Cover

Safeguarding the country life

Two rural regions lead their section with impressive scores as they face up to the challenge of serving widely dispersed populations

Brian Bergman June 5 2000
Cover

Safeguarding the country life

Two rural regions lead their section with impressive scores as they face up to the challenge of serving widely dispersed populations

Brian Bergman June 5 2000
If persons in Prince Edward Island need brain surgery, chances are they will be sent to Moncton, N.B. The same goes for any patient from the northern reaches of New Brunswick who requires kidney dialysis. Or even a cancer sufferer living across the Nova Scotia border. Moncton’s two hospitals treat 200,000 mostly working-class people scattered across the economically challenged southeast corner of the province. But as the main referral facilities for complex procedures in the area, the Moncton and the Dr. George L. Dumont Regional hospitals also get more than 20 per cent of their patients from far-off regions of New Brunswick or parts of two neighboring provinces. “If they are referred to us they are really sick,” says Gitta Kulczycki, acting chief executive officer for Moncton Hospital. “The demands are immense.”

The specialized services help bring up the ranking scores for those distant health regions that rely on Moncton’s expertise. But the same skills are apparently a blessing for the Moncton region’s own residents, giving them access to specialist care relatively close to home. In the rankings of the services available to a region’s residents, Moncton ties for first place in the “largely rural” category. The result suggests that the local health workers—from specialists, to local clinics and outpatient services—have a good handle on the region’s needs.

Moncton ranked second among all 50 regions in minimizing low birth weights, and sixth overall in avoiding hip fractures. The 412-bed Moncton Hospital has specialists in neuro-, vascular and thoracic surgery, provides chemotherapy for cancer patients, runs a neonatal intensive-care unit and treats HIV and other infectious diseases. George L. Dumont, with 423 beds, mainly serves the areas large French-speaking community. It offers radiation treatment as well as chemotherapy for cancer patients, kidney dialysis and an obstetrics clinic. “We have different specialties,” says Pierre Le Bouthillier, chief executive at George L. Dumont. “But we cover the waterfront.”


Each hospital will soon install new magnetic resonance imaging units to improve the detection of cancer, brain ailments and bone disease—at $3 million to $4 million per unit. And the George L. Dumont has a project under way to reduce the number of days patients spend in hospital— a measurement, to some extent, of the availability of followup care in the community. That is one area in which New Brunswick’s health regions fared poorly in the rankings.

Maintaining high marks in the midst of fiscal restraint has taken some scrambling. Administrators at both hospitals contend they have done a good job of cutting administrative and support costs to save money for patient care. Even so, the breaking point may be near. The province has given every New Brunswick hospital until June 15 to develop “action plans” for balancing their budgets. Specialists, however, are already in short supply, a fact underlined by the current 5 ’/2-month wait for orthopedic surgery at Moncton Hospital, which posted a $9.7-million loss in the last fiscal year. At George L. Dumont, 10 to 15 patients sleep in the emergency ward most nights because no beds are available in the wards. “We can try to squeeze here and there,” says Le Bouthillier, whose facility was $6 million in the red last year. “But maintaining the basic necessities is going to be a big challenge.” John DeMont


LETHBRIDGE: Top-quality doctors

Stretching eastward from the Rockies to the prairie sugar-beet fields near Taber, halfway across the province, the Chinook Health Region takes in a broad, scenic swath of southwest Alberta. It is a land of ranchers, farmers and urban dwellers—the latter mostly centered in Lethbridge. It is also home to one of the highest proportions of senior citizens in the province—just under 14 per cent of the region’s 150,000 residents are over 64. So when Gil Tourigny, chief executive officer of the Chinook Health Region, is asked to cite the initiatives he is most proud of, it’s not surprising that he names several targeted at seniors. Among them: a 4 5-bed geriatric assessment and rehabilitation unit and a series of “enhanced” seniors’ lodges that provide enough professional care to keep the elderly out of nursing homes for longer. “Seniors consume the greatest proportion of health-care resources,” says Tourigny. “They have an impact on everyone in the system.”


In southwest Alberta, few patients have to be referred to the big center


While seniors are an obvious priority, Tourigny believes the success of the Chinook health authority—tied for top spot in the rankings’ “largely rural communities” category—has much to do with a government-imposed effort to reorganize health-care delivery. In 1995, Alberta merged 250 hospital and health-care boards into 17 regional and two provincial authorities. The Chinook region’s single authority replaced 14 boards. As well as streamlining administration, the reforms gave the regions control over nearly every aspect of health-care delivery— and the authority to quickly shift resources from one sector to another. “The trick,” says Tourigny, “is to rise to the highest common denominator when you do these things.”

Currently, the big push is to improve the level of long-term care. Five years ago, notes Tourigny, there were no waiting lists for long-term beds in the Chinook region; projections now show a need for about 250 new spaces by 2006. “A major issue,” he says, “is to make sure we provide enough bed spaces for our seniors so the acute-care side can continue to function efficiently.” Fortunately, adds Tourigny, the Alberta government appears to understand the challenge; last week, the Chinook region secured $4.5 million in new provincial funding for long-term care.

Although primarily a rural region, Chinook exports few patients to larger centers. The main exceptions are open-heart and neurosurgery patients, who normally travel to Calgary or Edmonton. Tourigny credits the regions self-sufficiency to the talent of its medical staff. “When I moved here from Calgary five years ago,” he says, “I was overwhelmed by the quality of both our medical specialists and our rural family docs.”

