It has been proven to be problematic to have access to hospital and emergency services in a more distant location in Canada. Geographical distance can result to poor access to healthcare services and poor usage of emergency services in the rural areas. Meanwhile, there is an increased pressure to reduce the infrastructure of hospitals, rationalize specialized services to provide appropriate amount of procedures and quality of care within the rural and remote areas. Also, this solicits the movement of services from hospitals into the communities; however, from the perspective of capital expenditure and budget cost, it has become a problem to retain the financial support of small hospitals among rural populations. Attracting skilled healthcare professionals in the rural and remote areas acts as a challenge in the advancement of healthcare services among these communities (Rechel et al., 2016).
The health communities in the rural and northern areas of Canada emulates the problems of the healthcare system today. The main issues of the healthcare system are the inadequate access to healthcare services between the indigenous and non-indigenous populations in Canada. However, for several years there has been an increase of physicians, nurses and access to healthcare services within the rural and remote communities; yet, it seems that having “more” healthcare practitioners is not enough. The rural health reform depends on the emphasis of developing a new set of relationship between the rural and urban centers; on the scale of providing other means of healthcare matches the current geographical problems, educational challenges and allocation of resources that will support the Improvement of healthcare capacity within the localities(Brown, 2018).
While accessibility is one of the five pillars of the Canada Health Act, many Canadians still face major barriers to their access to health care (Friesen, 2019).Citizens living in rural areas in Canada have been met with obstacles for a long time to achieve equal access to health care. They make up 18% of the Canadians, yet only 8% of the Canadian physicians serve them. In order to improve access and equity of healthcare services, better recruitment and retention of professional family physicians is essential (The College of Family Physicians of Canada, 2017). Access to care that urban residents consider to be routine, such as services for mental health, counselling, caring for disabled children, speech therapy, physiotherapy, occupation and job therapy, support groups, etc. either is rarely found in rural areas or is improved by very short practitioners (Newfoundland and Labrador Medical Association, 2010).
Studies in several countries have shown that suicide has increased significantly in rural communities in respect of urban populations. Although there is a growing suicide rate, rural communities do not seem to face a rising mental illness burden. However, most of the research suggests that mental illness in rural communities was comparable or reduced compared to urban centers. There has been a lower risk of depression in rural populations, for example in Canada, in Romans and colleagues. One reason for a higher suicide rate in rural communities without a proportionally higher mental illness rate is that limited access to mental health services leads to rising adverse outcomes of mental health, including suicide. In a recent study in Newfoundland, people who live in rural communities have been shown to be very difficult to access their community-based mental health services, and rural residents need to travel to large centers to receive treatment. The lack of psychiatrists working in rural areas can partially explain limited access to rural mental health services (Friesen, 2019).
Studies on health disparities confirm that geography is a health determinant. Rural and rural people tend to have poorer health outcomes than Individuals residing in broader centers. life expectancy for people in predominantly rural areas is lower than the Canadian averages. It is more likely that Canadians in rural parts of the country have poorer economic conditions and less healthy behaviors, which results in higher Overall death rates. While low-level health areas tend to have small populations and cover large geographic areas, higher-level regions generally have large populations and smaller geographical regions (Newfoundland and Labrador Medical Association, 2010).
Health facilities are significantly less concentrated in remote and rural areas than in urban areas. Therefore, people usually travel far away to retrieve services which are unavailable locally. It is common to go travel kilometers to the nearest healthcare facility for people requiring specialized health services and diagnostic testing. In the northern regions, the issue is exacerbated by the difficult weather north which renders road or air travel risky or impractical. The financial burden of travel is not only stressful; families and communities should find ways to cope without members, parents, salaried workers or community leaders. Pregnant women in communities without a hospital must move to a regional center weeks before babies are delivered. This separation between their families and their homes takes a toll in relationships, problems with childcare and related stresses (Browne, n.d.).
In contrast, there is a high burden of travel costs in accessing the necessary treatment for patients in rural communities. It often requires days or weeks to provide families and social care with extra accommodation and food prices (Newfoundland and Labrador Medical Association, 2010).
Problems with healthcare access are caused by a serious shortage of healthcare providers even for the most basic healthcare services. Rural communities often have difficulty accessing primary and community hospitals and retaining access to healthcare facilities, providing access to clinical clinics, and more specialized therapies. This increase in the pressure on rural physicians, nurses and administrators contributes to the existing recruitment and retention problem. The burden of paying the high cost of travel to the health care required is also added for people in rural communities. Often means days or weeks away from family and social support and the additional cost of lodging and food (Newfoundland and Labrador Medical Association, 2010).
Professional isolation is very problematic for rural health care professionals who are often isolated from regional hospitals and medical specialists, particularly when medical emergencies arise Geographic distance often contributes to the cost of attending selected CPE activities and can increase the time to be away from family and work. Some rural health care professionals, many of whom are the sole providers of health care in their communities, simply cannot leave their communities to attend an educational session, regardless of how beneﬁcial it might be for their patients and their practices (Curran, Fleet, & Kirby, 2006).
