Pubdate: Tue, 31 Mar 2015
Source: Globe and Mail (Canada)
Copyright: 2015 The Globe and Mail Company
Contact:  http://www.theglobeandmail.com/
Details: http://www.mapinc.org/media/168
Author: Frances Bula
Page: S1

DTES HEALTH SERVICES TO GET REVAMPED

Vancouver Coastal Health, which spends $54-million a year in the area,
aims to get rid of duplication in the cumbersome system

Vancouver Coastal Health is undertaking a massive plan to remake
health services in the Downtown Eastside to get rid of duplication
built up over the years by layers of agencies providing health care to
10,000 people struggling with significant mental and physical health
problems.

The system also needs to change because people are living longer, a
result of past successes, health authority leaders say.

The authority spends $54-million a year to provide care in the
three-square-kilometre zone, about 2 per cent of the $3.1-billion it
spends on health care for the million residents of the whole region.

"We've said that we've got to do this differently," said Rolando
Barrios, a senior medical director who is heading up the effort to
create what is being called a second-generation strategy.

"We've created a system where we have people working in
silos."

Part of the plan is to keep the city's supervised injection site open
longer hours so the region's health-care authority can ensure as many
people as possible have access, given the unlikelihood that the
federal government will allow any other sites to open. As well,
Vancouver Coastal Health is looking at establishing a new,
ultra-low-barrier methadone clinic.

The Downtown Eastside's huge health system, often delivered through
non-profits and scattered health clinics instead of in a traditional
hospital, is cumbersome because services have been piled on top of
other services each time the authority has tackled a new health crisis.

To illustrate the problem, Dr. Barrios said he had to call a meeting
recently to deal with a single client, an older woman with dementia,
who wanted to move out of her residential-care facility.

That meeting ended up involving nine people, including several
separate case managers who were dealing with the woman in different
clinics and housing projects. None had ever talked to the other before.

"We'll certainly be aiming at better integration," Dr. Barrios
said.

The change to a second generation system, outlined in a 42-page
document now circulating in the community, includes everything from
broad reorganizations to small but unusual new initiatives.

Among them: A place for people with alcohol problems to drink safely,
mobile health services, housing projects that are set up to serve only
targeted populations, a client database to share health information,
support for research efforts to find a cocaine substitute similar to
what methadone is for heroin users, and a new payment system so
welfare cheques don't all get delivered the same day.

Dr. Barrios said the health-care system has achieved some successes,
in spite of all its apparent complications. In the mid-1990s,
authorities declared Vancouver had a public-health epidemic because
the rates of HIV infection were as high as in parts of Africa. That's
changed. "When we look at the data, we are doing something right,
because people are getting better."

In fact, the success is causing part of the problem.

People are living longer, thanks to improvements in AIDS, HIV,
hepatitis, and overdose care, so the challenge now is figuring out how
to deliver complex medical services to an older population, as well as
dealing with the usual group of younger alcoholics and drug users.

A lot of the changes are vague so far, because the authority is
talking to different groups in the Downtown Eastside about them before
doing anything definite.

But two specific ideas are being worked on.

One is a change to the hours at Insite, the city's only legal
supervised-injection site on East Hastings, so that it can serve more
people.

At the moment, Insite serves about 1,000 people a day, who sometimes
end up waiting in line to use one of the facility's 12 injection
booths. It is open 10 a.m. to 4 a.m., seven days a week.

VCH has applied for a permit for another supervised-injection site at
the Dr. Peter Centre in the West End.

The long-term plan, outlined in the reorganization document, envisions
having injection sites in many community health centres.
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MAP posted-by: Matt