Non-Insured Walk-In Clinic (NIWIC) ANNUAL REPORT

Transcription

1 Non-Insured Walk-In Clinic (NIWIC) ANNUAL REPORT

2 NIWIC: The Non-Insured Walk-In Clinic 2 Since 2012, the Non-Insured Walk-In Clinic (NIWIC) has supported residents of Toronto who do not have health insurance or who are under-insured. NIWIC exists through a partnership between seven west-toronto Community Health Centres and the support of volunteer midwife allies. NIWIC means that vulnerable individuals can access necessary primary care and prenatal care and, importantly, NIWIC can connect these vulnerable individuals to partner agencies for on-going interdisciplinary primary care. Ongoing primary care results in better management of health, staying well and accessing specialist, hospital or emergency services only when it is appropriate. With just over five years in operation, 2018 marks an occasion to celebrate NIWIC s service to Toronto s uninsured and under-insured communities and a moment to retrospectively evaluate growth, strengths, and areas for future improvements. In this report you will see an overview of NIWIC services from April 1, 2017 to March 31, 2018 with comparisons to previous annual report results to build a picture of clinic capacity, the clients who access the clinic, health issues addressed and trajectories of care. Acknowledgements Monika Dalmacio, Registered Nurse Jessica Fowlie, Report Consultant Julia Murphy, Primary Care Manager, APOD Published January 28th, 2018

3 Who is Uninsured? 3 People can be or become uninsured for a multitude of reasons, such as: losing your OHIP card, remaining in the country following the denial of a refugee claim, or a precarious work visa that does not qualify for a path towards citizenship. Migration doesn t presuppose lack of health insurance, but in Canada, being an immigrant is linked to being without health insurance (Caulford & D Andrade, 2012). It is inherently difficult to capture attributes like health insurance or immigration status in estimates of migrant populations because immigration status can be fluid and change quickly (UN, 2017: 20). Still, migration estimates can be instructive in gauging the population of uninsured Torontonians. We know There are 250 Million Migrants Worldwide according to the UN's 2017 estimation Uninsured People Live in as estimated by a 2016 Wellesley Institute report (Barnes, 2016:2). Canada 50% of Canada's Migrants live in Toronto (Magalhaes, Carrasco & Gastaldo, 2010; Barnes, 2016). Toronto's Uninsured Population could be People NIWIC adopted the Toronto Central LHIN's definition of 'uninsured' as the basis of eligibility criteria to access services in are NON-STATUS Toronto residents who... are in the 3-MONTH WAIT PERIOD for OHIP are REFUGEE CLAIMANTS with pending or expired IFH/whose refugee claims have been rejected, suspended or are ineligible are TEMPORARY FOREIGN WORKERS who cannot afford private health insurance (minimum wage or less)

4 NIWIC Data 4 The data for this report were extracted from our Electronic Medical Records system from client visits within the 2017/2018 fiscal year. Unless otherwise specified, data presented in this report is for the 2017/2018 reporting period. Data for this report were analysed according to three main groupings of uninsured clients - 'Non-Status,' refers to clients who are without legal immigration status; 'Precarious, refers to clients who have temporary or impermanent immigration status; and 3-Month Wait Period, which refers to clients who will qualify for OHIP within 3 months of their arrival in Ontario. An in-depth description of the methods of evaluation are available in the April 2015-March 2016 Annual Report. Non-Status Expired Student Visas Expired Visitor Visas Expired Work Permits Denied Refugee Claims Precarious Refugee Claimants Humanitarian and Compassionate Permanent Residency applicants Temporary Foreign Workers Live-In Caregivers Pending Scholarship applicants 3-Month Wait Newcomer Permanent Residents Canadian Citizens who have lost their OHIP Monika Dalmacio NIWIC Registered Nurse "Working as a RN at the NIWIC has been one of my highlights working at Access Alliance. With client numbers continuing to grow each year, it is clear that the NIWIC is meeting an important need in the community. Everybody faces health challenges, regardless of their access to healthcare insurance. Medically uninsured people have few options for accessible health services. The NIWIC helps address inevitable health challenges early on. It is an important entry point for uninsured people to gain access to a range of health and social services directly at our clinic or through referrals to partner agencies. "

