Winnipeg Free Press - PRINT EDITION
Manitoba's quick health-care fix
Few people have heard of them, the Opposition decries a lack of consultation, but patients who have used them have high praise for Quick Care clinics
They were touted as a way for folks with minor health ailments to avoid six- to eight-hour waits in hospital emergency rooms, but in the 18 months since the first Quick Care clinic opened on McGregor Street, the clinics -- staffed by nurses and nurse practitioners -- have largely operated below the public's radar.
The two Winnipeg facilities -- a second opened last November on St. Mary's Road -- are fully staffed, and patient volumes have climbed, mainly through word of mouth.
But health officials have found it more difficult to attract and retain staff in the clinics in Selkirk and Steinbach, both of which are operating well below capacity and are having difficulties maintaining regular hours.
The province says that's about to change. A batch of hirings taking effect this fall will see two nurse practitioners in each clinic (but not always at the same time) with up to three registered nurses.
With the staffing issues hopefully solved, the province plans to launch an $80,000 advertising blitz in the next few months to trumpet the Quick Care clinics not only as an alternative to hospital ERs, but as a community health resource where you can receive immunizations, get advice on birth-control options, or even receive assistance in finding a family doctor.
According to Health Department officials and staffed employed in the Winnipeg clinics, the feedback from the public has been positive.
"Probably no other initiative since I've been here has inspired more people to write to our office to say nice things," said Health Minister Theresa Oswald, who has held the portfolio for seven years.
Once fully staffed, the four Manitoba clinics will have a combined annual budget of close to $3.2 million. Four more clinics are expected to sprout up in the next 18 months -- all in Winnipeg.
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Annabelle Reimer has been a nurse practitioner (NP) since 2010 and a registered nurse for two decades, working in community and hospital settings as well as in northern nursing stations.
Now she is the lead nurse practitioner for the province's Quick Care clinics, doing hands-on care and mentoring less experienced NPs as they settle into their practices.
One of the reasons the province has found it difficult to staff its clinics is nurse practitioners have become a hot commodity across Canada as governments struggle to improve access to medical services and control costs.
"Right now, the demand for nurse practitioners is definitely higher than the supply," Reimer said in a recent interview at the St. Mary's Road Quick Care clinic.
To become an NP, you must be a registered nurse with a degree and then complete a master's-level program. The University of Manitoba and a distance education program run by Athabasca University are among the sources of new graduate nurse practitioners recognized by the Manitoba College of Registered Nurses.
In Manitoba, NPs can prescribe a range of medications, order diagnostic tests such as MRIs and do many other tasks usually performed by doctors. Recently passed legislation -- still to be proclaimed -- will also give hospital admitting privileges to nurse practitioners.
Reimer said the Quick Care clinics allow NPs such as herself to make use of all their training. "It's a high learning environment. There's absolutely no opportunity for boredom."
The clinics act as walk-ins, although there are limited opportunities to book appointments. If a clinic is crowded, staff will make an appointment for people to return at a specific time later in the day. The idea is to not keep folks waiting for hours.
"Quick care isn't right-this-second-care, (but) it is definitely quicker than the other options," said Frankie Scribe, manager of Quick Care clinics for the Winnipeg Regional Health Authority.
In the city, if one Quick Care clinic is backed up with patients, it can forward clients to the other one, she said. In a year or so, when there are six clinics operating in Winnipeg, there will be even more ability for the facilities to even out the work.
"We don't operate (each clinic) in silos," said Scribe. In certain cases, bus fare or even taxi fare can be provided to patients to receive treatment elsewhere, she said.
Unlike regular walk-ins, clients can bring up more than one medical issue -- although if they have a long shopping list of problems and the waiting room is full, the NP may ask them to prioritize the top two and ask them to return the next day.
Reimer stressed the clinics are designed to complement other players in the health system, such as private-practice doctors -- not replace them.
