Community Profiles Have Been Developed to Inform Clinical Services/ Population: 21,209 Health System Planning for Community-Based Programs at Capital Health
Community Capital Health Community Clinical Profile Services / Health System Planning Group (2014)
Created by the Capital Health Community Clinical Services/
Health System Planning Group
November 2014
Contact: Primary Health Care, Capital Health Eastern Shore [email protected] Musquodoboit
Community Health Network 4 Overview:
Community Profiles have been developed to inform Clinical Services/ Population: 21,209 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 4 and Capital
District Health Authority Geography. There are five proposed Community Health Networks (formerly referred to as Zones) across the district.
Community Health Network 4: Eastern Shore Musquodoboit Page | 1 Capital Health Community Clinical Services / Health System Planning Group (2014) Community Composition
Figure 2: Community Health Network 4 Geography
Community Health Network 4 (CHN 4) includes the communities of:
Table 1: CHN 4 Communities and Populations Community Population Community Population Chezzetcook 3,916 Musquodoboit Harbour 2,251 Jeddore 1,445 Porters Lake 3,202 Lake Echo 3,044 Sheet Harbour 1,562 Middle Musquodoboit 2,055 Ship Harbour 1,869 Moser River 794 Upper Musquodoboit 1,071 CHN 4 Total: 21,209 Source: 2011 Canadian Census data (Government of Nova Scotia, 2013. Nova Scotia Community Counts).
The population of CHN 4 is 21,209 citizens, which accounts for 5.0% of the population of the Capital District Health Authority (CDHA). The Millbrook First Nation Community – Sheet Harbour 36 is also located within this geography; however, no population or demographic data is available.
CHN 4 encompasses the Eastern Shore Musquodoboit Community Health Board (population: 24,598). Data for the CHB is used as a geographic comparator (e.g., a proxy measure of the CHN average) where aggregate data is not available (the CHB has 116% of the CHN population). 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 4: Eastern Shore Musquodoboit Page | 2 Capital Health Community Clinical Services / Health System Planning Group (2014) Rurality
Figure 3: CHN 4 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 Communities Rural Lake Echo (rural, but higher population density),
100 % of Porter’s Lake, Chezzetcook, Jeddore, Sheet Population Harbour, Ship Harbour, Moser River, Middle
Musquodoboit, Upper Musquodoboit, Suburban Musquodoboit Harbour 0% of
Population Suburban Communities
n/a
Urban Urban Communities 0% of n/a 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 4: Eastern Shore Musquodoboit 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 for the in projected populations for the Capital Health district 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). However, population projections specifically for CHN 4 reflect population decline for this particular area. CHN 4 will experience a 5% decrease in population by 2019 and 4% decrease in population by 2024. The youth population is expected to decrease by approximately one-quarter and the senior population is expected to increase by 63% by the year 2024.
Within the CHN, the community that is projected to have the highest percentage of population growth over the next five and ten years is Middle Musquodoboit; the community’s population will increase by 67% by 2019 and will result in a 64% increase over a ten year period by 2024. In addition to experiencing the largest population growth by percentage, Middle Musquodoboit will also see the higher percentage of growth in both the senior and youth populations, each increasing by 29% and 184%, respectively, by 2024.
Community Health Network 4: Eastern Shore Musquodoboit Page | 4 Capital Health Community Clinical Services / Health System Planning Group (2014) The community within the CHN that will experience the greatest decrease in population is Moser River; the community’s population is expected to drop by 58% by the year 2024. In addition to experiencing the largest population decline by percentage, Moser River will also see the higher percentage of decline in both the senior and youth populations, each decreasing by 72% and 38%, respectively, by 2024. Upper Musquodoboit will also experience a high percentage of population decline in future years.
