The recent decision to close several of the main primary care clinics in Vancouver Coastal Health has brought to the forefront grave concerns for not only the public but those of us in higher levels of education who are teaching the principles of primary health care and population health.
The UBC School of Nursing has had a long standing partnership with Pine Clinic where our nursing students at both the undergraduate and graduate levels have had an opportunity to work with the expert nurses at the clinic. As a result, there are a few points which are of particular concern to me.
We believe that it is important to discuss the clinic as a regional service for youth – not just a Westside or Kitsilano clinic. Young people access the Pine Clinic from across the city – it serves the 'community of Youth' without barriers of residency, insurance, diagnoses or other barriers such a fear of judgment, lack of privacy/confidentiality - perceived or real - which youth fear at walk-in clinics or family physicians’ offices. Youth often present with a medical concern or sexual health concern but, once trust has developed with the expert professionals at Pine, they are able to disclose other concerns such as high risk behaviours, mental health or addiction concerns. Early identification of concerns during this vulnerable age is a critical part of the work that is carried out at Pine.
The benefits of a broad approach to youth care in terms of prevention and early treatment is the crux of primary prevention and can result in long term savings for the health care system. If services become targeted only to high risk youth, there is concern that other youth, vulnerable youth, may not feel comfortable accessing care. There may be a corresponding impact on STI rates, associated complications, and pregnancy rates. Opportunities to work with youth with early mental health and substance abuse issues may also be missed. It should be noted that the current professional staff at Pine have specialized training and experience in addictions, eating disorders, street involved youth, LGBT care, primary care, psychiatry, post sexual assault care, HIV care, Emergency Room care. Youth benefit from this spectrum of skills because they are able to follow through at one site and often with one clinician.
Pine is currently configured as a stand-alone clinic that the younger generation trusts - it is not affiliated with schools or other agencies. Youth appreciate the casual and very youth friendly environment and organization of the clinic. If they require referral to other agencies they are assisted in navigating the complex systems which increases trust, compliance and better outcomes.
The Clinic provides a team approach - collaboration between nurses in an expanded role, physicians with a specialized youth focus and counselors. Youth benefit from the urgent care model of the drop-in format and the ability to spend time with a clinician regarding several concerns in one visit.
Research clearly indicates that outcomes for healthier populations rely on accessibility, equity, creating a supportive environment, appropriate technology, attention to health promotion and protection, intersectoral cooperation, public participation and focus on the determinants of health. Pine clinic for the past 40 years has adhered to these components of Population Health.
It is truly a travesty that the professionals who are passionate about youth health were not involved in the decision to close Pine and that the individuals who are served by this agency were not given a voice. Short term gain does not equate with long term savings when it comes to the health of our populations!
ABOUT JOANNE RICCI
Joanne Ricci is a tenured Senior Instructor at the UBC School of Nursing. She received her BScN and MSN from UBC and has been teaching at UBC for 37 years. She has taught in various areas of nursing during her time at UBC from basic skills, maternity, surgical, Post RN and for the past 20 years in population and public health. Joanne has not only demonstrated expertise in the area of public health but is also an exemplary clinical instructor and has been instrumental in supervising masters and Nurse Practitioner students.
She has developed strong relationships with her partners in the community and has contributed to countless hours on many committees and boards. Her passion for health promotion and illness prevention of infant children and youth is evident in all aspects of her work.