In the rankings, Chinook scores relatively poorly in terms of physicians and specialists per capita. “But if you compare us to other smaller centers, I think we re not so bad,” says Tourigny. “We don’t have a shortage of physicians and we have almost every specialty covered.” But the rankings correctly identify one shortcoming, he acknowledges, in the area of preventable admissions—people whose conditions do not necessarily require a hospital stay. “There’s a rural factor in play,” Tourigny says. Because some residents have to travel distances for care, “our physicians sometimes choose to admit patients for observation, whereas that might not be necessary in a large urban center.” It is a reminder that delivering health care in rural Canada presents its own set of challenges. Brian Bergman



Rank by region

Rank last year / Overall Scores / Overall Ranking

1* Moncton, N.B. — / 81.9 / 17*

1* Lethbridge, Alta. — / 81.9 / 17*

3 Nanaimo, B.C. — / 80.8 / 22

4 Trois-Rivières/Drummondville/ Shawinigan, Que. — / 78.9 / 30*

5 Red Deer, Alta. — / 78.1 / 33*

6 Yarmouth/Digby, N.S. — / 77.7 / 35

7* Thunder Bay, Ont. — / 76.9 / 37*

7* Owen Sound, Ont. — / 76.9 / 37*

9 Saint John, N.B. — / 76.3 / 41

10 Fredericton 15 / 75.3 / 44

11 Hull/Aylmer, Que. — / 74.6 / 45

12 Antigonish/Cape Breton, N.S. — / 73.9 / 46

13 North Bay/Huntsville, Ont. — / 73.7 / 47

14 Prince Edward Island — / 73.6 / 48

15 Sudbury/Sault Ste. Marie, Ont. 16 / 72.5 / 49

16 Prince George, B.C. — / 72 / 50

* indicates a tie



OUTCOMES

Life expectancy

* Moncton, N.B. 13*

1* Lethbridge, Alta. 28*

3 Nanaimo, B.C. 18*

4 Trois-Rivières/Drummondville/ Shawinigan, Que. 40*

5 Red Deer, Alta. 18*

6 Yarmouth/Digby, N.S. 18*

7*Thunder Bay, Ont. 46

7* Owen Sound, Ont. 28*

9 Saint John, N.B. 39

10 Fredericton 35*

11 Hull/Aylmer, Que.43

12 Antigonish/Cape Breton, N.S. 47

13 North Bay/Huntsville, Ont. 44*

14 Prince Edward Island 28*

15 Sudbury/Sault Ste. Marie, Ont. 49*

16 Prince George, B.C. 49*

* indicates a tie



PRENATAL CARE

Low birth weight / Caesarean section / Births after c-section

1* Moncton, N.B. 2 / 30* / 45

1* Lethbridge, Alta. 10 / 7 / 26*

3 Nanaimo, B.C. 4 / 37 / 28*

4 Trois-Rivières/Drummondville/ Shawinigan, Que. 25* / 8* / 10*

5 Red Deer, Alta. 19* / 26 / 10*

6 Yarmouth/Digby, N.S. 47* / 22 / 38*

7*Thunder Bay, Ont. 1 / 35 / 32*

7* Owen Sound, Ont. 13* / 30* / 38*

9 Saint John, N.B. 38* / 32* / 44

10 Fredericton 11* / 47 / 49

11 Hull/Aylmer, Que. 34* / 27 / 43

12 Antigonish/Cape Breton, N.S. 13* / 19* / 8

13 North Bay/Huntsville, Ont. 7 / 49 / 50

14 Prince Edward Island 8* / 43* / 26*

15 Sudbury/Sault Ste. Marie, Ont. 32* / 46 / 47

16 Prince George, B.C. 38* / 48 / 48

* indicates a tie


COMMUNITY HEALTH

Hip fractures / Pneumonia and flu

1* Moncton, N.B. 6 / 37

1* Lethbridge, Alta. 1 / 28

3 Nanaimo, B.C. 37 / 20

4 Trois-Rivières/Drummondville/ Shawinigan, Que. 16* / 5

5 Red Deer, Alta. 11 / 49

6 Yarmouth/Digby, N.S. 31* / 39

7*Thunder Bay, Ont. 40* / 29

7* Owen Sound, Ont. 49 / 44

9 Saint John, N.B. 25 / 45

10 Fredericton 7 / 46

11 Hull/Aylmer, Que. 30 / 35

12 Antigonish/Cape Breton, N.S. 39 / 50

13 North Bay/Huntsville, Ont. 50 / 43

14 Prince Edward Island 44* / 48

15 Sudbury/Sault Ste. Marie, Ont. 43 / 42

16 Prince George, B.C. 35 / 47

* indicates a tie


ELDERLY SERVICES

Hip replacements / Knee replacement / Possible patients

1* Moncton, N.B. 11 / 23 / 36

1* Lethbridge, Alta. 3 / 5 / 20*

3 Nanaimo, B.C. 35 / 26 / 12*

4 Trois-Rivières/Drummondville/ Shawinigan, Que. 44* / 40 / —

5 Red Deer, Alta. 116 / 11 / 33*

6 Yarmouth/Digby, N.S. 18 / 13* / 25*

7*Thunder Bay, Ont. 27* / 30 / 23*

7* Owen Sound, Ont. 2 / 3 / 25*

9 Saint John, N.B. 25 / 6 / 25*

10 Fredericton 21* / 9 / 39

11 Hull/Aylmer, Que. 39 / 39 / —

12 Antigonish/Cape Breton, N.S. 8 / 4 / 31*

13 North Bay/Huntsville, Ont. 9 / 16 / 30

14 Prince Edward Island 15 / 35 / 37

15 Sudbury/Sault Ste. Marie, Ont. 33 / 27 / 22

16 Prince George, B.C. 1 / 2 / 31*

* indicates a tie