More innovative ways of helping those without a doc

Pembroke – Clinical Assessment Centres which have been developed as a way of continuing to monitor the transmission of COVID-19 could be a model moving forward of offering health care in the county for in-person assessments as part of a combined health model.

“The Clinical Assessment Centres represent a new point of access to care,” Director of Emergency Services Mike Nolan told Renfrew County council at the April meeting of council.

“A quarter of us don’t have family doctors,” Renfrew Reeve Peter Emon noted, adding this is a way of providing service to many more people.

County councillors were told county paramedics began the transition from COVID-19 testing clinics to Clinical Assessment Centres over the past several weeks. Through stationary and mobile teams, the Emergency Services Department is performing COVID-19 rapid molecular testing through a nasopharyngeal (NP) swab and the use of ID Now equipment. Should a patient test positive, based on risk factors, they are then provided an assessment to determine their eligibility in receiving antivirals. COVID-19 testing appointments are booked through RCVTAC (Renfrew County Virtual Triage Assessment Centres) to ensure eligibility and are performed on site by paramedics with administrative support.

“It is version 2.0 of VTAC,” Chief Nolan explained. “VTAC remains very important.”

He explained the testing with the ID Now equipment for COVID provides more accurate results in 15 minutes and offers a higher reliability than other rapid tests. Since the results are on-site, follow-up can occur in person as well.

“There is space for paramedics to do a full physical assessment and history taking to determine your eligibility for antivirals,” he said. “Antivirals are a first line of defence for people with COVID and comorbidities.”

Antivirals have been available in Ottawa for a longer time and some people were travelling to Ottawa for assessment for antivirals, he noted.

“Some people have been inconvenienced by going into the city,” he said.

Now having dedicated spaces to access around the county makes it easier to provide local care where people can reach it easily.

While the current focus is COVID and antivirals, Chief Nolan said the paramedics can offer many other levels of care. Likely the next step is working with family health teams for cancer screening and other exams a nurse practitioner currently provides.

“Some Clinical Assessment Centres may run seven days a week,” he said. “Some may be half time.”

The county emergency services department is continuing to look at places to rent to provide the services in various locations across the county, he said.

“These Clinical Assessment Centres I’m hopeful are here to stay,” he said.

Reeve Emon said it is important to recognize the traditional bricks and mortar doctor office may not be a possibility for everyone. As well, the distances people need to travel in the county must be considered.

“This recognizes one of the inherent weaknesses of our county, that we don’t have public transportation,” he said.

“We are trying to implement innovation to accommodate our residents,” he said.

Warden Debbie Robinson said it is important to recognize there are currently 25,000 people in the county without a doctor and more doctors are scheduled to retire in the coming year.

“There has to be innovation,” she said.

As well, it is important to recognize that because the Clinical Assessment Centres are being developed does not mean VTAC is going off-line, she said.

Petawawa Mayor Bob Sweet said the county’s population is growing older and transportation is a challenge for many people. He noted when he was diagnosed with COVID he had to go to Ottawa for antivirals and was fortunate to have someone drive him there. Because of his age, he qualified, he said. Having mobile clinics is important for an aging population.

“The silver tsunami as it is called,” he said.

New Layer of Care

In speaking with the Leader, Chief Nolan said the Clinical Assessment Centres are a new layer of care for the approximately 30,000 people in the county who will be without a physician following impending doctor retirements.

“We are needing at least 30 physicians to deal with that number,” he said.

There are some patients who need an attachment to a family doctor the most, he added. The older population needs a family doctor, for example. Others could require only more occasional assessment. If the assessment requires further follow up, this is coordinated.

“We are trying to say this is an integrated virtual health model,” he said.

Chief Nolan said this utilizes both VTAC and primary care physicians working very effectively.

“The physician can be more of an air traffic controller,” he explained.

A physician can refer a patient to others — paramedics in this case – for the physical exam though the Clinical Assessment Centres.

Similar models are in place in Ottawa at Brewer’s Park and Bell’s Corners which are working well, he said.

Chief Nolan said this is a way of utilizing some of the systems set up during the COVID pandemic to continue to provide care for residents of Renfrew County.

“We are not swabbing like we used to,” he said. “We are doing quality of care.”

The county is looking for dedicated spaces which will work to serve the community. While during the pandemic many arenas and community centres were utilized, as they become busier with the resumption of programing other places are being considered. In Arnprior, for example, instead of using the Nick Smith Centre, there is now a new space for the testing and assessment at the Grove Nursing Home.

VTAC continues to give episodic primary care for people and this is a much better option than visiting an emergency department or calling 911, he said. Having the option of the Clinical Assessment Centre provides the in-person assessment needed in some cases.

“It provides the system a way to triage people,” he said.

Chief Nolan said new technology allows the paramedics to consult with doctors or nurse practitioners quickly to determine an accurate diagnosis. An example would be technology to allow a paramedic to look in a baby’s ear, take a recording and share it with the doctor or nurse practitioner to see if a prescription of antibiotics is required for an ear infection.

“And that is happening right now,” he said.

Paramedics can also do ultrasounds and blood labs, he said.

This in many ways is part of the continuing work of the community paramedicine program which has helped fragile seniors stay at home and receive assessments and care as needed there through paramedics.

Chief Nolan noted while the 911 service is funded on a 50/50 model, with the province paying half and the County of Renfrew paying the other half, these new programs are totally funded by the Ontario government. The integrated care model program is 100 percent provincially funded. The community paramedicine program is 100 percent provincially funded. VTAC is 100 percent provincially funded and the Clinical Assessment Centres are 100 percent provincially funded.

Paramedics in Hospitals

Another innovative program which is helping ease the health care burden is having paramedics in hospital emergency departments. Chief Nolan said paramedics are now working regularl scheduled shifts at the Arnprior and District Memorial Hospital.

“Our paramedics work in triage,” he said.

This is helping ease the burden at the hospital for other health care staff. Paramedics regularly are placed in a 12-hour shift at the hospital.

“They are in during the peak period working at the triage desk,” he said.

The paramedics support hospital staff by doing triage and other activities as required. This allows nursing staff to be working in other areas of the emergency department during peak hours.

While the program is unique, there is a similar one at the Queensway Carleton Hospital in Ottawa.

Having paramedics at the emergency department to ease the burden was first discussed with the Pembroke Regional Hospital (PRH) a few years ago, but the official program there never got off the ground. At the time there were some objections from the hospital unions.

However, now there are also paramedics working at PRH using a slightly different model, more on an as needed basis.

Chief Nolan said while paramedics are working in these various capacities around the county, people who call 911 for an emergency still should feel very confident there are paramedics ready to respond quickly to their emergency. In fact, helping deal with medical situations close to home in a timely manner such as through the community paramedicine program and the Clinical Assessment Centres means some calls are being diverted away from the 911 system. As well, paramedics working in the ER is easing a burden for ER staff, so paramedics are not having to remain in the ER with patients waiting to offload them.

“I would say there is more available now because we are doing these proactive models,” Chief Nolan said.

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