Community Meeting, November 18, 2010
Survey and Questionnaire Results

240 people attended the Community Meeting held at Kings Theatre.  Each person was given an agenda as they entered the lobby.  The agenda package contained survey information.  There were oral presentations provided by community groups and local doctors in the first part of the meeting.  At intermission questionnaires were distributed on separate small 4 X 5 cards.

The raw data have been counted, recorded and presented below.

The survey and questionnaire instruments were developed in a short meeting and refined during a week of email interaction.  There was no attempt to have the instruments juried by a professional research group.  Nor has there been any attempt to compile correlations or suggest any causative factors.

A brief review of the data suggests that there were no unintended answers; the respondents clearly understood what was expected of them.  And the rate of return was very high.  On the evening the audio-visual transmission of information at Kings Theatre was excellent.  The audience listened intently.  Each audience member had the opportunity to fill out his/her own information anonymously.  From this perspective, the data provide a reasonable snapshot of community attitudes at the meeting.

The Survey
The intent of the survey was to give members of the audience at the community meeting an opportunity to provide information about themselves and their experiences with the Annapolis Community Health Centre. 213 surveys were returned although not every respondent replied to every question. The items from the survey and item-by-item number of responses, and percentages are outlined below.

1. Do you have a family doctor?
    Yes 196 96%
    No 7 3%
    Have applied for one 2 1%

2. Is your doctor situated in
    Middleton 4 2%
    Lawrencetown 4 2%
    Bridgetown 2 1%
    Annapolis Royal 176 89%
    Digby 5 3%
    Elsewhere   3%
    - Wolfville 3  
    - Antigonish 1  
    - Kentville 2  

3. How far is the Health Centre from your residence?
    1 km 64 31%
    5 km 53 27%
    10 km 48 23%
    15 km 22 11%
    20 km 13 6%
    25 km 5 2%
    greater than 25 km – how far? 2 1%

4. Do you live between the Community Health Centre in Annapolis Royal and:
    The Bear River Bridge on Highway 101, or 16 8%
    Bear River, or; 1 .5%
    Caledonia on the #8 Highway, or; 5 3%
    Bridgetown on the 201Highway, or; 26 13%
    Bridgetown on Highway #1, or; 26 13%
    Hampton along the Shore Road, or; 2 1%
    Delaps Cove, or; 5 3%
    Victoria Beach, or; 51 26%
    - Annapolis Royal 53 27%
    - Lequille 3 2%
    - Cornwallis 1 .5%
    - Upper Clements 2 1%
    - Clementsport 2 1%
    - Virginia East 1 .5%
    - Hillsburn 1 .5%
    - West Springhill 1 .5%

5. Have you used ER/Out Patient services at the Community Health Centre in the last two years?
    Yes 189 89%
    No 24 11%

6. How did you get to the Community Health Centre?
    Walked 22 11%
    Drove myself 129 65%
    Got a ride 34 17%
    Taxi 0  
    Bus 0  
    Ambulance 12 6%
    Other – bicycle 2 1%

7. If yes, how long before you were seen?
    15 minutes 52 27%
    30 minutes 42 22%
    1 hour 60 31%
    How long?    
    - 1.5 hours 1 .5%
    - 2.0 hours 20 10%
    - 3.0 hours 7 3.5%
    - 3.5 hours 1 .5%
    - 4.0 hours 6 3%
    - 5.0 hours 2 1%
    - 9.0 hours 1 .5%

8. Were you well cared for?
    Yes 178 96%
    No 2 1%
    Have applied for one 5 3%

9. Do your answers represent others in your family?
    Just me 88 47%
    One other 97 49%
    How many?    
    - Three 5 2.5%
    - Four 3 1.5%
    - Five 4 2%


The Questionnaire
The purpose of the questionnaire was to seek input from the community with respect to retaining the 24/7 ER at the ACHC – Annapolis Community Health Centre – and to ask the community if the citizens want the FACHC – Friends of Annapolis Community Health Centre – to continue to work on their behalf.

1. I support a full-service 24-hour 7 day-a-week ER at ACHC.
    Yes 130 75%
    No 20 12%
    No Opinion 23 13%

2. I support the proposed change to the 16-hour 7 day-a-week CARE: Collaborative Assessment Room Emergency system as described for ACHC.
    Yes 86 50%
    No 57 33%
    No Opinion 30 17%

3. I support the FACHC: Friends of Annapolis Community Health Centre continuing to work on our behalf.
    Yes 168 97%
    No 1 .6%
    No Opinion 4 2.4%


Comment and/or Question: Are there any comments or questions you wish to record?
93 people took the opportunity to express themselves by means of comments in the space provided and they are transcribed verbatim below. They were found in random order and numbered so as to ensure there was no duplication of responses in the transcription process.