Not only are there few services available to people living in northern, agricultural and remote regions, but there are a limited number of professionals that provide care. Across rural communities, health care workers, including physicians, surgeons, dentists and others, usually face higher turnover (Browne, n.d.). Part of the difficulty of recruiting medical providers and maintaining them in northern and rural areas is attributed to demanding working conditions. Long working hours, a shortage of staff, the absence of additional training, difficulties in the regular continuing education, and a perceived failure to provide wife and childcare for these obstacles (Browne, n.d.).
Across the provinces of Canada, Health Canada; Northern First Nations; local physicians; and health authorities, have searched for various creative means of delivering healthcare services in the rural and northern areas. As a result of this effort, there has been an introduction of the use of different technologies such as digital and portable diagnostic devices to provide the necessary healthcare assistance to the rural and remote population (Khan, Ndubuka, Stewart, McKinney, & Mendez, 2017). World Health Organization defines telehealth care as the delivery of healthcare services for far distance purpose to improve the access to healthcare services for people who live in the rural and remote communities (Goodridge & Marciniuk, 2016).
The application of telehealth care has the means to address several problems of the present-day healthcare system by improving the quality, accessibility, efficiency and effectiveness of the delivery of healthcare services as well as escalating the advantages of cost reduction. To example, a significant amount of research studies has indicated that telehealth could bring about a positive impact on the organizational, educational and professional aspects of recruiting and retaining healthcare providers among the rural and remote areas (Mbemba, Bagayoko, Gagnon, Hamelin-Brabant, & Simonyan, 2016b).
With the use of technology, the previously mentioned struggles of delivering healthcare to remote areas of Canada can be reduced. The main strategy to reducing limitations currently being used are Telehealth or other e-consultation services (Kue Young et al., 2016). These types of services can increase populations’ access to healthcare providers (Mbemba, Bagayoko, Gagnon, Hamelin-Brabant, & Simonyan, 2016a). By having the technology to support Telehealth it can connect specialist to those areas, such as psychiatric assessments. This is done by family physicians, or other primary care givers, being able to communicate with the specialist, with or without the patient, to discuss treatment options and care plans. This allows access to physicians in areas that are not typically accessible, while reducing travel time and costs (Kue Young et al., 2016).
Telehealth can also help in educating healthcare providers that are currently located in remote areas (Young, 2013). Best practices are always changing and as healthcare providers continuous education is very important to providing quality care. Technology allows these providers to remotely access education seminars and classes, while allowing them to stay where they are, reducing travel time away from their practices/jobs. Technology allows for these professionals to be trained through virtue or augmented realities to improve the variety of care and treatments available to their patients (CADTH, 2018).
The availability of these services in remote areas of Canada can also help to recruit and retain healthcare providers as they, themselves, have the effective means to support their patients (Mbemba et al., 2016a). Another potential available support for remote healthcare providers is artificial intelligence-this technology can help in reading diagnostics or test results that could potentially be more accurate depending on the healthcare providers area of practice (CADTH, 2018). This could also help to evaluate, monitor, and treat chronic conditions in remote areas.
Having access to more healthcare professionals will also increase these areas in accessing timely care. Telehealth will help family physician diagnoses and treat conditions/illness with the guidance of specialists. As well as reduce the number of patients travelling long distances to receive care, which can increase the patient level of comfort (Khan, Ndubuka, Stewart, Mckinney, & Mendez, 2017). and potentially improve their recovery time.
Technology can also improve access to care through robots or portable machines, such as scanners, or health monitors. TELUS Health has created peripheral devices that connect to a tablet and transmit data related to heart failure to a remote nurse for monitoring (Kue Young et al., 2016). This allows for the patient to have continuous care while still living in their desired location or home. Khan et al. (2017) also discussed the use of portable liver scanner in remote regions to help in diagnostics (Khan, Ndubuka, Stewart, Mckinney, et al., 2017). An example is that of a pediatrician using remote diagnostics to detect infants with pneumonia in more remote regions so that they then were able to stay in a smaller hospital closer to home instead of being transported to a larger facility (CADTH, 2018). Also, there is the use of robots. The Canadian Medical Association (2018) discuss the use of remote presence robots to help in delivering care. These robots have been used to provide mental health services to youth in remote areas (CADTH, 2018) as well as perform surgeries. This allows the patient to have the right health care provider at the right time (Cazac & Radu, 2014) even when they are not physically in the same location. Some examples of these robots are “Rosie”, and “Doc-In-The-Box” (Khan, Ndubuka, Stewart, Mckinney, et al., 2017)
To conclude, Canadian rural and remote areas are facing the challenge of inadequate healthcare services. A considerable number of studies have illustrated that geographical diverse populations have difficulty in receiving the necessary medical treatment due to far distance, and limited number of healthcare providers. Even though in the recent years there has been an increase of health care professionals in the rural and remote settlements of Canada, there are still healthcare disparities among these areas. For this reason, many of the physicians and other practitioners have introduced the idea of incorporating the use of technology in the healthcare system. This innovation will aid at delivering the best quality of healthcare services to the rural and remote population efficiently and effectively. Patients that reside in the remote areas will have the convenience of communicating with their healthcare provider from a distance.
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