Rural Remote Health
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Rural Remote Health · Jan 2004
Use of the emergency room in Elliot Lake, a rural community of Northern Ontario, Canada.
There is ample documentation that use of hospital emergency facilities for reasons other than urgencies/emergencies results in clogged services in many urban centers. However, little has been published about similar misuse of emergency rooms/departments in rural and remote areas, where the situation is usually compounded by a scarcity of healthcare professionals. In Canada there is a shortage of physicians in rural and remote areas as a consequence of misdistribution (most physicians staying in southern urban centers after residence), and there is a chronic misuse of facilities meant for urgencies/emergencies to cope with primary healthcare needs. We address the problem in Elliot Lake, a rural Northern Ontario community of 12,000 people. The economy of Elliot Lake was based on uranium mining until the mid-1990s, when it drastically changed to become a center for affordable retirement and recreational tourism. As a consequence, at the present time the proportion of seniors in Elliot Lake doubles the Canadian average. Our objectives are to elucidate the demographics of emergency room (ER) clients and the effect of the elderly population; the nature of ER use; the perceived level of urgency of clients versus health professionals; and possible alternatives offered to non-urgent/emergency visits. This is the first study of the kind in Northern Ontario, a region the size of France. ⋯ The core of the problem identified by this research is that more physicians, nurse practitioners, and other health care professionals are needed in Elliot Lake to provide continuity of care. A new medical school is being created for the region, but the first family physicians from this initiative will only be available in 2012. In the meantime, healthcare professionals may need to take more preventive and educational measures to reduce ER misuse, and the use of other town's agencies, Telehealth, case-management of recurrent clients, and collaboration with local pharmacists need to be maximized. Further research is urgently needed into the effects on health outcomes in rural communities that may result from health services having to function beyond their capacity. Rural health clinicians, communities, researchers, and policy makers must work together to design, implement, and evaluate, both immediate and longer term solutions to the problems identified in this study.