CommunityCapital Health Community Clinical Profile Services / Health System Planning Group (2014)
Created by the Capital Health Community Clinical Services/
Health System Planning Group
November 2014
Dartmouth / Contact: Primary Health Care, Capital Health [email protected] Southeastern
Community Health Network 1 Overview:
Community Profiles have been developed to inform Clinical Services/ Population: 112,382 Health System Planning for community-based programs at Capital Health. The Community Profiles, including citizen engagement results from the Community Health Boards, provide a community lens that will inform an evidence-based approach to future planning at a local level. The purpose of the profile is to provide a snapshot of the populations and communities within each of the five Community Health Networks (CHNs; formerly referred to as Zones). Please refer to the Glossary and Data Dictionary for key definitions and data sources for each of the indicators/concepts mentioned in the report. These community profiles build upon the work of the Population Health Status Report (Public Health, Capital Health, 2013), which can be referenced for further detail regarding demographics, methodology, and additional analysis of selected variables. A full list of contributors to this report is located in Appendix A.
Table of Contents: (for a full table of contents and list of tables and figures, refer to Appendices B-D) I. Geography II. Community Health Board Engagement III. Community Health Network Inventory IV. Population Demographics V. Health Status VI. Service Delivery Locations VII. Health Service Utilization Data VIII. Summary of Observations for each Community within the Community Health Network
GEOGRAPHY
CHN 4
CHN 5 CHN 3
CHN 1
CHN 2
Figure 1: Community Health Network 1 and Capital
District Health Authority Geography. There are five proposed Community Health Networks (formerly referred to as Zones) across the district.
Community Health Network 1: Dartmouth / Southeastern Page | 1 Capital Health Community Clinical Services / Health System Planning Group (2014) Community Composition
Figure 2: Community Health Network 1 Geography
Community Health Network 1 (CHN 1) includes the communities of:
Table 1: CHN 1 Communities and Populations Community Population Cole Harbour 25,161 Dartmouth East 23,616 Dartmouth North 19,238 Dartmouth South 24,719 Eastern Passage 11,740 Lawrencetown 5,639 Preston 2,269 CHN 1 Total 112,382 Source: 2011 Canadian Census data (Government of Nova Scotia, 2013. Nova Scotia Community Counts).
The population of CHN 1 is 112,382 citizens, which accounts for 26.6% of the population of the Capital District Health Authority (CDHA). The Milbrook First Nation Community - Cole Harbour 30 is also located within this geography; however, no population or demographic data is available.
CHN 1 encompasses the Dartmouth Community Health Board (population: 68,210) and the Southeastern Community Health Board (population: 43,393). Together, the two CHBs represent 99.5% of the population of the CHN, thus combined data for the two CHBs are used as a geographic comparator (e.g., a proxy measure of the CHN average) where aggregate data is not available. Comparisons made within CHNs are based on observation only; statistical tests for significance were not completed for the purposes of this project. Please refer to Appendix E for a data disclaimer applicable to all readers and users of this report.
Community Health Network 1: Dartmouth / Southeastern Page | 2 Capital Health Community Clinical Services / Health System Planning Group (2014) Rurality
Figure 3: CHN 1 Rurality (Canadian Census, 2011; Community Counts Community Boundaries, 2011).
Communities were categorized as being urban, suburban, or rural, using a definition1 based on population density and proximity to the urban core:
Rural Rural Communities 2.0% of Population Preston
Suburban 5.0% of Suburban Communities Population Lawrencetown
Urban Communities Urban Cole Harbour, Dartmouth East, Dartmouth 93.0% of North, Dartmouth South, Eastern Passage Population
1 Urban: greater than 280 people per km2; Suburban: between 46 people per km2 and 280 people per km2 and surrounding an urban core; Rural: <46 people per km2 and/or identifying pockets of higher population density that may be above 46 people per km2, but not surrounding the urban core (definition adapted for Capital Health by Public Health & Primary Health Care, Capital Health).
Community Health Network 1: Dartmouth / Southeastern Page | 3 Capital Health Community Clinical Services / Health System Planning Group (2014) Population Projections
Figure 4: Percentage of population change from 2014-2024, by community (Environics Analytics Group LTD., 2014, modeled from Census Canada data, 2011).
Population projections for communities in the Capital Health district were obtained from Environics Analytics Group Ltd (2014) and analyzed for Capital Health. This data provided five and ten year projections for six-digit postal codes in Capital Health, which were aggregated to the community level. The five and ten year projections for each community, as well as projections for the youth (<20 years of age) and senior (65 years and above) population are highlighted in Table 2. Figure 4 depicts the percent change in population for communities within the CHN over a ten year period (2014-2024). Refer to Appendix E for a detailed breakdown of all ages groups by community.
Trends in projected populations are generally consistent with the trends reported in the Ivany Report (2014) for the Halifax Regional Municipality. The Ivany Report noted a decrease in the percentage of population of youth and a 49% increase in population for the age category >64 years. This will result in a +1% net increase in population for the HRM by the year 2034 (Nova Scotia Department of Finance, 2013).
Population growth in CHN 1 is relatively stable over the next ten years, with the CHN experiencing a 3% increase in population by 2019 and a 5% increase in population by 2024. Within the CHN, the majority of communities show small increases or decreases over a ten year period, with the exceptions being Dartmouth South and Lawrencetown. Lawrencetown is the community within CHN 1 experiencing the larger growth in population over a five year and ten year period (32% and 38% population growth, respectively). Lawrencetown is also the community that will have the largest percent increase in senior population, while Dartmouth North will have the lowest percent increase in the senior population. Dartmouth South will have the larger percent increase in the youth population, while Preston will experience the largest percent decrease of the youth population. Refer to Table 2 for a detailed breakdown by community.
Community Health Network 1: Dartmouth / Southeastern Page | 4 Capital Health Community Clinical Services / Health System Planning Group (2014)
Table 2: 2019 (5 Year) and 2024 (10 year) Population Projections for Communities within the CHN 20193 20244 20142 Percent Change (%) Percent Change (%) Projected Projected Population Population Total Youth Seniors Population Total Youth Seniors CDHA 423,163 463,931 10 -7 50 476,940 13 -4 78 CHN 1 112,382 116,044 3 -13 31 118,232 5 -11 58 Community Cole Harbour 25,161 24,074 -4 -24 59 24,509 -3 -26 100 Dartmouth 23,616 22,872 -3 -24 16 22,956 -3 -24 40 East Dartmouth 19,238 18,972 -1 -7 12 18,897 -2 -3 29 North Dartmouth 24,719 29,109 18 14 20 29,781 20 19 39 South Eastern 11,740 11,346 -3 -19 44 11,988 2 -15 85 Passage Lawrencetown 5,639 7,416 32 5 144 7,773 38 5 227 Preston 2,269 2,254 -1 -29 48 2,328 3 -32 91 Net Change for CHN 1 ↑3,662 citizens ↑5,850 citizens
Source: Environics Analytics Group LTD., 2014
Note for Readers: Throughout the report, you will notice numbers bolded in red and blue (like the above example). This is to identify the highest value within a CHN (red) and the lowest value within a CHN (blue). In some cases, bolded numbers also designate when the CHN rate is higher than the district rate (red) or lower than the district rate (blue).
2 As reported by 2011 Canadian Census Data 3 All percentages reported for population projections are relative to the 2014 population: 5 year projections are calculated based on percent change from 2014-2019 4 All percentages reported for population projections are relative to the 2014 population: 10 year projections are calculated based on percent change from 2014-2024
Community Health Network 1: Dartmouth / Southeastern Page | 5 Capital Health Community Clinical Services / Health System Planning Group (2014)
COMMUNITY HEALTH BOARD (CHB) ENGAGEMENT
Dartmouth Community Health Board findings from 2013 Community Health Plan
The Dartmouth CHB includes the communities of Dartmouth North, Dartmouth East, and Dartmouth South Working groups that support mental health, healthy eating, and physical activity within the community are a key activity These groups will support and provide education on mental health and foster community partnerships that promote healthy food options in Dartmouth area schools Social media will be used to highlight resources including 211, community health initiatives, and the Helping Tree
Southeastern Community Health Board findings from the 2013 Community Health Plan
The Southeastern CHB includes Eastern Passage, Cole Harbour, Preston and Lawrencetown Residents do not know about existing programs and services provided by Capital Health in the community; therefore, a goal for the SECHB is to become a hub for information and learning about programs and services and a conduit connecting community to those programs and services The development of a health equity lens is a key activity
Note: The information provided in this section is a brief overview only; further information regarding community consultations and priority issues and actions identified by each Community Health Board is available via the CHBs and the 2013 Community Health Plan (http://www.cdha.nshealth.ca/involving-patients-citizens/news/community-health-plan)
Community Health Network 1: Dartmouth / Southeastern Page | 6 Capital Health Community Clinical Services / Health System Planning Group (2014)
COMMUNITY HEALTH NETWORK INVENTORY
The Community Health Network Inventory provides a brief overview of some of the data available regarding community assets that have an impact on health (e.g., recreation locations) and access (e.g., transportation). This is not an exhaustive list of all of the community resources and partners that exist within geographies contributing to the overall health and well-being of citizens. Other community assets that are not listed in this section include, but are not limited to: shelters, food banks, faith-based organizations, educational institutions, libraries, social clubs and organizations, community leaders, other municipal, health, social, and not-for-profit partners and organizations, and many others. Further information and details about community assets can be found through 211 Nova Scotia5 and using Nova Scotia Community Counts Map Centre6.
Food Sources
Figure 5: CHN 1 Food Source Locations. Locations for the grocery stores/fast food sites provided by Dr. S. Kirk, Dalhousie University (2011); adapted from Population Health Status Report, Public Health, CDHA (2013)
Figure 5 depicts food availability across the CHN as indicated by locations of food sources. Observationally, clusters of food sources are evident in the urban core. Tables 3 and 4 below indicate the density per 100,000 population of grocery stores and fast food locations, respectively.
5 211 Nova Scotia: http://ns.211.ca/homepage 6 http://www.novascotia.ca/finance/communitycounts/map_centre/dha.html#
Community Health Network 1: Dartmouth / Southeastern Page | 7 Capital Health Community Clinical Services / Health System Planning Group (2014)
Table 3: Density of Grocery Store Locations per 100,000 by Community within CHN 1 Density of grocery locations per 100,000 Communities within the CHN Low Density 0.0 – 45.5 Dartmouth South, Dartmouth East, Preston, Cole Harbour, Eastern Passage, Lawrencetown 45.6 – 91.1 Dartmouth North Medium Density 91.2 – 182.2 n/a High Density 182.3 – 227.8 n/a Source: Dr. S. Kirk, Dalhousie University (2011); Population Health Status Report, Public Health, CDHA (2013)
Table 4: Density of Fast Food Locations per 100,000 by Community within CHN 1 Density of fast food locations per 100,000 Communities within the CHN Low Density 0.0 – 84.7 Cole Harbour, Eastern Passage, Preston, Lawrencetown 84.8 – 169.5 Dartmouth East Medium Density 169.6 – 254.3 Dartmouth South 254.4 – 339.0 Dartmouth North High Density 339.1 – 433.8 n/a
Source: Dr. S. Kirk, Dalhousie University (2011); Population Health Status Report, Public Health, CDHA (2013)
Information regarding liquor store locations is based on Nova Scotia Liquor Commission (NSLC) locations including agencies and specialty stores (n = 51) that were present during the period of 2006 to 2011. It is important to note that various NSLC locations have opened and closed between 2011 and 2014 (Population Health Status Report, Public Health CDHA, 2013). Refer to Table 5.
The Dartmouth CHB had five liquor stores at a density of 7.4 stores per 100,000 population with sales per capita being $582 (second highest in the district). Currently in 2014, there are six NSLC locations in the Dartmouth CHB, located in the communities of Dartmouth South (4) and Dartmouth East (2).
The Southeastern CHB has two liquor stores at a density of 4.7 stores per 100,000 population, with $372 per capita in sales, which is the lowest per capita sales in the district. These liquor stores are located in the communities of Eastern Passage and Cole Harbour.
Table 5: Nova Scotia Liquor Commission Data, by Community Health Board, for period 2006-2011 CHB Number of Stores Number of Stores per 100,000 population Sales per Capita7 Dartmouth 5 (2014: 6) 7.4 $582 Southeastern 2 4.7 $372 Halifax Peninsula 10 (2014: 11) 13.9 $870 Chebucto West 5 (2014: 7) 5.9 $378 Cobequid 8 (2014: 6) 9.6 $541 Eastern Shore 4 18.6 $491 Musquodoboit West Hants Uniacke 1 (2014: 2) 4.6 $374
Source: Population Health Status Report, Public Health, Capital Health, 2013; Nova Scotia Liquor Commission data for time period 2006-2011; Nova Scotia Liquor Commission, Store Information (2014), retrieved August 15, 2014 from http://www.mynslc.com/Pages/storeInformation.aspx
7 Annual sales per capita are not necessarily reflective of the population living in the CHB (based on total revenue of the stores in the CHBs).
Community Health Network 1: Dartmouth / Southeastern Page | 8 Capital Health Community Clinical Services / Health System Planning Group (2014)
Transportation
Figure 6: CHN 1 method of transportation to work by community and Metro Transit Bus Routes (Transportation: Canadian Census, 2006; Bus routes: Halifax Regional Municipality, 2014)
Transportation was measured as the method of transportation to and from work. Figure 6 depicts the breakdown of transportation methods by community, as well as the bus routes servicing CHN 1.
CHN 1 has the highest rate of the population reporting public transit as the predominant method of transportation to work across the district (15.2%). The communities within the CHN reporting the higher rate of public transit use are: Dartmouth North (23.4% of citizens), Preston (18.2% of citizens), and Dartmouth South (18.1% of citizens). Of note to this observation is the limited access to bus routes within the community of Preston.
Lawrencetown is the community within the CHN reporting lower use of public transit as the method of transportation to work (1.8%) and the higher percentage of vehicle use (94.6%), likely related to the fact that there are no bus routes servicing the community of Lawrencetown.
Community Health Network 1: Dartmouth / Southeastern Page | 9 Capital Health Community Clinical Services / Health System Planning Group (2014) Recreation Locations
Figure 7: CHN 1 Recreation Locations by Type (Halifax Regional Municipality, HRM Park Recreation Features, 2014).
Figure 8: CHN 1 Park Locations by Type (Restricted and Limited Use Land Database, Government of Nova, 2013; Halifax Regional
Municipality, HRM Parks, 2014; Halifax Regional Municipality, Trails, 2014).
Figure 7 depicts recreation locations in CHN 1, based on type of facility and location. Observationally, clusters of recreation locations are evident in the more urban areas of CHN 1. Figure 8 depicts the locations of recognized parks and trails, by type, in CHN 1.
Community Health Network 1: Dartmouth / Southeastern Page | 10 Capital Health Community Clinical Services / Health System Planning Group (2014) Public Housing Communities
Figure 9: Public/Affordable Housing Units per 1000 population (Housing Nova Scotia, 2014).
Figure 9 depicts the density of public/affordable housing units per 1000 population in CHN 1. Data were suppressed for any community with less than five public housing units for confidentiality purposes. The community in CHN 1 with the greater density of public housing units per 1000 population is Dartmouth South. The actual number of public/affordable housing units in each community is indicated by the number on the map. Dartmouth South has the greatest total number of housing units (525 units). “Units” may mean an apartment for one person or a home for a family with multiple occupants; therefore, the number of units is not indicative of the number of people living in public housing.
There are two public housing communities identified by the Department of Community Services (2014) in CHN 1: Lahey Road and Victoria Road. Both Lahey Road and Victoria Road are located in the community of Dartmouth North.
Community Health Network 1: Dartmouth / Southeastern Page | 11 Capital Health Community Clinical Services / Health System Planning Group (2014)
COMMUNITY HEALTH NETWORK POPULATION DEMOGRAPHICS
Population Age Groups
CHN 1 and CDHA Population Pyramid, 2011
85+ yrs 80-84 yrs
75-79 yrs
70-74 yrs
65-69 yrs Female
60-64 yrs Zone 1
55-59 yrs Female
50-54 yrs CDHA
45-49 yrs Male 40-44 yrs Zone 1
35-39 yrs Male 30-34 yrs Age Group Age (Years) CDHA 25-29 yrs 20-24 yrs 15-19 yrs 10-14 yrs 5-9 yrs 0-4 yrs
-10 -5 0 5 10 Percent of Total CDHA Population
Figure 10: Population Pyramid for CHN 1 reflecting size, age, and sex distribution as compared to CDHA (Note: prepared using 5-year age group breakdowns from combined Dartmouth CHB and Southeastern CHB; population 111,803), Canadian Census, 2011).
Figure 10 represents the age, sex, and gender distribution by 5-year age groups of the population of CHN 1 and of CDHA. Comparatively, CHN 1 has a similar age distribution to the Capital district in all age categories.
Community Health Network 1: Dartmouth / Southeastern Page | 12 Capital Health Community Clinical Services / Health System Planning Group (2014)
Figure 11: CHN 1 Population Age Groups (Canadian Census, 2011)
Figure 11 represents the proportion of the population within each community that falls into the age categories of under 20 years of age, 20-29 years of age, 30-39 years of age, 40-49 years of age, 50-65 years of age, and those 65 years or older. This information is further detailed in Table 6.
Table 6: Population breakdown by age category and community (percentage, %) for CHN 1. % < 20 % 20 – 29 % 30 – 39 % 40 – 49 % 50 – 64 % 65 Total years years years years years years + Population Nova Scotia 21.2 12.1 11.7 15.0 23.3 16.6 921,725 CDHA 21.5 14.9 13.4 15.6 21.3 13.3 412,518 Dart CHB & SECHB 22.0 13.0 13.1 16.0 22.5 13.4 111,803 By Community Cole Harbour 25.2 11.5 12.6 16.7 23.7 10.1 25,161 Dartmouth East 22.8 11.4 12.1 16.3 22.9 14.5 23,616 Dartmouth North 17.5 17.3 14.2 15.1 22.4 13.5 19,238 Dartmouth South 18.5 13.5 12.6 14.5 22.8 18.2 24,719 Eastern Passage 26.4 13.1 16.7 17.1 17.0 9.3 11,740 Lawrencetown 23.8 9.8 13.2 20.0 24.0 8.7 5,639 Preston 25.9 11.5 8.9 15.5 25.3 13.8 2,269 Source: Canadian Census Data, 2011
Community Health Network 1: Dartmouth / Southeastern Page | 13 Capital Health Community Clinical Services / Health System Planning Group (2014)
Figure 12: CHN 1 Average Age by Community (Canadian Census, 2011)
Figure 12 depicts average age by community within CHN 1. Dartmouth South is the community with the older average age and Cole Harbour and Eastern Passage have the youngest average age.
In CHN 1, Eastern Passage and Preston have a higher rate of the youth population (<20 years of age), with 26.4% and 25.9% of the population being under 20 years of age, respectively. The communities of Cole Harbour, Lawrencetown, Dartmouth East, and Preston have a higher percentage of both the under 20 years and 50-64 years age categories (indicative of family structure).
Within the CHN, Lawrencetown has the lower percentage of the population aged 65 and older (8.7%), while Dartmouth South has the higher percentage of the population aged 65 and older (18.2%).
Community Health Network 1: Dartmouth / Southeastern Page | 14 Capital Health Community Clinical Services / Health System Planning Group (2014)
Population Density
Figure 13: CHN 1 Population density by community (Canadian Census, 2011; Community Counts Community Boundaries, 2011).