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 4 21,209 20,185 -5 -24 41 20,477 -4 -26 63 Community Chezzetcook 3,916 2,908 -26 -47 28 3,061 -22 -46 53 Jeddore 1,445 1,047 -28 -50 15 995 -31 -56 24 Lake Echo 3,044 2,714 -11 -23 56 2,824 -7 -22 106 Middle 2,055 3,430 67 37 151 3,379 64 29 184 Musquodoboit Moser River 794 350 -56 -67 -43 334 -58 -72 -38 Musquodoboit 2,251 1,991 -12 -36 43 2,043 -9 -38 68 Harbour Porters Lake 3,202 4,004 25 1 88 4,234 32 2 145 Sheet Harbour 1,562 1,228 -21 -43 4 1,178 -25 -50 11 Ship Harbour 1,869 1,895 1 -21 38 1,811 -3 -29 48 Upper 1,071 618 -42 -52 -21 586 -45 -57 -17 Musquodoboit Net Change for CHN 4 ↓-1024 citizens ↓-762 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 4: Eastern Shore Musquodoboit Page | 5 Capital Health Community Clinical Services / Health System Planning Group (2014)
COMMUNITY HEALTH BOARD (CHB) ENGAGEMENT
Eastern Shore Musquodoboit Community Health Board findings from 2013 Community Health Plan:
• The Eastern Shore Musquodoboit CHB includes the communities of: Chezzetcook, Jeddore, Lake Echo, Middle Musquodoboit, Moser River, Musquodoboit Harbour, Porter’s Lake, Sheet Harbour, Sheet Harbour IR 36, Ship Harbour, and Upper Musquodoboit. • The Eastern Shore Musquodoboit CHB will continue to address issues affecting our rural communities such as: Access to services and information Food security Mental health Healthy eating Physical activity • The Eastern Shore Musquodoboit CHB will work to address transportation, advocate for local programs and services, and promote existing services through our Community Connections newsletter and bulletin
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 4: Eastern Shore Musquodoboit 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 4 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. While there appears to be a small number of locations observationally, Table 3 indicates that there are some communities within the CHN with a medium and high density of grocery stores per 100,000 population. 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 4: Eastern Shore Musquodoboit 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 4 Density of grocery stores per 100,000 Communities within the CHN Low Density 0.0 – 45.5 Lake Echo, Sheet Harbour 45.6 – 91.1 Jeddore, Middle Musquodoboit, Upper Musquodoboit, Ship Harbour Medium 91.2 – 136.7 n/a Density 136.8 – 182.2 Chezzetcook, Musquodoboit Harbour High Density 182.3 – 227.8 Moser River 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 4 Density of fast food locations per 100,000 Communities within the CHN Low Density 0.0 – 84.7 Chezzetcook, Jeddore, Lake Echo, Middle Musquodoboit, Moser River, Sheet Harbour, Ship Harbour, Upper Musquodoboit 84.8 – 169.5 n/a Medium 169.6 – 254.3 n/a Density 254.4 – 339.0 Musquodoboit Harbour 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 Eastern Shore Musquodoboit CHB had four liquor stores within its boundaries, which resulted in the highest density of stores per 100,000 population across all CHBs, with 18.6 stores per 100,000 population. The average annual per capita sales in this CHB was $491. Currently in 2014, there are four NSLC locations in the Eastern Shore Musquodoboit CHB in the communities of Middle Musquodoboit (1), Jeddore (1), Porters Lake (1), and Sheet Harbour (1).
Table 5: Nova Scotia Liquor Commission Data, by Community Health Board, for period 2006-2011 CHB # of Stores # 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 Musquodoboit 4 18.6 $491 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 4: Eastern Shore Musquodoboit Page | 8 Capital Health Community Clinical Services / Health System Planning Group (2014)
Transportation
Figure 6: CHN 4 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 4.
There is no access to regular public transportation in CHN 4, with the exception being a commuter (MetroX) that goes to Porters Lake twice a day. As a result, the majority of residents report ‘vehicle’ as their predominant method of transportation to and from work (94.6%, highest in the district). Of note is Moser River, where 11.5% of residents report walking to work.
Community Health Network 4: Eastern Shore Musquodoboit Page | 9 Capital Health Community Clinical Services / Health System Planning Group (2014) Recreation Locations
Figure 7: CHN 4 Recreation Locations by Type (Halifax Regional Municipality, HRM Park Recreation Features, 2014).
Figure 8: CHN 4 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 4, based on type of facility and location. Figure 8 depicts the locations of recognized parks and trails, by type, in CHN 4.
