This year, PACC was fortunate to have three students from Selkirk College’s Rural PreMed Program partner with us for their community engagement project. These student projects are focused on identified needs of the community organization and are co-designed with those groups. Given the changing health care environment with establishment of team-based care and creation of Community Health Centres (CHCs), PACC wanted to know more about patients’ perspectives on team-based care. This year’s students – Amy Tite, Brynn Magner, and Emily Pierce – undertook a project to answer the following research questions: Which healthcare providers do residents of the Kootenay Boundary region believe should comprise their primary health care team? And: Would they be inclined to be attached to a CHC?
The students developed and conducted a 15-question survey following approval of their proposed project by the Selkirk College Research Ethics Board. The survey was available to anyone 18 years or older who resided in the KB region and was available in written and online forms. Potential participants were made aware of the survey through social media and posters displayed in local businesses in Castlegar, Christina Lake, Fruitvale, Grand Forks, Greenwood, Kaslo, Midway, Nelson, Rock Creek, Rossland, and Trail.
Survey questions included demographics, current access to a primary care health care team/provider, participants’ current and ideal health care team composition, and willingness to affiliate with a CHC. Examples of potential primary care team members included allied health professionals such as social workers, therapists, and physiotherapists. Alternative medicine practitioner examples included: chiropractor, naturopath, massage therapist, acupuncturist, and dietitian. The results were summarized and analyses included comparisons by respondent’s age (under or over age 65), gender (male/female/non-binary) and size of community (large or small).
Results
The students received 490 responses to the survey. The majority of respondents self-identified as women (84.5%), were over age 40 years (66.5%), White (91.4%), and had a post-secondary school diploma (60%). 58% of respondents were from the 3 largest communities of Castlegar, Trail, and Nelson. Just over one-quarter (26.2%) of respondents did not have a health care team to support them (similar results regardless of age and size of community). Males reported having no health care team to support them more than female or non-binary respondents (32.8%, 25.5% and 12.5%, respectively).
Current composition of participants’ primary healthcare team are shown in the Figure below.
In terms of the ideal composition of their health care team, nearly all respondents (92.2%) included a primary care doctor; this was followed by alternative medicine practitioner (64.1%), allied health professionals (61.2%), specialist physician (59.8%) and nurse practitioner (54.8%) (see Figure below). Almost half (46.6%) of respondents chose 5 or more healthcare providers for their ideal primary health care team, followed by 43.8% choosing 3 or 4 types of providers, 5.7% wanting 8 or more types of providers and 3.9% choosing only one or two providers on their ideal team.
When asked about willingness to affiliate with a primary health care team clinic, over 80% reported being highly likely or likely to do so. Only 4.3% reported being unlikely or highly unlikely to affiliate.
Younger respondents compared to those 65 years and older were slightly more likely to be highly likely or likely to affiliate (82.1% vs. 79.6%) as were women (82.4% vs. 77.9% of men and 75.0% non-binary) and those living in smaller vs. larger communities (82.4% vs. 79%).
In summary, from the point of view of KB survey respondents, both current and ideal health care team membership includes both traditional and non-traditional members, and the vast majority (90.4%) of respondents included 3 or more providers to be on their team. Most of our respondents were willing to affiliate with a CHC. Successful integration of CHC’s will likely depend on creating the right mix of health care professionals and allied support persons who can provide locally-informed, coordinated care to their communities.
There were several study limitations. More women than men responded to the survey and this population was more highly educated than regional census (Bachelor’s degree or higher was reported by 20.2% of households vs. about one third in our sample and some post-secondary education was reported for 63.3% vs. 89% in our sample). Although the vast majority of our respondents (91.4%) were White, in the KB region, 95.9% of the population is a non-visible minority (i.e., mostly White) (Census Profile, 2021 Census of Population, 2023). Overall, the total number of respondents was larger than the calculated needed sample size of 381 to have a confidence level of 95% and an alpha level of ±0.05 for generalizability of results to our rural population.
PACC is grateful to these wonderful Selkirk College PreMed students for helping us to add patient voices to the discussions about how to structure effective primary health care teams and create acceptable delivery systems going forward.
Check out the full research report here >>
Mindy Smith, MD, MS; PACC member