Figure 13 represents population density. CHN 1 has the highest population density within the district at 442 people per km2. Within the CHN, the communities with the higher population density are Dartmouth South (1522.1 people per km2) and Dartmouth East (1415.8 people per km2).
Community Health Network 1: Dartmouth / Southeastern Page | 15 Capital Health Community Clinical Services / Health System Planning Group (2014)
Visible Minorities
Figure 14: Percentage of the population identifying as a visible minority in CHN 1 (National Household Survey, 2011).
Within the geography of CHN 1, approximately 5.6% of the population identifies as a visible minority, which is lower than the district average of 8.8%. Preston has the highest percentage of citizens identifying as a visible minority within the CHN and within the district (69.2% of residents of the community). Of those identifying as a visible minority in Preston, 68.6% identify as Black, which is the highest rate of individuals identifying as Black within the CHN and also within the district. Lawrencetown has the lower rate of citizens identifying as a visible minority within the CHN (1.7%). Figure 14 and Table 7a provides a full breakdown by community.
Finally, 1.9% of citizens living in CHN 1 report being of Aboriginal identity8, which is lower than the district average of 2.5% of citizens. Within the CHN, the community with the higher number of individuals identifying with an Aboriginal group is Preston (3.7% of citizens). Refer to Table 7b.
8 Aboriginal Identity is not classified as a visible minority; it is a separate identity category
Community Health Network 1: Dartmouth / Southeastern Page | 16 Capital Health Community Clinical Services / Health System Planning Group (2014)
Table 7a: Percentage of Individuals within CHN 1 identifying as a Visible Minority Total Arab/West Chinese/ Korean/ South Asian/ Black, % Other9, % Percentage Asian, % Japanese, % East Indian, % CDHA 8.8% 3.5% 1.7% 1.4% 0.2% 2.0% Dartmouth + Southeastern 5.6% 4.9% 0.2% 0.3% 0.1% 0.2% CHB By Community Cole Harbour 6.9 4.3 0.3 0.3 0 2 Dartmouth East 8.4 5.3 0.2 0.2 0 2.7 Dartmouth 10.8 5.7 0.2 0.3 0.5 4.1 North Dartmouth 5.8 1.2 0.5 0.4 0.2 3.5 South Eastern Passage 2.1 0.5 0 0.5 0 1.1 Lawrencetown 1.7 1.2 0.2 0 0 0.3 Preston 69.2 68.6 0 0 0 0.6
Source: National Household Survey, 2011 (Note: the percentages are based on total number of individuals reporting through the National Household Survey).
Table 7b: Individuals within CHN 1 identifying as Aboriginal Total percentage identifying as Aboriginal
CDHA 2.5 Dartmouth and Southeastern CHB 2.2 By Community Cole Harbour 1.9 Dartmouth East 1.2 Dartmouth North 3.2 Dartmouth South 2.6 Eastern Passage 2.5 Lawrencetown 0.7 Preston 3.7
Source: National Household Survey, 2011 (Note:the percentages are based on total number of individuals reporting through the National Household Survey).
9 Other – Filipino, Latin American, Southeast Asian
Community Health Network 1: Dartmouth / Southeastern Page | 17 Capital Health Community Clinical Services / Health System Planning Group (2014)
Citizenship, Language, and Immigration
Figure 15: Percentage of the population identifying as being an immigrant to Canada in CHN 1 (National Household Survey data, 2011).
Within CHN 1, 5.2% of the population identify as being an immigrant to Canada, which is lower than the district average (7.9%). Of the communities within CHN 1, Dartmouth South has the higher number of citizens identifying as being an immigrant to Canada with 7.3% of residents reporting being an immmigrant to Canada, followed by Dartmouth North (5.3% of residents). The community with the lowest percentage of residents identifying as being an immigrant to Canada is Preston (0.6% of residents). All community percentages are identified in Figure 15.
Within the CHN, 98.3% of residents report being a Canadian Citizen, which is higher than the district average of 96.2%. Within the CHN, Dartmouth North is the community with the higher percentage of citizens being non- Canadian residents, with 2.9% of residents reporting not being a Canadian Citizen.
English is the predominant language reported being spoken at home in CHN 1 (98.3%). The communities of Dartmouth North and Dartmouth South have higher percentages of residents reporting speaking languages other than English at home, with 4.6 and 4.5 percent of residents reporting other languages in Dartmouth North and Dartmouth South, respectively.
Community Health Network 1: Dartmouth / Southeastern Page | 18 Capital Health Community Clinical Services / Health System Planning Group (2014) Total Deprivation
Figure 16: Total deprivation scores for the communities of CHN 1 (5=high/red; 1=low/blue) based on the INSPQ index (Dr. M. Terashima, Dalhousie University; Population Health Status Report, Public Health, CDHA, 2013).
According to the Population Health Status Report (Public Health, Capital Health, 2013):
“A deprivation index is a proxy measure of the health status of a population based on the aggregation of a number of variables representing the determinants of health. The index is intended for the surveillance of social inequalities in health (Gamache, Pampalon, & Hamel, 2010). The INSPQ tool measures total deprivation by describing its two distinct components: material and social deprivation. Scores are generated for each of the six factors, and then aggregated to define social, material, and total deprivation for a given geographical region.”
Deprivation by community was calculated using data provided by Dr. M. Terashima, Dalhousie University, and analyzed for Capital Health by Dr. H. D’Angelo Scott, Public Health, for the Population Health Status Report (2013) and for Community Profiles (2014). The scores for communities within CDHA were extracted and sorted into equal quintiles which were ordered to represent a range of lowest deprivation (1) to highest deprivation (5) for material, social and total deprivation. The six factors comprising total deprivation include: the proportion of persons living alone; the proportion of single-parent families; the proportion of persons who are widowed, separated or divorced; the proportion of persons without a high school degree; the ratio of employment to population (employment rate); and average individual income. Data for the six factors comprising material and social deprivation were from 2006 Canadian Census data. Community boundaries were defined by Nova Scotia Community Counts (Government of Nova Scotia, 2011).
Community Health Network 1: Dartmouth / Southeastern Page | 19 Capital Health Community Clinical Services / Health System Planning Group (2014)
Total deprivation for CHN 1 is depicted in Figure 16. Within CHN 1, Dartmouth North is the community with the highest total deprivation. The communities with the lowest total deprivation are Cole Harbour and Lawrencetown. Table 8 provides a detailed breakdown of the total, material, and social deprivation score for each community within CHN 1. The subsequent sections provide further details about the material and social components for CHN 1.
Table 8: Total Deprivation Score Summary, by Community Community Total Deprivation Material Deprivation Social Deprivation Cole Harbour 1 1 2 Dartmouth East 3 1 4 Dartmouth North 5 3 5 Dartmouth South 4 2 5 Eastern Passage 3 2 4 Lawrencetown 1 1 1 Preston 4 5 2
Source: Dr. M. Terashima, Dalhousie University; Population Health Status Report, Public Health, CDHA, 2013.
Community Health Network 1: Dartmouth / Southeastern Page | 20 Capital Health Community Clinical Services / Health System Planning Group (2014) Social Deprivation
Figure 17: Social deprivation scores for the communities of CHN 1 (5=high; 1=low) based on the INSPQ index (Dr. M. Terashima, Dalhousie University; Population Health Status Report, Public Health, CDHA, 2013).
Social deprivation is a component of total deprivation and is determined by three factors: The proportion of persons living alone; The proportion of single-parent families; and The proportion of persons who are widowed, separated or divorced.
As depicted in Figure 17, the full spectrum of social deprivation is observed across communities in CHN 1. Within the CHN, Dartmouth North and Dartmouth South are the communities scoring in the highest category of social deprivation. Lawrencetown is the community within the CHN scoring in the lowest category of social deprivation.
One component of social deprivation, the proportion of lone parent families, is explored further detail in the next section.
Community Health Network 1: Dartmouth / Southeastern Page | 21 Capital Health Community Clinical Services / Health System Planning Group (2014) Lone Parent Families
Figure 18: CHN 1 percentage of lone parent families, by community (National Household Survey data, 2011)
CHN 1 has the highest percentage of lone parent families within the district at 19.5% (district average: 16.6%). Within the CHN, the community of Preston has the highest percentage of lone parent families within the CHN and also within the district at 37.0% of families identifying as being lone parent. This is followed by Dartmouth North, with 27.8% of families being lone parent. The higher percentage of lone parent families in Dartmouth North offers an explanation for the high social deprivation score and contributes to the social deprivation score in Preston. Lawrencetown is the community with the lowest percentage of lone parent families within the CHN. Refer to Figure 18 and Table 9.
Table 9: Social Deprivation and Percentage of Lone Parent Families, by community Social Deprivation % of lone parent families
Canada / Nova Scotia n/a 16.3 / 17.3 CDHA n/a 16.6 Dart CHB & SECHB n/a 19.5 By Community Cole Harbour 2 16.2 Dartmouth East 4 19.3 Dartmouth North 5 27.8 Dartmouth South 5 19.1 Eastern Passage 4 17.3 Lawrencetown 1 8.8 Preston 2 37.0 Source: Social Deprivation: Dr. M. Terashima, Dalhousie University; Population Health Status Report, Public Health, CDHA, 2013; Lone Parent Families: National Household Survey, 2011)
Community Health Network 1: Dartmouth / Southeastern Page | 22 Capital Health Community Clinical Services / Health System Planning Group (2014) Material Deprivation
Figure 19: Material deprivation scores for the communities of CHN 1 (5=high; 1=low) based on the INSPQ index (Dr. M. Terashima, Dalhousie University; Population Health Status Report, Public Health, CDHA, 2013).
Material deprivation is a component of total deprivation and is determined by three factors: The proportion of persons without a high school degree; The ratio of employment to population (employment rate); and Average individual income.
As depicted in Figure 19, the communities in CHN 1 have a range of material deprivation scores. Within the CHN, Preston has the highest material deprivation. The communities of Dartmouth East, Cole Harbour, and Lawrencetown have the lowest material deprivation.
The components of material deprivation and additional income-related factors are explored in further detail in the subsequent sections and Table 10 provides a summary of the factors presented in relation to material deprivation.
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Table 10: Summary of income-related factors and material deprivation for communities within CHN 1 Material Low Income Average Average Family # of Households 10 Deprivation Families, % Individual Income Income Receiving ESIA CDHA n/a 9.9 $36,387 $77,052 11,443 Dartmouth + Unable to Unable to n/a 9.8 4,171 Southeastern CHB estimate estimate By Community Cole Harbour 1 5.7 $37,686 $79,862 277 Dartmouth East 1 9.3 $36,614 $77,947 681 Dartmouth North 3 19.4 $32,054 $65,015 1751 Dartmouth South 2 10.8 $37,946 $79,487 1028 Eastern Passage 2 6.8 $35,210 $68,976 177 Lawrencetown 1 2.7 $38,612 $81,093 51 Preston 5 13.1 $24,069 $51,327 199 Sources: Material deprivation (Dr. M. Terashima, Dalhousie University; Population Health Status Report, Public Health, CDHA, 2013); Low income families, average individual income, and average family income (Canadian Census, 2006); Employee Support and Income Assistance (ESIA Administrative Data, Department of Community Services, 2014).
Income Related Factors
Figure 20: Average Family Income in Dollars, by community, in CHN 1 (Canadian Census, 2006).
Figure 20 depicts average family income, in dollars, across CHN 1. Within the CHN, the community with the lower average family income ($51,327) and the lower average individual income ($24,069) is Preston. The community within the CHN with the higher average family income ($81,093) and higher average individual income ($38,612) is Lawrencetown.
10 ESIA: Employee Support and Income Assistance
Community Health Network 1: Dartmouth / Southeastern Page | 24 Capital Health Community Clinical Services / Health System Planning Group (2014)
Figure 21 represents the percentage of low income families across CHN 1. CHN 1 has a comparable number of families classified as low income (9.8%) when comparing to the district (9.9%). Within the CHN, the community with the highest percentage of low income families is Dartmouth North (19.4% of families; third highest in the district), followed by Preston (13.1% of families). Lawrencetown has the lowest number of low income families within the CHN (2.7% of families).
Figure 21: Percentage of low income families in CHN 1 (Canadian Census, 2006). Figure 22 depicts the number of households receiving income assistance or employment support within CHN 1. Within the CHN, the community of Dartmouth North, followed by Dartmouth South, has the greatest number of households receiving employment support and income assistance provincially11, according to the Department of Community Services (2014). This information is summarized in Table 10 and further demographic information about citizens receiving employee support and income assistance will be available in the district summary. It is important to note that this data is not Department of Community Services and Primary Health Care/DDFP, Public Health, CDHA comparable across communities Figure 22: Number of households receiving provincial income assistance/employment given data is reported by number support in CHN 1 (ESIA Administrative Data, Department of Community Services, 2014) of households (count only; not a rate) and there may be multiple people per household receiving assistance.
11 Does not include income assistance from Federal sources, provincial only (counts)
Community Health Network 1: Dartmouth / Southeastern Page | 25 Capital Health Community Clinical Services / Health System Planning Group (2014) Employment & Education
Education and employment rates for CHN 1 are similar to the district average. Table 11 provides a breakdown of the employment and education rates for the communities within CHN 1. The community with the highest number of citizens without a high school education is Preston (39.5% of citizens). The community with the lowest number of people without a high school education (or highest percentage of high school completion) is Lawrencetown (12.3% without a high school education).
Within CHN 1, the community with the highest percentage of the population aged 25 years and older employed is Lawrencetown (73.3% employed). The community with the lowest percentage of the population 25 years of age or older employed is Preston (51.6% employed). For the population aged 15-24 years, the community in the CHN with the highest percentage employed is Dartmouth North (62.3% employed) and the community with the lowest percentage of the population aged 15-24 years employed is Eastern Passage (51% employed).
Table 11: Summary of education, employment, and material deprivation for communities within CHN 1 Material Percentage without Percentage Employed: Percentage Employed: Deprivation high school education >25 years of age 15-24 years of age CDHA n/a 16 65.2 58.3 Dartmouth + n/a 16.5 65.8 58.5 Southeastern CHB By Community Cole Harbour 1 12.8 72.2 59 Dartmouth East 1 13.5 64.8 60.7 Dartmouth North 3 21.8 61 62.3 Dartmouth South 2 17.9 61.2 56.4 Eastern Passage 2 15.8 71.9 51.0 Lawrencetown 1 12.3 73.3 56 Preston 5 39.5 51.6 52.5
Sources: Material deprivation (Dr. M. Terashima, Dalhousie University; Population Health Status Report, Public Health, CDHA, 2013); Education and Employment (Canadian Census, 2006)
Community Health Network 1: Dartmouth / Southeastern Page | 26 Capital Health Community Clinical Services / Health System Planning Group (2014) Birth Data
Figure 23: Birth rate per 1000 women aged 15-49 for 2012-2013 by community (Public Health, Capital Health data for 1 year: 2012-2013).Birth rates for 15-19 year olds higher than the district rate are differentiated.
To describe birth rate patterns in the Capital District Health Authority, birth data for one year was provided by Public Health, Capital Health (2013). Birth rates were calculated to identify an average annual rate per community per 1000 women. Maternal age was considered in this calculation, with rates being a measure per 1000 women of a selected maternal age group, ranging from 15 to 49 years of age (age specific fertility rate; ASFR).
Figure 23 depicts the birth rate per 1000 women aged 15-49 in the CHN. The figure also indicates which communities have a teenage birth rate (births among women age 15-19 years) that is higher than the district average. CHN 1 accounts for approximately 29% of all births occurring within the district. Within the CHN, the higher number of births occurs within the community of Dartmouth South, which had 239 births in 2012-2013. The community within the CHN with the highest birth rate is Eastern Passage with on average, 46.9 births occurring per 1000 women aged 15-49 annually. A detailed breakdown of births by community is provided in Table 12. Lawrencetown has the lower birth rate when compared to other communities within the CHN.
When looking at births among women age 15-19, the communities within the CHN that have a birth rate higher than the district average for this age group are Dartmouth North, Dartmouth South, Eastern Passage, and Preston. Dartmouth North has a highest rate of births among women aged 15-19 in the CHN and also within the district, at a rate of 34.9 births per 1000 women aged 15-19. Eastern Passage has the higher birth rate per 1000 women aged 20-34 and Dartmouth East has the higher birth rate among women aged 35-45.
Community Health Network 1: Dartmouth / Southeastern Page | 27 Capital Health Community Clinical Services / Health System Planning Group (2014)
Table 12: Birth data by Community for CHN 1 for 2012-2013 ASFR13 per 1000 ASFR per 1000 ASFR per 1000 Total number Total births per Community women 15-19 women 20-34 women 35-49 of births 1000 women12 years years years Cole Harbour 236 37.42 4.29 87.02 12.90 Dartmouth East 227 39.10 6.23 76.99 19.31 Dartmouth 229 45.97 34.93 78.14 13.30 North Dartmouth 239 40.28 11.54 72.27 17.72 South Eastern 150 46.90 8.15 94.59 14.02 Passage Lawrencetown 44 31.01 0.00 83.33 11.18 Preston 18 32.32 17.09 68.97 15.04 CHN 1 Total 1143 (28.7%) 40.53 10.66 80.35 15.35 District Total 3976 36.92 10.59 66.41 16.24
Source: Public Health, Capital Health for time period 2012-2013.
Note: Birth rate data for the smaller communities with older populations should be interpreted with caution because the total population of women in the 15-20, 20-34, and 35-49 age demographics may be small, so even a small number of births in any given age group (e.g., n=<5) could result in higher rates per 1000 population.
12 This calculation was based on women aged 15-49 years only 13 ASFR: Age Specific Fertility Rate; calculated as a measure of the number of live births per 1,000 females in a specific age group (15-19; 20-34; 35-49) for one year
Community Health Network 1: Dartmouth / Southeastern Page | 28 Capital Health Community Clinical Services / Health System Planning Group (2014) Crime Rates – Halifax Regional Police
Figure 24: Crime occurrences by type, as a proportion of total crimes occurring in CHN 1 (Halifax Regional Police, 2013)
Crime data for the Capital Health district was obtained from the Halifax Regional Police and analyzed for Capital Health by Dr. H. D’Angelo Scott, Public Health, for the Population Health Status Report (2013) and for Community Profiles (2014).
Note that crimes occurring in a community are not necessarily committed by residents of that community; counts are reflective of where the crime occurred.
Based on data from 2008-2012 from the Halifax Regional Police14 (HRP) only, in CHN 1, the higher volume of crime occurs in the community of Dartmouth North, followed by Dartmouth South and Dartmouth East. When viewing the data at dissemination area level a high volume of crimes is observed in Dartmouth North – Burnside Area. In terms of types of crimes occurring proportionally within communities in CHN 1, theft <$5000 is the predominant non-violent crime, followed by mischief. Refer to Figure 24 and Table 13 for a detailed breakdown by community.
14 Within CHN 1, crimes are captured though both the Halifax Regional Police (HRP), RCMP, and their Integrated Crime Unit. The communities of Lawrencetown, Preston, and others are predominately served by RCMP.
