Mobile clinics could revolutionize N.S. healthcare

Dr Ken BuchholzA senior Annapolis doctor says that just four mobile clinics could revolutionize healthcare for rural Nova Scotians – and they would come cheap. Dr. Ken Buchholz (pictured), a former senior physician advisor with the Department of Health, estimated that four fully-equipped trailers plus their support vehicles would cost just over $1 million. This is the same average price tag as a single bricks-and-mortar collaborative care clinic that the government plans to roll out across the province.

“Nova Scotia was once a leader in the country with this mobile health model, but it fell victim to fiscal restraint and a lack of vision by health department officials. Perhaps it is time to revisit the notion of mobile healthcare, but this time with an open mind and a more positive approach,” said Buchholz.

In 2013, Nova Scotians were served by two MediBus mobile health clinics based in the Head of St. Margaret’s Bay-Tantallon area. Buchholz said both were “cutting-edge.”

Each MediBus featured high tech secure video-consultations, a home visiting program, regular stops in a range of communities, and a secure electronic medical record platform to track patients. In addition, the mobile units were licensed phlebotomy clinics that brought the lab to local communities.

He said that caregivers on each MediBus were plugged into a desktop telemedicine link with a physician, and patients could be ‘seen’ by their consultant and their family practitioner without ever having to leave home. Additionally, the NP (nurse practitioner) and nurse on board could consult with an off-site physician for assistance if needed.

“The video link was stable on smartphones, tablets, PCs and Mac platforms. In addition, the platform integrated the medical record, so each provider could follow what a previous caregiver had recommended, essentially preventing “double-doctoring,” said Buchholz.

The MediBus held other advantages, including the use of expensive equipment in multiple communities at a fraction of the cost of fixed clinics. Healthcare providers can also cover large service areas effectively, including those patients living in isolated communities.

In many ways an early version of the government’s collaborative care clinics, a MediBus crew included doctors, nurse practitioners and nurses, nutritionists, physiotherapists, and respiratory and ECG technicians all working out of a single location.

The MediBuses ran for three months in 2013 and served about 1,000 patients.

According to Buchholz, such mobile units can go where and when they are needed: offering school-based care in the winter by supporting the SchoolsPlus program or setting up neighbourhood centres in the summer.

“Mobile health provides timely access to healthcare by reaching out to patients in their own communities, providing best available care in the most timely manner,” said Buchholz.

One MediBus was stolen but patient records remained safe thanks to the secure electronic filing system.

Bucholz said fixed clinics are necessary but “there are still far too many patients around this province waiting without practitioners, driving long distances to sit in ERs… get their prescriptions filled.”

Nova Scotia Health Authority spokeswoman Lesley Mulcahy said interim plans are being developed to help patients in need of primary medical care as collaborative care clinics are readied.

One possible plan is a vacancy replacement program, where family physicians complete rotations in communities deemed as high-need.

Other interim solutions could include mobile clinics, although “there are no current plans to implement those at this time,” said Mulcahy.

Backers of the new Our Health Centre in Chester – a collaborative practice – say that they are being actively held back by the Health Department.

Ministry of health spokesman Tony Kiritsis said that the department had committed a one-time grant of $500,000 in 2013 – 2014. Beyond funding, operational requirements rest with the Nova Scotia Health Authority, he said.

“We understand that the Health Authority will be reaching out to the group. We are not aware of any delays as a result of the department,” said Kiritsis.

Source: Chronicle Herald