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Virtual Learning Exchange in Virtual Primary Care

Health system leaders, communities and patients in northern and remote areas of Canada face unique challenges when developing, implementing and evaluating effective and sustainable healthcare solutions. These challenges are amplified by the rapid changes occurring across the health system due to COVID-19, particularly in the area of virtual care in primary care (as this recent rapid review, , shows).

The Canadian Northern and Remote Health Network (CNRHN) brings senior decision-makers, leaders, policymakers and practitioners to identify solutions to improve healthcare and the health status of people living in these areas of Canada.

All those interested in virtual primary care in northern and remote areas of Canada, and fostering networks of learning and innovation, were able to participate in Virtual Learning Exchange (VLE), in Virtual Primary Care in 2020鈥�21, delivered by 日本无码 and CNRHN.

Panel members shared learning in three 90-minute webinars, focusing on these identified priority topics within the overarching theme of virtual primary care:

• Cultural Safety and Indigenous Partnership
• Enhancing Equity and Access
• Patient and Family Centred and Partnered Care.

Cultural Safety and Indigenous Partnership: A Story of Bringing Virtual Primary Care Services to Community from the First Nations Health Authority

November 27, 2020

Following an opening land acknowledgement and ceremony, co-host Kelly Brownbill shared her experiences delivering cultural safety training for over 25 years, including considerations reflecting the increased shift to virtual service delivery as a result of the COVID-19 pandemic.

Eyrin Tedesco then spoke about the First Nations Health Authority (FNHA) and the variety of virtual healthcare services they provide 鈥渢o First Nations people in BC who have limited access to healthcare services in their communities, who must travel long distances for appointments or whose access to healthcare has been disrupted by the COVID-19 pandemic鈥�. She shared their process of engaging and partnering with communities to co-design and deliver services that meet local priorities, grounded in cultural safety. These efforts contributed to the development of the recently launched program.

To learn more about the work that the FNHA is doing in virtual primary care, please visit: .

Learning objectives

The learning objectives discussed and explored together were:

• Cultural safety and Indigenous partnership in virtual primary care, including what may be needed to support culturally appropriate care.
• Opportunities and challenges that have emerged with virtual primary care, and how we can sustain and grow culturally safe virtual care (co-developed in partnership with Indigenous patients, families and communities, and with patients and families as members of the care team).

Speakers

Fiona MacLeod

Fiona MacLeod is the Clinical Project Manager with the FNHA Primary Care and e-Health Team. Fiona graduated from nursing school in 2004 and completed a Masters in Intercultural and International Communication in 2012. Soon after graduating from nursing school, Fiona found her passion in community-based work. She has since worked in outreach programs supporting people living with substance use and HIV, in First Nations community health, and as a nursing practice consultant with FNHA. Fiona is also a certified Project Management Professional. Fiona is excited to have the opportunity to combine her community, clinical and project management experience in her role on the FNHA Primary Care and e-Health Team, and to be able to support the innovative work the team is doing in virtual health across the province. Fiona lives, works and plays on the beautiful traditional, ancestral and unceded territory of the Syilx Nation.

Eyrin Tedesco

Eyrin Tedesco is the聽Clinical Director of Primary Care Development and eHealth with the FNHA. Eyrin, alongside her exceptional team, has led First Nations health services in the integration of primary care, clinical eHealth pathways and technologies that enhance and support the delivery of health and wellness programs to all 203 First Nations communities in British Columbia. Creative and dynamic in her approach to leadership, Eyrin is known for developing and implementing innovative health initiatives while fostering strong relationships with community based, regional and provincial stakeholders.

Eyrin holds a Master鈥檚 of Health Administration from the University of British Columbia as well as a Bachelor of Arts degree and Bachelor of Science in Nursing degree, both from Vancouver Island University. Eyrin currently works and plays in the聽unceded聽territory of the聽Snuneymuxw聽First Nation聽on Vancouver Island, British Columbia.

Kelly Brownbill

Kelly Brownbill's spirit name,聽Wabunnoongakekwe, means Woman Who Comes from the East and she is proud to be Wabizhashi Dodem,聽Marten Clan.聽 She is a member of the Flat Bay community of the Mi鈥檏maq Nation in Newfoundland.

