Low-Barrier Access to Health Care for Victoria

Active ImageJuly 28, 2010 – Dr. Chris Fraser – The Times-Colonist recently reported on emerging research concerning health care for the homeless.  This research sought to determine the reasons why individuals experiencing homelessness would have unmet health needs with Canada’s universal health care system.

As a physician specializing in inner-city medicine at Cool Aid’s Community Health Centre, I work as part of a health care team to provide a medical home for the homeless and marginalized in Victoria.

The Toronto study by Dr. Stephen Hwang and researchers with the Centre for Research on Inner City Health suggests possible strategies to reduce the barriers these populations face in accessing health care, including special programs that provide primary care for homeless populations, and health care services that are non-stigmatizing towards those experiencing homelessness, and the experiences that often accompany homelessness, such as abuse, violence, substance use and mental illnesses.

At the Health Centre that is exactly what we do. Cool Aid provides health care and social services for over 4,000 people by providing a unique approach to inner-city medicine that emphasizes low-barrier access to interdisciplinary primary health care services for economically vulnerable clients with complex medical needs and multiple barriers to accessing care.

Cool Aid’s interdisciplinary approach means, as a doctor, I am one member of a team that also includes nurses, counsellors, psychiatrists, a pharmacist and pharmacy technician, dentists and dental hygienist, and a nutritionist and acupuncturist.  A patient may see several different health providers in a single visit. As well, our clients can access services of AIDS Vancouver Island, Victoria Native Friendship Centre and VIHA – all located at the Access Health Centre.

When a patient enters the Access Health Centre they may be seeking treatment for a single presenting issue, however, their health care needs are likely much more complex. Our practice is specially designed to treat high numbers of patients with severe mental health conditions, problematic substance use, hepatitis C and HIV/AIDS.

Treatment plans can be complex where patients could be active in the sex trade, living in situations that compromise hygiene and self-care, living with current or historical trauma and abuse, and a myriad of concurrent issues that define homeless individuals’ vulnerability and wellness.  As a doctor I cannot effectively treat a patient’s symptoms without also addressing the complex barriers and health needs that defines effective health care for the homeless.

A homeless person may feel just as uncomfortable walking into a mainstream doctor’s office or even emergency department as many of us would feel walking into Cool Aid’s emergency shelters or eating at a drop-in centre or food bank.

The Access Health Centre’s low-barrier approach means that our services are dedicated to serving the homeless and other vulnerable individuals. We are ready to treat individuals without health care coverage, people who may not be able to pay for necessary prescriptions or dental care, those who may be considered disruptive or unwanted in other settings, and those who may struggle with keeping appointments.

Low barrier health care also means taking our services beyond the front desk. The Health Centre outreach team takes our services to where people are located – whether on the streets, in other social agencies, in the drop-in centres, shelters or in their homes.

The Access Health Centre is an integral part of the health care system as we provide a unique, targeted service to populations with complex health care needs and both financial and non-financial barriers to accessing care elsewhere.  Our services relieve pressure on other health services and have demonstrated an ability to greatly reduce this population’s use of costly and often inappropriate emergency room visits and hospital admissions.

Ending homelessness in Victoria includes providing a medical home for those experiencing homelessness and those able to become housed.  Just as research is demonstrating that it is cheaper to house people than leave them homeless, it is also showing that it is more cost effective to provide a medical home to the homeless than not.

The Access Health Centre, open at 713 Johnson Street since last September, still requires $880,000 to finish paying for the $5.3 million reconstruction costs of opening up the 15,000 square foot, shared facility. Million dollar contributions have been provided by the Capital Regional Hospital District and VIHA.

By providing health care for those who are homeless and marginalized we are playing an integral role in our health care system and in ending homelessness.

Dr. Chris Fraser is the Medical Director of the Cool Aid Community Health Centre, an interdisciplinary practice in Victoria’s inner city.  The Access Health Center works with complex populations dealing with chemical dependency, mental health, unstable housing, hepatitis C and HIV/AIDS.