Comments on: Pine for PINE!!! by Joanne Ricci, RN, MScN

By: Hannah Varto

Hannah Varto — Mon, 22 Dec 2014 05:23:53 +0000

There is a larger question which is being missed here in the discussion about primary care clinics. Let's examine the original role/intent of Health Authorities: to operate hospitals, home care and public health. It was not supposed to be to provide primary health care. Whether you agree or not, the current system that is supported by our government is that family physicians are supposed to be the ones offering primary health care whilst Health Authorities operate the acute care services, home care and public health. Youth clinics were started by public health nurses who recognized that youth required contraceptive services as a way to prevent unintended teen pregnancies - a public health role. Public health clinics specific to STD testing and management were started as a way to respond to public health's responsibility of disease control. Youth clinics were never meant to take the place of a family doctor or general primary care services. So, what happened? Why have HA's taken over primary care roles? For the answer we need to examine who the HA's primary care clinics were for: vulnerable populations (aka homeless, addicted, mentally ill, people with complex social needs, etc). HA's have filled the gap in primary care services that really were supposed to be the responsibility of family physicians. These gaps were created when vulnerable populations were unable to access a family doctor. A fee-for-service environment has created time limits and incentives for doctors to see only the least complex patients meanwhile leaving the vulnerable patients with complex social and medical needs to the HA's. And right or wrong, the HA's stepped up to fill in the gaps in service. Please don't mistake my comments as "doctor blaming". Far from it. Rather, it's a systems issue that was created by our governments in creating a two-tiered health care service. The reality is that the HAs are realizing that they can't keep filling the ever widening gap and demand for care that is occurring. Anyone wonder why Pine's waiting room was full every day? It's because the health care providers at Pine had the time to both educate and advocate and they provided high quality care without a fee-for-service environment pushing the patient out the door. We need to shift the discussion from blaming HAs for closing primary care clinics to examining the underlying reasons that these clinics existed in the first place...and why they are still so necessary...but not technically the responsibility of HAs but of our current provincial government to solve.

By: Erin

Erin — Thu, 25 Sep 2014 01:22:52 +0000

Pine Clinic delivers a health care model that has proven successful for over 40 years and offers unparalleled accessibility to its clients in a safe, discreet, supportive environment. As a student nurse I had the honour of shadowing two nurses in the clinic and I witnessed the personalized care and attention delivered by staff and the sigh of relief clients would breathe knowing they were in a safe, non-judgmental environment. Clients feel comfortable opening up about their health challenges at Pine which facilitates early treatment and prevention of illness. Clients receive medical care as well as education on issues such as sexual health, prevention and treatment of communicable diseases, substance misuse and mental health challenges. Transitioning to a fee-for-service model would decrease the accessibility of the clinic to its clientele. This could lead to vulnerable youth and individuals in need of health care at further risk, thus increasing visits to emergency rooms, which in the end is more costly to the individual and the health care system. Why change a health care model that is clearly providing so many benefits to our population's health?

By: Eric

Eric — Sun, 27 Jul 2014 05:51:52 +0000

In reply to Joel Nicholson. I concur with Mr. Nicholson. I had a chance to shadow a nurse at The Pine Clinic and they definitely provided important services that were much needed by a significant portion of our population. A specialized clinic like the Pine clinic acts as a tool to nip in the bud health problems that left un-detected or untreated, would become more unmanageable and costly in the future. The shut-down of this clinic will no doubt lead to serious and negative consequences for the long-term health of our population.

By: Kirsten

Kirsten — Sun, 20 Jul 2014 00:49:43 +0000

I am really concerned about the centralisation of primary health care services. If Pine Clinic closes, people may not want to travel farther to get services at another clinic. This plan may place more stress on our emergency care services.

By: Joel Nicholson

Joel Nicholson — Sun, 06 Jul 2014 00:08:02 +0000

As a male nursing student sent down to Pine Clinic to shadow one of the nurses on staff, I was surprised to have found the experience quite eye-opening. I had no idea these services were being offered! I remember entering through the front door and immediately noticing the amount of chairs that were filled and remained to be filled throughout the duration of my visit. Young person after young person walked in and were seen; some seeking answers to questions, others seeking solutions to problems. All arrived with an unmet need and all left that need addressed by a member of the Pine Clinic health care team.
One has to question the removal of a service that met the needs of a very unique - yet distinct - population representing the very future of this country.

By: NNPBC

NNPBC — Thu, 26 Jun 2014 21:22:10 +0000

On June 25th, Vancouver City Councillor Kerry Jang introduced a motion regarding the closing of Vancouver's Urban Primary Care Clinics. A number of organizations, politicians and individuals spoke to the importance of these clinics, and the impacts of closing them on the community, including Stan Marchuk, President of the BCNPA who spoke on behalf of nurse practitioners and registered nurses.

To view the motion: https://www.nnpbc.com/blog/wp-content/uploads/2014/06/ptec5.pdf

To view video of the proceedings and the unanimous vote in support of the motion: http://cityofvan-as1.insinc.com/ibc/mp/md/open/c/317/2311/201406250915wv150en,003

By: Stan Marchuk

Stan Marchuk — Thu, 26 Jun 2014 04:10:00 +0000

The closing of Pine Clinic is a decision that is NOT based on any good evidence, except perhaps a desire to save money. In the long run who will pay, unfortunately it is the youth who will suffer from short sighted decision making. As has been pointed out the Pine Clinic has been in existence for greater than 40 years and serving a diverse group of youth with a depth and breadth of health and social needs. VCH leadership recently presented to city council that youth were attending Pine from outside of their catchment area and felt that they should be accessing services from within their geographical area, thus they would look to "realign" youth health care needs. Unfortunately, consultation with youth and the community at large has been absent. The degradation of such services signals that health care is in crisis, with senior leadership making life altering decisions. I say engage the community, the health care providers, don't act in isolation, recognize that communities can and will come together to find a solution! Let's not break what not's broken, let fix an age old funding issue!

By: Sally Thorne

Sally Thorne — Thu, 26 Jun 2014 01:57:50 +0000

This is an example of the kind of planning that is based on partial analysis, oriented toward available metrics rather than a more fulsome understanding of the implications of decisions. Nurses in the field see the complexity of populations such as those being served by Pine Clinic. Although it is always difficult to calculate the eventual economic impact of each individual “missed opportunity” or unmet need, we can clearly see the patterns across the populations we serve, and we know that failures in primary care cost the entire system plenty going forward. The health care system is best served by strengthening, not fracturing, the kinds of relational practices with complex populations that this particular clinic stood for. We clearly need to find better ways to help the public and those who manage our publicly funded system to recognize the wisdom in good comprehensive primary care across the board. Nurses and nurse practitioners in BC have so much to offer to fixing the current gaps, barriers and missed opportunities within the primary care system. In that context, dismantling community primary care clinics with a track record of excellence in reaching complex populations, especially without any meaningful consultation with nursing, is a serious blow. Thanks for putting this on the radar as an issue about which all nurses, whether in the Lower Mainland or anywhere else in the province, ought to be very concerned.