Community Health Network 1: Dartmouth / Southeastern Page | 29 Capital Health Community Clinical Services / Health System Planning Group (2014)
Table 13: Total crimes occurring in each community, by type, as reported by Halifax Regional Police from 2008-2011 Break Impaired/ Theft Theft Youth Total by Assaults Drugs Mischief &Enter Alcohol <$5000 >$5000 Crime Community Cole Harbour 518 418 463 450 1274 2295 106 243 5,767 Dartmouth East 839 621 228 202 1291 2507 133 102 5,923 Dartmouth North 2019 1149 632 430 2215 4659 336 93 11,533 Dartmouth South 1211 872 274 262 1577 3273 171 118 7,758 Eastern Passage 245 200 146 115 537 725 55 107 2,130 Lawrencetown* 48 85 43 33 122 146 16 <5 562 Preston 108 78 46 51 172 98 25 12 590 CHN 1 Total 4,988 3,423 1,832 1,543 7,188 13,703 842 675 34,194 Type as % of total 14.6% 10.0% 5.4% 4.5% 21.0% 40.1% 2.5% 2.0% 100.0% CHN crime *Crime counts of ≤5 crimes per community have been suppressed for confidentiality purposes
Source: Halifax Regional Police, Crime Database, 2013 for time period 2008-2011 (five years worth of data)
Community Health Network 1: Dartmouth / Southeastern Page | 30 Capital Health Community Clinical Services / Health System Planning Group (2014) Crime Rates – RCMP
As described above, crime data captured through HRP is reportable at the community and CHN level; however, RCMP15 data is captured and reported via Policing Districts. The two policing districts that align with CHN 1 are the East Policing District and the Cole Harbour Policing District, represented in Figure 25. A key consideration is the boundaries of these policing districts, which do not exactly align with CHN boundaries, so the numbers reported below in Table 14 are not a true CHN count (but include areas such as communities in CHN 4 as well).
Similarly to the data reported by the Halifax Regional Police, Table 14 indicates that the predominant crimes in the Cole Harbour Policing District are theft under $5000 and mischief.
It is important to note that crimes occurring in policing districts are not necessarily committed by residents of that community; counts are reflective of where the crime occurred. Figure 25: RCMP Policing Districts in CHN 1 (RCMP, 2014)
Table 14: Total number of crimes occurring by type in RCMP Policing Districts aligned with CHN for 2013 Policing District count and percentage of total CHN crime Crime Type Cole Harbour East* Assaults 144 9.9% Arson 8 0.6% Break & Enter (home/business/other) 83 5.7% Theft - Over $5000 36 2.5% Any available data for the Theft - Under $5000 498 34.4% East Policing District was Possession/Trafficking of stolen goods 15 1.0% suppressed due to low Fraud/Identity Theft 77 5.3% numbers – the geography is Mischief 248 17.1% mainly covered by Halifax Drug possession/Trafficking/Production/Import 124 8.6% Regional Police Impaired Operation of Motor vehicle/boat 124 8.6% Traffic Offences 51 3.5% Youth Complaint/Crime 40 2.8% CHN 1 Total RCMP Crimes 1448 n/a *Crime counts of ≤5 crimes per type have been suppressed for confidentiality purposes Source: RCMP Crime Database for the (2014) for the January 1, 2013 – December 31, 2013 Calendar Year
Note: Halifax Regional Police Data is based on five year’s worth of data; therefore, crime totals are reflective of that count. RCMP data represents one year of data; thus, the two are not comparable.
15 Within CHN 1, crimes are captured though both the Halifax Regional Police (HRP), RCMP, and their Integrated Crime Unit. Communities, such as Dartmouth North, Dartmouth South, and Dartmouth East are predominately served by HRP.
Community Health Network 1: Dartmouth / Southeastern Page | 31 Capital Health Community Clinical Services / Health System Planning Group (2014) Nova Scotia School Test Results
Table 15 represents school test scores provided by the Department of Education for the 2013-2014 academic year (exception: grade 8 results are from 2012-2013). 44 Schools in CHN 1 contributed to the scoring results. CHN 1 scored below the provincial average in Grade 3 reading, Grade 4 math, Grade 6 math, and Grade 8 math and trended above the provincial average in Grade 6 reading and Grade 8 reading. 16
Table 15: CHN 1 School Test Scores 2013-2014 Testing Category CHN 1, percentage Nova Scotia, percentage Trend Number of Schools 44 345 12.8% of schools Average of Reading 3 65 69 ↓ Average of Math 4 71 73 ↓ Average of Reading 6 76 74 ↑ Average of Math 6 69 71 ↓ Average of Reading 8 70 69 ↑ Average of Math 8 48 55 ↓
Source: Nova Scotia Department of Education for the 2013-2014 academic school year, with the exception of Grade 8 math, which is from the 2012-2013 academic year).
Note: One school board represents the communities of CHN 1 – the Halifax Regional School Board
16 As reported by the Chronicle Herald newspaper: http://thechronicleherald.ca/novascotia/1216114-interactive-school- test-data-map; published June 19th, 2014
Community Health Network 1: Dartmouth / Southeastern Page | 32 Capital Health Community Clinical Services / Health System Planning Group (2014)
COMMUNITY HEALTH NETWORK HEALTH STATUS
Community Engagement – 2013 Community Health Plan
Table 16: Health Concerns Dartmouth/Southeastern CHBs (n=901) Physical Activity, Healthy Eating, Healthy Weight 23% Table 16 indicates the top health concerns reported through the Access to health services and information 23% Dartmouth and Southeastern CHB Mental Health 17% Community Consultations during the Health Inequities 15% preparation of the 2013 Community Chronic Conditions 11% Health Plan. This information is Stress 4% reported here to provide a Sense of Belonging 3% qualitative perspective to the data related to health status below. Health Screenings 3% Substance Use and Addictions 1% Total 100%
2009-2010 Canadian Community Health Survey Data for Self-Reported Health Status
Canadian Community Health Survey Data is reportable at the Community Health Network level only (community-level data is not available). Figures 26 and 27, along with Table 17 cross-compare selected chronic conditions and risk factors across CHNs. Comparisons were made across CHNs and with district, provincial, and national rates in Table 18.
Self Reported Risk Factors % of CHN Cross Community Health Network Comparision 80.00% 70.00% 60.00% 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% High Blood Smoking Stressful Daily BMI Overweight BMI Obese Intention to Pressure Daily/Occas. Life improve health in next year Risk Factor CHN 1 (Dartmouth/Southeastern) CHN 2 (Halifax Peninsula/Chebucto) CHN 3 (Bedford/Sackville) CHN 4 (Eastern Shore Musquodoboit) CHN 5 (West Hants) CDHA (district average)
Figure 26: Self-reported risk factors reported by Community Health Network (Canadian Community Health Survey, 2009)
When looking at risk factors across CHNs, CHN 1 has the highest rate of citizens reporting having a stressful daily life when compared to other CHNs across the district. CHN 1 also has among the highest percentage of
Community Health Network 1: Dartmouth / Southeastern Page | 33 Capital Health Community Clinical Services / Health System Planning Group (2014)
citizens reporting having an intention to improve health in the next year, with exercise being cited as the most common method of doing so. CHN 1 also has the lowest rate of citizens self-reporting being overweight/obese.
Self Reported Chronic Conditions Cross Community Health Network Comparision % of CHN 35.00% 30.00% 25.00% 20.00% 15.00% 10.00% 5.00% 0.00% Diabetes COPD Heart Disease Mood Disorder Arthritis Chronic Condition CHN 1 (Dartmouth/Southeastern) CHN 2 (Halifax Peninsula/Chebucto) CHN 3 (Bedford/Sackville) CHN 4 (Eastern Shore Musquodoboit) CHN 5 (West Hants) CDHA (district average)
Figure 27: Self-reported chronic conditions reported by Community Health Network (Canadian Community Health Survey, 2009)
When looking at select chronic conditions across CHNs, CHN 1 has the highest rate of citizens reporting having COPD (2.7%) and the highest rate of citizens reporting having a mood disorder (10.9%).
Table 17: Summary of Selected Self-reported Chronic Diseases and Risk Factors - CHN and District comparison CPCSSN Prevalence Self-reported Chronic Disease Prevalence & Selected Risk Factors, Percentage Rates, Percentage17 CHN 1 CHN 2 CHN 3 CHN 4 CHN 5 CDHA CDHA NS Diabetes 9.5 7.0 7.4 10.7 8.7 8.5 8.0 9.0 COPD 2.7 1.8 1.2 1.8 2.4 2.1 4.0 5.0 Heart Disease 5.2 5.2 3.2 6.7 6.0 5.3 - - Mood Disorder 10.5 9.6 8.6 9.2 9.9 9.7 - - Depression ------15.0 15.0 Arthritis 23.9 21.2 18.9 27.9 29.3 23.7 - - Osteoarthritis ------8.0 8.0 High BP 21.6 18.3 16.3 24.9 21.1 20.3 19.0 22.0 Smoking Daily/ 20.5 19.5 17.5 20.4 25.6 20.5 - - Occasional Stressful Daily Life 65.6 65.5 64.8 62.3 62.1 64.5 - - BMI (Overweight/ 35.3/ 36.0/ 38.9/ 40.2/ 36.9/ 38.1/ - - Obese) 22.5 22.7 28.2 28.1 29.6 25.2 Intent to improve 69.2 69.4 68.8 64.8 66.3 68.5 - - health in next year Source: Self-reported data: Canadian Community Health Survey 2009-2010; CPCSSN Prevalence: Maritime Family Practice Research Network as part of Canadian Primary Care Sentinel Surveillance Network study (CPCSSN; 2014)
17 Prevalence of index conditions based on two year contact group, n=36,640 patients in urban and rural family practices derived from extraction from family physicians’ EMR based on clinical algorithms.
Community Health Network 1: Dartmouth / Southeastern Page | 34 Capital Health Community Clinical Services / Health System Planning Group (2014)
Table 18 provides a more detailed view of additional CCHS self-reported variables for several chronic conditions, risk factors, health behaviours, and perceptions of health for a sample within CHN 1. Table 18 also and provides a comparison to the district, provincial, and national rates.
Table 18: Health Status indicator by CHN and compared to CDHA and Nova Scotia and Canada (where available) CHN 1, % CDHA, % Health Status Indicator Nova Scotia, % Canada, % (n = 803) (n = 2819) Positive Physical Health 86.9 87.1 86.8 88.6 Positive Mental Health 94.5 94.5 94.4 94.7 Satisfied with life 89.9 90.8 92.9 92.3 Stressful Daily Life 65.6 64.5 62.2 64.5 Stress at Work 72.3 71.5 64.9 71.1 Sense of Belonging 67.0 68.4 71.2 65.4 Intend on Improving Physical Health in next year: Yes 69.2 68.5 72.8 66.8 Exercise 56.4 58.3 48.2 50.7 Lose Weight 12.5 12.9 13.0 9.4 Improve Eating Habits 15.7 13.1 17.4 19.0 Quit smoking 9.5 8.5 13.5 10.8 No 28.8 30.2 27.2 33.2 Body Mass Index: Normal/Underweight 32.3 36.7 -- -- Overweight 35.2 38.1 36.5 34 Obese 22.5 25.2 24.3 18.3 No Food Security 1.6 1.7 3.4 2.3 Positive Oral Health 87.8 88.1 - - Flu Shot < 1 years ago 45.5 44.8 46.2 29.6 Arthritis 23.9 23.7 22.9 16.2 Back Problems 26.7 7.1 22.9 18.8 High blood Pressure 21.6 20.3 22.6 17.5 Migraine Headaches 17.6 15.8 11.3 10.2 Chronic Bronchitis 3.7 3.7 - - COPD 2.7 2.1 6.3 4.3 Diabetes 9.5 8.5 8.6 6.3 Heart Disease 5.2 5.3 5.8 4.8 Mood Disorder 10.5 9.7 9.0 7.1 Smoking (Daily or Occasionally) 20.5 20.5 22.8 20.1 5 or more drinks once a week or more 8.2 8.7 9.8 8.5 5 or more fruits/vegetables per day 36.0 38.4 34.0 40.5 Source: Canadian Community Health Survey, 2009-2010
When compared to district, provincial, and national rates, CHN 1 has a higher percentage of the population self-reporting: having a stressful daily life (65.6%), experiencing stress at work (72.3%), intending to improve physical health in the next year (69.2%), having arthritis (23.9%), back problems (26.7%), migraine headaches (17.6%), diabetes (9.5%), and mood disorder (10.5%).
Community Health Network 1: Dartmouth / Southeastern Page | 35 Capital Health Community Clinical Services / Health System Planning Group (2014) Sexually Transmitted Infections (STIs)
Table 19 shows the incidence rates per 10,000 population of sexually transmitted infections (chlamydia, gonorrhea and infectious syphilis) by sex, age group (years) and CHN for Capital Health (2013). The highest and lowest STI incidence rate for each age group in both females and males has been bolded. CHN 1 incidence rates for STIs are highest in the district for females, age 25 to 29 years and age 30 to 39 years. CHN 1 incidence rates for STIs are highest in the district for males, age 15 to 19 years and age 20 to 24 years. When looking at the incidence rates for males, the highest rate was found among males aged 20 to 24 years who resided in CHN 1.
Table 19: Incidence rates per 10,000 population of sexually transmitted infections in Capital Health (2013) Female Males Age 15 to 40 and 15 to 20 to 25 to 30 to 40 and 20 to 24 25 to 29 30 to 39 Group 19 over 19 24 29 39 over CHN 1 247.8 340.9 161.2 43.7 1.6 61.4 163.4 71.2 24.5 2.9 CHN 2 214.2 269.8 94.5 32.2 2.6 41.4 123.9 42.2 30.4 3.1 CHN 3 209.2 229.9 72.9 32.8 1.8 24.2 86.2 45.8 21.2 2.8 CHN 4 196.3 422.0 35.7 13.1 1.4 12.2 135.6 37.7 21.1 0.0 CHN 5 280.2 330.7 159.7 14.6 3.1 39.9 75.9 85.3 24.6 0.0
Source: Public Health, Capital Health, 2013
Community Health Network 1: Dartmouth / Southeastern Page | 36 Capital Health Community Clinical Services / Health System Planning Group (2014) Disability
There is a lack of data related to disability available particularly at the community level, but also at the district level for Capital Health. Table 20 provides a breakdown of the prevalence of disability for adults by age group for Nova Scotia (Canadian Survey on Disability, 2012). The prevalence of disability in Nova Scotia is 18.8%, which is higher than the Canadian average of 14.9%. There is a variance between males and females, with 18.4% of the total count being represented by males and 19.2% of the count being represented by females, which is consistent with national data of women having a higher prevalence of disability in all age groups.
Table 20: Disability Prevalence for Nova Scotia, by age category for the population aged 15 years+ Total population of NS Persons with disabilities Prevalence of disability (aged 15 years+) (count) (% of total population) Total - aged 15 and over 765,100 143,760 18.8 15 to 64 years 628,310 89,410 14.2 15 to 24 years 120,430 6,990 5.8 25 to 44 years 223,880 20,920 9.3 45 to 64 years 284,000 61,500 21.7 65 years and over 136,790 54,350 39.7 65 to 74 years 80,360 27,310 34.0 75 years and over 56,430 27,040 47.9 Source: Canadian Survey on Disability, 2012
Specific to CDHA, the Department of Community Services reports in March of 2014, there are 4,485 persons classified as having a disability on the Employment Support and Income Assistance (ESIA) caseload residing within the boundaries of the CDHA. This represents 39% of the ESIA caseload. Within this population, there is an almost equal proportion of men (52%) and women (48%); approximately 50% are 50 years of age or older, and approximately 88% are single adults without children (Department of Community Services, 2014).
Community Health Network 1: Dartmouth / Southeastern Page | 37 Capital Health Community Clinical Services / Health System Planning Group (2014) Life Expectancy at Birth
The life expectancy at birth in the Capital Health district is higher than the provincial life expectancy at birth for both females and males. Within the CHN, the majority of communities have a lower life expectancy at birth for females than the district life expectancy, with the exception of Lawrencetown and Cole Harbour. All communities within the CHN, with the exception of Cole Harbour, have a lower life expectancy at birth for males than the district life expectancy.
Within the CHN, life expectancy at birth is higher for females in the community of Lawrencetown (83.42 years) and lowest for females living in Preston (80.07 years). Life expectancy at birth is higher for males living in the community of Cole Harbour (79.03 years) and lowest for males living in Preston (70.09). The largest disparity between male and female life expectancy is in the community of Preston, where females have a life expectancy of nearly ten additional years. Refer to Table 21 for a detailed breakdown by community.
Table 21: Life expectancy at birth, by community and by sex Community Female Life Expectancy (years) Male Life Expectancy (years) Cole Harbour 82.9 79.0 Dartmouth East 82.4 78.1 Dartmouth North 81.1 74.6 Dartmouth South 82.4 77.2 Eastern Passage 81.1 76.2 Lawrencetown 83.4 77.9 Preston 80.1 70.1 CDHA / Nova Scotia 82.7 / 82.4 78.3 / 77.7 Source: Community data: Dr. M. Terashima, Dalhousie University (2011) for time period 2003-2007. District and Provincial averages: Statistics Canada, Canadian Vital Statistics, Death Database and Demography Division (population estimates),
2007/2009
Community Health Network 1: Dartmouth / Southeastern Page | 38 Capital Health Community Clinical Services / Health System Planning Group (2014) Causes of Death
Cause of death data is not readily available at the community level; therefore, cause of death is reported at the district and provincial level and is listed below in Table 22. All causes listed below are reported as an age- standardized rate of death per 100,000 population.
The Capital District Health Authority has a lower rate of death per 100,000 population for the majority of identified common causes of death, with the exception of colorectal cancer, which is higher than the provincial rate, and breast cancer, which is the same as the provincial rate. Within CDHA, females have higher rates of death from breast cancer, cerebrovascular diseases and bronchitis, emphysema and asthma when compared to males. Males have higher rates of all other identified common causes of death.
Table 22: Causes of Death for NS and CDHA, rate per 100,000 population Nova Scotia (per Capital District Health Authority 100,000 population) (per 100,000 population) Cause of Death Total Total Males Females Total, all causes of death 603.8 583.4 716.4 487.3 All cancers 188.6 182.2 224.8 154.5 Colorectal cancer 18.0 18.8 23.1 15.4 Lung cancer 54.3 50.8 62.4 43.2 Breast cancer 11.9 11.9 - 21.2 Prostate cancer 9.2 8.6 23.1 - Circulatory diseases 179.6 169.9 211.7 137.7 Ischaemic heart diseases 92.5 82.5 114.7 57.9 Cerebrovascular diseases 34.9 33.5 32.0 34.0 All other circulatory diseases 52.3 54.0 65.0 45.8 Respiratory diseases 54 50.9 63.1 43.9 Pneumonia and influenza 13.9 13.3 16.0 11.9 Bronchitis, emphysema, asthma 2.4 2.4 1.6 3.0 All other respiratory diseases 37.7 35.2 45.5 29.0 Unintentional injuries 32 28.8 36.6 22.1 Suicides and self-inflicted injuries 9.1 8.6 12.8 4.6 Premature mortality 280.5 262.1 324.8 204.5 Source: All cause of death data provided by Statistics Canada, Canadian Vital Statistics, Death Database and Demography Division (population estimates), 2005/2007, with the exception of premature mortality which is from 2006/2008.
Community Health Network 1: Dartmouth / Southeastern Page | 39 Capital Health Community Clinical Services / Health System Planning Group (2014) Family Physician Visits by Chronic Disease Diagnosis
Physician Billing Data was obtained for family physician billings for four chronic conditions: Diabetes Mellitus (DM), Chronic Obstructive Pulmonary Disease (COPD), Congestive Health Failure (CHF), and Hypertension (HTN) based on patient postal code information. The data source was billing data provided by the Department of Health and Wellness from 2011/12 and 2012/13. Data was analyzed and there was no great variability between the two years; therefore, for generalization purposes, an average of the two years was calculated to estimate annual patient visits. This information provides an estimated prevalence measure of how many individuals received care from a family physician for one of the four selected chronic conditions within a certain geographic area. As such, it has been included in the health status section. All data is for adults, age 20 years and above.
