Closing the health equity gap

The patient’s airway was swelling shut and Dr. Mary Koziol needed to act fast.

As a newly graduated family physician serving rural communities, Dr. Koziol had seen anaphylaxis — a serious, potentially fatal allergic reaction — many times before, but she had never had to intubate a patient whose airway was compromised.

“In the vast majority of cases, anaphylaxis resolves with the administration of epinephrine, but in this case, it didn’t. The situation was novel,” she remembers. Dr. Koziol dialed into Real-Time Virtual Support (RTVS) and was immediately connected by video link with an emergency medicine colleague.

“I was using a glide scope, and based on what the specialist could see on the screen, he told me exactly how to move my hand so I was able to slide the tube safely into the patient’s trachea, securing the airway and ensuring the patient could be effectively ventilated.”

RTVS connects physicians, nurses and other healthcare providers working in rural, remote and Indigenous communities across British Columbia with a wide range of emergency and specialist support — from obstetrics to hematology and neurology.

The UBC Faculty of Medicine’s Drs. John Pawlovich, Ray Markham and Kendall Ho, along with partners across the health sector, were instrumental in setting up RTVS as a province-wide service at the start of the pandemic.

“With the click of a button, you can connect online or by phone with a colleague and receive help and advice about the case you’re dealing with,” explains Dr. Pawlovich, who is also the Rural Doctors’ UBC Chair in Rural Health.

A partnership between UBC, the Rural Coordination Centre of British Columbia (RCCbc), the First Nations Health Authority and other health authorities across the province, RTVS offers multiple different helplines, or pathways. Three of them — the emergency (known as RUDi), maternity and newborns (MaBAL), and pediatrics (CHARLiE) pathways — are available 24 hours per day, seven days a week.

An additional six specialist pathways are available weekdays during office hours. There are also patient-facing pathways, including the First Nations Virtual Doctor of the Day and First Nations Substance Use and Psychiatry Service, as well as the emergency medicine HEIDi line, which is available to both rural and urban patients, and is connected to the provincial 8-1-1 service.

“It’s about closing the health and healthcare inequity gaps that exist between remote, rural and Indigenous communities and better-resourced urban centres by making high-quality care accessible to everyone, everywhere in the province,” says Dr. Markham, a clinical professor in the Department of Family Practice and the UBC Special Advisor on Health Systems to the Vice-President, Health.

RTVS is also an important teaching platform for UBC resident doctors intending to practice in rural communities.

“Through the UBC Rural Continuing Professional Development Program, we offer training simulations that give resident doctors first-hand experience of how they can integrate RTVS into their practice in the future,” explains Dr. Kendall Ho, one of the RTVS co-founders and a professor in the Faculty of Medicine’s Department of Emergency Medicine.

“The goal is to help them feel empowered, knowing they can access the support of a knowledgeable colleague, 24/7.”

Since its launch, RTVS has provided support to hundreds of healthcare providers and thousands of patients across the province. In just its first 18 months of existence, the emergency RUDi pathway alone provided over 16,000 hours of coverage and 2,800 hours of clinical time to 75 rural communities. It now provides support to over 150 communities.

And with demand for these services continuing to rise, there are plans to expand RTVS to include additional specialty pathways such as internal medicine.

“Ultimately, what we’re seeing is that RTVS eases the burden on health professionals in these communities, which enhances the quality of care. The network is also helping to improve continuity of care and access to culturally appropriate care within the health system,” Dr. Ho says.