Local services ‘have become increasingly difficult to organize,’ says spokesperson for health authority
People in the N.W.T. who live with rheumatoid arthritis will now have to travel to Alberta for care, after the territory’s health department opted to stop offering rheumatology services in Yellowknife.
The decision was “based on the interest in having regular providers and a coordinated program to support the triage, management and coordination of care for residents in a consistent and ongoing manner,” according to an emailed statement from David Maguire, a spokesperson for the territory’s health and social services authority.
“The services that we were delivering via visiting rheumatologists have become increasingly difficult to organize in a way that would provide continuity for patients,” Maguire wrote.
The change was first reported last week by Cabin Radio. The health authority did not make an announcement about it.
Continuity of care is crucial for patients, says health authority
Until now, people in need of rheumatology services in the N.W.T. were seen by visiting specialists from Alberta. That sort of “episodic” care was inadequate, according to Maguire.
“The crux of the issue is ensuring that we have consistency in frequency of visiting specialists and critically: support in between visits,” Maguire wrote.
Steven Katz, an Alberta-based rheumatologist who’s been making trips to see patients in the N.W.T. since last year, agrees that continuity of care is crucial for patients.
He had been in discussions with the N.W.T. health authority about setting up a local rheumatology program that would be staffed by a rheumatologist and another allied health professional. He says the health authority decided that wouldn’t work.
“My understanding is they’re not happy that we can’t identify a given rheumatologist to take the lead on this [local program], in a long-term sort of way,” said Katz.
“Certainly we’ve made clear that, at least for the next 12 to 18 months, as long as we start up this arthritis program, that we would be more than willing to continue to provide service in Yellowknife.”
Decision affects about 400 people
Katz said the decision affects about 400 people, according to the government’s list, but he figures it’s probably more. Those patients will now have to fly to Edmonton for care, he said.
“How many patients who are established patients and have known rheumatic disease aren’t on that list [of 400]? We don’t know that and of course there’s new referrals coming in all the time,” Katz said.
Rheumatoid arthritis is an autoimmune and inflammatory disease that mainly attacks the joints. Katz says if it’s not treated promptly, it can cause permanent joint damage, disability, and increase the risk of heart disease.
“So getting treatment quickly is really important and is life-altering,” he said.
Katz also says it’s not the sort of thing that can be treated over the phone or by video call.
“Rheumatology really relies on doing a physical exam. It’s very hard to assess if you have joint swelling over the phone, or on Zoom. You do need to see these folks in person.”
‘Not ideal,’ but better than flying to Edmonton
According to Maguire, spokesperson for the N.W.T. health authority, money is also an issue.
“If there were to be discussions with Alberta about a more cohesive program that provides the continuity and coordination of service and providers that we require, we would need to seek additional funding to support this level of service,” he wrote.
“In addition to an agreement with Alberta about the provision of specialist providers, a coordinated program would also require a suite of on-site resources that would need to be established if we were to be able to deliver this service in the N.W.T. on an ongoing basis.”
Katz agrees that it’s “not ideal” for patients when there are different rheumatologists who come and go, but he argues that it makes sense in the long term to develop a local program.
He thinks it would be better for patients — some dealing with a lot of pain and discomfort — to avoid regular travel to Edmonton. He also believes it would be a lot cheaper for the N.W.T. government.
“So not great for the patient, but I think the cost is significantly more as opposed to some of us coming up to Northwest Territories and providing that care there,” Katz said.
-With files from Hilary Bird and Rachel Zelniker
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