Note for Readers: Throughout the report, you will notice that the number of patients/clients and
the number of visits may have decimal points (e.g., 5.5 visits or 125.5 patients). This is a result of the weighting method that was used to distribute patients in communities based on the boundaries identified by NS Community Counts using 6-digit postal code data and taking into account the population density. Decimals were retained in the reporting of data for accuracy.
1. Diabetes
Figure 28: Rate of individuals receiving care from a family physician for a diagnosis of diabetes per 1000 population (Department of Health & Wellness, MSI Billing Data two year average for fiscal 2011/12; 2012/13)
The number of citizens per 1000 population accessing care from a family physician (FP) for a diagnosis of diabetes is higher within CHN 1 than the district as a whole at 83 citizens per 1000 population receiving care from a FP for diabetes (compared to 72.3 per 1000 population across CDHA). Figure 28 shows that within the
Community Health Network 1: Dartmouth / Southeastern Page | 40 Capital Health Community Clinical Services / Health System Planning Group (2014) communities of Preston, Dartmouth East, and Lawrencetown there are a higher number of people receiving care from an FP for diabetes.
Specifically, Preston has the higher rate within the CHN with 109 people per 1000 population receiving care from a family physician for diabetes. Eastern Passage has the lowest rate of citizens receiving care for a diagnosis of diabetes at 73.4 citizens per 1000 population. The average number of visits per patient is generally consistent across the CHN. Refer to Table 23 for a detailed breakdown by community.
Table 23: CHN overview of citizens receiving care for a diagnosis of diabetes from a family physician FP Visits for Average Visits per Patients per 1000 Community # of Patients Diabetes Patient population Cole Harbour 4218.6 1599.4 2.6 85.2 Dartmouth East 4369.2 1625.9 2.7 89.1 Dartmouth North 3659.6 1303.5 2.8 82.2 Dartmouth South 4221.5 1514.1 2.8 75.0 Eastern Passage 1762.3 631.6 2.8 73.4 Lawrencetown 1078.5 407.6 2.6 95.5 Preston 539.5 185.2 2.9 109.0 CHN 1 Total 19,849.1 7,267.3 2.7 82.94 District Total 66,043.3 23,951.4 2.8 72.26
Source: Department of Health & Wellness, MSI Billing Data two year average for fiscal 2011/12; 2012/13
2. COPD
Figure 29: Rate of individuals receiving care from a family physician for a diagnosis of COPD per 1000 population (Department of Health & Wellness, MSI Billing Data two year average for fiscal 2011/12; 2012/13)
Community Health Network 1: Dartmouth / Southeastern Page | 41 Capital Health Community Clinical Services / Health System Planning Group (2014)
The number of citizens per 1000 population accessing care from a family physician for a diagnosis of COPD is marginally higher for CHN 1 than the district as a whole, with 77.1 citizens per 1000 population receiving care from an FP for COPD (compared to 76.0 per 1000 population for the district).
Figure 29 shows that within CHN 1, there is a higher percentage of the population receiving care from a family physician for COPD residing in Lawrencetown, with 88.1 people per 1000 population receiving care for a diagnosis of COPD, followed by Dartmouth North. Eastern Passage has the lower rate of citizens receiving care for a diagnosis of COPD, with 65.6 citizens per 1000 population receiving care for COPD, followed by Cole Harbour. The average number of visits is relatively consistent across communities within the CHN. Refer to Table 24 for a detailed breakdown by community.
Table 24: CHN overview of citizens receiving care for a diagnosis of COPD from a family physician FP Visits for Average Visits per Patients per 1000 Community # of Patients COPD Patient population Cole Harbour 2066.8 1258.5 1.6 67.1 Dartmouth East 2565.8 1401.4 1.8 76.8 Dartmouth North 2706.2 1389.8 1.9 87.7 Dartmouth South 3174.4 1626.9 2.0 80.6 Eastern Passage 1049.5 564.1 1.9 65.6 Lawrencetown 606.6 376.0 1.6 88.1 Preston 217.1 137.7 1.6 81.0 CHN 1 Total 12,386.5 6,754.3 1.8 77.09 District Total 44,016.6 25,191.6 1.7 76.01
Source: Department of Health & Wellness, MSI Billing Data two year average for fiscal 2011/12; 2012/13
3. Congestive Heart Failure
Figure 30: Rate of individuals receiving care from a family physician for a diagnosis of Congestive Heart Failure per 1000 population (Department of Health & Wellness, MSI Billing Data two year average for fiscal 2011/12; 2012/13) Community Health Network 1: Dartmouth / Southeastern Page | 42 Capital Health Community Clinical Services / Health System Planning Group (2014)
The number of citizens per 1000 population accessing care from a family physician for a diagnosis of Congestive Heart Failure (CHF) is marginally higher for CHN 1 than the district as a whole, with 9.94 citizens per 1000 population receiving care from an FP for CHF (compared to 9.03 per 1000 population for the district).
Figure 30 shows that within CHN 1, there is a higher percentage of the population in Dartmouth East receiving care from an FP for a diagnosis of CHF at 11.8 people per 1000 population. However, Preston and Dartmouth South have similar rates of 11.5 and 11.3 per 1000 population, respectively. Eastern Passage has the lowest rate of citizens receiving care for a diagnosis of CHF, with 6.4 citizens per 1000 population accessing care. The average number of visits per patient is highest within the CHN (and also in the district) in Preston, with an average of seven visits per patient to an FP for a diagnosis of CHF. Refer to Table 25 for a detailed breakdown by community.
Table 25: CHN overview of citizens receiving care for a diagnosis of CHF from a family physician FP Visits for Average Visits per Patients per 1000 Community # of Patients CHF Patient population Cole Harbour 613.2 163.0 3.8 8.7 Dartmouth East 809.5 214.8 3.8 11.8 Dartmouth North 537.9 152.4 3.5 9.6 Dartmouth South 1011.7 227.3 4.5 11.3 Eastern Passage 156.0 54.9 2.8 6.4 Lawrencetown 150.0 39.1 3.8 9.2 Preston 136.4 19.6 7.0 11.5 CHN 1 Total 34,14.6 871.1 3.92 9.94 District Total 10,407.9 2,994.4 3.48 9.03
Source: Department of Health & Wellness, MSI Billing Data two year average for fiscal 2011/12; 2012/13
4. Hypertension
Figure 31: Rate of individuals receiving care from a family physician for a diagnosis of Hypertension per 1000 population (Department of Health & Wellness, MSI Billing Data two year average for fiscal 2011/12; 2012/13) Community Health Network 1: Dartmouth / Southeastern Page | 43 Capital Health Community Clinical Services / Health System Planning Group (2014)
The number of citizens per 1000 population accessing care from a family physician for a diagnosis of hypertension is higher for CHN 1 than the district as a whole with 190.1 citizens per 1000 population receiving care from an FP for hypertension (compared to 164.3 per 1000 population for the district).
Figure 31 shows that within CHN 1, the higher rate of the population accessing care from a family physician for a diagnosis of hypertension occurs in Preston, with 243.1 citizens per 1000 population accessing care for hypertension. Eastern Passage has the lowest rate of citizens receiving care for a diagnosis of hypertension with 157.1 citizens per 1000 population. The average number of visits per patient is relatively consistent across communities in the CHN. Refer to Table 26 for a detailed breakdown by community.
Table 26: CHN overview of citizens receiving care for a diagnosis of hypertension (HTN) from a family physician FP Visits for Average Visits per Patients per 1000 Community # of Patients HTN Patient population Cole Harbour 8644.7 3771.2 2.3 201.0 Dartmouth East 9487.7 4024.9 2.4 220.6 Dartmouth North 6052.3 2581.0 2.3 162.8 Dartmouth South 8525.8 3557.6 2.4 176.2 Eastern Passage 3167.8 1351.7 2.3 157.1 Lawrencetown 2065.6 952.7 2.2 223.3 Preston 1057.5 413.1 2.6 243.1 CHN 1 Total 39,001.3 16,652.1 2.34 190.05 District Total 128,405.9 54,460.0 2.36 164.31
Source: Department of Health & Wellness, MSI Billing Data two year average for fiscal 2011/12; 2012/13
Community Health Network 1: Dartmouth / Southeastern Page | 44 Capital Health Community Clinical Services / Health System Planning Group (2014) Specialist Visits for Chronic Disease (Summary)
Physician Billing Data was obtained for specialist billings for four chronic conditions: Diabetes Mellitus (DM), Chronic Obstructive Pulmonary Disease (COPD), Congestive Health Failure (CHF), and Hypertension (HTN) based on patient postal code information. The data source was billing data provided by the Department of Health and Wellness from 2011/12 and 2012/13. Data was analyzed and there was no great variability between the two years; therefore, for generalization purposes, an average of the two years was calculated to estimate annual patient visits. This information is intended to complement the family physician billing data for the same four conditions over the same two year time period. All data is for adults, age 20 years and above.
Table 27 describes the number of patients per 1000 population receiving care from a specialist for a particular chronic condition. Within CHN 1 there is generally a higher rate of people per 1000 population accessing specialist care compared to the district rate. Within the CHN, there is a higher rate of patients per 1000 population receiving care from a specialist for a diagnosis of diabetes residing in the community of Preston. There are a consistent number of visits per patient to a specialist for this condition across communities in CHN 1 (average: 3.1 visits per patient). The lowest rate of individuals per 1000 population receiving care for diabetes from a specialist reside in Eastern Passage (Figure 32). Within the CHN, the rate of patients accessing a specialist for a diagnosis of hypertension is marginally higher than the district rate: 6.62 patients per 10000 population in CHN 1 compared to 6.0 patients per 1000 population for the district (Figure 33). Within the CHN, there is a marginally higher rate of patients per 1000 population receiving care for COPD than the district rate. The community with the higher rate of people seeing a specialist for COPD is Dartmouth South (Figure 34). Preston has the lowest rate of people receiving care from a specialist for COPD. Finally, there is also a higher rate of people per 1000 population accessing specialist care for a diagnosis of CHF within CHN 1, with the highest rate occurring in the community of Preston (Figure 35). The lowest rate occurs of people receiving specialist care for CHF occurs in Eastern Passage.
Table 27: Rate of patients per 1000 population accessing a specialist for a diagnosis of DM, HTN, COPD, or CHF Diabetes - # of Hypertension # of COPD - # of CHF - # of Patients Community Patients per Patients per Patients per per population of population of 1000 population of 1000 population of 1000 1000 Cole Harbour 26.2 7.1 6.6 5.0 Dartmouth East 28.4 7.2 7.8 7.3 Dartmouth North 24.2 6.0 9.1 5.9 Dartmouth South 22.2 6.6 9.4 6.9 Eastern Passage 21.7 5.5 7.3 4.9 Lawrencetown 26.1 6.1 6.4 5.8 Preston 36.9 7.2 5.2 9.7 CHN 1 Total 25.14 6.62 7.98 6.20 District Total 18.04 6.0 7.09 5.24
Source: Department of Health & Wellness, MSI Billing Data two year average for fiscal 2011/12; 2012/13
Community Health Network 1: Dartmouth / Southeastern Page | 45 Capital Health Community Clinical Services / Health System Planning Group (2014) 1. Specialist Care for Diabetes
Figure 32: Rate of patients per 1000 population receiving care from a specialist for Diabetes (MSI Billing Data two year average for fiscal 2011/12; 2012/13)
2. Specialist Care for Hypertension
Figure 33: Rate of patients per 1000 population receiving care from a specialist for Hypertension (MSI Billing Data two year average for fiscal 2011/12; 2012/13)
Community Health Network 1: Dartmouth / Southeastern Page | 46 Capital Health Community Clinical Services / Health System Planning Group (2014) 3. Specialist Care for COPD
Figure 34: Rate of patients per 1000 population receiving care from a specialist for COPD (MSI Billing Data two year average for fiscal 2011/12; 2012/13) 4. Specialist Care for Congestive Heart Failure
Figure 35: Rate of patients per 1000 population receiving care from a specialist for CHF (MSI Billing Data two year average for fiscal 2011/12; 2012/13)
Community Health Network 1: Dartmouth / Southeastern Page | 47 Capital Health Community Clinical Services / Health System Planning Group (2014) COMMUNITY HEALTH NETWORK SERVICE DELIVERY LOCATIONS
Capital Health Community-Based Service Locations
Figure 36: Capital Health Community Based Programs and Services locations, by Department/Program Area, Fall 2013
Figure 36 and Table 28 outline the locations where Capital Health community-based programs and services operate out of/have physical space in CHN 1. Note that this is not an inclusive list of programs offered because it does not consider district wide programs and services that are available for residents of CHN 1 to access that do not operate out of a physical space, home visits that occur in the CHN, or programs offered out of different rotating community sites; refer to the Community Program and Service Inventory18 for a full listing.
Table 28: Capital Health Community Based Program and Service Locations, by Department/Program Area Programs Mapped in Figure 36 by Department Capital Health Mental Health Community Mental Health Clinics, Community Hubs (Connections locations), & Addictions Program Addictions Community Based Services Integrated Continuing Care Care Coordinator locations, Nursing Homes Patient & Public Engagement Community Health Board Coordinator locations Primary Health Care Community Health Team, Community Health & Wellness Centre, Diabetes Management Centre locations Public Health Drop in Centres, Youth Health Centres, Fluoride Mouthrinse Program, Prenatal Classes, Satellite Offices (note: all elementary school locations not recorded, but services are provided to all; e.g., vision screening) Rehabilitation Services Programs offered from DGH, other community locations Hospital Facilities Dartmouth General Hospital
18 This document is available via the Community Clinical Services/Health System Planning Group and is a detailed inventory of all programs and services offered by the Community-based Programs district wide
Community Health Network 1: Dartmouth / Southeastern Page | 48 Capital Health Community Clinical Services / Health System Planning Group (2014) Family Practice in CHN 1
Figure 37: Family Practice locations in CHN 1 (DDFP Database (Medical Services Information System; CDHA; DDFP Members; April 2014)
Figure 38: Family physician FTE per 1000 population in CHN 1 (Department of Health and Wellness Physician Resource Plan 2012 Billings)
Community Health Network 1: Dartmouth / Southeastern Page | 49 Capital Health Community Clinical Services / Health System Planning Group (2014)
Figure 37 depicts locations of family physician offices, nurse practitioners, family practice nurses, and urgent care locations in CHN 1. There are approximately 79 family physician FTEs working in CHN 1 and the rate of family physician FTE per population for each community in CHN 1 is depicted in Figure 38. According to Figure 38, Dartmouth East has the highest working number of family physicians per 1000 population, followed by Dartmouth South. Eastern Passage is the only community within CHN 1 without a family physician practicing within the immediate community. There is one Urgent Care Centre located in the community of East Dartmouth and one nurse practitioner located in the community of Preston. There are approximately seven family practice nurses working across the CHN.
Figure 39: Individuals placed with a family physician (or NP) through the Primary Health Care Connections program (Primary Health Care data for the period of March 2011 – June 2014)
Primary Health Care Connections is an initiative that assists citizens in Capital Health with finding a family practice if they do not currently have a primary care provider. People looking for a family physician for their routine care are directed to contact family practices in their community that are advertising for new patients. Those with complex health needs, such as individuals with chronic conditions, complete a medical history form with the Primary Health Care Connections coordinator and are placed with a family practice by the coordinator.
Table 29 and Figure 39 detail the number of individuals known to be placed with a family practice, by the community in which the individual resides, from March 2011-June 201419. Note that the family physician/nurse practitioner may practice out of any community. Residents of CHN 1 accounted for 25.17% of all individuals being placed with a family physician through the Primary Health Care Connections Program. Within the CHN,
19 From November 2013 onward, the data also includes those who were re-directed with information. This is a result of the program and data collection mechanisms evolving over time. Generally, this information is intended to show communities with higher call volumes to the service.
Community Health Network 1: Dartmouth / Southeastern Page | 50 Capital Health Community Clinical Services / Health System Planning Group (2014) the higher number of citizens being placed with a family practice reside in the community of Dartmouth North, with approximately 53 citizens being connected to a family doctor.
Table 29: Individuals placed with a Family Physician (or NP), by Community Community Number of Individuals Placed Percentage of CHN Total Cole Harbour 20.51 12.79 Dartmouth East 18.00 11.23 Dartmouth North 53.44 33.33 Dartmouth South 44.05 27.47 Eastern Passage 21.00 13.10 Lawrencetown -- -- Preston -- -- CHN 1 Total 160.33 25.17 (of district total) District Total 636.98 100 *Some data suppressed due to small numbers
Source: Primary Health Care, Capital Health, for the period of March 2011 – June 2014.
Community Health Network 1: Dartmouth / Southeastern Page | 51 Capital Health Community Clinical Services / Health System Planning Group (2014) Community Pharmacies
Figure 40: Community-based pharmacy locations in CHN 1 (Pharmacy Association of Nova Scotia (PANS), 2014).
Figure 40 depicts community-based pharmacy locations in CHN 1. Observationally, clusters of community pharmacies are evident in the more urban areas of CHN 1. All communities within the CHN have a pharmacy located within their community, with the exception of Preston.
Community Health Network 1: Dartmouth / Southeastern Page | 52 Capital Health Community Clinical Services / Health System Planning Group (2014) Nursing Home Locations
Figure 41: Nursing Home and Residential Care Facility locations in CHN 1 (Integrated Continuing Care, Capital Health, April 2014, as retrieved from http://novascotia.ca/dhw/ccs/documents/Nursing-Homes-and-Residential-Care-Directories.pdf)
Figure 41 represents the nursing home (NH) and residential care facility (RCF) locations in CHN 1. Table 30 identifies the facilities and number of beds, by community. There are no nursing homes or RCFs located within the communities of Dartmouth North, Preston, or Lawrencetown.
Table 30: Nursing Home and RCF locations by Community, indicating number of beds Community Nursing Home(NH)/Residential Care Facility (RCF) Location Number of Beds Cole Harbour 1. Bissett Court (NH), 74 Chameau Crescent, Cole Harbour 50 NH beds Dartmouth East 1. The Admiral Long Term Care Centre, 6 Admiral Street 65 NH beds + 1 respite bed 2. Precision Health Group (RCF), 21 & 24 Kincardine Drive 4 + 3 = 7 RCF beds 3. Clarmar Residential Care Facility (RCF), 200 Main Street 24 RCF beds 4. Precision Health Group (RCF), 16 Rannoch Road 3 RCF beds Dartmouth 1. Oakwood Terrace (NH), 10 Mount Hope Avenue 111 NH beds South 2. Parkland by the Lakes – Glasgow Hall (NH), 76 Baker Drive 72 NH beds Eastern 1. Oceanview Continuing Care Centre (NH), 1909 Caldwell 176 NH beds + 1 respite bed Passage Road, Eastern Passage NH beds per 100,000: 421.8 CHN 1 NH and RCF Beds per 100,000 population RCF beds per 100,000: 6.2
Source: Integrated Continuing Care, Capital Health, April 2014, as retrieved from http://novascotia.ca/dhw/ccs/documents/Nursing -Homes-and-Residential-Care-Directories.pdf).