  1. We must all work together and communicate and be so thankful for the services we do have.
  2. I do not support 24/7 ER if we lose services already in place.
  3. I’m concerned that the younger population are leaving this area while the senior population pass away or move out as well.  If it continues, how will our economy support the medical facilities, etc.
  4. Having a 16/7 CARE emergency is better than a closure of all Emergency Care.  All a matter of money.
  5. The cost of an ambulance from home to Health Centre is a huge concern.
  6. Include RESTORE with item #2 (Question 2).
  7. The ambulance cost issue must be addressed if 24/7 emerg is not maintained.
  8. Dr. Buchkolz presented a very clear solution which is more sustainable than a 24/7 service.
  9. YES to question #2 only if we can’t have #1 (24/7).
  10. YES to #2 if there is no other alternative.
  11. Need more info to answer #2.
  12. NO to #2 unless it is the only option.
  13. YES to question #2 but prefer 24/7.  (this person answered YES to both #1 and #2)
  14. Answered YES to both #1 and #2 then commented “24/7 until EHS is free, then CARE”
  15. Answered YES to both #1 and #2 then commented “Prefer #1, accept #2 if necessary”
  16. Answered YES to both #1 and #2 then commented “CARE only as an alternative”
  17. Need more info for #2.  Economy of our rural area will go down.  Investments are being made by local entrepreneurs.  Town is hoping to build 200+ homes/apts/etc.
  18. How would option 2 affect the recruitment of new doctors and other professionals and the desire of current providers to remain in the area?
  19. 18/7 open seems reasonable as long as there is someone “on call” 24/7 and could be there should someone arrived inadvertently or in an absolute emergency: no one should be turned away or die “outside the door”
  20. This (#2) seems like a done deal.  Both Docs seem to see it as inevitable given the $ crisis and may result in better care overall.  It seems at present that medically getting to ACHC may delay optional care for stroke, septis etc – the only advantage is $ (to the patient) since the ride to Kentville is then between health centre – thus no charge – eliminate the EHS fee and we’re all better off.
  21. Shouldn’t necessarily be an either/or response.  We should have 24/7 emerg service as well as striving to attain and promote systems which encourage better health.  Helping this along not waiting for it to come.
  22. Mental & emotional health relies on surroundings and in this area we have lost railways, schools, churches and we struggle to support Legions, community centres, nursing homes and so-on, not to mention health centres and hospitals.  It’s tiring.
  23. Ambulance service has to be improved and something done about the cost.
  24. (#2) I need to know that the required training of ambulance drivers has been done and the system is fully operative.
  25. Whenever I use the ER it is after 10:00 at night.
  26. A true ER needs to be open around the clock.
  27. ACHC is doing a good job.  Keep up the good work.
  28. Need better access to primary care.
  29. I question when we have the seniors comples here, how we can close these fac.  Doesn’t that mean that the whole community will close as well.
  30. With 16/7 service, will I be permitted to go to ACHC for primary care.
  31. I am for the 18 hrs 7 days a week.  Excellent idea.
  32. Should be able to see primary care Dr. when needed …not weeks later.
  33. Provide more GPs.  Current docs are overworked by #’s Primary care would alleviate most of problems.
  34. Add user fees to cover the budget shortfall.
  35. We have to live within our means.
  36. #2 – Have Dr on call for hours not open.  Not necessarily at the facility.. at home, so cover emergencies during closure times.
  37. Dr B or B -  What’s in a name ?  Do we actually have an ER at ACHC, or do we have a walk-in clinic.
  38. How does all this affect the recruitment of new doctors to this area (ACHC) ?
  39. If we can’t have 24/7, any improvement is better to the ER situation than no improvement at all.
  40. Only (#2) if it means the doctors will still be able to see the full range of issues (levels 1-5) so that they can maintain their skills.
  41. Re: #2.  Maybe 18/7.  With the money saved can we reduce the ambulance charge.
  42. Need to stop long waiting time.  Could people be screened or prioritized so if ER is not the place to be – they have the long if they so choose.
  43. Can we facilitate a model of several Nurse Practitioners in fewer Dr’s to recruit ?  Primary Care.
  44. Can’t afford a Cadilac.  Get a Toyota.
  45. If ACHC goes to a 16hr/7day a week how can you keep your in-beds and pallieative care rooms – it does not compute.
  46. Change government….government 4 people, by people.
  47. I need the Health Centre.
  48. Please keep our Health Centre OPEN & AVAILABLE.
  49. It would be wonderful to keep what we have now, however, anything would be better than closure.  So even though I answered “no” to #2, it would be satisfactory.
  50. If paramedics are used to administer the care that would normally be given in the ER, does the patient have to pay for it as they to pay for the ambulance?
  51. Why not dismantle some of the administrative overhead associated with regional health boards and re-direct into patient care/services.
