objectives.

Planned alignment with the provincial surgery strategy will be essential to leveraging the opportunity for increased operational capacity in some of the smaller communities.

Working with BCMQI and other quality leads in the province, the team has developed the Continuous Quality Improvement (CQI) pillar as part of RSON with flexibility to adapt and respond to health authority and community/provider needs.

The purchase of an InTouch camera system to be piloted in Revelstoke is the first step in implementing new remote presence technology (RPT). This technology is intended to support the Clinical Coaching for Excellence relationships supported by UBC CPD.

The Centre for Rural Health Research has been contracted to conduct the RSON Evaluation which will align with the CQI initiatives as well as provide ongoing and summative review of both process and outcomes.

Finally, the RSON team is engaged in ongoing communication with provincial maternity initiatives to ensure integration of RSON at a level to enhance provincially sustainable models of maternity care.

Submitted by Dr. Trina Larsen Soles

2017-18 Highlights

Some rural and remote communities in BC are only accessible via logging roads or aircraft Photo: John Pawlovich

The RCCbc Transport Working Group consists of Drs. Trina Larsen Soles, Jel Coward and Nancy Humber. The group’s activities this year have centred around involvement with the Rural Patient Transfer and Transport Working Group (RPTTWG) established under and reporting to the Ministry of Health Standing Committee on Health Services and Population Health, through to Leadership Council. This working group was established in response to the Applied Policy Research Unit paper “Rural Patient Transport and Transfer: Findings From a Realist Review” released in November 2016. The first meeting of the working group was June 2017. It was the first time the Ministry of Health, health authorities, BC Emergency Health Services (BCEHS) and rural docs gathered together in the same room to address these issues, and the process went very well. Unfortunately the subsequent intermittent teleconferences were far less effective and somewhat sporadically attended. It took 9 months to develop a work plan to present to the Standing Committee and the plan itself was initially soft on specific deliverables. However, the plan was approved in March and a subsequent full day face to face meeting took place on April 30, 2018. The meeting was highly positive with evidence of specific planning and progress in a number of areas within BCEHS. The collaborative culture seems to have solidified and all involved are committed to seeing the plan implemented.

Key opportunities include to continue to build relationships with BCEHS who have been open to feedback more so than in previous attempts. Dr. Larsen Soles was able to spend a day at the Patient Transfer Network and BCEHS Dispatch to identify some systemic issues from the rural doctor perspective. Continued involvement between RCCbc and the Community Paramedicine Program, while not directly focused on transport, is a mechanism to continue to build capacity for EHS in rural communities. The planned deployment of Advanced Care Parmedice (ACPs) in rural communities provides further opportunities to strengthen transport options in rural.

The frustrations have been due to the incremental rate of change at the Ministry and BCEHS levels. There was initially more of a focus on process rather than outcomes. The underlying major issue of lack of capacity in the system to adequately provide the service has been acknowledged in some ways, but is deemed out of scope for the activities of this working group.

The RPTTWG has one year to complete its work. Our members will continue to participate actively and attempt to encourage meaningful solutions. We are actively working on the parts of the plan which fall under the auspices of the RCCbc, the Rural and Remote Division of Family Practice, and the JSC. There is considerable motivation for change among the members of the group and more hope that we can overcome historical bureaucratic inertia and make meaningful changes to the transport system in BC.

Submitted by Dr. Jim Christenson and Sharla Drebit

2017-18 Highlights

The BC Emergency Medicine Network (EM Network) officially launched September 12, 2017. There are currently 543 members and growing from over 75 hospitals across the province. The network has built a web site that features: a suite of clinical resources (two-page summaries, procedural videos, patient information sheets, ECGs and useful apps and sites); CPD course listings and calendar; archived webinars and rounds; research and innovation projects from across BC and a discussion area where members can discuss various topics.

The EM Network is working with RCCbc to obtain rural knowledge into its clinical resources. Drs. Danette Dawkin, John Soles and Dave Whittaker are leading sessions where rural doctors will provide their input into the Network’s clinical summaries to make sure they are relevant and useful to rural practitioners. The first session will occur April 2018. Danette and John are also members of the EM Network’s Clinical Resources Committee.

The Robson Valley Telehealth Pilot, a project to test the opportunities provided by virtual medicine and technology to enhance and support patient care by connecting providers in rural communities, has completed data collection. An evaluation is underway to describe and analyze user experience, health outcomes and costs.

The EM Network’s CPD program carried our several STRUC Rural (trauma) courses this year and is working with course providers across BC to promote their courses on the EM Network’s CPD page.

Networks Leadership Symposium – the EM Network co-hosted a symposium on March 19-20, 2018 titled: Networks Leadership Symposium: Managing Inherent Tensions? The Network joined a panel to discuss tensions in managing networks and the strategies to overcome.