Overview of Integration
Towards a Rural Health Strategy: Integration that Solves Rural Health Challenges
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Community Health Ontario
CHO is a strategic partnership between the: Association of Ontario Health Centres (AOHC), Ontario Community Support Association (OCSA) and Ontario Federation of Community and Mental Health and Addiction Programs/Addictions Ontario (OFCMHAP/AO). Together we represent the majority of not-for-profit home, community support, mental health, addictions and community-governed primary health care providers in Ontario. CHO envisions strong community-based services that address the social determinants of health as the key to a healthy society and are integrated and coordinated with the full continuum of care.
www.communityhealthontario.org 2
Healthy Community Collaborations
Healthy Community Collaborations (HCC) is a CHO project funded by the Trillium Foundation. Its aim is to support the community health sectors in their integration initiatives among themselves and with the broader health and social systems, in keeping with community health values such as: • • • • •
person-centred care community-driven, bottom-up process inter-professional collaboration strong relationships among sectors and across sectors overarching concern with the social determinants of health 3
Why a Focus on Rural Integration?
• LHINs moving forward with a variety of approaches • Community health organizations taking a pro-active role • Political parties and health sector players adopting a variety of different positions • MOHLTC has started, but not completed, development of a Rural Health Framework 4
Process
Review of key documents Meetings to address integration in rural areas Key informant interviews Compiling of draft results Your input! More meetings and interviews More input from key stakeholders White Paper finalized and distributed
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Geographic location is a determinant of health.
• Across Canada, the self-rated health of Canadians declines from the most urban regions to the most rural and remote • Rural residents have a lower than average life expectancy, are more likely to smoke, be overweight, and have arthritis/rheumatism and high blood pressure • Numerous studies find that social determinants such as low income and lower levels of education affect health more negatively in rural areas than in urban settings
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Key Rural Health Service Challenges
Hospitals often the default primary care provider Transportation and weather are significant barriers Basket of services is less comprehensive, available and accessible Continuum of care is fragmented by gaps in services, distances Limited availability of culturally and linguistically appropriate services Workforce recruitment and retention difficult Lack of access to affordable and alternative housing Limited sharing of health records and information across professionals Lack of ongoing research/sharing of existing research to improve services 7
Key Rural Health Policy Challenges
• Lack of rural perspective in LHIN and provincial planning • Population health data doesn’t explore social determinants of health • Population-based funding methodologies don’t take into account additional costs caused by dispersed populations, weather, geography • Rurality Index used to distribute additional funds based on service location not area covered • Historic trend toward centralization - need instead increased local flexibility to drive innovations and synergies across continuum of care • Worse health outcomes and higher delivery expenses is health equity issue 8
Integration Solution Debates
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Creation of hospitals hubs One administration for all services One governance for all services Integration around identified needs Addressing social determinants of health Building on existing relationships, trust, power dynamics Strengthening the role of the community health sector 9
Documented Service Integration Solutions
1. Community engagement in planning, delivery, monitoring and evaluation, by for example community governance and administration
Documented Service Integration Solutions
2. Collaborative care, bringing together multiple levels/sectors of community supports, e.g. community hubs (physical or virtual), interdisciplinary teams, multi-service centres
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Documented Service Integration Solutions
3. Implement enhanced scopes of practice for health providers. While to some degree this can be done and is being done locally, it will also depend on policy changes from the Ministry.
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Documented Service Integration Solutions
4. Improve transportation, including strengthened relationships between EMS (land and air) with planning and delivery of local health services at all levels, as well improved inter-facility transfers and non-urgent transportation
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Documented Service Integration Solutions
5. Technology: identify and implement telemedicine hubs and supports needed to improve equitable access, and use telemedicine and EMR to expand and enhance access to specialists and academic health sciences centres.
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Suggested Policy Solutions
• Planning that leverages small health facilities/agencies as potential local hubs • Planning that balances services close to home with those provided at LHIN and/or provincial-level, including referral centres, outreach networks • Enable enhanced scope of practice • Enable local flexibility to plan concerning transportation planning and delivery • Expand access to technology and supports • Meaningfully engage communities in policy, planning and funding • Enable inter-sectoral integration, including via funding and policy • Enhance funding for rural medical training • Determine Rurality Index based on area served rather than service location
What Do You Think?
• Did we miss any challenges, or include inappropriate ones? • Do the solutions presented resonate with your experience? • How has integration helped your organization or others in your area to address these or other challenges – or failed to do so? • Where do you see the greatest gaps in your integration, and do you envision any potential solutions? • Are there other emerging or good practices – or cautionary tales - from your experiences with rural health integration? 16
Annexes
• Healthy Community Collaborations Project Activities • Rural, Remote and Northern Definitions • Populations of Rural, Remote and Northern Ontario
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Healthy Community Collaborations Project Activities ∗ Help CHO partners to pursue back-office integration ∗ Develop and communicate common CHO positions to strengthen the voice of the community health sector in Ontario ∗ Identify the extent of community health sector integration and success stories, challenges though a member survey ∗ Help members address integration challenges and take advantage of opportunities through regional meetings ∗ Develop a Position Paper on Rural Health Integration ∗ Provide integration resources though an online repository ∗ Build members’ integration and collaboration capacities through learning events 18
Rural, Remote, Northern: Definitions
There are no agreed-upon definitions, making research and discussion a bit difficult, but MOHLTC’s still-in-progress Rural and Northern Health Care Framework offers working definitions: • ‘Rural’ communities in Ontario are those with a population of less than 30,000 that are greater than 30 minutes away in travel time from a community with a population of more than 30,000. • ‘Remote’ communities are without year-round road access, or rely on a third party (e.g. train, airplane, ferry) for transportation to a larger centre. • ‘Northern Ontario’ extends from the southern boundary of the District of Parry Sound, north to Hudson Bay and James Bay, and westerly from 19 Quebec to the Manitoba border.
Populations of Rural, Remote and Northern Ontario
• According to MOHLTC Framework, 1.9 million people in Ontario live in rural, remote and northern areas of the province • Only one LHIN, Toronto Central, does not include areas considered rural. • Northern Ontario is home to 26% of the provincial Francophone population and 40% of the provincial Aboriginal population, including 104 of the 134 First Nations communities in Ontario.
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Thank You!
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