Background/ Why Is This Important?
Ensuring that children across the province have easy access to subspecialists continues to be important, particularly for those who are ill with chronic health conditions. Travel to Vancouver can be very challenging, costly and disruptive to children and families. Children miss school, parents miss work, siblings are impacted and costs of travel can be a significant burden.
In the past 10 years since Child Health BC was formed, the growth in the numbers of outreach visits provided by BC Children’s’ teams has been impressive, and the child health service system has grown stronger. Ten years ago (2006/07), in the first year of Child Health BC, six subspecialty pediatric medical/surgical programs from BC Children’s Hospital initiated some outreach. Now, in the year 2015/16, there are 11 clinic areas with ever expanding locations of service. In the past three years alone, between 2013/14 to 2015/16, outreach patient visits by BC Children’s Hospital subspecialty teams supported by Child Health BC increased by over 30 per cent.
Telehealth is another important strategy for increasing access to subspecialty care, and is addressed here.
What Actions Have Already Been Taken?
Outreach team members can include subspecialty physicians, nurses, physiotherapists, echo sonographers and dieticians; depending on the needs of children they serve. Clerical support for the outreach activities has also been an important part of the service. The development of standardized roles and processes has allowed improvements of service delivery in the regional health authorities.
Cystic Fibrosis: Children with cystic fibrosis make many trips over their lives to see the subspecialty team at BC Children’s. The team is now travelling to Prince George and Kelowna to see families as part of their care, as well as Victoria where they work with a regional pediatric cystic fibrosis team to serve children on the island. BC Children’s Hospital team members include the subspecialty pediatrician, sub-specialty nurse and physiotherapist. An expert pharmacist is also part of the team when needed.
Cardiology: A team including a pediatric cardiologist, a sub-specialty cardiology nurse and a pediatric echosonographer travel to 12 different communities in BC & Yukon, including Surrey, Trail, Penticton, Kelowna, Kamloops, Vernon, Williams Lake, Fort St. John, Prince George, Terrace and Whitehorse. Meanwhile, patients in Hazelton get access to care from a cardiologist and nurse.
Dermatology: Regional dermatologists provide service in many BC communities, but outreach by a pediatric dermatologist helps children in the Northern Health communities of Prince George and Terrace, where there are no regional dermatologists.
Endocrinology: This subspecialty team includes a pediatric endocrinologist and sub-specialty pediatric nurse visit Prince George, Abbotsford, and Kelowna and provides care to children with diabetes and other endocrine conditions such as growth disorders. The outreach clinic to Kelowna was new in 2016, and now children in the Interior Health can also see the BC Children’s Hospital team without travel.
Gastroenterology: The gastroenterology team treats children with problems relating to their digestive system and liver, which may include such conditions such as Crohn’s disease, Inflammatory Bowel Disease and congenital problems. A pediatric gastroenterologist and sub-specialty nurse travel to Nanaimo and Prince George to see children on the island, and new in 2016/17, are travelling to Victoria. Plans are underway to start an outreach clinic in Kelowna where many children and families will benefit from this expert team.
Hemophilia: This team cares for children with blood disorders, such as hemophilia. The team includes pediatric hematologist, nurse practitioners, and physiotherapist. Some clinics also include an attending social worker. The team travels to Victoria, Kelowna and Prince George to see children as part of their ongoing care.
Nephrology (Renal): A team including a pediatric nephrologist and both a sub-specialty nurse and dietician provide expert care to children in Prince George and Surrey. This has been an area of growth in 2016, with the addition of a new outreach clinic in Surrey, and the addition of a full team service in Prince George to act as a complement existing physician outreach. Surrey clinics play an important role in meeting the needs of children who live not only in Surrey, but also in the more distant communities of the Fraser Health Region, such as Hope. Nephrology has seen impressive growth in outreach considering the new clinics began in the fall of 2015.
Neurology: Travelling teams of a sub-specialty nurse and pediatric neurologist aid the high volumes of patient visits at BC Children’s and growing telehealth with regular outreach to five different BC communities.
Rheumatology: The pediatric rheumatology outreach team from BC Children’s Hospital includes a subspecialty pediatric rheumatologist and subspecialty nurse and physiotherapist. Clinicians see children in Surrey, Prince George and Terrace to treat their childhood rheumatic diseases, such as juvenile idiopathic arthritis, and conditions such as lupus, vasculitis, inflammatory myositis and fever syndromes.
ENT (Ear, Nose, and Throat): Pediatric ENT surgeons are found in many areas of the province, but remote and rural areas are often without local access. The ENT outreach service improves that access by visiting the Sechelt Peninsula and Prince George, and arriving in 2016/17 to Bella Bella and Bella Coola.
Ophthalmology: A pediatric ophthalmologist and pediatric orthoptist travel to Prince George four times a year to compliment the local ophthalmologists care for children who need a more specialized team. Orthoptists are highly specialized optical professionals who treat eye muscle imbalances, eye alignment troubles, focusing errors, and nerve issues.
Where Are We Going Next?
The years ahead will see existing pediatric subspecialty outreach grow to new communities, and the addition of new clinical programs using outreach as a means to better reach families, when their own community does not have the capacity to provide the specialized health services they need. The travelling teams will complement their service to children and families across BC with telehealth and services that need to be provided at the only Tier 4 Children's Hospital in BC – BC Children's Hospital.