Community Health Network 1: Dartmouth / Southeastern Page | 53 Capital Health Community Clinical Services / Health System Planning Group (2014)
COMMUNITY HEALTH SERVICES UTILIZATION
Emergency Department Visits (Adult – Capital Health)
The number of visits per 1000 population to the Emergency Department (ED) was retrieved from the Emergency Department Information System (EDIS) for communities across the District. Both visits of high acuity (CTAS 1,2,3) and visits of low acuity (CTAS 4 and 5) as a rate per 1000 population were calculated. This data is based on the postal code of the citizen and includes all emergency departments with Capital Health (Halifax Infirmary, Dartmouth General Hospital, Hants Community Hospital, and Cobequid Community Health Centre), with the exception of the EDs located within the Tri-Facilities (data captured through the Nightingale EMR). Table 31 details emergency department (ED) utilization, by community, by type of visit.
Table 31: Emergency Department Utilization by Community for Adults using CDHA Emergency Departments # of CTAS 1,2,3 # of CTAS 4,5 CTAS 1-3 Visits per CTAS 4-5 Visits per Community Visits Visits Population of 1000 Population of 1000 Cole Harbour 4,461.1 2,455.2 237.8 130.8 Dartmouth East 5,142.8 2,672.1 281.8 146.4 Dartmouth North 5,799.3 2,924.6 365.9 184.5 Dartmouth South 6,681.2 3,117.5 331.0 154.4 Eastern Passage 2,210.0 1,324.3 256.9 153.9 Lawrencetown 1,113.6 552.4 261.0 129.5 Preston 493.6 265.9 290.5 156.5 CHN 1 Total 25,901.7 13,312.0 295.6 151.9 District 90,116.6 54,946.9 271.9 165.8 (CDHA Residents Only) Source: EDIS data for Fiscal Year 2013/14, Capital Health
CHN 1 has a higher rate of visits per 1000 population to the ED for visits of high acuity (CTAS levels 1, 2, and 3) than the district rate and a lower rate of visits per 1000 population to the ED for visits of low acuity (CTAS level 4 and 5). Within the CHN, the community with the highest volume of ED visits for both levels of acuity is Dartmouth South. As a rate per 1000 population, Dartmouth North has the highest rate of visits of high acuity to the ED (365 visits per 1000 population) and as well the highest rate of visits to the ED for visits of low acuity (184.5 visits per 1000 population). The rate of CTAS visits of high acuity and low acuity per 1000 population are depicted in Figures 42 and 43, respectively.
Community Health Network 1: Dartmouth / Southeastern Page | 54 Capital Health Community Clinical Services / Health System Planning Group (2014)
Figure 42: Number of visits per 1000 population to an ED within Capital Health for a visit of high acuity in CHN 1 (EDIS data for Fiscal Year 2013/14, Capital Health)
Figure 43: Number of visits per 1000 population to an ED within Capital Health for a visit of low acuity in CHN 1 (EDIS data for Fiscal Year 2013/14, Capital Health)
Community Health Network 1: Dartmouth / Southeastern Page | 55 Capital Health Community Clinical Services / Health System Planning Group (2014) Emergency Department Visits (Child/Youth – IWK)
Emergency Department data was also retrieved from the IWK Health Centre to provide information related to child and youth visits to the emergency department. Both visits of high acuity (CTAS 1,2,3) and visits of low acuity (CTAS 4 and 5) as a rate per 1000 child/youth population were calculated (age 0-19). This data is based on the postal code of the citizen and includes all ED visits occurring at the IWK Health Centre, but not for children/youth visiting other EDs within Capital Health. Table 32 details emergency department (ED) utilization by community, by type of visit.
Table 32: IWK Health Centre Emergency Department Utilization by Community for Children/Youth CTAS 1,2,3 CTAS 4,5 CTAS 1-3 Visits per CTAS 4-5 Visits per Community Visits (#) Visits (#) Population of 1000 Population of 1000 Cole Harbour 453.47 1032.83 53.82 123.79 Dartmouth East 551.45 1017.39 75.95 139.41 Dartmouth North 416.31 837.66 89.56 177.40 Dartmouth South 383.03 843.82 64.08 135.48 Eastern Passage 278.73 471.53 63.89 117.07 Lawrencetown 145.81 266.74 81.63 151.97 Preston 30.70 85.75 39.13 113.31 CHN 1 Total 2,259.5 4,555.72 67.84 137.10 District (CDHA Residents Only) 7,411.48 14,404.5 60.25 118.62
Source: IWK Health Centre Emergency Department data for Fiscal Year 2013/14
CHN 1 has a higher rate of children/youth per 1000 population visiting the ED for visits of both high and low acuity (CTAS levels 1-5) than the district rate. Within the CHN, the community with the highest volume of IWK ED visits for visits of high acuity is Dartmouth East and the community with the highest volume of IWK ED visits for visits of low acuity is Cole Harbour. As a rate per 1000 child/youth population, Dartmouth North has the highest rate of visits of high acuity to the IWK ED (89.56 visits per 1000 child/youth population) and as well the highest rate of visits to the ED for visits of low acuity (177.4 visits per 1000 child/youth population). Lawrencetown has the second highest rate per 1000 population of visits of both high and low acuity to the IWK ED. The rate of CTAS visits of high acuity and low acuity per 1000 child/youth population are depicted in Figures 44 and 45, respectively.
Community Health Network 1: Dartmouth / Southeastern Page | 56 Capital Health Community Clinical Services / Health System Planning Group (2014)
Figure 44: Number of Child/Youth visits per 1000 population to the IWK Health Centre Emergency Department for visits of high acuity (IWK Health Centre, Meditech Registrations for Time Period Fiscal 2012-2013)
Figure 45: Number of Child/Youth visits per 1000 population to the IWK Health Centre Emergency Department for visits of low acuity (IWK Health Centre, Meditech Registrations for Time Period Fiscal 2012-2013)
Community Health Network 1: Dartmouth / Southeastern Page | 57 Capital Health Community Clinical Services / Health System Planning Group (2014) Hospital Admissions
Table 33 highlights the top 5 reasons for admission to hospital in CHN 1, according to the Discharge Abstract Database (DAD) for Fiscal Year 2012-2013. CHN 1 has a higher admission rate than the district rate for all of the top 5 reasons for admission.
Table 33: Hospital admissions by diagnosis for CHN 1 (DAD, Fiscal 2012-2013) CHN 1 Admission District Admission NS (per 1000 ICD Code Total Rate per 1000 pop Rate per 1000 pop population) J44 Oth chronic obstructive pulmonary 263 2.35 1.77 disease I21 Acute myocardial infarction 220 1.97 1.82 2.53 Z51 Other medical care 206 1.84 1.65 M17 Gonarthrosis [arthrosis of knee] 205 1.83 1.49 Z54 Convalescence 161 1.44 1.33
Table 34 highlights the top 5 reasons for unplanned re-admission to hospital in CHN 1 (from previous acute admit with same or related diagnosis in 0-28 days after discharge) according to the DAD for Fiscal Year 2012- 2013. In CHN 1, the rate of readmission for heart failure and COPD was higher than the district rate. Table 34: Re-admissions by Diagnosis for CHN 1 (DAD, Fiscal 2012-2013) CHN 1 Admission District Admission National re- ICD Code Total Rate per 1000 pop Rate per 1000 pop admit rate I50 Heart failure 27 0.24 0.19 21% T81 Complications of procedures NEC 24 0.21 0.25 - J44 Oth chronic obstructive pulmonary 18 0.16 0.11 18.8% disease Z51 Other medical care 16 0.14 0.14 12.5% F43 React to severe stress & adjustment Not top 5 for 11 0.10 - disease district
Ambulatory Care Sensitive Conditions
Table 35 describes the top five reasons for admissions for ambulatory care sensitive conditions (ACSCs) in CHN 1 according to the Discharge Abstract Database (DAD) for Fiscal Year 2012-2013. Table 35: Admissions by ambulatory sensitive condition (DAD, Fiscal 2012-2013) CHN 1 Admission Rate per District Admission Rate per Condition Total 1000 pop 1000 pop Heart Failure and Pulmonary Edema 109 0.98 0.88 Diabetes 55 0.49 0.27 Grand mal status/other epileptic 25 0.22 0.18 convulsion COPD 240 2.15 1.62 Asthma 22 0.2 0.13 Angina 33 0.3 0.24 The ACSC hospitalization age standardized rate per 1000 population for CDHA is 3.50 per 1000 population, which is lower than the rate for NS (4.64 per 1000 population) and Canada (3.89 per 1000 population). 20 CHN 1 has a higher rate of admission to hospital for all ACSCs listed in Table 35 when compared to the district rate.
20 Provincial and National benchmarks are provided by CIHI, where available.
Community Health Network 1: Dartmouth / Southeastern Page | 58 Capital Health Community Clinical Services / Health System Planning Group (2014) Community Mental Health and Addictions Services
Adult and Child/Youth mental health and addictions service utilization data was collected for individuals accessing services across CDHA and accessing the IWK Health Centre. The rate per population was calculated for each age demographic; however, it is important to note that Capital Health sees some child/youth mental health and addictions clients in the West Hants Area (not registered via IWK). The Capital Health data contains data for community-based mental health and addictions services only; however, the child/youth data from the IWK Health Centre includes a broad range of services offered (from specialty therapy and diagnostics to group programs and allied health visits).
1. Addictions Community Based Services (Adult – Capital Health)
Capital Health Addictions Community-Based Services offer support to individuals, in the community, for their ongoing recovery from alcohol, substances, nicotine and gambling. Services include group therapy, one-on-one counseling, and recreation therapy (Capital Health, 2014).
Figure 46: Clients per 1000 population accessing Addictions Community Based Services (Adult – Capital Health) in CHN 1 (STAR and Addictions Assist (Provincial Database) for time period April 2012 – September 2013)
Figure 46 depicts the number of clients per 1000 population accessing Addictions Community Based Services in CHN 1. CHN 1 has the highest number of people utilizing Addictions Community Based Services per 1000 population across all CHNs in the district, with 14.1 clients per 1000 population accessing services, compared to the district rate of 11.8 clients per 1000 population. Within the CHN, Dartmouth North as the greatest number of clients, the highest volume of visits, and the highest number of clients per 1000 population, which is also among the highest in the district. The average number of visits per client is also the highest in CHN 1 across all CHNs, with the average being 16.2 visits per client. Addictions clients residing in Dartmouth North have the highest average number of visits per client (22.0 visits per client), followed by Lawrencetown (20.5 visits per client). A detailed breakdown of Addictions services utilization is provided in Table 36.
Community Health Network 1: Dartmouth / Southeastern Page | 59 Capital Health Community Clinical Services / Health System Planning Group (2014)
Table 36: Addictions Community Based Services Utilization (Adults – Capital Health) in CHN 1 Addictions Community Average Visits per # of Clients per Community Clients Based Services Visits21 Client population of 1000 Cole Harbour 2,427.0 198.5 12.2 10.6 Dartmouth East 2,517.4 216.4 11.6 11.9 Dartmouth North 7,510.6 328.4 22.9 20.7 Dartmouth South 5,250.7 321.1 16.4 15.9 Eastern Passage 1,168.7 93.9 12.4 10.9 Lawrencetown 1,083.7 53.0 20.5 12.4 Preston 118.0 25.5 4.6 15.0 CHN 1 Total 20,076.1 (40% of district) 1,237.0 16.2 14.1 District Total 50,651.5 3,908.0 13.0 11.8
Source: STAR and Addictions Assist (Provincial Database) for time period April 2012 – Sept 2013, Capital Health
2. CHOICES Addictions Services (Child/Youth – IWK Health Centre)
CHOICES provides treatment services for adolescents aged 13 to 19 years who are harmfully involved with substances, gambling and/or who have a concurrent disorder. CHOICES provides voluntary services including health promotion and prevention, community cutreach, outclient clinical services, a day program and a provincial 24/7 inpatient treatment service (IWK Health Centre, 2014). Excluded from the total number of visits are registrations for inpatients of the CHOICES Residential Unit at the time of their clinic visit.
n <5
Figure 47: Number of clients per 1000 child/youth population accessing IWK CHOICES Addictions Services in CHN 1 (IWK Health Centre, Meditech Registrations for Time Period Fiscal 2012-2013)
21 Note: total number of visits over an 18 month period (not annual)
Community Health Network 1: Dartmouth / Southeastern Page | 60 Capital Health Community Clinical Services / Health System Planning Group (2014)
All CHOICES Addictions data should be interpreted with caution due to low numbers of clients by community. The rate of clients accessing services per 1000 child/youth population (age 0-19) 22 was mapped for some CHNs; however, some communities with small youth populations show high rates, yet the number of clients is still very small (<5 clients). Any community with less than five children/youth accessing services is noted and data are suppressed. Communty and CHN data for CHOICES is displayed in Table 37 and rates per 1000 children/youth are also depicted in Figure 47.
CHN 1 has a higher number of clients per 1000 youth population accessing CHOICES Addictions Services from the IWK Health Centre than the district rate, with 2.99 clients per 1000 child/youth population accessing services from CHN 1, compared to the district rate of 2.47 clients per 1000 children/youth. CHN 1 also has a higher number of visits per client than the district rate, averaging 6.5 visits per client. Residents of CHN 1 account for approximately one-third of CHOICES client population and visit volume.
Within the CHN, the community with the higher number of CHOICES clients per 1000 child/youth population is Lawrencetown, with 4.5 clients per 1000 child/youth population accessing services. Within the CHN and also across the district, the community with the highest total number of clients is Cole Harbour, with 19 children/youth accessing services. The higher total number of visits occurs by residents of Dartmouth East. Finally, the average number of visits per client is higher in Dartmouth North, with each CHOICES client having 9.4 visits each, on average. Numbers for Preston were suppressed due to low client volumes.
Table 37: Addictions Community Based Services Utilization (Youth – IWK) in CHN 1 Average Visits per # of Clients per 1000 Community CHOICES Visits Clients Client youth population Cole Harbour 85.0 19.0 4.5 3.0 Dartmouth East 117.0 14.0 8.4 2.6 Dartmouth North 83.4 8.9 9.4 2.6 Dartmouth South 91.0 18.0 5.1 3.9 Eastern Passage 58.0 8.0 7.3 2.6 Lawrencetown 44.1 6.0 7.3 4.5 Preston <5 <5 -- -- CHN 1 Total 478.6 (36% of district) 73.9 6.5 3.0 District Total 1339.0 225.4 6.0 2.5
Source: IWK Health Centre, Meditech Registrations for CHOICES for Time Period Fiscal 2012-2013
22 This age demographic does not exactly correlate to the demographic of the population served by the program; however, it is a more accurate measure of the rate than the total population of the community (all age groups)
Community Health Network 1: Dartmouth / Southeastern Page | 61 Capital Health Community Clinical Services / Health System Planning Group (2014) 3. Community Mental Health (Adult – Capital Health)
Capital Health Community Mental Health Services offer general mental health services for adults. Hants Community also provides child and adolescent mental health services. Community/outpatient and shared care Mental Health Services are provided by inter-disciplinary teams including and the services offered vary depending on the issues/illness the person presents with. Some people are seen for assessment only; others may have a set number of individual treatment sessions or group programs, while those with more serious and persistent illness, resulting in disability, are supported by the service over a longer period of time. People may receive services in an office, in the community, or in their home (Capital Health, 2014).
Figure 48: Number of clients per 1000 population accessing Community Mental Health in CHN 1 (STAR Registrations from time period April 2012 – Sept 2013, Capital Health)
Figure 48 depicts the number of clients per 1000 population accessing Community Mental Health services in CHN 1. CHN 1 has a higher number of people utilizing Community Mental Health services per 1000 population than the district rate. CHN 1 has 39.3 clients per 1000 population accessing services compared to the district rate of 31.6 clients per 1000 population.
Within the CHN, Dartmouth South has the greatest number of clients and the highest volume of visits to Capital Health Community Mental Health. Dartmouth North has the highest rate of utilization, with 53.2 patients per 1000 population accessing services. The average number of visits per client is also higher in CHN 1, with residents averaging 10.3 visits, compared to the district rate of 7.7 visits per client. Dartmouth South clients have the highest average number of visits (12.5 visits per client), followed by Preston (12.2 visits per client). A detailed breakdown of Community Mental Health services utilization is provided in Table 38.
Community Health Network 1: Dartmouth / Southeastern Page | 62 Capital Health Community Clinical Services / Health System Planning Group (2014)
Table 38: Community Mental Health Services Utilization in CHN 1 Community Mental Health Average # of visits # of Clients per Community Clients Visits per client population of 1000 Cole Harbour 5,570.0 614.8 9.1 32.8 Dartmouth East 6,094.6 643.4 9.5 35.3 Dartmouth North 8,898.1 843.5 10.5 53.2 Dartmouth South 11,135.6 892.0 12.5 44.2 Eastern Passage 1,889.5 257.6 7.3 29.9 Lawrencetown 1,157.0 141.2 8.2 33.1 Preston 603.7 49.4 12.2 29.1 CHN 1 Total 35,348.4 (43.5% of district) 3,442.0 10.3 39.3 District Total 81,272.0 10,469.7 7.7 31.6 Source: STAR Registrations from time period April 2012 – Sept 2013, Capital Health
4. Mental Health Services (Child/Youth – IWK Health Centre)
The IWK Mental Health Program provides mental health services to children and youth up to 19 years of age. There are a variety of services offered, including community mental health, shared care, day treatment clinics, and inpatient/acute services (IWK Health Centre, 2014). Data for children/youth in inpatient or residential care were excluded from the data.
Figure 49: Number of clients per 1000 youth population accessing IWK Mental Health Diagnostic and Therapeutic Services in CHN 1 (IWK Health Centre, Meditech Registrations for Time Period Fiscal 2012-2013)
Figure 49 depicts the number of child/youth mental health clients accessing services from the IWK Health Centre as a rate per 1000 child/youth population (age 0-19). CHN 1 has a higher number of clients per 1000
Community Health Network 1: Dartmouth / Southeastern Page | 63 Capital Health Community Clinical Services / Health System Planning Group (2014) child/youth population accessing Mental Health Services from the IWK Health Centre than the district rate, with 39.3 clients per 1000 child/youth population from CHN 1 accessing services (district rate of 31.6 clients per 1000 child/youth). CHN 1 also has a higher number of visits per client than the district rate, averaging 10.3 visits per client. Residents of CHN 1 account for approximately 29% of the client population and visit volume for the district.
Within the CHN, the community with the higher number of IWK Mental Health clients per 1000 child/youth population is Dartmouth North, with residents accessing services at a rate of 41.5 clients per 1000 child/youth population. Within the CHN, the community with the highest total number of clients and the highest total number of visits is Dartmouth East, with 218 youth accessing services. Finally, the average number of visits per client is higher in Dartmouth South, with IWK Mental Health clients having 9.8 visits each, on average. The community of Preston has the lowest rate of clients per 1000 population accessing services and the lowest number of average visits per client. Detailed information by community is provided in Table 39.
Table 39: Mental Health Services Utilization for Children/Youth from IWK Health Centre in CHN 1 Average # of visits # of clients per Community Mental Health Total Visits Clients per client population of 1000 Cole Harbour 1739.2 216.3 8.0 34.1 Dartmouth East 1760.5 218.1 8.1 40.5 Dartmouth North 910.3 139.6 6.5 41.5 Dartmouth South 1513.3 154.4 9.8 33.7 Eastern Passage 816.4 109.9 7.4 35.5 Lawrencetown 306.4 51.3 6.0 38.2 Preston 61.4 15.5 4.0 26.3 CHN 1 Total 7,107.6 905.2 (28.9%) 7.9 36.6 District Total 25,684.3 3,246.7 7.9 35.6
Source: IWK Health Centre, Meditech Registrations for Time Period Fiscal 2012-2013
5. Reproductive Mental Health (Women – IWK Health Centre)
The Reproductive Mental Health Service at the IWK provides assessment, treatment and management for mental health concerns arising in reproductive care, particularly pregnancy and the postpartum period. Problems addressed include depression, anxiety disorders, high-risk obstetrical difficulties, perinatal loss, the impact of prior trauma on obstetrical care and broader adjustment issues (Making Waves, IWK Health Centre, 2011).
