Publication DateMonday, January 28, 2013 - 15:30
Type of PracticePromising
CategoryHuman Resources Rural and Remote Health
This practice was recognized as a Promising Practice by the Health Council of Canada using the Health Innovation Portal Evaluation Framework
SNAPSHOT: This innovative practice focuses on increasing access to health care professionals in remote places. Launched In 2001 in two rural communities in Nova Scotia, the three-year initiative implemented the health service delivery model that uses the more widely practiced model of community paramedicine and introduced a novel collaboration with registered nurse practitioners (NPs).
Long and Brier islands are two remote islands in Nova Scotia with a combined population of about 1,240 residents. Reaching these islands requires a one-hour commute by car and ferry from the nearest town, Digby. Access to primary care services on the islands has been minimal for many years because there are no resident physicians. Instead, paramedics and one registered nurse provided health services for these residents; if additional health services were required, a 50-minute trip was taken to Digby’s General Hospital. In 2001 the Emergency Health Services (EHS) and the residents launched a three-year initiative focused on increasing access to health care professionals on the islands. The initiative consists of an innovative health service delivery model that uses the more widely practiced model of community paramedicine. In addition, it introduced a novel collaboration with registered nurse practitioners (NPs). The NP also acts as a liaison with an off-site physician in Digby. This model uses the islands’ human health resources and demonstrates an innovative approach of tailoring delivery models to the community’s needs.
The first phase of this model was established in an ambulatory base with increased access to paramedic care. Paramedics provided 24/7 ambulatory care to the residents in this phase. Paramedic services expanded in the second phase to include clinic roles and delivery of non-emergency services. The third phase marked the addition of the NP and, consequently, led to increased development of non-emergency services by the NP, of complex care by the paramedics, and of prevention and promotion programs by the health care team.
With the needs of the residents expanding, ongoing professional development has been provided to paramedics to help them better adapt to their community’s needs and to become proficient in providing various medical services to the Long and Brier islands residents. Learning sessions have been a key resource in promoting these expansions.
This initiative not only models community-based care but also demonstrates the role of effective communication and collaboration among health care professionals, community residents, and provincial leaders in providing accessible and adequate care.
The Long and Brier model has successfully achieved greater access to primary health care services for the residents of these two islands. Interviews with residents have highlighted personal success stories and satisfaction with the health services provided by the paramedics and NPs. They also noted that their health status has improved, and they expressed satisfaction with the shorter wait times and travel times to obtain access to care. These stories have been documented and shared with the public in recent news releases and program reports on Nova Scotia’s government websites.
Furthermore, preliminary data collection has shown a 23% decrease in emergency department visits by islanders and an increase in the project’s patient contacts by 250 to 300 during the 2002/2003 fiscal year. Average visits by islanders to Digby facilities decreased by 24% to 28% from 2001 to 2006. Data and figures have been documented in program reports.
In late 2006, the Beausoleil First Nation on Lake Huron’s Christian Island in Ontario started a program modelled after Nova Scotia’s Long and Brier Island Community Paramedicine Project. In its first year of implementation, from November to July, paramedics provided 1,000 home visits, lasting almost 495 hours to total, in addition to handling their usual volume of emergency calls (approximately 300 calls a year). Community paramedics do an average of six daily home visits, checking on the same three patients every day and sometimes visiting as many as nine. The daily check-ups and expanded practice of paramedics have reduced the number of transports and hospital admissions in this location. Similar programs in remote locations in countries such as Australia and Scotland have also consulted with Long and Brier administrators about their projects.
Those wishing to implement this innovative practice in a different context must be aware that this project dramatically altered the traditional scope of work for the paramedics involved. Accustomed to quickly responding to emergency calls within a specified period of time, paramedics are now called upon to spend more time with residents to conduct falls prevention assessments, participate to monthly first-responder training programs with fire departments on the islands, and generally establish closer relationships with local home-health services, including the Victorian Order of Nurses.
The success of the Long and Brier Island Community Paramedicine Project has spurred interest in expanding the initiative and the facilities in Digby County. In November 2012, Premier Dexter announced a two-year investment in a new health care facility for Digby County that will continue to provide care to Island residents via the expanded scope model. The facility will unite the clinic and EHS base in order to maximize collaboration and centralize services.
Finally, in February 2011, EHS launched a subsequent paramedic expanded scope initiative as part of the Better Care Sooner plan. Similar to the Long and Brier Island Community Paramedicine Project, the Collaborative Emergency Centres care model uses paramedics as health care professionals who can provide a larger repertoire of services to remote areas. The aim is to provide care to seniors in remote resident homes through collaboration among paramedics, NPs, EHS staff, and Capital Health. Further, the Ministry of Health in Saskatchewan is also adopting the community paramedicine concept.
Content has been adapted from the following sources and relevant websites:
- Government of Nova Scotia. (2013, January 18). P.E.I. exploring Nova Scotia’s innovative emergency care model [News Release]. http://novascotia.ca/news/release/?id=20130118007
- Government of Nova Scotia. (2012, September 27). Province invests in new health-care facility for Digby County [News Release]. http://novascotia.ca/news/release/?id=20120927003
- Nova Scotia Health and Wellness. (n.d.). Emergency health services: System report fiscal years 2009–10 and 2010–11. http://www.gov.ns.ca/health/ehs/documents/EHS_System_Report_2011.pdf
- Lanktree, G. (2008, April). Paramedics ease rural MD’s load. National Review of Medicine, 5(4). http://www.nationalreviewofmedicine.com/issue/2008/04/5_advances_medicine04_4.html
- Garza, M. (2008, July 26). Beyond EMS: Community paramedics make house calls. http://www.jems.com/article/cardiac-circulation/beyond-ems
- Dobson, T., & Buchholz, K. (n.d.). Community paramedicine and the extended care paramedic [Presentation Notes]. Halifax, NS: Nova Scotia Emergency Health Services System. http://www.cfhi-fcass.ca/Libraries/Picking_up_the_pace_files/Ken_Buchholz.sflb.ashx
- Nova Scotia Emergency Health Services. (2005, April 1). Community paramedicine: A part of an integrated health care system. http://www.gov.ns.ca/health/ehs/documents/Community%20Paramedicine%20Article.pdf
Name: Connie Day
Title: Nurse Practitioner
Organization: Island Health Centre & EHS Paramedic Excess Line Capacity
Telephone number: 902-839-2398
Information last updated on: March 6, 2013