The role of Real-Time Virtual Support in improving rural health care delivery

In urban settings, the scope of practice for family physicians is often narrowed, with most solely managing clinic patients.[1] Rural family physicians may face more varied challenges. Due to a lack of medical specialists in many rural areas, these doctors need to adopt a broad scope of practice, spanning both acute and chronic conditions across every age group. Depending on where they are situated, rural family physicians often require further training in advanced skills such as adult and pediatric resuscitation, simple fracture reduction, casting techniques, venous access, lumbar puncture, endotracheal intubation, and obstetrical care.

For rural family physicians, skills that are not used regularly are susceptible to decline. In Northern British Columbia’s rural communities, physicians encounter obstetric and pediatric cases less frequently due to a predominant elderly population.[1] As a result, when faced with such cases, especially complicated deliveries or acutely ill infants, physicians may grapple with challenges. Furthermore, trauma cases are infrequent in rural emergency departments compared with bustling urban centres, which can pose challenges when they do arise.[2] Continually participating in training programs to prepare for these rare cases becomes impractical for rural physicians. It detracts from time spent serving already underserved communities, and access to the training facilities, which are often located in distant urban areas, is both time-consuming and challenging.

The experience gap faced by rural family physicians in addressing infrequent cases has been substantially bridged by telehealth consulting services.[3] In April 2020, British Columbia introduced the Real-Time Virtual Support initiative, which provides around-the-clock clinical assistance to health care providers in rural regions.[4] These programs facilitate direct videoconferencing, guiding health care professionals through diagnosis, management, and use of medical equipment.[3] The program’s scope has broadened since its inception and now includes phone access to specialists in pediatric, maternity, and newborn care.[4] Highlighting the program’s evolution, Rural Urgent Doctors in-aid (RUDi), one of the four Real-Time Virtual Support programs, garnered only a couple calls upon its launch in 2020.[5] In 2023, RUDi doctors answered an average of 34 calls over a 12-hour shift.[4] Due to high demand, the service sometimes encounters delays.

The challenges encountered by rural family physicians and nurses in managing infrequently encountered conditions require innovative solutions. While Real-Time Virtual Support has provided a safety net, expansion to more rural communities, increased funding, and recruitment of more specialists to ensure timely support are essential.[6] Specialists are encouraged to get involved by signing up at https://rccbc.ca/stay-connected/contact-us.
—Xi Yao Gui, MD
Family Medicine Resident, Department of Family and Community Medicine, University of Toronto
—Eric McMullen, MD
Dermatology Resident, Division of Dermatology, University of Toronto
—Chris Bhatla, MD
Physical Medicine and Rehabilitation Resident, Division of Physical Medicine & Rehabilitation, University of Toronto
—John Siewert, MD
Family Medicine Resident, Division of Medical Sciences, University of Northern BC
—Ramy Melek, MD
Family Medicine Clinical Instructor, Division of Medical Sciences, University of Northern BC
—Jessica Burian, MD
Family Medicine Clinical Instructor, Division of Medical Sciences, University of Northern BC

hidden

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

References

1.    Statistics Canada. In the midst of high job vacancies and historically low unemployment, Canada faces record retirements from an aging labour force: Number of seniors aged 65 and older grows six times faster than children 0-14. 27 April 2022. Accessed 22 October 2023. www150.statcan.gc.ca/n1/daily-quotidien/220427/dq220427a-eng.htm.

2.    Lipsky AM, Karsteadt LL, Gausche-Hill M, et al. A comparison of rural versus urban trauma care. J Emerg Trauma Shock 2014;7:41-46.

3.    Lapointe L, Lavallee-Bourget MH, Pichard-Jolicoeur A, et al. Impact of telemedicine on diagnosis, clinical management and outcomes in rural trauma patients: A rapid review. Can J Rural Med 2020;25:31-40.

4.    Rural Coordination Centre of British Columbia. Real-Time Virtual Support. Accessed 22 October 2023. https://rccbc.ca/initiatives/rtvs.

5.    Rural Coordination Centre of British Columbia. RTVS RUDi. 22 October 2023. https://rccbc.ca/initiatives/rtvs/rudi.

6.    Jong M, Mendez I, Jong R. Enhancing access to care in northern rural communities via telehealth. Int J Circumpolar Health 2019;78:1554174.