The West EndNon-Insured Walk-in Clinic (NIWIC)      Sideeka Narayan, RN, MPH           March 16, 2013
West End - Non-Insured Walk in Clinic                 (NIWIC)Background   – Official number of persons living without reco...
The NIWICPartnership of 7 Community Health Centers in West Toronto:1.   Black Creek CHC2.   Unison HCS3.   Access Alliance...
NIWIC Proposed Outcomes1. Increased linkage between service providers with shared concerns;2. Effective matching of need w...
Eligibility Criteria– Anyone matching these criteria can use the NIWIC during open  hours;   • People with no-status/the n...
NIWIC ServicesWhat service can a person expect to receive at the NIWIC:  1. Episodic : Care for a specific medical problem...
RN Triage/Assessment                                •   Confirms eligibility                      Settlement Community & A...
NIWIC: March 12th - November 30th 2012Hours and Staff                                             Patient StatisticsHours ...
Patient Demographics – Age & Gender                     30                     25Number of Patients                     20...
Preferred Languages of Patients• Medical interpretation  available over the phone  through RIO services
Immigration Status• Non-status/non-insured  “undocumented”: lack  official documentation,  (i.e. PR card, student  visa, w...
Region of Origin                     25                     20Number of Patients                     15                   ...
Country of Origin                     16                     14Number of Patients                     12                  ...
Arrival to Canada                     40                     35                     30Number of Patients                  ...
Average Income                     60                     50Number of Patients                     40                     ...
Distribution of NIWIC patients in GTA by             postal code and CHC PartnersClient by postal codeAccess Alliance CHCU...
Reasons for Visit: Broad Categories                       350                       300                       250Number of...
Frequency of Medical Reasons for Visit                          25% of Patient Encounters                          20     ...
Frequency of Medical Issues Addressed by a               Practitioner                            25  % of Patient Encounte...
Reasons for Visit – Major Categories & Subcategories                                                                  % of...
Health Issues Addressed – Major Categories & Subcategories                                                            % of...
Settlement Support                       60                       50Number of Encounters                       40         ...
Frontline Challenges             Key Developments• Access to hospital based       • CHC Referral Pathway  care            ...
CHC Referral Process1. NIWIC NP to identify level of urgency     – Medium Risk (PCP in 4-8 weeks)     – High Risk (PCP in ...
NIWIC - Partner CHC Referrals      CHC Name     # of NIWIC Patient                         ReferralUnison                 ...
Prenatal Pathway
NIWIC - Midwifery Referrals   (August-December 2012)        Midwifery Group          # of NIWIC Patient ReferralWest End M...
Next Steps• Implement onsite midwifery• Continue to build new partnerships that facilitate a  system of support for the no...
References1. Access Alliance Multicultural Health & Community Services & Toronto Public Health.   (2011). The Global City:...
Questions? For more information aboutthe NIWIC please contact me:snarayan@accessalliance.ca
Synthesis of Recommendations1. Promote progressive policies for ‘regularization’ of non-status groups2. Remove restriction...
NIWIC presentation to Metropolis March 2013
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NIWIC presentation to Metropolis March 2013

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Sideeka Narayan, Registered Nurse at Access Alliance presented about our west-end walk-in clinic (NIWIC) at the 2013 Metropolis conference in Ottawa. She highlighted the collaboration and service innovations necessary to support the health needs of non-status people within our current health system.

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NIWIC presentation to Metropolis March 2013

  1. 1. The West EndNon-Insured Walk-in Clinic (NIWIC) Sideeka Narayan, RN, MPH March 16, 2013
  2. 2. West End - Non-Insured Walk in Clinic (NIWIC)Background – Official number of persons living without recognized status in Canada unknown. – Estimates say: 200,000 and 500,000 persons without status, majority living in major urban centres. – Increasing awareness of health issues affecting the non- status/non-insured (poor access to perinatal care, unmanaged chronic disease, mental health problems) – Non-status newcomers are at High Risk for poor access to preventive care – Toronto LHIN: CHCs have identified there is an opportunity to enhance services to non-insured clients.
  3. 3. The NIWICPartnership of 7 Community Health Centers in West Toronto:1. Black Creek CHC2. Unison HCS3. Access Alliance MHCS4. LAMP CHC5. Rodale CHC6. Stonegate CHC7. Davenport-Perth NCHCGoal: To improve access to basic primary care (episodic)for unattached non-status/non-insured people living in thecity of Toronto.