Community Health Network 4: Eastern Shore Musquodoboit Page | 10 Capital Health Community Clinical Services / Health System Planning Group (2014) Public Housing
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 4. Data were suppressed for any community with less than five public housing units for confidentiality purposes. The community in CHN 4 with the greater density of public housing units per 1000 population is Upper Musquodoboit. The actual number of public/affordable housing units in each community is indicated by the number on the map; Chezzetcook has the greater number of units in the CHN (24). “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.
Community Health Network 4: Eastern Shore Musquodoboit Page | 11 Capital Health Community Clinical Services / Health System Planning Group (2014) Spryfield: Greystone COMMUNITY HEALTH NETWORK POPULATION DEMOGRAPHICS
Population Age Groups
CHN 4 and CDHA Population Pyramid, 2011 85+ yrs 80-84 yrs 75-79 yrs 70-74 yrs 65-69 yrs Female
60-64 yrs Zone 4 55-59 yrs Female 50-54 yrs CDHA 45-49 yrs Male 40-44 yrs Zone 4 35-39 yrs Male 30-34 yrs Age Group (Years) (Years) Group Age 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 DHA Population
Figure 10: Population Pyramid for CHN 4 reflecting size, age, and sex distribution as compared to CDHA (Note: prepared using 5-year age group breakdowns for Eastern Shore Musquodoboit CHB; population 24,598), Canadian Census, 2011.
Figure 10 represents the age, sex, and gender distribution by 5-year age groups of the population of CHN 4 and of CDHA. In comparison to CDHA, CHN 4 has a lower percentage of the population in the 20 to 35 year old age groups and a higher percentage of the population in the 50 to 64 years and age 65 years and above age categories.
Community Health Network 4: Eastern Shore Musquodoboit Page | 12 Capital Health Community Clinical Services / Health System Planning Group (2014)
Figure 11: CHN 4 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.
Figure 12 depicts average age by community within CHN 4. Generally speaking, CHN 4 has an older average age. The communities with the youngest average age include Lake Echo, Porters Lake and Middle Musquodoboit. The communities with the oldest average include Ship Harbour, Sheet Harbour, and Moser River.
In CHN 4, Porters Lake (25.8%), followed by Lake Echo (25.3%) have the highest rate of the youth population (<20 years of age). Sheet Harbour is the community with the lowest rate of the population under Figure 12: CHN 4 Average Age by Community (Canadian Census, 2011) Community Health Network 4: Eastern Shore Musquodoboit Page | 13 Capital Health Community Clinical Services / Health System Planning Group (2014) 20 years of age (17.5%). CHN 4, together with CHN 5, has the lowest rate of the population in the 20 to 29 years demographic across the district, with only 9.1% of the population falling into this age bracket.
CHN 4 has the highest percentage of the population in the 50 to 64 years age group across the district (25.1% of the population) and there are more people in the 50 to 64 years age group than all other age groups in every community in the CHN. The community within the CHN with the highest percentage of the population falling in this age group is Ship Harbour (28.5% of the population).
CHN 4 also has a higher rate of the population aged 65 years and above, with 15.3% of the population of the CHN falling into this age category, second only to CHN 5.The communities within the CHN with the higher percentage of the population aged 65 and above are Moser River (28.0%), Sheet Harbour (27.7%), Ship Harbour (24.1%), and Musquodoboit Harbour (20.1%) all of which are much higher percentages than the district average of 13.3%.
Table 6: Population breakdown by age category and community for CHN 4. % < 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 Eastern Shore 21.9 9.1 12.1 16.3 25.1 15.3 24,598 Musquodoboit CHB Community Chezzetcook 21.6 10.6 13.6 16.9 24.6 11.8 3,916 Jeddore 20.1 8.6 11.0 16.1 26.6 17.8 1,445 Lake Echo 25.3 9.8 16.0 15.2 25.0 8.8 3,044 Middle 21.5 8.0 11.4 15.3 26.0 16.9 2,055 Musquodoboit Moser River 18.3 5.8 6.4 14.2 28.1 28.0 794 Musquodoboit 19.5 9.0 10.0 16.0 26.1 20.1 2,251 Harbour Porters Lake 25.8 10.3 12.7 18.5 21.6 10.9 3,202 Sheet Harbour 17.5 6.0 8.3 12.9 27.9 27.7 1,562 Ship Harbour 18.2 5.6 9.5 14.0 28.5 24.1 1,869 Upper 19.0 7.3 10.3 15.4 27.5 18.5 1,071 Musquodoboit
Source: Canadian Census, 2011
Community Health Network 4: Eastern Shore Musquodoboit Page | 14 Capital Health Community Clinical Services / Health System Planning Group (2014) Population Density
Figure 13: CHN 4 Population density by community (Canadian Census, 2011; Community Counts Community Boundaries, 2011).
