How one Ontario community avoided chaos at H1N1 clinics

TheStar.com – Opinion – How one Ontario community avoided chaos at H1N1 clinics: Sault Ste. Marie facility offers shining example of how primary care system delivers service
Published On Tue Nov 03 2009.   Michael Rachlis

Canadians are rightfully enraged at the chaos of last week’s H1N1 vaccine clinics. There must be a better way to run a vaccine program. There are two main reasons why the vaccine rollout looks like rush hour at a Mexican bus terminal.

Late last week, vaccine manufacturer GlaxoSmithKline notified the federal government that it would not meet its production quotas and would temporarily reduce the amount of vaccine delivered. As a result, British Columbia had no vaccine over the weekend and Alberta had no vaccine Monday.

However, there is a worldwide problem producing the vaccine. The horror stories in Canada are matched by those in the United States. And the federal government has already shipped 6 million doses of vaccine, which should be enough to vaccinate those at high risk – pregnant women, children 6 months to less than 5 years of age, people under 65 with chronic conditions, people who live with or care for infants under 6 months old and immuno-compromised people, and health-care workers. The real problem is delivering the vaccine to those who need it.

There are some communities in Canada that are delivering vaccine expeditiously to those who need it and we can learn from them.

For example, in Sault Ste. Marie, the Group Health Association Clinic is using its computerized appointment system to book patients for H1N1 vaccinations from throughout the Algoma Public Health Unit. Eighty per cent of “the Soo’s” residents get their health care from Group Health. The appointments schedulers have access to Group Health’s electronic medical record so they can ensure that the patients they book are indeed high risk. Patients arrive at the clinic and get their needle within 10 minutes. No waiting

Group Health has more than 60 doctors and 300 other staff and is cooperatively run by a community board and the Algoma District Medical Group. It has been a national leader in health-care innovation since it opened in 1963. The centre has had a computerized appointment system for 20 years and a comprehensive medical record since 1997. Roy Romanow referred to it as a “the jewel in the crown of medicare.”

In other parts of Ontario, public health is now delivering the vaccine to selected family doctors’ offices. Some might ask why public health didn’t simply give the vaccine to family doctors in the beginning. In fact, Ontario and some other provinces have been quietly distributing the vaccine to clinics and shelters dealing with very high risk populations such the homeless, AIDS patients and drug addicts.

Public health authorities balked at distributing vaccine to family doctors’ offices because much of it would have been squandered. Most Canadian family physicians still work in small offices with one or two doctors, a non-professionally trained receptionist and no electronic records. Many family doctors don’t even have adequate refrigerators to store the vaccine. The vaccine is packaged in multiple-dose vials so public health authorities were understandably concerned that much of the precious medicine would go to waste in doctors’ offices.

On Friday, Ontario officially announced it would distribute vaccine to family doctors who met criteria and requested it. These family practices know their high risk patients and are now inoculating them. In the midst of Toronto’s chaos and confusion, one of the city’s new family health teams is advertising this week’s vaccination clinics for its high risk patients in its website. No fuss, no muss, no waiting.

That’s how Canada could have rolled out the vaccine if we had a decent system of primary health care. Family doctors offices and community health centres would have vaccinated the patients they knew to be at high risk from their electronic health records. Public health then could have focused on groups like the homeless, who otherwise might not get the inoculated.

Thirty years ago, the father of medicare, Tommy Douglas, warned Canadians that we had only implemented the first stage of medicare: public payment for the old health system. He said the second stage of medicare would feature a new way of delivering services focused on prevention.

If there were a Group Health Centre in every Canadian community, the H1N1 vaccination campaign wouldn’t make us look like a Third World country. We need more effective primary health care in Canada and we need to seamlessly link primary health care to public health. Let’s not wait 50 years for the next pandemic to make this a reality.

Michael Rachlis is a health policy analyst and an associate professor at the University of Toronto.

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