Introduction

Working on the frontlines of healthcare is more challenging than ever. Our teams know the toll that lack of access to safe, culturally competent health care has on citizens. This is particularly pronounced in northern, rural and remote communities (National Collaborating Centre for Indigenous Health, 2019).

At the core of our efforts as a health solutions partner is the goal of improving the wellbeing of Canadians by delivering high-quality, localized, team-based, patient-centric care when and where people need it. Important to our success is finding opportunity to use existing primary health care resources in the most effective and efficient ways and expanding the delivery of health care in out-of-hospital settings.

One promising approach to increasing capacity and reducing strains on hospital resources is community-centered care. Through community paramedicine and other mobile integrated health programs, paramedics and other allied health professionals are able to expand their roles within communities, large and small, to assist with public health initiatives, deliver primary and preventive care and provide support to people in need in socially vulnerable patient populations such as seniors, individuals with complex medical needs and those in remote, rural and Indigenous communities.

Jennifer Zelmer, President and CEO of Healthcare Excellence Canada notes that "People living and working in northern, rural, and remote communities want and deserve excellence in care (Healthcare Excellence Canada, 2023).” Meeting the growing health care demand for underserved communities necessitates adapting, scaling and testing new care models tailored to people's diverse needs and lived experiences. It often requires a shift in thinking, embracing new strategies and accounting for geographic variations, cultural differences and other local factors to redefine what care can and should be for those living outside large urban centers.

When developing these models, it is crucial to listen to and understand the voices of Indigenous Peoples and/or other underserved communities. It is also important to implement practices of culture competent care and include citizens and other community partners in the design and decision-making process.

Community Wellness on Wheels, One KM at a Time

Through a collaboration between the Saskatoon Tribal Council and the provincial and federal governments, the Saskatoon Tribal Council Health Bus in Saskatchewan has been providing dental services, community paramedicine and mental health support to the seven First Nation communities since 2021.

With a five-year, $2.5 million operating budget, the bus, a "fully loaded RV" with advanced technology and facilities, operates four days a week, 10 months a year, providing direct access to care to over 15,000 people. The dedicated team on board consists of an Intermediate Care Paramedic, a dentist and dental assistant. Dental services include exams, x-rays, cleanings, fillings, extractions, sealants and stainless-steel crowns. Community paramedicine services include assessments, diagnostics, vital sign monitoring, wellness checks and nasopharyngeal swabs.

Since 2008, through collaboration with the Saskatchewan Health Authority and Saskatchewan Ministry of Health, the Saskatoon Primary Health Care Health Bus has been providing primary care services to geographically, socially, economically and isolated individuals.

This bus has adapted Saskatoon’s model of care to socially vulnerable citizens to access chronic disease management, wound care, flu immunization, blood pressure, blood glucose level checks, health education and referrals without the need for an appointment. It’s received national award recognition for a diverse, innovative way to bring care to those who experience marginalization. The scope of services continues to be refined based on consultation with key community partners and patient need, with potential applicability in communities across Canada.

Wîcihîtowin Project – Coming Together

The Wîcihîtowin (Coming Together) Project, through another important collaboration with the Saskatoon Tribal Council, employs culture as a health intervention for alcohol and drug treatment. An Indigenous-led care team focuses on harm reduction and recovery by re-establishing connections and providing holistic and integrated services and supports. Paramedics, as part of a multi-disciplinary team, play a vital role in offering medical and non-medical supports to those suffering from substance use, seven days a week.

Program services include advocacy, continuous care within the community, transportation (as needed), at-home detox supports, harm reduction, cultural support and connection, crisis intervention, follow-up services, programming, referral services, and emotional support.

Since October 2022, the Project has supported over 300 emergency room diversions and has conducted over 700 follow-up visits.

Care for Canada’s North

The National Collaborating Centre for Indigenous Health highlights the challenges to recruit and retain health care professionals in Canada’s north due to remote locations and small population sizes. To support medical personnel shortages, these communities may rely on non-resident health professionals to fly in for short durations to see patients (National Collaborating Centre for Indigenous Health, 2019).

From Fort Hope to Pikangikum to Fort Severn, New Osnaburgh, Keewayin, Waskonbika, Bearskin Lake and beyond, paramedic teams are actively engaged in direct patient care and consultation in approximately 30 rural and remote communities, ranging in size from a couple of hundred people to a couple of thousand.

This team-based model of care, through a contract with Indigenous Services Canada, supports local efforts in delivering care across a vast landscape. Paramedic teams on rotation since May 2020 work alongside other health care professionals in these communities, including First Nations and Inuit Health Branch-employed nurses.

On an average day, the paramedics engaged in these communities provide a broad spectrum of family medicine services, from assessing a patient’s health and providing advice on medications, to performing routine bloodwork and examining infections ― even treating dental problems and administering vaccines. They also draw on their skills and training in crisis response when leading trauma responses in the communities, supported by their local colleagues, which can include coordinating air ambulance medivacs in challenging weather conditions.

And their role continues to evolve, influenced heavily by local needs and considerations. Paramedics often provide health and safety training to community elders, going beyond their clinical responsibilities. During the pandemic, for example, a paramedic in Gods River assumed the role of the local COVID-19 contact authority and public health educator, ensuring the implementation of safety protocols and managing community testing.

In two and a half years, 570+ rotations have been completed with work ongoing.

Final Thoughts

Community-centered health care initiatives are indispensable for the wellbeing of people in underserved areas of the country, granting them access to relevant services and supports when and where they need them most. The care models highlighted in this article demonstrate the value of well-established relationships with local community collaborators.

By maintaining momentum and constantly evolving community-centered care to meet the diverse needs of Canada's regions and populations, we can put health care back into the heart of our communities, ultimately saving lives and fostering prosperity for all.

Sources

National Collaborating Centre for Indigenous Health. Social Determinants of Health: Access to Health Services as a Social Determinant of First Nations, Inuit and Métis Health. 2019. Accessed September 2023 at https://www.nccih.ca/docs/determinants/FS-AccessHealthServicesSDOH-2019-EN.pdf.

Healthcare Excellence Canada. Join us to strengthen primary care in northern, rural and remote communities. News release, July 10, 2023. Accessed September 2023 at https://www.healthcareexcellence.ca/en/news/2023-07-10-join-us-to-strengthen-primary-care/.