How does a chemotherapy outreach program impact on cancer care in rural / northern Ontario?

"Although Canada has one of the best health care systems in the world, some Canadians do not have ready access to needed health care, primarily due to the geographic maldistribution of health care providers and other resources. For example, over 50% of chemotherapy patients in northeastern Ontario live more than 50 km from the Northeastern Ontario Regional Cancer Centre (NEORCC), which itself is about 400 km from another such centre. To ameliorate such disparities, the provinces have put in place various programs to bring needed health services to patients or bring patients to services. Examples include the Underserviced Area Program and the Northern Health Travel Grant Program in Ontario. But, despite such worthwhile efforts, access to health care by residents in rural, northern and more remote areas can still be problematic and is a frequently expressed concern.

"NEORCC has addressed the issue of access to cancer care by rural residents in northeastern Ontario with the development of its Community Oncology Clinic Network (COCN) Program. This program has brought a number of community hospitals into a network of community oncology clinics. The COCN Program enables patients in more remote communities in northeastern Ontario to receive chemotherapy treatment closer to home under the supervision of local physicians and Community Chemotherapy Nurses (CCNs) at community oncology clinics and with support and direction provided by NEORCC. Although the initiative is important from the perspective of health service delivery, little is known about the impact such an initiative has on the patients and providers involved, as well as on NEORCC itself.

"In view of the need to objectively examine the impact of the program, NEORCC and the Centre for Rural and Northern Health Research (CRaNHR) at Laurentian University have collaboratively conducted an impact assessment of the COCN Program.

"This study differs from traditional social or environmental impact assessment in that our concern is not with the physical environment or the broad social environment. It is more narrowly focused. In the context of the present study, impact assessment refers to an examination of how the COCN Program affects the patients, NEORCC and the health care practitioners involved in the program. It describes and documents the effects of the program has on the various players and, more specifically, how it impinges on the structure, operations, resource utilizations, etc. at NEORCC. The assessment includes both intended and unintended consequences.

"The major findings of the study are summarized as follows:

Impact of COCN Program on Patients and Their Families

The COCN Program saved patients about four trips to NEORCC on average. This translates into a saving of $524 in out-of-pocket expenses. If the costs of owning and operating a vehicle are included, the estimated saving is $1,176. Chemotherapy patients and those who accompanied them might also benefited from having to take less time off work.

The NHTG Program could see savings of up to $292 per patient. For the fiscal year 1998-99, the savings to the NHTG Program could total $78,840.

NEORCC patients tended to have more access to sources of information pertaining to cancer and cancer treatment, but did not necessarily use these sources more frequently than COCN patients.

NEORCC and COCN respondents used supportive care services in their communities equally often. Most of the supportive care services used were informal in nature.

Satisfaction with COCN Program

Patients treated at community oncology clinics were surveyed in relation to their satisfaction with and acceptance of the COCN Program.

The ability to go home right after treatment and the availability of support from family members and friends, as well as the reduced need to travel long distances, were the main reasons for patients to take part in the COCN Program.

The disadvantages, according to the COCN patients, were the lack of cancer specialists at the community oncology clinics and the perception that the health care practitioners in their home towns might not be as up-to-date about cancer treatment as those at NEORCC.

Although patients were generally very satisfied with the COCN Program, a greater proportion of COCN patients than NEORCC patients were less satisfied with the care they had received.

Impact of COCN Program on NEORCC

The workload data collected from the NEORCC staff showed that the COCN Program had an impact on NEORCC in a number of ways.

The numbers of chemotherapy patients and treatments increased at both COCN clinics and NEORCC. When the COCN Program was first introduced, patient volume initially declined at NEORCC. However, patient volume has risen in recent years and it is now greater than before the program was introduced.

NEORCC is delivering more of the time-consuming treatments which have a greater impact on workload.

The COCN Program has eliminated some responsibilities but created new ones for the Primary Nurses and pharmacists. These new responsibilities are mainly administrative in nature.

The medical oncologists and NEORCC chemotherapy nurses see patients less frequently as a result of the program, but they have more administrative responsibilities for the COCN patients.

Three-quarters of the estimated COCN spending is attributable to manpower costs, half of which are salaries for the peripheral clinic personnel. Much of the costs of the program would have to be incurred by NEORCC whether the COCN Program existed or not.

It is estimated that 3,300 hours of chemotherapy delivery time at NEORCC have been saved as result of the program. However, the COCN Program has created new responsibilities for NEORCC staff, which are mainly administrative in nature."

From: Raymond W. Pong, Andrew Irvine, Claire McChesney, Cheryl DesRochers, Huguette Blanco and Alain Valiquette (2000). Impact Assessment of an Outreach Chemotherapy Program in Northeastern Ontario. Sudbury, Ontario: Centre for Rural and Northern Health Research, Laurentian University