Figure 13 represents population density. CHN 4 has the lowest population density in the district, with 6.6 people per km2. All communities within the CHN have a population density of less than 34 people per km2, with the exception of Lake Echo, which has the highest population density in the CHN (98.9 people per km2).
Community Health Network 4: Eastern Shore Musquodoboit 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 4 (National Household Survey, 2011).
Within the geography of CHN 4, approximately 1.5% of the population identify as a visible minority, which is the lowest percentage of all CHNs in the district (district average: 8.8%). Within the CHN, the higher percentage of people identifying as a visible minority reside in Musquodoboit Harbour (3.8%), Porter's Lake (3%), and Middle Musquodoboit (2.9%). Refer to Figure 14 and Table 7a for a detailed breakdown by community.
There are no reported people identifying as a visible minority living in Jeddore, Moser River, Sheet Harbour, or Ship Harbour.
2.6% of citizens living in CHN 4 report being of Aboriginal identity8, which is highest percentage of all CHNs across the district. The communities in CHN 4 that have the highest percentage of people who identify as Aboriginal are Moser River (6.1%) and Sheet Harbour (6.0%). Refer to Table 7b for a detailed breakdown by community.
8 Aboriginal Identity is not classified as a visible minority; it is a separate identity category
Community Health Network 4: Eastern Shore Musquodoboit Page | 16 Capital Health Community Clinical Services / Health System Planning Group (2014) Table 7a: Percentage of Individuals within CHN 4 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% Eastern Shore 1.5% 0.7% 0.4% 0.1% 0 0.3% Musquodoboit CHB Community Chezzetcook 0.3 0 0 0.3 0 0 Jeddore 0 0 0 0 0 0 Lake Echo 2.2 1.9 0 0 0 0.3 Middle 2.9 2 0 0 0 0.9 Musquodoboit Moser River 0 0 0 0 0 0 Musquodoboit 3.8 0 3.8 0 0 0 Harbour Porters Lake 3 1.8 0.1 0.6 0 0.5 Sheet Harbour 0 0 0 0 0 0 Ship Harbour 0 0 0 0 0 0 Upper 0.6 0.4 0 0 0 0.2 Musquodoboit
Source: National Household Survey, 2011 (Note:percentages based on total number of individuals reporting through the National Household Survey).
Table 7b Percentage of Individuals within CHN 4 identifying as Aboriginal Percentage identifying as Aboriginal
CDHA 2.5% Eastern Shore Musquodoboit CHB 2.6% Community Chezzetcook 1.1 Jeddore 1.8 Lake Echo 4.6 Middle Musquodoboit 1.9 Moser River 6.1 Musquodoboit Harbour 2.6 Porters Lake 2.3 Sheet Harbour 6.0 Ship Harbour 2.5 Upper Musquodoboit 0
Source: National Household Survey, 2011 (Note:percentages based on total number of individuals reporting through the National Household Survey).
9 Other – Filipino, Latin American, Southeast Asian
Community Health Network 4: Eastern Shore Musquodoboit 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 4
(National Household Survey, 2011).
Within CHN 4, 2.5% of the population identify as being an immigrant to Canada, which is the lowest percentage in the district (disrict average: 7.9%). Of the communities in CHN 4, the community with the higher percentage of the population identifying as being an immigrant to Canada is Musquodoboit Harbour (5.5% of the population). All percentages are identified in Figure 15.
Within the CHN, 99% of residents report being a Canadian Citizen, which is higher than the district average of 96.2% and together with CHN 5, is among the highest rate across CHNs.