5 Clients Served by NIWIC /17 N = /18 N = /16 N = /15 N = 393 LEGEND 3-MONTH WAIT PERIOD PRECARIOUS NON-STATUS

6 Top Health Conditions treated at NIWIC The 80/20 rule (also called the Pareto Principle ) is a common principle applied in quality improvement to focus on changing the vital few causes (the 20%) that result in 80% of the poor outcomes. NIWIC assessment codes were analyzed using the Pareto Principle to paint a picture of the conditions that walk through the clinic door. 6 PREVENTATIVE HEALTHCARE 31% 1. Request for Referral 2. Request for Test Results 3. Visit for Preventative Immunization/Medi cations 4. Medication 5. Problem with Health System SYMPTOMS 22% 1. Elevated Blood Pressure Reading 2. Cough 3. Other & Unspecified Abdominal Pain 4. Nervousness 5. Malaise & Fatigue PREGNANCY AND CHILDBIRTH 8% 1. Supervision of a normal pregnancy Genitourinary 7% 1. Urinary tract infection, site not specified 2. Amenorrhoea, unspecified 3. Unspecified Lump in Breast 4. Abnormal uterine and vaginal bleeding, unspecified 5. Other and unspecified ovarian cysts Musculoskeletal 5% 1. Pain in Joint 2. Dorsalgia, unspecified 3. Low Back Pain 4. Other Specified Joint Disorders 5. Cervicalgia

7 7 Referrals Made for Specialist Care Obstetrics & Gynecology 121 Midwifery Gastroenterology Endocrinology Referrals made in Total Orthopedics Referrals were made for Ongoing Primary Care at Partner CHCs Telephone interpretation supported Appointments

8 8 Total # of Midwifery Visits: 142 Total # of Prenatal Visits: 98 Prenatal Client Volume Trend April 2014 to March 2018

9 Capturing NIWIC Capacity 9 YEAR CLIENTS SEEN VOLUME OF HEALTH ISSUES ADDRESSED # OF CLINIC VISITS AVERAGE NUMBER OF VISITS PER CLIENT # OF CLINIC DAYS Four 95 NIWIC clinic days were held without a Nurse Practitioner. Ninety-five eligible clients were turned away from service between September 2017-March 2018 due to clinic capacity. Total Number of Clients Seen, Client Visits & Health Issues Addressed

10 10 NIWIC Client Story "Ronnie, a 55 year old woman from the Caribbean, first came to the NIWIC in 2015 for back pain and concerns about her skin. When she was assessed, she had high blood pressure. Unfortunately, Ronnie never returned to the NIWIC for follow up. She had a stroke and was hospitalized for one month. When Ronnie was discharged, she had a hard time walking, used a wheelchair, and relied heavily on her partner for everyday needs. Her medications cost almost $300 per month. She needed intensive rehabilitation services but could not afford it. Ronnie returned to the NIWIC and was referred to a CHC for ongoing care. Ronnie now has a family doctor and receives physical and occupational therapy to improve her independence." Had Ronnie returned for follow-up at NIWIC her outcome may have been different. Ultimately, NIWIC improved Ronnie's circumstances significantly and connected her to ongoing primary care.

11 11 NIWIC Clients came from 86 C O U N T R I E S in 2017/2018 PORTUGAL, MEXICO, BRAZIL & JAMAICA have appeared in the top 5 countries of origin since /2018 Top 10 Racial-Ethnic Origins

12 12 Top Ten Countries of Origin by NIWIC report grouping Non-Status 3-Month Wait Period Precarious The #1 status in the Precarious grouping for 2017/2018 was Temporary Foreign Worker 2017/2018 saw Temporary Foreign Workers top Refugee Claimants for the third highest spot among the three immigration categories. Year of Arrival to Canada n = 490

13 13 Education Levels among NIWIC Clients Age & Gender of NIWIC Clients

14 14 Annual Income Among NIWIC Clients Over one quarter of NIWIC Clients' annual household income is between 0-$14,000 (27.83%) which supports 2.3 people on average % of NIWIC clients did not provide an answer about their income and could not give an estimate. "[T]he distribution of money, power, and resources at global, national and local levels" shape the circumstances within which we are born into, raised, live, work and age (WHO, 2018). Annual client household income (before taxes)

15 15 References Barnes, S. (2016). Health Care Access for the Uninsured in Ontario: Symposium Report. Retrieved from content/uploads/2017/01/health-care-access-for-the-uninsured-symposium- Report.pdf Caulfort, P. & J. D'Andrade. (2012). Health care for Canada's medically uninsured immigrants and refugees: Whose problem is it? Canadian Family Physician, 58(7). Retrieved from Department of Economic and Social Affairs. (2017). International Migration Report 2017 [highlights]. Retrieved from ntionreport/docs/migrationreport2017_highlights.pdf International Organization for Migration. (2017). World Migration Report Retrieved from Magalhaes,L, Caarrasco, C, & Gastaldo, D. (2010). Undocumented migrants to Canada: a scope literature review on health, access to services, and working conditions. Journal of Immigrant and Minority Health, 12. Retrieved from UN General Assembly. (2016). Migration 'Defining Human Rights Issue of Our Time,' Experts Tell Third Committee, Urging More Ratifications, Greater Compliance with Conventions. Retrieved from World Health Organization. (2018). About social determinants of health. Retrieved from