The Positive Side

Summer 2021 

Digital Delivery

COVID-19 has forced many healthcare providers to deliver their services by phone and video. Wellness Wheel in Saskatchewan had pioneered this approach before the pandemic—Jennifer McPhee talks to Susanne Nicolay to find out more.

At the start of the COVID-19 pandemic, healthcare providers across Canada switched to virtual healthcare. This shift has led to services that better serve the needs of patients, says Susanne Nicolay, a nurse based in Regina. Nicolay is clinical coordinator and nursing lead at Wellness Wheel, a mobile healthcare service serving Indigenous people who live on reserves and in cities and towns across Saskatchewan.

Before the pandemic, Susanne’s Wellness Wheel team drove between 19 Indigenous communities to provide HIV and hepatitis C care. They also provided general health care and treated other diseases in about four of these communities. Through their work providing mobile care, the team already had some experience with virtual healthcare; they texted to confirm appointments, and they offered video calls to patients. These services had some limitations, though. Patients still had to book appointments and make their way to a health centre that offered the virtual care service. Once there, they could see Wellness Wheel’s staff on a TV screen. This was not great for people who lived far from a service location, or who did not have access to a car. But it was the only virtual option that doctors could bill for in the province.

In November 2019, Wellness Wheel decided to test a virtual platform called OnCall. This provides secure text and video messaging between patients and their healthcare team. At the time, Wellness Wheel could not bill the province for OnCall visits. Nicolay would travel to a community and see a patient at the health centre or find them in the community. Then, she would use OnCall to talk to the doctor about any issues outside her area of expertise. She began to see more people where it was easiest for them, such as in their house or car. The platform also meant Wellness Wheel’s doctor no longer had to travel as often and could spend the extra time treating more patients.

When the pandemic hit in March 2020, First Nations governments closed their communities to outsiders to protect themselves from COVID-19. At first, Wellness Wheel staff worried about how to adapt their services so that they could keep meeting their clients’ needs. However, the Saskatchewan Ministry of Health quickly increased the ways that healthcare providers could communicate with patients and get paid. As a result, Wellness Wheel staff were suddenly able to bill the province for their virtual services. These included healthcare services they provided through phone calls, virtual platforms and text messages. Since many local healthcare centres in Indigenous communities fully or partly shut down when the pandemic arrived in the province, Wellness Wheel staff filled the gap. They expanded their services and began to treat people for all their health issues virtually.

For example, Wellness Wheel saw lots of patients with wounds caused by diabetes. Patients often sent photographs of these wounds to staff by text. “It wasn’t 100 percent by the book and in an ideal world, we wouldn’t do that,” says Nicolay. “But in an emergency, you can’t prioritize confidentiality and not provide care to someone.” To protect patient privacy, staff came up with ways to make sure they were texting the right person. They also knew it was possible that someone else might get a patient’s phone and read their messages, says Nicolay. “In COVID, you had to get creative. I didn’t say ‘How are your HIV medications?’ I would say ‘How are the three pink pills we gave you?’”

In many ways, the pandemic has made it easier for people to get medical help. Virtual care is accessible for those who cannot easily move around because of health issues. It is also easier for people without transportation. And it allows more people to get medical help exactly when they are ready and feel safe enough to do so, says Nicolay. She explains that virtual care also protects patient privacy and reduces stigma. Patients don’t need to go to a healthcare centre or clinic where they could be seen receiving HIV care. This is an even bigger issue in places where everyone knows each other.

In North America, healthcare is set up for what’s easiest for healthcare providers. Virtual care makes it possible to do what’s easiest for patients. Often, healthcare providers expect patients to travel to clinics or hospitals between certain hours. Many don’t provide care on weekends, after hours or during lunch. “Healthcare providers also want the four walls, the exam bed; they want all their tools,” says Nicolay. “But really, there’s a lot we can do in the back seat of a car.”

“Yes, certainly sometimes people need to be examined. I am not saying that’s not important. But we also have to think about whether we want people to drive four hours for a 20-minute appointment. Or do we want to be respectful of their time, so they feel valued? Not everyone feels safe going to a hospital. Not everyone has sick time or transportation that is easy to arrange. We think we need to lay eyes on people every few months. You may want to physically see people every year, but in between, you could see them by phone or using OnCall. It’s possible now and we need to be open to this.”

Virtual care has also made it possible to increase people’s access to medical help by enabling different types of healthcare providers to work together. For instance, Wellness Wheel provided a tablet for a pharmacist in Regina that is located near a community organization that offers free meals and harm reduction supplies in a safe, accepting atmosphere. When people are ready to begin or restart HIV treatment, the pharmacists use the tablet to make on-the-spot virtual appointments with a member of the Wellness Wheel team.

Healthcare providers need to be open to these kinds of relationships, says Nicolay. “Because, if someone is never going to come into your office, it’s not helpful to believe they’re just not interested. That’s not usually the case. They just may not have the ways and the means.”

Jennifer McPhee is a Toronto-based writer who contributes regularly to The Positive Side.