English is the predominant language reported being spoken at home in CHN 4 (98.8%). The communities with the higher percentage of residents speaking languages other than English at home are Porter’s Lake and Lake Echo, both having 2.2% of residents reporting speaking a language other than English at home.
Community Health Network 4: Eastern Shore Musquodoboit Page | 18 Capital Health Community Clinical Services / Health System Planning Group (2014) Total Deprivation
Figure 16: Total deprivation scores for the communities of CHN 4 (5=high/red; 1=low/blue) based on the INSPQ index (Dr. M. Terashima, Dalhousie University; Population Health Status Report, Public Health, CDHA,
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 4: Eastern Shore Musquodoboit Page | 19 Capital Health Community Clinical Services / Health System Planning Group (2014)
Total deprivation for CHN 4 is depicted in Figure 16. Total deprivation in CHN 4 is generally moderate to high when compared to other CHNs across the district. Within CHN 4, the communities with the highest total deprivation are Moser River, Sheet Harbour, and Ship Harbour. The community with the lowest total deprivation is Lake Echo. Table 8 provides a detailed breakdown of the total, material, and social deprivation score for each community within CHN 4. The subsequent sections provided further details about the material and social components for CHN 4.
Table 8: Deprivation Score Summary, by Community Community Total Deprivation Material Deprivation Social Deprivation Chezzetcook 4 4 4 Jeddore 3 4 4 Lake Echo 1 2 2 Middle Musquodoboit 4 4 3 Moser River 5 5 5 Musquodoboit Harbour 3 3 3 Porters Lake 2 3 2 Sheet Harbour 5 5 4 Ship Harbour 5 5 3 Upper Musquodoboit 4 5 1
Source: Dr. M. Terashima, Dalhousie University; Population Health Status Report, Public Health, CDHA, 2013.
Community Health Network 4: Eastern Shore Musquodoboit Page | 20 Capital Health Community Clinical Services / Health System Planning Group (2014) Social Deprivation
Figure 17: Social deprivation scores for the communities of CHN 4 (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 4. Within the CHN, the community of highest social deprivation is Moser River. The community in the lowest category of social deprivation is Upper Musquodoboit.
One component of social deprivation, the proportion of lone parent families, is explored further detail in the next section.
Community Health Network 4: Eastern Shore Musquodoboit Page | 21 Capital Health Community Clinical Services / Health System Planning Group (2014) Lone Parent Families
Figure 18: CHN 4 percentage of lone parent families, by community (National Household Survey, 2011).
CHN 4 has 14.0% of families reporting to be lone parent, which is a lower percentage of lone parent families than the district average of 16.6%. Within the CHN, the community with the higher percentage of lone parent families is Lake Echo (18.1%) and the community with the lower percentage of lone parent families is Porter’s Lake (10.9%). Refer to Figure 18 and Table 9.
Table 9: Social Deprivation and Percentage of Lone Parent Families, by community Social Deprivation Percentage of lone parent families
Canada / Nova Scotia n/a 16.3 / 17.3 CDHA n/a 16.6 Eastern Shore Musquodoboit CHB n/a 17.4 By Community Chezzetcook 4 16 Jeddore 4 14.3 Lake Echo 2 18.1 Middle Musquodoboit 3 14.1 Moser River 5 13.1 Musquodoboit Harbour 3 13.8 Porters Lake 2 10.9 Sheet Harbour 4 12.4 Ship Harbour 3 11.5 Upper Musquodoboit 1 15.8 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 4: Eastern Shore Musquodoboit Page | 22 Capital Health Community Clinical Services / Health System Planning Group (2014) Material Deprivation
Figure 19: Material deprivation scores for the communities of CHN 4 (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, CHN 4 has moderate to high material deprivation. Within the CHN, the communities of the highest material deprivation are Moser River, Sheet Harbour, Ship Harbour, and Upper Musquodoboit. The community of Lake Echo has a lower material deprivation score within the CHN (2).
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.
Community Health Network 4: Eastern Shore Musquodoboit Page | 23 Capital Health Community Clinical Services / Health System Planning Group (2014) