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)
Conclusion:
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.
REFERENCES:
Brown, A. D. (2018). The
challenge of rural and northern health systems. Healthcare Papers, Vol.
17, pp. 3–4. https://doi.org/10.12927/hcpap.2018.25508
Browne, A. (n.d.). Issues
Affecting Access to Health Services in Northern, Rural and Remote Regions of
Canada.
CADTH. (2018). Characteristics
of Remote and Isolated Health Care Facilities: An Environmental Scan
ENVIRONMENTAL SCAN. Retrieved from
https://www.cadth.ca/sites/default/files/pdf/es0318_remote_isolated_health_care_facilities.pdf
Cazac, C., & Radu,
G. (2014). Telesurgery--an efficient interdisciplinary approach used to improve
the health care system. Journal of Medicine and Life, 7 . 3(3),
137–141.
Curran, V. R., Fleet,
L., & Kirby, F. (2006). Factors influencing rural health care
professionals’ access to continuing professional education. Australian
Journal of Rural Health, 14(2), 51–55.
https://doi.org/10.1111/j.1440-1584.2006.00763.x
Friesen, E. (2019). The
landscape of mental health services in rural Canada. University of Toronto
Medical Journal, 96(2), 47–52.
Goodridge, D., &
Marciniuk, D. (2016). Rural and remote care. Chronic Respiratory Disease,
Vol. 13, pp. 192–203. https://doi.org/10.1177/1479972316633414
Khan, I., Ndubuka, N.,
Stewart, K., Mckinney, V., & Mendez, I. (2017). The use of technology to
improve health care to Saskatchewan’s First Nations communities. 43(6).
https://doi.org/10.14745/ccdr.v43i06a01
Khan, I., Ndubuka, N.,
Stewart, K., McKinney, V., & Mendez, I. (2017). The use of technology to
improve health care to Saskatchewan’s First Nations communities. Canada
Communicable Disease Report, 43(6), 120–124.
https://doi.org/10.14745/ccdr.v43i06a01
Kue Young, T., Chatwood,
S., Ford, J., Healey, G., Jong, M., Lavoie, J., & White, A. M. (2016).
Transforming Health Care in Remote Communities: Report on an international
conference. BMC Proceedings, 10.
https://doi.org/10.1186/s12919-016-0006-0
Mbemba, G. I. C.,
Bagayoko, C. O., Gagnon, M.-P., Hamelin-Brabant, L., & Simonyan, D. A.
(2016a). The influence of a telehealth project on healthcare professional
recruitment and retention in remote areas in Mali: A longitudinal study. SAGE
Open Medicine, 4, 205031211664804. https://doi.org/10.1177/2050312116648047
Mbemba, G. I. C.,
Bagayoko, C. O., Gagnon, M.-P., Hamelin-Brabant, L., & Simonyan, D. A.
(2016b). The influence of a telehealth project on healthcare professional
recruitment and retention in remote areas in Mali: A longitudinal study. SAGE
Open Medicine, 4, 205031211664804.
https://doi.org/10.1177/2050312116648047
Newfoundland and
Labrador Medical Association. (2010). Newfoundland and Labrador Medical
Association (NLMA) - Fact Sheets. Retrieved November 28, 2019, from
https://www.nlma.nl.ca/News-And-Events/Media/Fact-Sheets
Rechel, B., Džakula, A.,
Duran, A., Fattore, G., Edwards, N., Grignon, M., … Smith, T. A. (2016).
Hospitals in rural or remote areas: An exploratory review of policies in 8
high-income countries. Health Policy, 120(7), 758–769.
https://doi.org/10.1016/j.healthpol.2016.05.011
The College of Family
Physicians of Canada. (2017). Steps to improving rural healthcare in Canada.
Retrieved November 28, 2019, from
https://www.cfpc.ca/uploadedFiles/Publications/News_Releases/News_Items/ARFM
News Release FINAL ENG .pdf
Young, K. (2013). Transforming
Primary Health Care in Remote Northern Communities: The Circumpolar Health
Systems Innovation Team [CircHSIT]. Retrieved from
https://nwtspor.ca/sites/default/files/young1.pdf