As an educator on Indigenous issues, she has conducted countless cultural awareness training sessions and provided support for a broad range of service sectors including key staff from both the provincial and federal governments. Her aim is to make sure all service providers, Indigenous or non-Indigenous, are as effective as possible in making healthcare accessible for First Peoples in culturally safe and appropriate ways. She has published Indigenous perspectives in two peer-reviewed texts and is the Senior Editor of 4Canoes magazines and Canoe Kids children鈥檚 books.

Kelly honours the wisdom and vision of her Elders and she continues to seek their assistance with her ongoing journey. For more information, please visit .

Enhancing Equity and Access: Sharing Lessons Learned and Promoting Equitable Health Systems from the Saskatchewan Health Authority and the Northern Regional Health Authority

January 29, 2021

Charlene Lafreniere, Chief Indigenous Health Officer with Manitoba鈥檚 Northern Regional Health Authority (Northern Health Region or NHR) 鈥� a ground-breaking role in northern health systems 鈥� and co-host Maria Judd (Vice President, Strategic Initiatives and Engagement, 日本无码) explored with participants the realities of addressing equity and access in delivering virtual primary care programs and services.

With increased need for virtual care due to the global pandemic, this event then showcased lessons learned from two health regions that are addressing inequities and barriers to access using virtual care programs and technologies. Dr. Harsahil Singh and Julie Jacobs from Manitoba鈥檚 NHR shared their experiences of developing and delivering relevant and safe virtual care by working with the community, building trust and relationships. Building on that same theme, Dr. Ivar Mendez from the Saskatchewan Health Authority discussed the increased embrace of technology as a medium or tool for allowing for patients to receive timely primary care, alongside their families and in their communities 鈥� both northern and remote.聽

To learn more about the work being done to promote equity and access to virtual primary care by:

• Manitoba鈥檚 FNHA, please visit:
• the Saskatchewan Health Authority, please visit: .

Learning objectives

The learning objectives discussed and explored together were:

• Enhancing equity and access in virtual primary care, including what may be needed to help bridge gaps and address barriers to the provision of virtual primary care.
• Opportunities that have emerged with virtual primary care, and how we can enable continuity of care and enhance equity regardless of location.

Speakers

Charlene Lafreniere, Chief Indigenous Health Officer, Northern Health Region, Manitoba

Born and raised in Thompson, Manitoba, Treaty 5 territory and on the Traditional Lands of the Nisichawayasihk Cree Nation, Charlene Lafreniere is a proud northern Indigenous woman, who values her time with family and friends, especially her beautiful daughter Sage. In September of 2019, Charlene joined the NHR as the Chief Indigenous Health Officer. As an executive member of the NHR, she leads engagement with Indigenous partners and communities. She is the trainer for cultural proficiency and cultural safety for all NHR staff. Prior to that she was the Director of Institutional Advancement at the University College of the North, Executive Director of the Thompson Neighborhood Renewal Corporation and Director of Justice at Manitoba Keewatinowi Okimakanak. In 2006, Charlene was elected as a Thompson City Councillor for two four-year terms and served as Deputy Mayor for two years. Charlene has and continues to serve on many boards and committees, and leads multi-sectoral tables, all with the intention to make life better for Northern and Indigenous people.

Dr. Harsahil Singh, Medical Director, Primary Care Clinics, Northern Health Region, Manitoba

Dr. Harsahil Singh is a Family Physician, a Family Practitioner in Oncology and Medical Director of Primary Care Clinics of the NHR, Manitoba. Since 2014, he lives in Thompson, which is 762km from Winnipeg. Dr. Singh graduated from medical school in 2008 in India, and he practiced there in a rural setting. Building on his experience and passion, he continued his journey working in rural and remote areas, and Northern Manitoba offered him the perfect opportunity. He has serviced multiple remote First Nations communities including Shamattawa, Oxford House, Lac Brochet, Split Lake and Tadoule Lake. During system transformation, he served as the co-chair of the provincial clinical team for Primary Health with Shared Health Manitoba in 2018鈥�2019, with the vision to democratize healthcare resources across the province. He continues to work advocating for equitable access in his current clinical and leadership roles.

Juliana Jacobs, Director, Primary Care & Home Care, Northern Health Region, Manitoba

Juliana Jacobs is the Director of Primary Care & Home Care in the NHR and resides in Thompson, Manitoba, located on Treaty 5 territory and on the Traditional Lands of the Nisichawayasihk Cree Nation and Homeland of the Metis. Juliana is a Registered Nurse and obtained a BScN from McMaster University in 2002. In 2003 she moved to Thompson, Manitoba and since then has worked in a variety of communities throughout northern Manitoba and Nunavut. Her experience in the north includes acute care, flight nursing, remote health centres and primary care. In 2009 she completed a Master鈥檚 in Nursing through Athabasca University and worked as a nurse practitioner in primary care until 2016 when she moved into her current role. She is actively involved in the provincial health transformations and continues to support and advocate for equitable and accessible care.