All Women’s Reproductive Mental Health data should be interpreted with caution due to low numbers of clients by community. The rate of clients accessing services per 1000 women (women aged 15 to 45 years) was mapped for some CHNs; however, some communities with small populations show high rates, yet the number of clients is still very small (<5 clients). Any community with less than five women accessing services is noted and data are suppressed. Communty and CHN data for IWK Women’s Mental Health services is displayed in Table 40 and rates per 1000 women are also depicted in Figure 50.
Community Health Network 1: Dartmouth / Southeastern Page | 64 Capital Health Community Clinical Services / Health System Planning Group (2014)
<5 clients
<5 clients
Figure 50: Rate of clients per 1000 women aged 15-45 accessing IWK Reproductive Mental Services in CHN 1 (IWK Health Centre, Meditech Registrations for Time Period Fiscal 2012-2013)
CHN 1 has a higher rate of the population accessing IWK Reproductive Mental Health Services than the district total, with the rate being 3.84 clients per 1000 women age 15-45 years. Specifically, Dartmouth North has the highest rate of service utilization, with 4.67 clients per 1000 women aged 15-45 years accessing services. Dartmouth North also has the higher number of visits per client, with each client having 4.45 visits to the service, on average. The community of Dartmouth South has the higher total number of clients.
Table 40: IWK Health Centre Reproductive Mental Health Services Utilization by women age 15 to 45 years Reproductive Mental Average # of visits # of clients per Community Clients Health Total Visits per client population of 1000 Cole Harbour 63.56 13.51 4.71 2.68 Dartmouth East 67.44 16.49 4.09 3.52 Dartmouth North 86.44 19.44 4.45 4.67 Dartmouth South 80.56 19.56 4.12 3.98 Eastern Passage 33.00 12.00 2.75 4.51 Lawrencetown -- <5 -- -- Preston -- <5 -- -- CHN 1 Total 352.02 88.37 3.98 3.84 District Total 1,283.32 322.84 3.98 3.59 Source: IWK Health Centre, Meditech Registrations for Time Period Fiscal 2012-2013
Community Health Network 1: Dartmouth / Southeastern Page | 65 Capital Health Community Clinical Services / Health System Planning Group (2014) Youth Health Centres
Figure 51: Youth Health Centres in CHN 1, reporting top 5 concerns by location (Public Health, Capital Health, 2014)
Youth Health Centres promote positive outcomes for youth, including school completion, safer sexual behaviours and healthy relationships, and reduction of risks associated with substance use and other risk-taking behaviours (Youth Health Centre, Capital Health, 2014).
There are four Youth Health Centres located at high schools within CHN 1, locations depicted in Figure 51. The top five concerns reported by each Youth Health Centre indicate the top 5 reasons students visit the Youth Health Centre in each of the CHN’s high schools. Support from a Youth Health Centre Coordinator is provided at Ecole du Carrefour on a part-time basis.
Community Health Network 1: Dartmouth / Southeastern Page | 66 Capital Health Community Clinical Services / Health System Planning Group (2014) Community Health Teams
Figure 52: Visits to the Community Health Team per 1000 population (Primary Health Care, CDHA, STAR Registrations for time period Fiscal 2012/13
The Community Health Teams offer free wellness programs and navigation for people who live, work, or have a family doctor in the Dartmouth or Chebucto (Halifax Mainland) area of communities. There is one Community Health Team (CHT) located in CHN 1 in the community of Dartmouth East (58 Tacoma Drive); however, the CHT delivers programs throughout the majority of the CHN in various community locations (Dartmouth North, Dartmouth South, and Dartmouth East, others) as needed.
Figure 52 shows client density per 1000 population for the communities served by both the Dartmouth and Chebucto CHTs. The highest number of people per 1000 population visiting the Community Health Team in CHN 1 reside in Dartmouth South and Dartmouth East. Community Health Teams are expanding to additional areas of CHN 2 and to CHN 3 in 2014.
Community Health Network 1: Dartmouth / Southeastern Page | 67 Capital Health Community Clinical Services / Health System Planning Group (2014) Integrated Continuing Care
1. Integrated Continuing Care Client Summary
As of August 2014, Integrated Continuing Care had 5202 active clients across the district. 1462 of these clients reside in CHN 1, which accounts for 28% of all Integrated Continuing Care clients in the district. Refer to Table 41 for a synopsis, by CHN and by type of client.
Table 41: Integrated Continuing Care Client Overview by CHN Service / CHN CHN 1 CHN 2 CHN 3 CHN 4 CHN 5 CDHA Community ------300 344 644 Chronic Clients 569 932 338 29 -- 1,868 Supportive Clients 491 731 202 28 -- 1,452 Palliative Clients 52 80 41 <5 -- 176 Specialized Acute Care 40 46 13 <5 <5 102 Discharges Receiving Acute Nursing Only 310 460 170 20 -- 960 CHN Total 1462 2,249 764 382 344 5,202 % District Total 28% 43% 15% 7% 7% 100% % of Total CHN Population 1.3% 1.3% 0.8% 1.8% 1.4% 1.3% Accessing Services (all ages)
Source: Integrated Continuing Care, Capital Health, STAR Registrations April 1, 2013 to March 31, 2014
2. Community Occupational Therapy and Physiotherapy Services
Integrated Continuing Care aligns OT/PT services by municipal polling station. The polling stations that cover the communities of CHN 1 are listed below (Table 42) with the number of referrals for community occupational therapy (OT)/physiotherapy (PT) through Integrated Continuing Care that are aligned with each area. However, it is important to note overlap with other CHNs (e.g., Polling District 2 covers part of CHN 1 and a large portion of CHN 4, Eastern Shore Musquodoboit). Refer to Figure 53.
When looking at the Polling Stations that align with CHN 1, the Preston-Porter’s Lake-Eastern Shore municipal polling district has the higher number of referrals to community OT/PT. The average age of referral to Community OT services is 72.5 years of age. 1,048 CDHA citizens received this service last year, resulting in 2,549 visits for the fiscal year. There was an average of 2.42 visits per client. The average age of referral to Community PT services is 75.3 years of age. 893 CDHA citizens received this service last year, resulting in 2,558 visits for the fiscal year. There was an average of 2.80 visits per client. Figure 53: Rate of patients per 1000 population accessing community OT/PT via
referral to Integrated Continuing Care, by numbered polling district (Integrated Continuing Care , CDHA, STAR Registrations for time period Fiscal 2013-2014) Community Health Network 1: Dartmouth / Southeastern Page | 68 Capital Health Community Clinical Services / Health System Planning Group (2014)
Table 42: Integrated Continuing Care Referrals to Community OT/PT by Polling District aligned with CHNs CHN CHN 1 CHN 2 CHN 3 CHN 4 CHN 5 Polling Station 3, 4, 5, 6, 7,8,9,10,11,12, 14, 15 *1, *2 n/a *2 *13, *16 *13, *16, *1 Polling Station Polling Station Polling Station Polling Station #13 Polling Station n/a Overlap #2 overlaps #13 + #16 (large (large portion of #1 overlaps with with a large portion of Hubbards/St. CHN 3 and geography in Bedford) both Margaret’s Bay) + Polling Station CHN 4 overlap with CHN #16 overlap with #2 overlaps with 3 CHN 3 and Polling CHN 1 Station #1 overlaps with CHN 4 Total OT (%) 396 (25%) 696 (45%) 233 (16%) 126 (8%) 89 (6%) Total PT (%) 288 (25%) 530 (45%) 182 (16%) 82 (8%) 69 (6%) Total OT/PT 684 (25%) 1226 (45%) 415 (16%) 208 (8%) 158 (6%) Referrals Total Referrals to 1462 (28%) 2249 (43%) 764 (15%) 382 (7%) 345 (7%) Continuing Care
Source: Integrated Continuing Care, Capital Health, STAR Registrations April 1, 2013 to March 31, 2014
3. Home Care and/or Nursing Support Services
Data regarding Integrated Continuing Care clients is collected via Seascape, the information management system used by Integrated Continuing Care, and this data is available at the district level only. A summary of home care and/or nursing clients for CDHA is presented in Table 43. Home care clients in CDHA account for 33.4% of the total home care clients in the province. The majority of clients accessing home care services are aged 65 years and older and there are more females than males accessing services. The home care utilization rate for CDHA is 14.9% (as measured by # of home care clients per population 65+), which is lower than the provincial utilization rate of 16.2%. The top two diagnoses of home care clients is arthritis (62.2%) and hypertension (62.1%) and almost 50% of clients report being on nine or more medications (NS DHW Continuing Care Branch, 2013).
Table 43: Home Care and/or Nursing Support Client Summary for Capital District Health Authority # of Female Clients # of Male Clients Total # of Clients Age 0-19 59 74 133 Age 20-64 1,636 1,336 2,972 Age 65+ 3,591 2,123 5,714 District Total 5,286 3,533 8,819 % of NS Total 33.8% 32.8% 33.4% Source: Nova Scotia Department of Health and Wellness, Continuing Care Branch, SEAscape Database for time period fiscal 2013-2014.
4. Care Plans, By Type
A detailed breakdown of the types of care plans created for clients over a one year period for Continuing Care Clients in Capital Health is provided in Table 44. The predominant type of care plan created is for skin care, which accounts for 20.6% of all care plans created. This is followed by activities of daily living, which accounts for 17.6% of all care plans created. The 65 and above age category accounts for the majority of care plans, with 72.6% of care plans being created for people aged 65 years and above. The predominant type of care plan
Community Health Network 1: Dartmouth / Southeastern Page | 69 Capital Health Community Clinical Services / Health System Planning Group (2014) created for the 65 years and above age group is for activities of daily living. The predominant type of care plan created for the 20 to 64 year old age group was for skin care. Finally, the predominant type of care plan created for the child/youth population (age 0-19 years) was for skin care as well.
Table 44: Care plans created in 2013-2014 by type and age category for CDHA Continuing Care Clients Care Plan Type 0 to 19 Years 20 to 64 years 65 + years Total Care Plans % of Total Activities of Daily Living 43 2,014 8,897 10,954 17.6% Communication <5 89 140 229 0.4% Continence 27 967 2,737 3,733 6.0% Instrumental Activities 11 1,357 5,091 6,459 10.4% of Daily Living Medication 113 2,692 5,366 8,171 13.1% Mental Health <5 8 20 28 0.0% Musculoskeletal/ 14 131 578 723 1.2% Neurological Nutrition 23 890 4,141 5,054 8.1% Palliative <5 979 2,194 3,177 5.1% Psychosocial <5 14 83 97 0.2% Respirology/Cardiology 19 304 1,134 1,457 2.3% Skin Care 244 5,379 7,184 12,807 20.6% Support (general) 120 1,519 7,619 9,330 15.0% Total CDHA 614 16,343 45,184 62,219 100.0% % of Total Care Plans by 1.0% 26.3% 72.6% 100.0% --- Age Group
Source: Nova Scotia Department of Health and Wellness, Continuing Care Branch, SEAscape Database for time period fiscal 2013-2014.
Community Health Network 1: Dartmouth / Southeastern Page | 70 Capital Health Community Clinical Services / Health System Planning Group (2014) Ambulatory Care Clinics (Adult – Capital Health)
Data was extracted from STAR registrations, provided by the Department of Medicine and based on visits during fiscal year 2011/2012 and 2012/2013, averaged for one year (adults aged 20 years and above). Table 45 describes the utilization of four ambulatory care clinics by residents of CHN 1 as a rate per 1000 population. Table 46 indicates the total visits to each of the four clinics, by community. A summary of the ambulatory care clinic utilization data, followed by maps depicting utilization rates for each clinic, is provided below: Within the CHN, there is generally a lower rate per 1000 population accessing the four ambulatory care clinics compared to the district rate. In terms of visits to the Cardiac Heart Function Clinic, while Dartmouth South has the higher number of visits, Preston has the higher rate per 1000 population accessing the clinic, at 12.13 patients per 1000 population (Figure 54). Use of the Hypertension Clinic is consistently low across the CHN; however, within the CHN, Dartmouth North has the higher number of visits and the higher number of patients per 1000 population receiving care at the Hypertension Clinic (Figure 55) Within the CHN, Dartmouth East has both the higher number of visits and higher number of patients per 1000 accessing the Endocrinology Clinic (Figure 56). Lawrencetown has a higher rate per 1000 population receiving care from the Respirology Clinic, followed closely by Dartmouth South (highest volume of visits) and Dartmouth East (Figure 57).
Table 45: Ambulatory Clinic Usage by Community as a rate per 1000 population Cardiac Heart Hypertension Rate Endocrinology Rate Respirology Rate Community Function Rate per per 1000 per 1000 per 1000 1000 Population Population Population Population Cole Harbour 4.73 1.89 9.18 32.73 Dartmouth East 4.87 1.84 10.20 34.22 Dartmouth North 3.85 2.47 6.98 30.88 Dartmouth South 8.02 1.84 7.98 35.84 Eastern Passage 3.99 1.24 8.91 28.32 Lawrencetown 3.59 2.12 7.83 36.13 Preston 12.13 -- 7.04 21.93 CHN 1 Total 5.37 1.91 8.59 32.94 District Total 7.62 3.77 9.15 34.31
Source: STAR registrations, provided by the Department of Medicine for fiscal year 2011/2012 and 2012/2013, averaged to 1 year
Table 46: Ambulatory Clinic Usage by Community, total number of visits per clinic Endocrinology Community Hypertension Visits Cardiac Visits Respirology Visits Visits Cole Harbour 172.33 35.51 88.68 614.14 Dartmouth East 186.17 33.49 88.81 624.41 Dartmouth North 110.61 39.22 61.00 489.51 Dartmouth South 161.11 37.13 161.87 723.49 Eastern Passage 76.70 10.65 34.31 243.64 Lawrencetown 33.42 9.05 15.31 154.11 Preston 11.96 -- 20.60 37.25 CHN 1 Total 752.30 167.27 470.58 2,886.56 District Total 3,031.15 1,248.82 2,526.25 11,372.75 Source: STAR registrations, provided by the Department of Medicine for fiscal year 2011/2012 and 2012/2013, averaged to 1 year Community Health Network 1: Dartmouth / Southeastern Page | 71 Capital Health Community Clinical Services / Health System Planning Group (2014) 1. Cardiology
Figure 54: Rate per 1000 population of citizens accessing the QEII Cardiology Heart Function Clinic (Department of Medicine, STAR data for fiscal 2011/12 and 2012/13 averaged, CUT Cd: CARHF)
2. Hypertension
Figure 55: Rate per 1000 population of citizens accessing the QEII Hypertension Clinic. (Department of Medicine, STAR data for fiscal 2011/12 and 2012/13 averaged, CUT Cd: GMHY) Community Health Network 1: Dartmouth / Southeastern Page | 72 Capital Health Community Clinical Services / Health System Planning Group (2014) 3. Endocrinology
Figure 56: Rate per 1000 population of citizens accessing the QEII Endocrinology Clinic (Department of
Medicine, STAR data for fiscal 2011/12 and 2012/13 averaged, CUT Cd: EN)
4. Respirology
Figure 57: Rate per 1000 population of citizens accessing the QEII, Cobequid, Hants and DGH Respirology Clinics. (Department of Medicine, STAR data for fiscal 2011/12 and 2012/13 averaged, CUT Cd: CPP; RS; RSPF) Community Health Network 1: Dartmouth / Southeastern Page | 73 Capital Health Community Clinical Services / Health System Planning Group (2014) Ambulatory Care Clinics (Child/Youth – IWK Health Centre)
1. IWK Dentistry Clinic
Figure 58: Rate of children/youth per 1000 accessing the IWK Dentistry Clinic for CHN 1 (IWK Health Centre, Meditech Registrations for Time Period Fiscal 2012-2013)
CHN 1 has a higher rate of children/youth accessing the IWK Dentistry Clinic (11.92 children/youth per 1000 population) when compared to the district rate (9.49 per 1000 child/youth population23). The highest number of visits occurs by residents of Cole Harbour. The highest rate per 1000 child/youth population occurs is in the community of Dartmouth North, with 18.36 children/youth per 1000 population accessing the Dentistry Clinic (nearly twice the district rate). Refer to Figure 58 and Table 47.
Table 47: IWK Ambulatory Dentistry Clinic Utilization by Children/Youth in CHN 1 for Fiscal 2012-2013 Community Visits Average Visits per Patient # of Patients per population of 1000 Cole Harbour 99.90 1.49 10.58 Dartmouth East 73.62 1.35 10.13 Dartmouth North 94.66 1.53 18.36 Dartmouth South 75.50 1.45 11.38 Eastern Passage 42.33 1.23 11.08 Lawrencetown 20.46 1.27 12.01 Preston 12.48 1.47 14.41 CHN 1 Total 418.93 1.4 11.92 District Total 1,240.28 1.34 9.49 Source: IWK Health Centre, Meditech Registrations for Time Period Fiscal 2012-2013
23 Many dentists refer children to pediatric dentists at private clinics; therefore, this data is not indicative of the true need for pediatric dentistry services. This data also excludes visits made by inpatients and those living in residential care.
Community Health Network 1: Dartmouth / Southeastern Page | 74 Capital Health Community Clinical Services / Health System Planning Group (2014) 2. IWK Diabetes Clinic
IWK Diabetes Clinic data should be interpreted with caution due to low numbers in some communities. Communities with low numbers of the population aged 0-19 may consequently have higher rates of service utilization, yet the number of patients is still small. Data are suppressed any community with less than five children/youth accessing services. Excluded from the total number of visits are registrations for inpatients and residential care residents.
Figure 59: Rate of children/youth accessing the IWK Diabetes Clinic for CHN 1 (IWK, Meditech Registrations for Fiscal 2012-13)
Figure 59 depicts the rate of children/youth accessing the IWK Diabetes Clinic, by community. CHN 1 has a lower rate of patients accessing the diabetes clinic at the IWK Health Centre than the district rate. Within the CHN, the higher number of patients per 1000 child/youth population accessing the IWK Diabetes Clinic reside in Lawrencetown. The higher volumes (patient and visits) within the CHN come from the community of Cole Harbour, which is also the community with the higher average number of visits per patient. Refer to Table 48.
Table 48: Patients and Visits to the IWK Ambulatory Diabetes Clinic for Fiscal 2012-2013 Average Visits per Community # of Patients # of Patients per 1000 youth Visits Patient Cole Harbour 20.5 3.2 70.8 3.5 Dartmouth East 9.0 1.7 24.0 2.7 Dartmouth North 10.0 3.0 33.0 3.3 Dartmouth South 14.8 3.2 45.6 3.1 Eastern Passage 8.0 2.6 26.0 3.3 Lawrencetown 6.1 4.5 15.5 2.6 Preston <5 ------CHN 1 Total 70.2 (24.7%) 2.8 218.7 3.1 District Total 284.1 3.1 814.3 2.9 Source: IWK Health Centre, Meditech Registrations for Time Period Fiscal 2012-2013
Community Health Network 1: Dartmouth / Southeastern Page | 75 Capital Health Community Clinical Services / Health System Planning Group (2014) 3. IWK Chest Clinic (Respiratory and Breathing Conditions)
IWK Chest Clinic data should be interpreted with caution due to low numbers in some communities. Communities with low numbers of the population aged 0-19 may consequently have higher rates of service utilization, yet the number of patients is still small. Data are suppressed any community with less than five children/youth accessing services. Excluded from the total number of visits are registrations for inpatients and residential care residents.
