White Coat, Black Art

How the pandemic sparked a new program that connects rural Ontarians to rapid-response health care

A new pilot program in rural Ontario is providing health-care services to thousands of people who don't have family doctors — and much of it is being done remotely, partly as a response to the COVID-19 pandemic.

The virtual triage assessment centre connects residents to health-care providers over phone or video chat

Community paramedic Matthew Cruchet pays a house call to Mary Lou Turner. Cruchet is the eyes and ears of family doctors and nurse practitioners. He does vital signs and can take blood, do an ECG and can also do an ultrasound. (Brian Goldman/CBC)

Originally published September 11, 2020

A new pilot program in rural Ontario is providing health-care services to thousands of people who don't have family doctors — and much of it is being done remotely, partly as a response to the COVID-19 pandemic.

The Virtual Triage Assessment Centre (VTAC) launched in late March, with the help of COVID-focused funding from the Ontario Ministry of Health. 

It connects residents who either can't travel or don't have a family doctor to primary health-care providers in the South Algonquin and Renfrew County townships on the west bank of the Ottawa River.

Residents can call a toll-free number and a receptionist sets up an appointment with a doctor or nurse practitioner, usually within hours. Most of these appointments are conducted over the phone or video chat.

Renfrew County already had 16 clinics equipped to help residents without a family doctor, said Michael Nolan, chief paramedic and director of emergency services for the County of Renfrew. But when COVID-19 hit and staff were ordered to stay home and close the clinics, the need to connect with the roughly 20 per cent of the county's 100,000 residents that don't have a family doctor became critical, he said.

The team got the program up and running after just 12 days of initial planning.

"It certainly wouldn't have happened as quickly, as completely or as effortlessly," he said.

"I don't say that in a way to minimize the amount of effort that it's taken ... but we were able to focus our efforts in a meaningful way, on providing a local solution to a global pandemic."

A 2019 report by the Canadian Institute of Health Information found that the number of doctors in Canada was growing at a rate more than double that of the population.

However, the institute's information manager Geoff Ballinger said that many Canadians still have trouble finding a regular physician — and that problem is exacerbated in rural or remote areas.

Making a house call

VTAC relies heavily on community paramedicine, a relatively new health-care model that teams up paramedics with family doctors and public health, to make house calls for check-ups and COVID-19 tests in underserved areas like Renfrew. 

"We have pockets of town spread throughout Renfrew County. But everybody that I see is living in the country in some shape, some way or form, whether it be an old farm, an old fishing lodge," said community paramedic Matthew Cruchet. 

Cruchet has been a community paramedic for five years, but his role has now become central to VTAC as the pandemic has forced many people to hunker down at home.

Dr. Brian Goldman speaks with community paramedic Cruchet. (Michael Nolan)

In July, White Coat, Black Art host Dr. Brian Goldman accompanied Cruchet during a house call to Mary Lou Turner, a Renfrew resident with multiple myeloma, a cancer of the white blood cells. 

Turner, 77, lives alone in a fishing lodge on the edge of Algonquin Park, far away enough from town that making an appointment at a clinic becomes difficult.

Cruchet chats about a recent fishing trip with his son, while he checks Turner's blood pressure and runs some other tests to pass along to her oncologist. As a community paramedic, he's visited her at least a dozen times in the last two years. She's thrilled to have a regular visitor — especially in recent months. Because of worries about COVID-19, she's only greeted other visitors through her window. 

"You have no idea how much I appreciate it," she said. "I'm not just trying to make Matt feel good, but it's true. And especially now with this virus, I don't want to go where there's other people — especially in a hospital. So this is special to me."

A pandemic 'silver lining'

Dr. Jonathan Fitzsimon, VTAC's physician lead and the chief of medicine at Arnprior Regional Health, hailed community paramedics for playing a key role as the mobile eyes and ears of physicians during their house calls. 

"There's an incredible synergy between community paramedics and family physicians. And I think we already knew that. We just hadn't really had the opportunity to fully exploit it."

Dr. Jonathan Fitzsimon, chief of medicine at Arnprior Regional Health and the physician lead for the Virtual Triage Assessment Centre (VTAC), attends a virtual meeting with other VTAC team leaders. (Brian Goldman/CBC)

The "silver lining" of the pandemic, he said, was that it provided the right opportunity to prove VTAC's usefulness and viability.

By the end of August, VTAC had completed 10,000 virtual appointments with a family physician, including 3,500 paramedic home visits, Fitzsimon said. They've also helped schedule 10,000 COVID-19 swab tests conducted at drive-through sites.

The total cost, he said, amounts to about five dollars per Renfrew County resident per month to fund VTAC's operations.

Fitzsimon hopes that it will prove itself invaluable enough to sustain funding and operate past the current COVID-focused pilot program, which will only last as long as the Ontario Ministry of Health continues to fund COVID assessment centres. 

"We are still a COVID-19 assessment centre. So there is a risk that at some point that definition and that funding tap could be turned off. I desperately hope it won't be," he said.

"I actually think that this could be a way forward for many remote, rural and Indigenous communities that have difficulty accessing primary care."

Cruchet has visited Turner over a dozen times in the last two years. He's a welcome visitor especially in recent months, as Turner otherwise only greets visitors through her window because of the pandemic. (Brian Goldman/CBC)

Back at the fishing lodge, Matthew Cruchet is helping Mary Lou Turner keep watch over her health while staying safe at home.

"You expect to hold my hand?" Turner joshes while Cruchet finishes drawing some blood for his tests.

"That's right, I do! It's the best part of my job," he counters.

Turner is all smiles. "I think the world of these people, I'm telling you."

Written by Jonathan Ore. Produced by Dr. Brian Goldman and Dawna Dingwall.


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