"Our role is never to replace your regular provider. We strongly encourage that you follow up with your regular provider," she said.
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Manitoba's Progressive Conservative Opposition accuses the province of setting up Quick Cares in direct competition with private clinics.
Health critic Cameron Friesen (Morden-Winkler) said Health Minister Oswald seems to be taking "an ideological approach" in the location of the clinics as well as in deciding to create stand-alone entities staffed by nurse practitioners when it might make more sense to encourage NPs to work in tandem with family doctors in private practice.
He's also critical of the government's failure to fully staff clinics outside the city, noting the Selkirk centre has at times only been staffed by registered nurses, with no nurse practitioner available. That, he said, amounts to "false advertising."
The NDP's plan is to spread the Quick Care clinics throughout the city. In addition to the McGregor facility and the St. Mary's Road facility in Norwood, there are clinics planned for Southdale, Seven Oaks, west Winnipeg and St. Vital.
"It seems a bit absurd that the minister locates her Quick Care clinics in areas of this city, for instance, where they directly compete with walk-in clinics and other clinics that are immediately adjacent in the area and meeting the need," Friesen said. "What about under-serviced areas of this city?"
He noted that St. Vital, for example, is already well-served by walk-ins, several of which are open on weekends and keep long hours on weekdays. "How much consultation has the minister done with doctors, with walk-in clinics, with fee-for-service doctors to know where the appropriate place would be to locate this new service?"
Tamara Buchel, executive director of the Manitoba College of Family Physicians, said there was little consultation by government with her organization before the first batch of Quick Cares was created, but the lines of communication have improved greatly since then.
"It (was) like, 'here, look at this,' this big announcement and nobody knew anything about what it was," said Buchel, who also practises medicine in northwest Winnipeg.
She said she had no idea, for example, that there would be a Quick Care on McGregor Street until it was announced, although she said that facility is probably well-located.
She said the initial announcements may have aroused fears and suspicions among family doctors at first, but the college now believes there is "lots of potential" for Quick Cares to enhance primary health services if they are linked to family medicine clinics in their areas.
Buchel also urged the government not to develop one cookie-cutter model for Quick Cares. She said they should be designed in a way that reflects the strengths and weaknesses of health delivery in each community. "What is needed in northwest Winnipeg is very different from what is needed in the core area of Winnipeg."
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The Free Press spent a couple of hours outside the two city Quick Care clinics one afternoon this week asking patients about the service as they emerged. No one had a bad word to say about them.
Included among the clients was a woman who had an ear infection, a middle-aged man who had developed an unexplained rash on his arms, a man with a bad cold who had not been to a doctor in a year-and-a-half, a man who had a difficult time getting a prescription refilled because of his pharmacy's restricted hours and a man who is on medication that requires him to have his blood pressure checked regularly.
Most people at the McGregor location said they were seen within 30 minutes, some in as little as 15 minutes. Several said they found the clinic through word of mouth; one woman said she discovered it online.
"It's convenient. It's fast service. The (test) results are easy to receive," said Sherry Bluebird, outside the McGregor clinic located in Win Garden Place. "People there are willing to listen to you... "
Cherry Reyes, a repeat client, said the service is quicker than in a walk-in clinic, where she's had to wait two hours.
"You're not going to wait long. Maybe 30 minutes at most," she said.
A bottleneck Wednesday at the St. Mary's Road location saw no patient leave that clinic for an hour, while more than a half-dozen new clients arrived. Still, the waiting room contained less than a dozen patients.
A man, who would not give his name, said the service there is usually very fast. "Today for some reason (there was a long wait)," he said. "Normally it's 15 to 20 minutes."
Then, in a backhanded compliment, he said: "I'll tell you what -- it's the first time in a long time that the Government of Manitoba and the health-care people involved did something right. If they leave it alone and don't tinker with it, it will be fine."
Republished from the Winnipeg Free Press print edition September 21, 2013 A6
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