Patient partner supports big changes through remote consult in BC

Despite serious issues with her heart function, Edwina Nearhood has never been one to sit back and “let it all happen.” A native of rural British Columbia, Edwina lives by a culture of resilience where people work together to accomplish goals, and where communication is considered a key element of success.

Edwina has lived with congenital heart disease for 30 years. Specifically, she has hypertrophic cardiomyopathy, in which part of the heart becomes thickened and is less capable of pumping blood. Edwina has faced major barriers accessing specialist care from her home in Fort St. John, B.C. – largely, she believes, because her unusual health status confounded primary healthcare practitioners in her region.

“My challenges were largely around the mini biases associated with being young and having major heart problems,” said Nearhood. “For example, I was told that I had to lose weight to help manage my health, but the cause of my weight was the heart problem itself.”

When B.C.’s RACETM North participated in CFHI’s 18-month Connected Medicine quality improvement collaborative, Edwina jumped at the chance to become a patient advisor. “I take on every opportunity to support improvements in the healthcare experiences of women living with heart issues in rural and remote areas,” she said.

The Connected Medicine collaborative, a partnership between CFHI, the College of Family Physicians of Canada (CFPC), Canada Health Infoway (Infoway), and the Royal College of Physicians and Surgeons of Canada (The Royal College) spread two proven Canadian healthcare innovations that improve access to specialist advice by allowing primary care providers, such as family doctors and nurse practitioners, to ask questions concerning patient care to a specialist:

  • the Champlain BASE™ eConsult Service, which is a secure, web-based service providing access to specialist consultations first launched by the Chaplain Local Health Integration Network
  • the RACE™ (Rapid Access to Consultative Expertise) telephone advice line first launched at Providence Health Care and Vancouver Coastal Health

Edwina was instrumental in promoting a RACETM telephone consult line in the north. “We ended up going right to local folks, handing out posters and speaking one-on-one with doctors about the RACETM service. I recognized more than ever that I have a great ability to communicate and articulate. I was an equal on the team.”

The project team from RACETM North also worked with specialists on establishing the right tone with primary care providers (i.e. no question should be considered “dumb”) and on building respectful relationships with leaders in Indigenous communities. “I was most concerned with building good relationships from the outset,” said Edwina.

She said CFHI’s collaborative also did an exemplary job of bringing patients onboard. “They allowed me to bring out the best in myself. Through workshops, great listening and relationship building the collaborative taught me well what works in building a Connected Medicine initiative.”

Sheri Yeast, Northern Health’s Regional Manager, CD Strategic Planning, and Administrative Lead for Kidney Care, COPD and Diabetes, said this initiative enabled primary care providers to access 12 specialists – including nephrologists, cardiologists, diabetes specialists, and mental health physicians – from 9 a.m. to 5 p.m., Monday to Friday via the RACETM telephone consult line.

The organization’s participation in the Connected Medicine collaborative resulted in a strong uptick in access to specialist advice by primary care physicians. Between October 2017 and November 2018, the RACETM telephone line saw an average of 40.5 calls per month. Most calls (20 percent) were to cardiologists, with many calls also accessing specialists in infectious diseases, gastroenterology, orthopedics, psychiatry and nephrology.

“We have learned a lot about patient and stakeholder engagement through this collaborative, and by working with our patient partner (Edwina),” said Yeast. “With the collaborative at an end, we plan to maintain the RACETM line and continue to promote the service. We’ll explore expanding it provincially in partnership with Shared Care, other health authorities in B.C. and family practice divisions.”

For Edwina, the results of RACETM North’s participation in collaborative have been profound. She has benefitted from easier access to diagnostics and imaging, and care for her urgent needs. Edwina is now a patient registered with a provincial clinic and has a nurse practitioner managing her care.

“When you see an opportunity, it’s up to you to reach for it and support the change,” said Edwina. “Living by that value has been so important to the management of my health.”