British Columbia is a vast province consisting of a population that spans five regional health authorities and one provincial health authority. General care can be accessed within these health authorities; however, pediatric subspecialty care is mainly provided at our hospital located in Vancouver. This requires many families to travel long distances to receive subspecialty care.
The limited local access to subspecialty care and the burden of making visits to Vancouver impact the health outcomes of children living with chronic conditions outside of metropolitan Vancouver. Families face financial strain because of the cost of time off work, transportation, accommodations, child care, and food. From a safety standpoint, families also risk traveling in poor weather in the winter to maintain regular follow-up. This may cause families to postpone travel or decrease the number of visits to our hospital. A number of studies (Vierhout et al., 1995; Tyrer, 1990; Williams, 1989, as cited in Gruen et al., 2009) show that clinical outcomes are poorer when patients are not seen in follow-up regularly.
Current literature suggests that outreach clinics are beneficial in improving access to specialty care (Gruen et al., 2006), reducing costs of accessing care (O'Brien et al., 2001), and improving the proportion of patients living in rural or remote communities receiving guideline consistent care (Howe et al., 1992).
It is obviously challenging within a regional system of care to provide specialty level services, but with capacity building and increased support from our hospital within these communities, I believe that children and families throughout BC can receive standardized nursing care and experience improved health outcomes such as prevention of severe illness episodes and stability of condition.
At our hospital, we have developed a mentorship program to enhance the capacity of regional clinic nurses working with pediatric endocrine patients and families. In addition, we have made efforts to improve accessibility of hospital resources, standardize care by creating an online guide, and increase support to nurses in regional clinics by providing telehealth and in person in-services and telephone or telehealth consultations.
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© 2012 Published by Elsevier Inc.