Dr. Ivar Mendez, Fred H. Wigmore Professor and Provincial Head of the Department of Surgery at the University of Saskatchewan and Saskatchewan Health Authority

As a Clinician/Scientist, Dr. Mendez鈥� research focus is in functional neurosurgery, brain repair, stem cells and remote presence robotic technology. His laboratory research has been supported by peer-reviewed funding from a number of sources including the Canada National Centers of Excellence, Canadian Institutes of Health Research and Canada Foundation for Innovation. For the past decade, he has worked in the use of remote-presence robotic technology. His work in robotics has focused on rural and remote healthcare, with particular emphasis on improving First Nation鈥檚 communities access to healthcare. In 2002, Dr. Mendez and his team performed the first long distance telementoring neurosurgery in the world and in 2013, he reported the first experience in remote programming for neuromodulation devices. Dr. Mendez has over 190 scientific publications and has given over 230 national and international lectures. In 2020, during the COVID-19 pandemic, Dr. Mendez and his team pioneered the use of remote telerobotic ultrasonography for prenatal care for Indigenous women in locked-down outbreak communities in the Saskatchewan North.

Dr. Mendez has received numerous awards including the Royal College of Physicians and Surgeons of Canada Medal Award in Surgery, the 2010 Canadian Red Cross Humanitarian Award, the Health Canada Award in 2011 for his contribution to the improvement of the health of Canadians and the Government of Canada Public Service Award of Excellence in 2016 for the use of remote presence robotic technology in the Canadian North.

Patient and Family Centred and Partnered Care: Sharing Experiences and Perspectives from Remote and Northern Communities in Yukon and Alberta

March 5, 2021

In the third and final event of this series, participants further explored the importance of building and sustaining trusting relationships in delivering virtual primary care.

In response to growing needs and requests from community, Dr. Amy Gausvik and Michelle Hoeber shared their experience in leading the initiative to launch the Alberta Indigenous Virtual Care Clinic (AIVCC) - an initiative the First Nations Technical Services Advisory Group Inc. (TSAG) and is supported by Indigenous Services Canada, Alberta Health Services and Alberta Health. The AIVCC provides same-day virtual primary care appointments that focus on being medically and culturally safe and accessible for First Nations, M茅tis and Inuit patients living in Alberta.

Michelle Stimson, Person with Lived Experience from the Yukon, spoke to her experiences accessing primary care in the territory and how virtual care has changed how she accessed programs and services, discussed what is working well and what barriers still exist. Joined by colleague Lauren White, they also talked about what it took to build, and maintain, a trusting relationship as partners in health and social services system improvement.

To learn more about the AIVCC, please visit: .

Learning objectives

The learning objectives discussed and explored together were:

• Utilizing virtual care as a medium to improve access, relationships and interpersonal care, while ensuring patients and families are at the center of the care model and woven through decision-making processes.
• The importance of engagement and building trust at the community level, to support and enhance patient-centred care in northern and remote settings.

Speakers

Michelle Stimson, Person with Lived Experience

Lauren White, Engagement Leader, Government of Yukon Department of Health and Social Services

Dr. Amy Gausvik, Family Medicine Physician, Alberta Health Services

Michelle Hoeber, Clinic Manager, Alberta Indigenous Virtual Care Clinic

Michelle Hoeber is the Clinic Manager of the AIVCC and Program Lead of Telehealth with the First Nations Technical Services Advisory Group Inc. Michelle has been working in telehealth for over 20 years; she has helped develop and establish some key virtual initiatives across the province that are still in place today. Michelle initially started her IT career with the Alberta Cancer Board where she played a key role in developing virtual pharmacy clinics across Alberta. Now working at TSAG for the past 11 years, Michelle has dedicated her time to ensure the First Nation communities within Alberta receive quality clinical and education telehealth services via the First Nations Telehealth Network. Michelle is a Red River Metis and is a descendent of Gabriel Dumont. She is happily married with two sons and lives in Treaty 6 Territory in Alberta.