​By: Dr. Munira Sultana, Research Specialist, Erie Shores HealthCare 

Since the onset of COVID-19, Erie Shores HealthCare (a 72-bed, non-tertiary facility located in the Municipality of Leamington) has been faced with an over-capacity emergency department. The hospital serves a diverse population across the Greater Windsor-Essex area, including Caldwell First Nation, Migrant Workers, undocumented/documented refugees, as well as isolated religious minority groups^[1]. Many individuals and families in these communities face significant challenges in accessing primary care for various reasons such as lack of transportation, language barriers, and/or fear of discrimination. They often avoid seeking health hcare unless they are critically ill. 

Through steadfast consultation with the relevant stakeholders and community partners, a mobile medical strategy was launched to effectively improve the situation, taking health care directly to vulnerable communities in the region. The Mobile Medical Support (MMS) was provided by a mobile clinic. This innovative approach, designed through a collaborative partnership through our Windsor-Essex Ontario Health Team (WEOHT) and its encompassing 45 partners^[2], has been a unique and sustainable solution to our health care challenges. 

The project is a groundbreaking initiative for these communities and was recently showcased in the Legislative Assembly of Ontario Official Report ^[3] and recieved the inagural Ontario Health System Quality and Innovation Awards 2024 in the Increased Equity category^[4].  

The MMS project offers a variety of health programs and services, including cancer screening, foot care, dental hygiene and urgent dentistry, overdose prevention, chronic disease management, and socio-cultural supports such as Ontario Works navigation, translation, and transportation services. The goal is to provide services to people of all ages, whether or not they have valid health insurance - a service that is uncommon in this area. The team includes nurses, nurse practitioners, and administrative support personnel led by the Community Outreach Director ^[5]. 

Erie Shores HealthCare team accepting inagural Ontario Health System Quality and Innovation award​

The health care delivery model is embedded in a multipronged strategy with primary care, health promotion and education, and preventative care services at the forefront, reaching socio-economically high-priority communities while providing cost-effective preventative care. The project served 3,014 unique clients (M:F = 51:49) since April 2022. Around 70 per cent of them were aged between 25 and 64, with most stating that they would have sought care at an urgent care centre or emergency department (51%) if our MMS had not been present in the community. In addition, 17 per cent stated they would not have sought care without MMS. The data also revealed that 74 per cent of the population availing MMS services did not have access to a primary care provider, delaying their referral and increasing their wait time. The MMS also screened 452 people for cancer awaiting a referral for cancer screening. 

A strong patient and family engagement since the inception of MMS was evident, reinforcing the project's effectiveness. The patient advisors were involved in every step, balancing the power dynamics between the service provider and the recipient. The mobile clinic installed a wheelchair lift, safety belts, signage, and an accessible doorbell for assistance, taking into account the patients' shared lived experiences. The mobile clinic also adopted a sex and gender-neutral graphic design, assuring a safe space for all. 

The iterative development of care pathways allowed the project to align the services with the community's needs. The service data is consistently shared with stakeholders and the Erie Shores Healthcare’s Ethics and Data Safety Monitoring Board to review opportunities for improved outcomes. 

The collective effort has been pivotal in informing future community revitalization work, particularly in the realm of minimizing geographical inequities. Crucially, the MMS experience has demonstrated that it is not just a unique health care delivery model, but a cost-effective one, perfectly ​​positioned to assess and fulfill the needs of underserved populations nationwide. This cost-effectiveness inspires a deep sense of confidence in its sustainability and potential for widespread application.               

References:

1. Municipality of Leamington. Community Profile. 2024. https://www.leamington.ca/en/business/demographics.aspx
2. Bellacicco B. Mobile health clinic with mental health, addiction and dental support an ‘exceptional model’. 2022. https://windsor.ctvnews.ca/mobile-health-clinic-with-mental-health-addiction-and-dental-support-an-exceptional-model-1.6085166 
3. Legislative Assembly of Ontario. Official Report of Debates (Hansard) No. 156A. May 2024. https://www.ola.org/en/legislative-business/house-documents/parliament-43/session-1/2024-05-09/hansard 
4. Dalla Lana School of Public Health, University of Toronto (2024). Ontario Health System Quality and Innovation Awards Ceremony. Retrieved from https://www.youtube.com/live/CENrhdLTWd8?si=BkHgK1aqilvpy-Ji 
5. Maluske M. DYK? Windsor-Essex has a walk-in clinic on wheels. 2023. https://windsor.ctvnews.ca/dyk-windsor-essex-has-a-walk-in-clinic-on-wheels-1.6288429  

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