  52. I believe that requiring patients who are in distress to travel to a remote hospital in the middle of the night would discourage them from seeking assistance until the morning.
  53. If a heart attack occurs does EHS have the ability to provide all meds to save the patient so they arrive to VRH in an appropriate time.
  54. #1 answered YES with the comment “till alternative proven”.  Additional comment was: Costs will be critical to the choice made – ( ex physicians fees).
  55. Need to follow approach suggested by Dr. Bucholz – think ouside box and be prepared to compromise.
  56. I would support either #1 or #2.
  57. Keep up the good work!
  58. 1 & 2 all depend on some of the options and discussions described during the presentations.
  59. I need the Health Care Centre.
  60. I see a need of preventative education in this area.  Ambulance fees are way to expensive.
  61. We will 1st achieve success if every citizen has a family doctor for primary care.
  62. This system ACHC works well. I recommend that Capital Health model its services on ACHC.
  63. More nurse practioners please.
  64. Item 2 is dependent on the proposal paramedic core routine.
  65. A week in clinic would be a way to lessen use of ER departments.  A compare of cost to make EMS technicians (Level 4) available 24/7.
  66. Re:2  -  If there will be no fee for EHS use during the 8 HR closure.
  67. Question 2 requires EHS commitment to extra training.
  68. Provided ambulance fees are not charged to the patient.
  69. Health Care should not be treated as a business.  Illness does not happen 9-5!  Allow communities to support the “hospitals” in their area in all ways.
  70. Re: #2 – Am concerned about enough paramedics for additional ambulances.  Enough ambulances and enough ER doctors and beds for patient care in Kentville and Halifax.
  71. If we have to go to larger centres for our Health Care how can they look after us as there are only so many they can handle.
  72. Re:#1 – if possible            Re:#2 – I would need a more thorough explanation.
  73. Re:#1 – or open as funding permits      Re:#2 – There may be no need for a 24/7 emergency room service as long as EHS ambulances can take up the slack.
  74. I prefer 16/7 to 24/5.
  75. Stuff Happens!
  76. I agree entirely with Dr Bucholtz’s approach as he presented it tonight.
  77. ACHC provides wonderful service at all times in all ends.
  78. Thus far the Friends have caused needless hysteria.
  79. I also support 24/7 ER.  But will if need be – support 16/7 ER.
  80. People need to understand an ER is for emergency.  But also need doctor appointments in a reasonable time frame (not months waiting).
  81. RE: #2  - not without good discussion about services.     Additional comment - Why are we not insisting on good discussion/communication for our unique community needs.
  82. We cannot control when an emergency occurs.  I REALLY don’t want to rely on an electronic transmission to determine whether or not I am having a stroke or heart attack.  However, I do have faith in our EHS department.  The Electronic transmission response may have and will fail in terms of his diagnosis.  This waiting 3-4 months to see my physicians is unacceptable.
  83. A 16 hr 7 day a week ER CARE is OK as long as ambulance service during closure is reduced or free.
  84. I would really rather have the 24/7 ER but can see the writing on the wall.  It is imperative we retain our palliative, in-patient beds & the rest of the services we now have.
  85. I still can’t accept Kentville.
  86. What we have works.  Please don’t change it.
  87. YES to #1 “At Present”.  When will the EHS begin advanced training ?  As was suggested by Dr. B, I agree we’re an 18/7, and therefore, strongly suggest adding $ towards lowering the ambulance cost as a high priority.
  88. Please do not give up on 24/7 service.  It will only be the beginning  -  we will lose more.  I suggest the DOH take a good look at administrative costs for each district – all 9 of them!  I can only imagine how much it costs to pay all those CEOs and VPs and all the many assistants to the assistants!  I have worked in the system and its unbelievable!  It is difficult for an employee to even know who to report to – there are too many bosses and at what cost?  It’s mind-boggling.  It would be interesting to know just how much $ is spent on mileage for these administrators annually.  We have lost sight of what is important here – a human being who is ill and in crisis and wants to be close to home if and when possible.
  89. What Happened?  We are caving in, and we will end up losing more than is predicted.
  90. Re: #2 – If only option other than closure.
  91. We need to be responsible and proactive there are solutions lets be willing.
  92. The only way Dr. Bucholz reduced hour – ER transport will work is if a 1-800 ???? line (could I be having a heart attack or is only indigestion).  Plus cost free transport.
  93. Re: #1 – Yes or valid alternative    Re: #2 – Yes Best Option.

This site has been created by the Friends of ACHC who are a concerned group of citizens working with the Annapolis West Health Foundation (AWHF), Annapolis Community Health Centre Auxiliary (ACHC Aux) and the Town of Annapolis Royal.

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