  4. 4. NIWIC Proposed Outcomes1. Increased linkage between service providers with shared concerns;2. Effective matching of need with resources;3. Develop and strengthen pathways and a delivery system for services to unattached non- status/non-insured population;4. Reduced unnecessary visits to the Emergency Department for unattached non-status/non- insured persons;5. Reduced progression to severe health outcomes;6. Increased linkages to support services and community agencies for unattached non- status/non-insured people;7. Improved self-management of health;8. Joint strategizing, project planning and initiation;9. Evidence-based practices established for unattached non-status/non-insured persons.
  5. 5. Eligibility Criteria– Anyone matching these criteria can use the NIWIC during open hours; • People with no-status/the non-insured • People who are in the 3 month wait period for their OHIP • People who do not have a primary care provider (i.e.. no doctor or nurse practitioner) • People who live west of Yonge Street in the City of Toronto– People who cannot use the NIWIC include: • Anyone who already has a doctor/nurse practitioner, • Anyone who already has OHIP or who covered by government insurance including IFH, • Anyone who has private insurance • Anyone who is a visitor or a student
  6. 6. NIWIC ServicesWhat service can a person expect to receive at the NIWIC: 1. Episodic : Care for a specific medical problem, without an ongoing relationship being established between the person and health care professionals – if medically required there will be follow-up; 2. No cost to patient 3. Telephone interpretation 4. Referral to medical specialists as appropriate 5. Referral to community services (Diabetes Education, Midwives) 6. Referral to Settlement Services (housing, food insecurity, health costs, etc.) 7. People identified with chronic and/or unstable conditions referred to one of the partner CHCs
  7. 7. RN Triage/Assessment • Confirms eligibility Settlement Community & Allied Health • Determines presenting issue • Information provision Services • Basic health hx & vitals • Support service referral • Identifies other risk factors Practitioner • Deals with chief complaint RN Case Manager • Diagnoses/Treatment• Patient care coordination • Consults Physician Consult• Urgent CHC Partner referral • Reviews labs • Patient follow-up
  8. 8. NIWIC: March 12th - November 30th 2012Hours and Staff Patient StatisticsHours of Operation Monday, 4:00pm-7:30pm; Total # of Patients 113 Wednesday, 1:00pm-4:30pm Total # of Encounters 533Location Access Point on Jane, 761 Jane St. Total # Male 44 2nd Floor Total # Female 69Total # of clinics 71 Total # < 5 yrs. 14Total # of hours 248.5 (7 hours per week)Staff Involved 1 Secretary, 1 Triage RN, 1-2 NPs, 1 Average Patient Age 29 Settlement Worker
  9. 9. Patient Demographics – Age & Gender 30 25Number of Patients 20 15 Male Female 10 5 0 0-3 04 - 9 10 - 17 18 - 29 30 - 39 40 - 44 45 - 64 65 - 74 75 - 84 Age Group
  10. 10. Preferred Languages of Patients• Medical interpretation available over the phone through RIO services
  11. 11. Immigration Status• Non-status/non-insured “undocumented”: lack official documentation, (i.e. PR card, student visa, work permit or IFH (61%)• Permanent Resident in 3 month wait period for OHIP (26%)• Refugee Claimant: Denied refugee status by Immigration & Refugee Board of Canada
  12. 12. Region of Origin 25 20Number of Patients 15 10 5 0 South Africa Carribean South North East Asia Central Europe Unknown America Asia America America Region of Origin
  13. 13. Country of Origin 16 14Number of Patients 12 10 8 6 4 2 0 Country of Origin
  14. 14. Arrival to Canada 40 35 30Number of Patients 25 20 15 10 5 0 Year of Arrival
  15. 15. Average Income 60 50Number of Patients 40 30 20 10 0 Income Level
  16. 16. Distribution of NIWIC patients in GTA by postal code and CHC PartnersClient by postal codeAccess Alliance CHCUnison CHCStonegate CHCLamp CHCRexdale CHCDavenport-Perth NCHCBlack Creek CHC
  17. 17. Reasons for Visit: Broad Categories 350 300 250Number of Encounters 200 150 100 50 0 Reason for Visit
  18. 18. Frequency of Medical Reasons for Visit 25% of Patient Encounters 20 15 10 5 0 Reason for Visit
  19. 19. Frequency of Medical Issues Addressed by a Practitioner 25 % of Patient Encounters 20 15 10 5 0 Health Issues Addressed