Figure 60: Child/youth patients per 1000 to the IWK Chest Clinic (IWK Meditech Registrations for time period fiscal 2012-2013)
Figure 60 depicts the rate of children/youth accessing the IWK Chest Clinic, by community. As a whole, CHN 1 has a higher rate of patients per 1000 child/youth population accessing the IWK Chest Clinic. Within the CHN, the higher number of patients per 1000 child/youth population accessing the IWK Chest Clinic reside in Dartmouth South. Dartmouth South also has the higher volumes (patient, visits) within the CHN. Data for Lawrencetown and Preston were suppressed to due low volumes. Refer to Table 49.
Table 49: Patients and Visits to the IWK Chest Clinic (Respirology – Asthma) for Fiscal 2012-2013 Average Visits per Community # of Patients # of Patients per 1000 youth Visits Patient Cole Harbour 16.9 2.7 28.3 1.7 Dartmouth East 22.4 4.2 42.7 1.9 Dartmouth North 13.4 4.0 32.4 2.4 Dartmouth South 24.7 5.4 50.5 2.0 Eastern Passage 9.0 2.9 19.0 2.1 Lawrencetown <5 ------Preston <5 ------CHN 1 Total 92.5 (33%) 3.7 188.5 2.0 District Total 281.7 3.1 560.5 2.0
Source: IWK Health Centre, Meditech Registrations for Time Period Fiscal 2012-2013
Community Health Network 1: Dartmouth / Southeastern Page | 76 Capital Health Community Clinical Services / Health System Planning Group (2014) IWK Primary Health: Halifax Regional School Board (HRSB) Nurse Visits
Within CHN 1, there were 14 children/youth who were registered for a HRSB nursing visit (home or phone visit) from IWK Primary Health. There were a total of 20 visits by this group. Data is not reportable at the community level (Source: IWK Health Centre, Meditech Registrations for Time Period Fiscal 2012-2013).
IWK Primary Health: Support for Parents (Groups/Classes)
Within CHN 1, there were 22 people who were registered for extra support for parents services from IWK Primary Health (includes community clinics/sessions/groups, home visits). There were a total of 76 visits by this group. Data is not reportable at the community level (Source: IWK Health Centre, Meditech Registrations for Time Period Fiscal 2012-2013).
Community Health Network 1: Dartmouth / Southeastern Page | 77 Capital Health Community Clinical Services / Health System Planning Group (2014)
Summary of Community Observations
Key observations made about each community in the Community Health Network regarding demographic information, health status, and health services utilization information are summarized below. The purpose of this section of the Community Profile is to summarize some of the factors that make each community unique based on the information presented in this profile to inform planning and health services delivery. This is not a comprehensive list of all of the attributes that make a community unique, nor is it reflective of all of the assets or community partners that that contribute to the health of a community; it is a compilation of facts based on the information presented in the profile.
Cole Harbour Total Deprivation: 1 Population: 25,161 Rurality: Urban Family Physicians: 5.1 FTE Material: 1 | Social: 2
What is distinctive about this community?
Urban community Largest community, by population, in CHN 1 One of the communities with the youngest average age One of the communities with the lowest total deprivation in the CHN One of the communities in the CHN with the lowest material deprivation Highest male life expectancy within the CHN (79.0 years) Within the CHN, the community with the highest volume of IWK ED visits for visits of low acuity is Cole Harbour
Community Health Network 1: Dartmouth / Southeastern Page | 78 Capital Health Community Clinical Services / Health System Planning Group (2014)
Dartmouth East Total Deprivation: 3 Population: 23,616 Rurality: Urban Family Physicians: 32.9 FTE Material: 1 | Social: 4
What is distinctive about this community?
Urban community One of the communities in the CHN with the lowest material deprivation Within the CHN, Dartmouth East has the higher birth rate among women aged 35-45 Within CHN 1, there is a higher percentage of the population in Dartmouth East receiving care from an FP for a diagnosis of CHF (11.8 people per 1000 population). One of the communities in the CHN with a higher rate per 1000 population receiving care from a specialist for hypertension (along with Preston) The community within the CHN, and one of the communities within the district, with the highest working number of family physicians per 1000 population The only community in the CHN with a Urgent Care Centre Within the CHN, the community with the highest volume of IWK ED visits for visits of high acuity is Dartmouth East Within the CHN, the community with the highest total number of clients and the highest total number of visits to IWK Mental Health services is Dartmouth East, with 218 youth accessing services. One of the communities in the CHN with highest number of people per 1000 population visiting the Community Health Team Within the CHN, Dartmouth East has both the higher number of visits and higher number of patients per 1000 accessing the Endocrinology Clinic (QE II location)
Community Health Network 1: Dartmouth / Southeastern Page | 79 Capital Health Community Clinical Services / Health System Planning Group (2014)
Dartmouth North (continued on next page) Total Deprivation: 5 Population: 19,238 Rurality: Urban Family Physicians: 7.7 FTE Material: 3 | Social: 5
What is distinctive about this community?
Urban community One of the communities within the CHN reporting higher use of public transit as the predominant method of transportation to work (23.4% of citizens) Two public housing communities (Lahey Road and Victoria Road) Within the CHN, Dartmouth North is the community with the higher percentage of citizens being non- Canadian residents, with 2.9% of residents reporting not being a Canadian Citizen. One of the communities within the CHN with a higher percentage of residents reporting languages other than English being spoken at home (4.6% of residents ) The community in the CHN with the highest total deprivation One of the communities in the CHN scoring in the highest category of social deprivation The community with the second highest percentage of lone parent families in the CHN (27.8% of families), which contributes to high social deprivation Within the CHN, the community with the highest percentage of low income families is Dartmouth North (19.4% of families; third highest in the district) Within the CHN, the community of Dartmouth North has the greatest number of households receiving employment support and income assistance provincially (1750 households) For the population aged 15-24 years, the community in the CHN with the highest percentage employed is Dartmouth North (62.3%) Dartmouth North has a highest rate of births among women aged 15-19 in the CHN and also within the district, at a rate of 34.9 births per 1000 women aged 15-19. Based on Halifax Regional Police data only, In CHN 1 the higher volume of crime occurs in the community of Dartmouth North (of note is the Burnside Area). Crimes occurring in a community are not necessarily committed by residents of that community; counts are reflective of where the crime occurred Within the CHN, the higher number of citizens being placed with a family practice reside in the community of Dartmouth North, with approximately 53 citizens being connected to a family doctor. One of the communities in CHN 1 with no nursing homes or residential care facilities Within the CHN, Dartmouth North has the higher rate of visits of high acuity to the ED (365 visits per 1000 population) and as well the higher rate of visits to the ED for visits of low acuity (184.5 visits per 1000 population). Dartmouth North has the highest rate of visits of high acuity to the IWK ED (89.56 visits per 1000 population) and as well the highest rate of visits to the ED for visits of low acuity (177.4 visits per 1000 population). Within the CHN, Dartmouth North as the greatest number of clients, the highest volume of visits, and the highest number of clients per 1000 population accessing Capital Health Addictions Community Based Services (adult). Addictions clients residing in Dartmouth North also have the highest average number of visits per client (22.0 visits per client). These rates are among the highest in the district. Dartmouth North has the highest rate of utilization of Capital Health Community Mental Health services (adult), with 53.2 residents per 1000 population accessing services Within the CHN, the community with the higher number of IWK Mental Health clients per 1000 child/youth population is Dartmouth North, at a rate of 41.5 clients per 1000 child/youth population
Community Health Network 1: Dartmouth / Southeastern Page | 80 Capital Health Community Clinical Services / Health System Planning Group (2014)
accessing services Dartmouth North has the highest rate of service utilization of IWK Reproductive Mental Health Services, with 4.67 clients per 1000 women aged 15-45 accessing services. Dartmouth North also has the higher number of visits per client, with each client having 4.45 visits to the service, on average Use of the Hypertension Clinic is consistently low across the CHN; however, within the CHN, Dartmouth North has the higher number of visits and the higher number of patients per 1000 population receiving care at the Hypertension Clinic (QE II location) Within the CHN, the highest rate of child/youth population accessing the IWK Dentistry clinic reside in the community of Dartmouth North, with 18.36 children/youth per 1000 population accessing the Dentistry Clinic (nearly twice the district rate)
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Dartmouth South Total Deprivation: 4 Population: 24,719 Rurality: Urban Family Physicians: 29.3 FTE Material: 2 | Social: 5
What is distinctive about this community?
Urban community One of the communities within the CHN reporting higher use of public transit as the predominant method of transportation to work (18.1% of citizens) The community in CHN 1 with the greater density of public housing units per 1000 population is Dartmouth South (525 units total) The community with the higher percentage of the population age 65 and above (18.2% of the population) and the community with the older average age within the CHN The community with the higher population density within the CHN (1522.1 people per km2) Of the communities within CHN 1, Dartmouth South has the higher number of citizens identifying as being an immigrant to Canada with 7.3% of residents reporting being an immmigrant to Canada One of the communities within the CHN with a higher percentage of residents reporting languages other than English being spoken at home (4.5% of residents ) One of the communities in the CHN scoring in the highest category of social deprivation Within the CHN, the higher number of births occurs within the community of Dartmouth South, which had 239 births in 2012-2013 Within the CHN, Dartmouth South is one of the communities with a higher rate of the population receiving care from a specialist for a diagnosis of COPD Within the CHN, the community with the highest volume (total number) of ED visits for visits of both high and low acuity is Dartmouth South Within the CHN, Dartmouth South has the greatest number of clients and the highest volume of visits to Capital Health Community Mental Health One of the communities in the CHN with highest number of people per 1000 population visiting the Community Health Team Within the CHN, the higher number of patients per 1000 child/youth population accessing the IWK Chest Clinic reside in Dartmouth South
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Eastern Passage Total Deprivation: 3 Population: 11,740 Rurality: Urban Family Physicians: 0.00 FTE Material: 2 | Social: 4
What is distinctive about this community?
Urban community The community with the higher rate of the youth population (<20 years of age), with 26.4% of the population being under 20 years of age and one of the communities with the youngest average age For the population aged 15-24 years, the community in the CHN with the lowest percentage of the population employed is Eastern Passage (51%) The community within the CHN with the higher birth rate is Eastern Passage with on average, 46.9 births occurring per 1000 women aged 15-49 annually. Within the CHN, Eastern Passage has the higher birth rate per 1000 women aged 20-34 Within the CHN, Eastern Passage is the community with the lower rate of the population receiving care from a family physician for a for diagnosis of diabetes, COPD, CHF, and hypertension. Eastern Passage is also the community with the lowest use of specialist care for diabetes, CHF, and hypertension (exception: COPD). Eastern Passage is the only community within CHN 1 without a family physician practicing within the immediate community
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Lawrencetown Total Deprivation: 1 Population: 5,639 Rurality: Suburban Family Physicians: 3.7 FTE Material: 1 | Social: 1
What is distinctive about this community?
Suburban community Lawrencetown is the community within CHN 1 experiencing the larger growth in population over a five year and ten year period Within the CHN, lowest use of public transit as the method of transportation to work (1.8%) and the highest percentage of vehicle use (94.6%) The community with the lower percentage of the population aged 65 and older (8.7% of the population) Lawrencetown has the lower rate of citizens identifying as a visible minority within the CHN (1.7%) One of the communities with the lowest total deprivation in the CHN The community within the CHN scoring in the lowest category of social deprivation. One of the communities in the CHN with the lowest material deprivation The community with the lower percentage of lone parent families within the CHN (8.8%) The community with the higher average family income and higher average individual income within the CHN Lawrencetown has the lowest number of low income families (2.7%) within the CHN Within the CHN, the community with the lowest number of people without a high school education (or highest percentage of high school completion) is Lawrencetown (12.3% without a high school education). The community with the highest percentage of the population aged 25 years and older employed (73.3% employed). Within the CHN, life expectancy at birth is higher for females in the community of Lawrencetown (83.42 years) Within CHN 1, there is a higher percentage of the population receiving care from a family physician for COPD residing in Lawrencetown (88.1 people per 1000 population receiving care for a diagnosis of COPD) One of the communities in CHN 1 with no nursing homes or residential care facilities Within the CHN, the community with the higher number of CHOICES clients per 1000 child/youth population is Lawrencetown, at a rate of 4.50 clients per 1000 child/youth population accessing services (**note: low client volume) Within the CHN, Lawrencetown has a higher rate per 1000 population receiving care from the respirology clinic Within the CHN, the higher number of patients per 1000 child/youth population accessing the IWK Diabetes Clinic reside in Lawrencetown (4.5 patients per 1000 child/youth population)
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Preston Family Physicians: 0.6 FTE + Total Deprivation: 4 Population: 2,269 Rurality: Rural 1.0 FTE Nurse Practitioner Material: 5 | Social: 2
What is distinctive about this community?
Rural community Smallest community, by population, in CHN 1 One of the communities within the CHN reporting higher use of public transit as the predominant method of transportation to work, despite limited routes (18.2% of citizens) Preston has the highest percentage of citizens identifying as a visible minority within the CHN and within the district (69.2% of residents of the community). Of those identifying as a visible minority in Preston, 68.6% identify as Black, which is the highest rate of within the CHN and also within the district. Within the CHN, the community with the higher number of individuals identifying with an Aboriginal group is Preston (3.7% of citizens). Preston has the highest percentage of lone parent families within the CHN and also within the district with 37.0% of families identifying as being lone parent The community in the CHN with the highest material deprivation Within the CHN, the community with the lower average family income and the lower average individual income is Preston. The community with the higher number of citizens without a high school education within the CHN is Preston (39.5% of citizens) The community with the lowest percentage of the population 25 years of age or older employed in the CHN is Preston (51.6% employed). Preston is the community with the lowest life expectancy at birth for both males (70.1 years) and females (80.1 years) within the CHN and Preston has the largest disparity between male and female life expectancy in the district. The male life expectancy at birth for males residing in Preston is also the lowest in the district. Preston has the higher rate of the population receiving care from a family physician for diabetes within the CHN (109 people per 1000 population) and within the CHN, there is a higher rate of patients per 1000 population receiving care from a specialist for a diagnosis of diabetes residing in the community of Preston. One of the communities with a higher rate receiving care from a Family Physician for a diagnosis of CHF and the highest number of visits per patient within the CHN (and also for the district) for CHF occurs by residents of Preston, with an average of seven visits per patient to an FP for a diagnosis of CHF. Preston also has a higher rate per population accessing specialist services for CHF Within CHN 1, the higher rate of the population accessing care from a family physician for a diagnosis of hypertension occurs in Preston, with 243.1 citizens per 1000 population accessing care for hypertension. And, Preston is one of the communities with the higher rate per 1000 population receiving care from a specialist for hypertension (along with Dartmouth East) The only community within the CHN with a nurse practitioner practicing in the community All communities in the CHN have a pharmacy located within their community, with the exception of Preston One of the communities in CHN 1 with no nursing homes or residential care facilities Preston is the community within the CHN that has the higher rate per 1000 population accessing the Cardiac Health Function Clinic, QEII Location (12.13 patients per 1000 population)
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Please do not distribute or duplicate this document without the permission of Primary Health Care, Capital Health.
Contact Primary Health Care at: [email protected]
Community Health Network 1: Dartmouth / Southeastern Page | 86 Capital Health Community Clinical Services / Health System Planning Group (2014)
APPENDIX
Appendix A: List of Contributors
Community Clinical Services/Health System Planning Steering Group Authorship, Data, Content, Mapping, Interpretation, and Review
Co-leads: Lynn Edwards, Director of Primary Health Care and District Department of Family Practice; and Dr. Rick Gibson, Chief, District Department of Family Practice, Capital Health
Project Lead: Erin Christian, Project Lead, Primary Health Care, Capital Health
Members: Christine Tompkins, Project Lead – Quality, Primary Health Care, Capital Health Dr. Holly D’Angelo-Scott, Senior Epidemiologist, Public Health, Capital Health Jill Robbins, Director, Integrated Continuing Care, Capital Health Randi Monroe, Director, Rehabilitation Services & Supportive Care and Geriatrics, Capital Health Trevor Briggs, Director, Capital Health Mental Health and Addictions Program Linda Young, Director of Public Health, Capital Health Margaret Merlin, Director of the Tri-Facilities and Cobequid Community Health Centre, Capital Health Sherri Parker, Director, Hants Community Hospital, Capital Health Geoff Wilson, Director, Patient and Public Engagement, Capital Health Nancy Hoddinott, Executive Director of Primary Health, IWK Health Centre Shauna McMahon, Director of Technology and Infrastructure Renewal, Capital Health
Community Profile Contributors Data, Content, Mapping, Interpretation and Review (in addition to Steering Group)
Max Lapierre, GIS Consultant, Primary Health Care, Capital Health Graeme Kohler, Health Services Manager, Primary Health Care, Capital Health Shannon Ryan Carson, Health Services Manager, Primary Health Care, Capital Health Julian Morrison, Practice Facilitator, Primary Health Care, Capital Health Angela Ghiz, IT Project Manager, Primary Health Care, Capital Health Sharon McNeil, Data Analyst, IWK Health Centre Suzanne Gray-Marmaroff, Manager, Integrated Continuing Care, Capital Health Suzanne Stevens, Manager, Integrated Continuing Care, Capital Health Lexie Steeves-Dorey, Manager, Integrated Continuing Care, Capital Health Christel Mueller, Project Manager, Integrated Continuing Care, Capital Health Cheri Gunn, Program Manager, Rehabilitation Services and Supportive Care, Capital Health Kim Parker, Data Analyst, Rehabilitation Services and Supportive Care, Capital Health Cindy Clark, Health Services Manager, Rehabilitation Services, Cobequid Community Health Centre Denise Titus, Program Manager, Rehabilitation and Supportive Care, Dartmouth General Hospital Susan Hare, Program Leader, Capital Health Mental Health and Addictions Program Rachel Boehm, Program Leader, Capital Health Mental Health and Addictions Program Patryk Simon, Data Analyst, Capital Health Mental Health and Addictions Program
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Robert Kiteley, Facilities Engineer, Infrastructure and Renewal, Capital Health Marilyn Cipack, Health Services Manager, Tri-Facilities, Capital Health Dianna Graham, Health Services Manager, Tri-Facilities, Capital Health Sarah Blades, Community Health Board Coordinator, Capital Health Chris Caudle, Capital Health Decision Support, Finance & eInformation Management, Capital Health Nancy MacDonald, Analyst, Decision Support, Finance & eInformation Management, Capital Health Niall Sheehy, Capital Health Decision Support, Capital Health Tom Henneberry, Data Analyst, Department of Medicine Amanda Murphy, Health Information Analyst, Decision Support, Capital Health Brenda Murray, Director, Policy, Planning & Research, Policy & Information Management, Department of Community Services Adam Holmes, GIS Analyst, Policy & Information Management, Department of Community Services Meghan MacDougall, GIS Analyst, Policy & Information Management, Department of Community Services Dr. Mikiko Terashima, Co-Director of the SILK Lab, Dalhousie University RCMP Data Division – Halifax Regional Municipality and West Hants/Windsor Division Halifax Regional Police Nirupa Varatharasan, Canadian Primary Care Sentinel Surveillance Network - Maritime Family Practice Research Network, Department of Family Medicine, Dalhousie University Emily Marshall, MAAP-NS Study, Assistant Professor, Primary Care Research Unit, Dalhousie Family Medicine and Community Health and Epidemiology Michelle Nugent, Statistics & Database Officer, Dalhousie Department of Medicine Sandy Newcombe, Coordinator of Project Management, Housing Nova Scotia Jim Graham, Program Coordinator, Affordable Housing Association of Nova Scotia Kevin Watkins, Research & Statistical Officer, Monitoring & Evaluation, Continuing Care Branch NS Department of Health and Wellness Vivian Barriault, Continuing Care Branch NS Department of Health and Wellness Nova Scotia Department of Health and Wellness, BIAP Division
All GIS Mapping for this project was completed by:
Christine Tompkins, Project Lead, Primary Health Care, Capital Health Holly D’Angelo-Scott, Senior Epidemiologist, Public Health Services, Capital Health Max Lapierre, GIS Consultant, Primary Health Care, Capital Health
An acknowledgement to Holly D’Angelo-Scott for sharing her knowledge and demographic data from her work with the Population Health Status Report to inform this project and for providing her epidemiological skills and expertise to work with Christine and Erin to review and interpret data.
