Pembroke – The Clinical Assessment Centers that have been developed to continue to monitor the transmission of COVID-19 could be a model moving forward in offering health care across the county for in-person assessments as part of a combined health model.
“Clinical Assessment Centers represent a new entry point to care,” Emergency Services Director Mike Nolan told Renfrew County Council at the April council meeting.
“A quarter of us don’t have a family doctor,” noted Renfrew Reeve Peter Emon, adding that it’s a way to provide services to many more people.
County councilors were told county paramedics began transitioning from COVID-19 testing clinics to clinical assessment centers in recent weeks. Through fixed and mobile teams, the emergency department performs rapid molecular COVID-19 tests through nasopharyngeal (NP) swab and the use of ID Now equipment. If a patient tests positive, based on risk factors, they then receive an assessment to determine their eligibility to receive antivirals. Appointments for COVID-19 testing are booked through RCVTAC (Renfrew County Virtual Triage Assessment Centers) to ensure eligibility and are conducted on-site by paramedics with administrative support.
“It’s VTAC version 2.0,” Chef Nolan explained. “VTAC remains very important.”
He explained that testing with the ID Now equipment for COVID provides more accurate results in 15 minutes and offers higher reliability than other rapid tests. Since the results are on site, the follow-up can also take place in person.
“There is room for paramedics to do a full physical assessment and take a history to determine your eligibility for antivirals,” he said. “Antivirals are a first line of defense for people with COVID and comorbidities.”
Antivirals have been available in Ottawa for longer and some people were traveling to Ottawa for an antiviral evaluation, he noted.
“Some people were inconvenienced entering the city,” he said.
Now, having dedicated access spaces across the county makes it easier to provide local care where people can easily access it.
Although the current focus is on COVID and antivirals, Chief Nolan said paramedics can provide many other levels of care. The next step is likely to work with family health teams for cancer screening and other examinations that a nurse practitioner currently provides.
“Some clinical assessment centers can operate seven days a week,” he said. “Some may be part time.”
The county’s Department of Emergency Services continues to look for places to rent to provide the services in various locations around the county, he said.
“I hope these clinical assessment centers are here to stay,” he said.
Warden Emon said it was important to recognize that the traditional brick-and-mortar medical practice may not be a possibility for everyone. Also, the distances that people have to travel in the county must be taken into account.
“It recognizes one of the inherent weaknesses of our county, that we don’t have public transit,” he said.
“We try to implement innovation to accommodate our residents,” he said.
Director Debbie Robinson said it was important to recognize there are currently 25,000 people in the county without a doctor and more doctors are expected to retire in the coming year.
“There has to be innovation,” she said.
Additionally, it’s important to recognize that just because the Clinical Assessment Centers are under development doesn’t mean VTAC is offline, she said.
Petawawa Mayor Bob Sweet said the county’s population is aging and transportation is a challenge for many people. He noted that when he was diagnosed with COVID, he had to travel to Ottawa for antivirals and was lucky to be driven there by someone. 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
Speaking with the chief, Chief Nolan said the clinical assessment centers are a new layer of care for the approximately 30,000 people in the county who will be without a doctor following the impending retirements of doctors.
“We need at least 30 doctors to cope with this number,” he said.
There are patients who need the attachment of a family doctor the most, he added. The elderly population needs a family doctor, for example. Others may only require more occasional evaluation. If the assessment requires additional follow-up, this is coordinated.
“We’re trying to say it’s an integrated virtual health model,” he said.
Chief Nolan said this uses both the VTAC and the primary care physicians working very efficiently.
“The doctor can be more of an air traffic controller,” he explained.
A doctor can refer a patient to others – paramedics in this case – for physical examination through clinical assessment centers.
Similar models are in place in Ottawa at Brewer’s Park and Bell’s Corners and are working well, he said.
Chief Nolan said it’s a way to use some of the systems put in place during the COVID pandemic to continue providing care to Renfrew County residents.
“We don’t swab like we used to anymore,” he said. “We do quality care.
The county is looking for dedicated spaces that will work to serve the community. While during the pandemic many arenas and community centers have been in use, as they become busier with the resumption of programming, other venues are being considered. In Arnprior, for example, instead of using the Nick Smith Centre, there is now a new space for testing and assessment at the Grove Nursing Home.
VTAC continues to provide episodic primary care to people and it’s a much better option than going to the emergency room or calling 911, he said. The Clinical Assessment Center option provides the in-person assessment needed in some cases.
“It provides a way for the system to sort people out,” he said.
Chief Nolan said new technology allows paramedics to quickly consult with doctors or nurse practitioners to determine an accurate diagnosis. An example would be technology that allows a paramedic to look into a baby’s ear, take a recording, and share it with the doctor or nurse practitioner to see if an antibiotic prescription is needed for an infection. of the ear.
“And it’s happening right now,” he said.
Paramedics can also do ultrasounds and blood tests, he said.
In many ways, this is part of the ongoing work of the Community Paramedic Program which has helped frail seniors stay at home and receive assessments and care there as needed through paramedics.
Chief Nolan noted that while the 911 service is funded on a 50/50 model, with the province paying half and Renfrew County paying the other half, these new programs are fully funded by the Ontario government. The Integrated Care Model program is 100% provincially funded. The community paramedicine program is 100% funded by the province. The VTAC is 100% provincially funded and the clinical assessment centers are 100% provincially funded.
Paramedics in hospitals
Another innovative program that helps ease the burden of health care is having paramedics in hospital emergency departments. Chief Nolan said paramedics are now working regular shifts at Arnprior and District Memorial Hospital.
“Our paramedics are working in triage,” he said.
This helps ease the burden in the hospital for other healthcare staff. Paramedics are regularly placed on a 12-hour shift at the hospital.
“They’re in peak time and working in the triage office,” he said.
Paramedics support hospital staff by doing triage and other activities as needed. This allows nurses to work in other areas of the emergency department during peak hours.
Although the program is unique, there is a similar one at the Queensway Carleton Hospital in Ottawa.
Having paramedics in the emergency department to ease the burden was first discussed with the Pembroke Regional Hospital (PRH) a few years ago, but the formal program never got off the ground. At the time, there were some objections from hospital unions.
However, now there are also paramedics working at PRH using a slightly different model, more as needed.
Chief Nolan said that while paramedics are working in these various capacities across the county, people who call 911 for an emergency should always be very confident that there are paramedics ready to respond quickly to their emergency. In fact, helping to deal with medical situations close to home in a timely manner, such as through the Community Paramedic Program and Clinical Assessment Centers, means some calls are diverted from the 911 system. paramedics working in the emergency room ease the burden on emergency room staff, so paramedics don’t have to stay in the emergency room with patients waiting to discharge them.
“I would say there are more now because we’re creating these proactive models,” Chef Nolan said.
Debbi Christinck, Local Journalism Initiative Reporter, The Eganville Leader