As we have progressed through MHST601 this semester, I acknowledge that although I was aware of the determinants of health, our multilevel approach of healthcare delivery, chronic diseases and vulnerable populations, I realized that I have a lot to learn about the difficulties our patients and their families have when trying to navigate our healthcare system. For this unit in particular, it has struck me pretty directly that although I strive to provide the best service for everyone within the community I live in, I need to learn more about the barriers that our vulnerable populations deal with on a daily basis. In my role as Director of Laboratory, Diagnostic Imaging and Quality, I do not routinely have the opportunity to work directly with the patients my departments serve. Although I am the one that receives and follows up on feedback received, both positive and negative, I find that one of the benefits from our learnings is that I am adjusting the lens through which I view and address these improvement opportunities.
To support my learning in this module, I engaged in a discussion with our organizations Director of Partnerships and System Integration. Their role is designed to review our healthcare delivery model, in conjunction with the needs of our community, and continuously improve the connections between our hospital and the broader community services that our patients require. Functionally, they are our liaison with our local vulnerable populations. When I asked what populations are the most vulnerable in our rural community, I very quickly received a response of those living with mental health, addictions, and poverty. This led me to research mental health and addictions in Ontario and supported the comparison with my British Columbia peer of how our provinces address the care and services provided for this population.
According to the Canadian Mental Health Association – Ontario, the delivery of mental health services in rural Ontario communities significantly differs from urban communities (CMHA-Ontario, 2009). Individuals living in rural communities face multiple mental health and geographic disparities for mental health services due to barriers created by availability of local accessible and comprehensive services (CMHA-Ontario, 2009). These barriers are present in my community. Our organizations primary provider of services for mental health and addictions is a not for profit agency funded by the Ministry of Health and Long-Term Care (CAMHS, n.d.). On-site services for mental health and addictions are only available once a week as our counsellors and team of experts rotate through multiple sites in our region to support our community. If an individual or family require in-person assistance outside of this availability, they are required to travel at least thirty-five minutes to connect with the services required, or complete a virtual appointment. For some of these patients, who are dealing with poverty as well, access to transportation or devices with internet connectivity is not routinely available and this creates a socioeconomic barrier to the services they require (Ross et al., 2015). One recent improvement to improve the availability of services in our rural community was the partnership with a rapid access addiction medicine (RAAM) clinic. RAAM clinics help people seeking treatment for substance use issues, including opioids, alcohol and other substances and you do not need a referral or appointment to visit a RAAM clinic. Access to this clinic is only available weekly as well.
The discussion with my colleague then turned to the topics of who is responsible for the on-going care of patients who present to the Emergency Department with mental health or addiction illness and how do the family physician or the patients support services remain connected. I received another quick response and a smile – the response was that this is something our community is struggling with and the provincial government has been supporting through the provision of coordinated care management. Coordinated care management is an approach that was developed by Health Quality Ontario in 2015 to support caring for patients with multiple conditions and complex needs (Figure 1) (HQO, n.d. a). In 2016, Health Quality Ontario further developed this approach specifically for those with mental health and/or addictions conditions (Figure 2) (HQO, n.d. b).
Figure 1: The approach to effective Coordinated Care Management (HQO, n.d. a).
Figure 2: Coordinated care management for patients with mental health and addictions conditions (HQO, n.d. b).
Although the Coordinated Care Management approach appears streamlined and effective, there is one health system barrier that limits the effectiveness of this approach for our organization – our electronic health record. eHealth Ontario defines the electronic health record as a secure lifetime record of your health history that gives your health care team real-time access to your relevant medical information (eHealth Ontario, n.d.). Unfortunately, in the year 2021, not all of the medical information recorded in our organization is available to those outside our walls in an electronic format. This creates a major barrier to quality care for people living with mental health and substance use issues due to the lack of communication and subsequent ineffective collaboration between health professionals (Ross et al., 2015). Although we can gather information and initiate the care plan for these patients using a hardcopy paper format, this approach relies on our team then faxing the plan to the subsequent services in a timely manner. Moreover, some of the reports for diagnostic services performed at our site are also not available to health professionals. Esoteric laboratory results, those tests we do not perform on site, are sent to a private laboratory for testing and the results are returned to us in paper format and are not transcribed into the electronic health record. They are only available in the patient chart. Our diagnostic imaging reports and images are also currently not available to those using ClinicalConnect, a key access point for diagnostic information for the province of Ontario.
For those in my community living with mental health and addictions illness, our organization could better serve them by improving our electronic health record. Although the government of Ontario supports the development of an electronic health record, the ability to implement the infrastructure to support this lies with the individual healthcare organization. This requires significant financial and technical support that a small rural hospital could only achieve through effective strategic planning. Wouldn’t it be nice if we all had a seamless, electronic health record that was accessible across our province, our country or perhaps anywhere we go? This seems like a good discussion to continue for future directions in healthcare, do you agree?
REFERENCES:
Canadian Mental Health Association, Ontario. (2009, August). Rural and northern community
issues in mental health. Retrieved from https://ontario.cmha.ca/documents/rural-and-
Community Addiction and Mental Health Services of Haldimand and Norfolk – CAMHS.
(n.d.). About us. Retrieved March 22, 2021 from https://www.camhs.ca/about-us/about-
eHealth Ontario. (n.d.) What’s an her? Retrieved March 22, 2021 from
Government of Ontario. (2021, March 1). Find mental health and addiction services in your
community. Retrieved March 22, 2021 from https://www.ontario.ca/page/mental-health-
Haldimand-Norfolk Health and Social Services. (2019). Community needs assessment
summary report. Retrieved from https://hnhu.org/wp-content/uploads/CNA-FINAL-
Health Quality Ontario. (n.d.a). Coordinated care management. Retrieved March 22, 2021
Health Quality Ontario. (n.d. b) Coordinated care management for patients with mental
health and/or addictions conditions. Retrieved March 22, 2021 from
Ross, L. E., Vigod, S., Wishart, J., Waese, M., Spence, J. D., Oliver, J., Chambers, J.,
Anderson, S., & Shields, R. (2015). Barriers and facilitators to primary care for people
with mental health and/or substance use issues: A qualitative study. BMC Family
Practice, 16(1), 1–14. https://doi.org/10.1186/s12875-015-0353-3
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