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header 2018 awards

Providing the Providers - an initiative to improve first line dermatology care to aboriginal communities in Northern Quebec

Excellence in Education Category - Community Vote Award

Providing the Providers
  • Lead Dermatologist: Dr. Elizabeth O'Brien
  • Project team members: Johanne Morel, Fatemeh Jafarian, Kimya Hassani-Ardakani, Hanieh Zargham
  • Affiliation: McGill University Health Centre, Canada

Aiming to improve the dermatological health status of Quebec’s aboriginal population by developing a comprehensive distance education program for primary care professionals and providing culturally appropriate patient education tools.

Executive Summary
Significant health disparities continue for Canada’s indigenous populations, particularly in the field of dermatology. Remote indigenous communities in Quebec experience a higher burden of skin disease with limited access to specialist care. General practitioners lack adequate dermatology training to address the populations’ needs and ensure compliance. We propose developing a comprehensive distance education program for primary care professionals to improve the diagnosis and management of common skin diseases and provide culturally appropriate tools for patient education. Ultimately, our goal is to improve the health status of Quebec’s aboriginal population from a dermatological standpoint and decrease morbidity from skin disease.

The Challenge
The Cree and Inuit are two of the largest indigenous groups in the province of Quebec, with approximately 30,000 members living in remote communities across Northern Quebec. Despite efforts to improve the health status of aboriginal people, serious health disparities remain in the prevalence of certain diseases and access to specialized medical services, including dermatology. Skin infections, such as scabies and impetigo, have a higher prevalence amongst aboriginal communities and contribute to significant morbidity. A recent retrospective study comparing hospitalization rates for indigenous and non-indigenous infants in Quebec found that indigenous infants were at 5 times higher risk for hospitalization due to skin infections. Indeed, skin infections and other skin diseases constitute a major reason for presentation to general practitioners and represent a significant health and socioeconomic burden. Unfortunately, there are no local or visiting dermatologists serving this population and access to teledermatology is limited. To see a dermatologist, patients must fly long distances to Montreal or Quebec city, which is often not feasible due to family arrangements (e.g. mothers leaving behind their children), expenses and other social factors. Family physicians and nurses have therefore become key players in management of dermatological cases. However, due to limited training in dermatology, they often do not feel comfortable with diagnosing and managing common skin diseases. The unmet dermatological needs of the aboriginal population can be improved through training primary care professionals how to better recognize and address common skin conditions, how to maintain compliance through patient education, and when to provide referrals.

Project Details
Our target audience will be healthcare professionals (including family physicians, general pediatricians and nurses) working in the Cree and Inuit communities in Quebec, as they are the key players in the management of skin conditions in this population.
We will work with these professionals towards the following objectives:
- Improving diagnostic accuracy and management of common skin diseases through a dermatology education program.
- Providing culturally appropriate tools for patient education that empower patients and increase compliance.
- Ultimately, improving the health status of Quebec’s aboriginal population from a dermatological standpoint and decreasing morbidity from skin disease.
The project will consist of a dermatology curriculum that includes 8 annual videoconferences, each including:
- Lecture by a McGill dermatologist on common skin diseases, selected on the basis of relevance and the target audience needs. Topics to be covered for the first year include: eczema, skin infections and infestations, psoriasis, acne and rosacea, skin cancer, drug reactions, and dermatological emergencies.
- Each lecture will be followed by discussion of a relevant challenging case already pre-selected by the target audience and submitted to the presenting dermatologist.
- Complementary high-yield notes (e.g. algorithms for basic workup and management, what to prescribe, and when to refer).
- Complementary educational pamphlets for patients in the Cree and Inuit (Inuktitut) languages, featuring culture-specific examples and illustrations. A culturally appropriate approach in patient education has been shown to improve health literacy and can lead to better health decision-making and outcomes.
- Self-assessment quizzes to track participant progress and a questionnaire used to solicit feedback.
The curriculum will also be strengthened by a special annual session on the importance of patient education. During the first year of the project, we will cover how to develop an eczema education program for patients and their caregivers. We will prepare resources to be shared with patients, including culturally-appropriate, illustrated educational pamphlets and short videos (already prepared in English) with Cree and Inuktitut voiceover on eczema skin care and preventing secondary skin infections.
To make this project possible, we will work with:
- The McGill Patient Education office and Northern Health program to develop culturally appropriate illustrated educational pamphlets.
- The RUIS (Réseau Universitaire Intégré de Santé) McGill Telehealth Centre, which has an established videoconference network in Cree and Inuit communities.
- McGill Distance Teaching and Learning Centre, which offers educational videoconferences for healthcare professionals in the remote northern communities. While this platform covers many topics, no dermatology lectures have thus far been included. The experience of our team members using the McGill videoconferencing network and telehealth services will facilitate the success of the project.
This project is specifically designed to be sustainable:
- Videoconferences and educational material from each year will be archived through the Distance Teaching and Learning Centre. New lectures will be added each year according to feedback.
- We will work with the McGill Distance Teaching and Learning Centre and RUIS McGill to secure additional funds after the first year.
- Each year, interested McGill residents will be invited to participate in this initiative and contribute to the project’s success.

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