  20. 20. Reasons for Visit – Major Categories & Subcategories % of Health Issues Category Count Addressed Pain 68 20.8%  Pain - Other 49 15.0%  Back Pain 13 4.0%  Headache/Migraine 6 1.8% Sexual and Reproductive Health Issues 63 19.3%  Pregnancy Related Issues 31 9.5%  Contraception Advice/Issues 15 4.7%  Other Reproductive Health Issues 11 3.4%  Sexually Transmitted Diseases 6 1.8% (excl. HIV/AIDS & Hepatitis) Respiratory/E.N.T. Issues 39 11.9%  Throat 22 6.7%  Cough 11 3.4%  URI/Colds 5 1.5%  Ear Infection/Inflammation 1 0.3% Gastrointestinal Issues 26 8.0%  Stomach Pain/Discomfort 19 5.8%  Constipation 4 1.2%  Diarrhea 2 0.6%  GERD and Gastritis 1 0.3%
  21. 21. Health Issues Addressed – Major Categories & Subcategories % of Health Issues Category Count Addressed Sexual and Reproductive Health Issues 84 20.7%  Pregnancy Related Issues 36 8.9%  Contraception Advice/Issues 18 4.4%  Other Reproductive Health Issues 17 4.2%  Sexually Transmitted Diseases 13 3.2% (excl. HIV/AIDS & Hepatitis) Pain 51 12.6%  Pain - Other 32 3.0%  Back Pain 12 3.0%  Headache/Migraine 8 2.0% Respiratory/E.N.T. Issues 39 9.6%  Throat 16 4.0%  Ear Infection/Inflammation 11 2.7%  Cough 7 1.7%  URI/Colds 4 1.0%  Allergic Rhinitis 1 0.2% Chronic Disease Risk Factors 29 7.1%  Hypertension/High Blood Pressure 18 4.4%  Smoking 6 1.5%  High Cholesterol 3 0.7%  Overweight and Obesity 2 0.5%
  22. 22. Settlement Support 60 50Number of Encounters 40 30 20 10 0 Issues Addressed
  23. 23. Frontline Challenges Key Developments• Access to hospital based • CHC Referral Pathway care • Prenatal Care Pathway• Access to perinatal care for - Midwifery partnership High Risk pregnancies • Toronto Public Health• Unmanaged chronic Partnership disease
  24. 24. CHC Referral Process1. NIWIC NP to identify level of urgency – Medium Risk (PCP in 4-8 weeks) – High Risk (PCP in 1-3 weeks)2. NIWIC RN identifies partner CHC closest to patient’s home & contacts CHC/NIWIC liaison by phone/email3. NIWIC RN to send NIWIC Referral Form4. CHC/NIWIC liaison to respond by email: – PCP Name, Title – Date, time, of initial appointment with PCP5. NIWIC RN to inform patient & patient to sign AA consent form for release of health info.6. NIWIC Secretary to fax Health Records to CHC & close patient’s NIWIC chart
  25. 25. NIWIC - Partner CHC Referrals CHC Name # of NIWIC Patient ReferralUnison 5Access Alliance 4Black Creek 2LAMP 1Rexdale 1Davenpoort-Perth 1Stonegate 1Total 15
  26. 26. Prenatal Pathway
  27. 27. NIWIC - Midwifery Referrals (August-December 2012) Midwifery Group # of NIWIC Patient ReferralWest End Midwives 12Diversity Midwives 1Midwives Collective of Toronto 2Total 15
  28. 28. Next Steps• Implement onsite midwifery• Continue to build new partnerships that facilitate a system of support for the non-status/non-insured.• Increase NIWIC promotion and outreach to the community• Strengthen NIWIC reporting to enhance evidenced- based research• Based on evidence, promote the uptake of service model at other urban based CHCs
  29. 29. References1. Access Alliance Multicultural Health & Community Services & Toronto Public Health. (2011). The Global City: Newcomer Health in Toronto. Retrieved from http://www.toronto.ca/health/map/newcomer.htm2. Caulford, P. & D’Andrade, J. (2012). Health care for Canada’s medically uninsured immigrants and refugees. Whose problem is it? Canadian Family Physician, 58, 725- 727.3. Shirane, R. (2009). Inequity in access to Canada’s health-care system: Medically uninsured, legal residents of Canada suffer from preventable and manageable conditions. (unpublished report).4. TC LHIN Community Health Centres. (2010). Examining the issue of non-insured in community health centres within the Toronto Central Local Health Integration Network catchment. Final report submitted to the Toronto Central LHIN. Toronto, ON: TC LHIN Community Health Centres.
  30. 30. Questions? For more information aboutthe NIWIC please contact me:snarayan@accessalliance.ca
  31. 31. Synthesis of Recommendations1. Promote progressive policies for ‘regularization’ of non-status groups2. Remove restrictions to accessing early and timely healthcare services3. Promote ‘Access without Fear’ model nationally (as opposed to Don’t Ask Don’t Tell)4. Expand ministry funding to increase and expand services to non-status/non- insured groups5. Need urgent action, particularly for priority groups/issues a. Pregnant women b. Children c. Mental health services d. Urgent care6. Promote partnerships and collaboration within healthcare sector and across sectors7. Expand research, improve reporting protocols, and promote knowledge sharing

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