People living in rural, remote and Indigenous communities have historically been challenged to access needed health care services. Geography provides a physical barrier, amplifying isolation and travel costs. A lack of cultural safety for Indigenous people due to systemic racism provides another.

In conversations about how to address those challenges, most recognized that virtual communication would be the key. Then came the COVID-19 pandemic in 2020, adding to BC’s ongoing public health crisis due to the toxic drug supply – and those conversations were spurred to immediate action.

In record time, the Real-Time Virtual Support Network was ready to launch in April 2020, thanks to the collaborative efforts of the First Nations Health Authority (FNHA), the Rural Coordination Centre of BC, Provincial Health Services Authority, Northern Health, Vancouver Coastal Health, Doctors of BC, the BC Emergency Medicine Network, UBC Digital Emergency Medicine and the Ministry of Health.

The Real-Time Virtual Support Network formed the necessary connections and partnerships to create a network linking rural health care providers and patients to virtual physicians, psychiatrists, mental health clinicians, care coordinators and specialists via Zoom videoconferencing or telephone, creating a team-based, wrap-around service. It also offered multiple ways for patients and providers to access culturally safe care and support.

“Meeting the immediate needs of rural, remote and Indigenous communities in BC during a global pandemic pushed virtual care further and faster in two years than it had come in the previous decade,” says an FNHA spokesperson. “There has been year-over-year growth in people accessing the service, improvements in health outcomes, and access to timely and equitable care closer to home, which demonstrates that virtual care makes a difference in peoples’ lives and health.”

There are two main pathways to the Network – patient facing support and provider facing support. Provider support helps health care providers in rural and remote communities by providing on-demand peer support for both urgent and non-urgent situations. These include the Rural Urgent Doctor in-aid (RUDi), Child Health Advice in Real-Time Electronically (CHARLiE), Maternity and Babies Advice Line (MaBAL), and Quick Reply for a diverse and growing set of specialist services.

RUDi, CHARLiE and MaBAL are “instant access” pathways, meaning they are available 24 hours a day, seven days a week. The Quick Reply pathway is available weekdays from 9 a.m. to late afternoon, and primarily operates on a call-back basis. Together, these offer physicians, resident physicians, nurse practitioners, nurses, and midwives access to free, real-time clinical support, including but not limited to case consultations, second opinions, and ongoing patient support. It has created virtual communities of practice that offer a “safety net” for rural and remote health care providers who are often isolated and under-resourced.

“For many, many years we’ve wanted this … a support network set up for rural communities and rural providers, because for so long they haven’t had a reliable doctor-on-call services,” says a RUDi virtual provider.

The other pathway is designed to give patients direct access to virtual care for primary, urgent and specialist health concerns.

Two of the patient-facing services are the First Nations Virtual Doctor of the Day and First Nations Virtual Substance Use and Psychiatry Service led by FNHA. Both provide any Indigenous person and their family members, even if they are not Indigenous, access to care from virtual care providers. The Doctor of the Day, which launched in April 2020, is the first of its kind in Canada, enabling patients to have scheduled appointments that ensure culturally safe, primary care seven days a week. The Substance Use and Psychiatry Service launched in August 2020, offers access to specialists in addictions medicine, psychiatry, and mental health and wellness care coordinators on a referral basis from trusted health and wellness providers, Knowledge Keepers, Elders and physicians.

These two services are so widely used – supporting over 20,000 appointments since launch – that expansion has become a top priority. Doctor of the Day evaluations show 90% of patients were satisfied with their care experience, while 97% of patients using the Substance Use and Psychiatry Service felt they received culturally safe care and 93% were satisfied with their care experiences.

“Words can’t describe how valuable this program is. The doctors are so knowledgeable and caring, taking time to explain things. My health issues are being addressed thoroughly and I am very thankful,” says one patient.

Two other virtual services are also offered to rural and remote patients through the Real-Time Virtual Support Network – the HealthLink BC Emergency iDoctor-in-assistance (HEiDI) and COVID Anti-viral Treatment eTeam (CATe). HEiDI connects people to a Real-Time Virtual Support Physician when they call 811. CATe connects patients who have COVID-19 to virtual pharmacists and physicians to obtain antiviral treatments.

“These pathways offer an important lifeline of support,” says FNHA. “It eliminates travel time, reduces wait times for urgent and non-urgent issues, offers direct paths to specialized care, redirects 811 calls to appropriate health services, reduces emergency department waits, and offers support to rural and remote care providers.”