Community Health Network 1: Dartmouth / Southeastern Page | 88 Capital Health Community Clinical Services / Health System Planning Group (2014) Appendix B: Table of Contents
COMMUNITY HEALTH PROFILE Overview:...... 1 Table of Contents: ...... 1 GEOGRAPHY ...... 1 Community Composition ...... 2 Rurality ...... 3 Population Projections ...... 4 COMMUNITY HEALTH BOARD (CHB) ENGAGEMENT ...... 6 Dartmouth Community Health Board findings from 2013 Community Health Plan ...... 6 Southeastern Community Health Board findings from the 2013 Community Health Plan ...... 6 COMMUNITY HEALTH NETWORK INVENTORY ...... 7 Food Sources ...... 7 Transportation ...... 9 Recreation Locations ...... 10 Public Housing Communities ...... 11 COMMUNITY HEALTH NETWORK POPULATION DEMOGRAPHICS ...... 12 Population Age Groups ...... 12 Population Density ...... 15 Visible Minorities ...... 16 Citizenship, Language, and Immigration ...... 18 Total Deprivation ...... 19 Social Deprivation ...... 21 Lone Parent Families ...... 22 Material Deprivation ...... 23 Income Related Factors ...... 24 Employment & Education ...... 26 Birth Data ...... 27 Crime Rates – Halifax Regional Police ...... 29 Crime Rates – RCMP ...... 31 Nova Scotia School Test Results ...... 32 COMMUNITY HEALTH NETWORK HEALTH STATUS ...... 33 Community Engagement – 2013 Community Health Plan ...... 33 2009-2010 Canadian Community Health Survey Data for Self-Reported Health Status...... 33 Sexually Transmitted Infections (STIs) ...... 36 Disability ...... 37
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Life Expectancy at Birth ...... 38 Causes of Death ...... 39 Family Physician Visits by Chronic Disease Diagnosis ...... 40 1. Diabetes ...... 40 2. COPD ...... 41 3. Congestive Heart Failure ...... 42 4. Hypertension ...... 43 Specialist Visits for Chronic Disease (Summary) ...... 45 1. Specialist Care for Diabetes ...... 46 2. Specialist Care for Hypertension ...... 46 3. Specialist Care for COPD ...... 47 4. Specialist Care for Congestive Heart Failure ...... 47 COMMUNITY HEALTH NETWORK SERVICE DELIVERY LOCATIONS ...... 48 Capital Health Community-Based Service Locations ...... 48 Family Practice in CHN 1 ...... 49 Community Pharmacies...... 52 Nursing Home Locations...... 53 COMMUNITY HEALTH SERVICES UTILIZATION ...... 54 Emergency Department Visits (Adult – Capital Health) ...... 54 Emergency Department Visits (Child/Youth – IWK) ...... 56 Hospital Admissions ...... 58 Ambulatory Care Sensitive Conditions ...... 58 Community Mental Health and Addictions Services ...... 59 1. Addictions Community Based Services (Adult – Capital Health) ...... 59 2. CHOICES Addictions Services (Child/Youth – IWK Health Centre) ...... 60 3. Community Mental Health (Adult – Capital Health) ...... 62 4. Mental Health Services (Child/Youth – IWK Health Centre) ...... 63 5. Reproductive Mental Health (Women – IWK Health Centre) ...... 64 Youth Health Centres ...... 66 Community Health Teams ...... 67 Integrated Continuing Care ...... 68 1. Integrated Continuing Care Client Summary ...... 68 2. Community Occupational Therapy and Physiotherapy Services ...... 68 3. Home Care and/or Nursing Support Services ...... 69 4. Care Plans, By Type ...... 69 Ambulatory Care Clinics (Adult – Capital Health) ...... 71
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1. Cardiology ...... 72 2. Hypertension ...... 72 3. Endocrinology ...... 73 4. Respirology ...... 73 Ambulatory Care Clinics (Child/Youth – IWK Health Centre) ...... 74 1. IWK Dentistry Clinic ...... 74 2. IWK Diabetes Clinic ...... 75 3. IWK Chest Clinic (Respiratory and Breathing Conditions) ...... 76 IWK Primary Health: Halifax Regional School Board (HRSB) Nurse Visits ...... 77 IWK Primary Health: Support for Parents (Groups/Classes) ...... 77 Summary of Community Observations ...... 78 Cole Harbour ...... 78 Dartmouth East ...... 79 Dartmouth North (continued on next page) ...... 80 Dartmouth South ...... 82 Eastern Passage ...... 83 Lawrencetown ...... 84 Preston ...... 85 APPENDIX ...... 87 Appendix A: List of Contributors ...... 87 Appendix B: Table of Contents ...... 89 Appendix D: List of Tables ...... 95 Appendix E: Community Profiles Data Disclaimer ...... 97 Appendix F: Detailed 2019 (5 Year) and 2024 (10 Year) Population Projections for Capital Health...... 98
Community Health Network 1: Dartmouth / Southeastern Page | 91 Capital Health Community Clinical Services / Health System Planning Group (2014) Appendix C: List of Figures
Geography ...... 1 Figure 1: Community Health Network and Capital District Health Authority Geography ...... 1 Figure 2: Community Health Network Geography ...... 2 Figure 3: Rurality ...... 3 Figure 4: Population Projections ...... 4 Community Health Network Inventory ...... 7 Figure 5: Food Source Locations...... 7 Figure 6: Method of Transportation to Work ...... 9 Figure 7: Recreation Locations by Type ...... 10 Figure 8: Park Locations ...... 10 Figure 9: Public Housing Communities ...... 11 Community Health Network Population Demographics ...... 12 Figure 10: Population Pyramid for CHN ...... 12 Figure 11: Population by Age Group ...... 13 Figure 12: Average Age by Community ...... 14 Figure 13: Population Density by Community ...... 15 Figure 14: Percentage of the Population Identified as a Visible Minority ...... 16 Figure 15: Percentage of the Population Identified as being an Immigrant to Canada ...... 18 Figure 16: Total deprivation ...... 19 Figure 17: Social deprivation ...... 21
Figure 18: Percentage of lone parent families ...... 22
Figure 19: Material deprivation ...... 23 Figure 20: Average Family Income ...... 24
Figure 21: Percentage of low income families ...... 25
Figure 22: Number of households receiving provincial income assistance/employment support ...... 25 Figure 23: Birth rate per 1000 women aged 15-49 ...... 27 Figure 24: Crime occurrences by type ...... 29 Figure 25: RCMP Policing Districts aligned with the CHN ...... 31 Community Health Network Health Status ...... 33 Figure 26: Self-reported risk factors reported by Community Health Network ...... 33 Figure 27: Self-reported chronic conditions reported by Community Health Network ...... 34
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Figure 28: Rate of individuals receiving care from a family physician for diabetes ...... 40 Figure 29: Rate of individuals receiving care from a family physician for COPD ...... 41 Figure 30: Rate of individuals receiving care from a family physician for congestive heart failure ...... 42
Figure 31: Rate of individuals receiving care from a family physician for hypertension ...... 43 Figure 32: Rate of the population receiving specialist care for diabetes ...... 46 Figure 33: Rate of the population receiving specialist care for hypertension ...... 46 Figure 34: Rate of the population receiving specialist care for COPD ...... 47 Figure 35: Rate of the population receiving specialist care for congestive heart failure ...... 47 Community Health Network Service Delivery Locations ...... 48 Figure 36: Capital Health Community Based Programs and Services locations ...... 48 Figure 37: Family Practice locations in CHN ...... 49 Figure 38: Family physician FTE per 1000 population ...... 49
Figure 39: Individuals placed with a family physician (or NP) via PHC Connections ...... 50 Figure 40: Community-based pharmacy locations ...... 52 Figure 41: Nursing Home and Residential Care Facility locations in CHN ...... 53 Community Service Utilization Data ...... 54 Figure 42: Emergency department utilization for a visit of high acuity (adult) ...... 55 Figure 43: Emergency department utilization for a visit of low acuity (adult) ...... 55
Figure 44: Emergency department utilization for a visit of high acuity (child/youth) ...... 57 Figure 45: Emergency department utilization for a visit of low acuity (child/youth) ...... 57 Figure 46: Rate of clients accessing CDHA Addictions Community Based Services (adult) ...... 59 Figure 47: Rate of clients accessing IWK CHOICES Addictions Services (youth) ...... 60 Figure 48: Rate of clients accessing CDHA Community Mental Health Services (adult) ...... 62
Figure 49: Rate of clients accessing IWK Mental Health Services (child/youth) ...... 63 Figure 50: Rate of women aged 15-49 accessing IWK Reproductive Mental Services ...... 65 Figure 51: Youth Health Centre locations and reasons for visit ...... 66 Figure 52: Community Health Team utilization by community ...... 67 Figure 53: Community OT/PT utilization via referral to Integrated Continuing Care (polling district) ...... 68 Figure 54: Rate of patients accessing the QEII Cardiology Heart Function Clinic ...... 72 Figure 55: Rate of patients accessing the QEII Hypertension Clinic ...... 72 Figure 56: Rate of patients accessing the QEII Endocrinology Clinic ...... 73 Figure 57: Rate of patients accessing QEII, Cobequid, Hants and DGH Respirology Clinics ...... 73 Figure 58: Rate of children/youth per 1000 accessing the IWK Dentistry Clinic ...... 74
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Figure 59: Rate of children/youth accessing the IWK Diabetes Clinic ...... 75 Figure 60: Rate of children/youth accessing the IWK Chest Clinic ...... 76
Community Health Network 1: Dartmouth / Southeastern Page | 94 Capital Health Community Clinical Services / Health System Planning Group (2014) Appendix D: List of Tables
Geography ...... 1 Table 1: CHN Communities and Populations…………………………………………………………………………………………………..2 Table 2: Population Projections ……………………………………………………………………………………………………………………..5 Community Health Network Inventory ...... 7 Table 3: Density of Grocery Store Locations per 100,000 by Community ...... 8 Table 4: Density of Fast Food Locations per 100,000 by Community ...... 8 Table 5: Nova Scotia Liquor Commission Data, by Community Health Board ...... 8 Community Health Network Population Demographics ...... 12 Table 6: Population Breakdown by age category ...... 13 Table 7a: Percentage of Individuals identifying as a Visible Minority ...... 17 Table 7b: Percentage of Individuals within CHN identifying as Aboriginal ...... 17 Table 8: Deprivation Score Summary, by community ...... 20 Table 9: Social Deprivation and Percentage of Lone Parent Families ...... 22 Table 10: Summary of Income-related factors and material deprivation ...... 24 Table 11: Summary of education, employment, and material deprivation ...... 26 Table 12: Birth data ...... 28 Table 13: Total number of crimes occurring, by type, as reported by Halifax Regional Police ...... 30 Table 14: Total number of crimes occurring, by type, in RCMP Policing Districts ...... 31 Table 15: CHN School Test Scores 2013-2014 ...... 32 Community Health Network Health Status ...... 33 Table 16: Health Concerns – CHB Community Consultations ...... 33 Table 17: Summary of Selected Self-reported Chronic Diseases and Risk Factors ...... 34 Table 18: Health Status indicator by CHN and compared to CDHA and Nova Scotia and Canada ...... 35 Table 19: Incidence Rates of sexually transmitted infections in Capital Health ...... 36 Table 20: Disability Prevalence for Nova Scotia, by age category for the population aged 15+ ...... 37 Table 21: Life expectancy at birth, by community and by sex ...... 38 Table 22: Causes of Death for NS and CDHA ...... 39 Table 23: CHN overview of citizens receiving care for diabetes from a family physician ...... 41 Table 24: CHN overview of citizens receiving care for COPD from a family physician ...... 42 Table 25: CHN overview of citizens receiving care for CHF from a family physician ...... 43
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Table 26: CHN overview of citizens receiving care for hypertension from a family physician ...... 44 Table 27: Rate of specialist utilization for four chronic conditions ...... 45 Community Health Network Service Delivery Locations ...... 48 Table 28: Individuals placed with a family physician (or NP) via PHC Connections ...... 51 Table 30: Nursing Home and RCF locations and number of beds, by community ...... 53 Community Service Utilization Data ...... 54 Table 31: Emergency Department Utilization for Adults using CDHA Emergency Departments ...... 54 Table 32: Emergency Department Utilization for children/youth at the IWK Health Centre ...... 56 Table 33: Hospital admissions by diagnosis ...... 58 Table 34: Hospital re-admissions by diagnosis ...... 58 Table 35: Ambulatory care sensitive condition rates ...... 58 Table 36: Addictions Community Based Services Utilization (Adults – Capital Health) ...... 60 Table 37: CHOICES Addictions Services Utilization (Youth – IWK) ...... 61 Table 38: Community Mental Health Services Utilization (Adults – Capital Health) ...... 63 Table 39: Mental Health Services Utilization (Child/youth – IWK Health Centre) ...... 64 Table 40: Reproductive Mental Health Services Utilization (Women – IWK Health Centre) ...... 65 Table 41: Integrated Continuing Care client overview by CHN ...... 68 Table 42: Integrated Continuing Care referrals to community OT/PT by polling district ...... 69 Table 43: Home care and/or nursing support client summary ...... 69 Table 44: Care plans created by type and age category for CDHA Continuing Care clients ...... 70 Table 45: Rate of ambulatory care clinic usage by community ...... 71 Table 46: Total number of visits per ambulatory clinic, by community ...... 71 Table 47: IWK Ambulatory Dentistry Clinic Utilization by Children/Youth ...... 74 Table 48: IWK Ambulatory Diabetes Clinic Utilization by Children/Youth ...... 75 Table 49: IWK Ambulatory Chest Clinic Utilization by Children/Youth ...... 76 Summary of Observations by Community ...... 77
Community Health Network 1: Dartmouth / Southeastern Page | 96 Capital Health Community Clinical Services / Health System Planning Group (2014) Appendix E: Community Profiles Data Disclaimer
The Community Profiles for each of the five Community Health Networks (herein referred to as the “reports”) are intended to be a composite of technical planning documents, with the primary audience being decision makers and planners at Capital District Health Authority (“Capital Health”).
Capital Health does not assume any liability for any errors, omissions, or inaccuracies in the information provided regardless of the cause and shall not be liable for any loss arising out of the use of or reliance on this information, including without limitation any direct or consequential damages. Capital Health expressly disclaims all warranties of any type, expressed or implied, including but not limited to, any warranty as to the accuracy of the data, merchantability, or fitness for a particular purpose.
Best efforts were made to ensure accuracy and correctness in data collection, interpretation, presentation, and GIS Mapping outputs and methodologies. All data are believed to be accurate by authors and reviewers; however, accuracy is not guaranteed. Data layers were compiled from various sources and are not to be construed or used as a "legal description".
Acknowledgement of all data sources and contributors was completed to the best of the authors’ ability. Time reporting periods varied (e.g., calendar year(s), fiscal year(s), etc) and therefore, there may be inconsistencies and readers should consider this when cross comparing data. Formal statistical analysis was not completed for the purpose of this project; therefore, direct associations between data elements presented cannot be assumed. Interpretation was based on observation only and interpretations have not been subject to an extensive reviewing process beyond review by Steering Group members.
Any errors, omissions, questions, or comments regarding any of the data or methodologies used to prepare these reports can be directed to Primary Health Care, Capital Health by email. Feedback is welcomed.
Please do not distribute these reports outside of Capital Health without permission of Primary Health Care, Capital Health. Please acknowledge the Capital Health Community Clinical Services/Health System Planning Steering Group (2014) as the source of these reports when data and information are used in presentations, reports, papers, publications, maps, or other products.
Use of these reports assumes that you understand and agree with the information provided in this disclaimer.
Community Health Network 1: Dartmouth / Southeastern Page | 97 Capital Health Community Clinical Services / Health System Planning Group (2014) Appendix F: Detailed 2019 (5 Year) and 2024 (10 Year) Population Projections for Capital Health
Source: Environics Analytics Group Ltd (2014). Appendix F is an internal document to Capital Health and the Community Clinical Services/Health System Planning Steering Group Members. Projections modeled from 2011 Canadian Census Data. Note: Percent change and net growth is relative to the 2014 population.
CHN 1: DARTMOUTH/SOUTHEASTERN
% %
Youth
65+
2014 2014 2014 2019 2024 2024
Youth
years)
2019 % % 2019
Seniors Seniors
Change Change Change Change Change Change Change Change Change Change
2024 2024 %
65+ Net 65+ Net 65+
Youth %
65+ % 65+
2019 Net 2019 Net 2024
Projected Projected
% Change % Change %
2019 (65+ 2019
YouthNet YouthNet
Population Population Population
2019 Youth 2019 Youth 2024 Community 2014 Cole Harbour 25,161 6,347 2,532 24,074 -1,087 -4 4,792 -1,555 -24 4,033 1,501 59 24,509 -652 -3 4,715 -1,632 -26 5,065 2,533 100 Dartmouth East 23,616 5,392 3,428 22,872 -744 -3 4,119 -1,273 -24 3,981 553 16 22,956 -660 -3 4,078 -1,314 -24 4,795 1,367 40 Dartmouth North 19,238 3,366 2,589 18,972 -266 -1 3,129 -237 -7 2,911 322 12 18,897 -341 -2 3,248 -118 -3 3,342 753 29 Dartmouth South 24,719 4,577 4,498 29,109 4,390 18 5,216 639 14 5,405 907 20 29,781 5,062 20 5,467 890 19 6,230 1,732 39 Eastern Passage 11,740 3,099 1,096 11,346 -394 -3 2,515 -584 -19 1,575 479 44 11,988 248 2 2,628 -471 -15 2,029 933 85 Lawrencetown 5,639 1,342 490 7,416 1,777 32 1,415 73 5 1,196 706 144 7,773 2,134 38 1,408 66 5 1,603 1,113 227 Preston 2,269 588 312 2,254 -15 -1 416 -172 -29 462 150 48 2,328 59 3 400 -188 -32 595 283 91 CHN 1 112,382 24,711 14,945 116,044 3,662 3 21,603 -3,108 -13 19,563 4,618 31 118,232 5,850 5 21,946 -2,765 -11 23,659 8,714 58 CDHA 423,163 91,150 55,869 463,931 40,768 10 85,193 -5,957 -7 83,741 27,872 50 476,940 53,777 13 87,298 -3,852 -4 99,272 43,403 78
Community Health Network 1: Dartmouth / Southeastern Page | 98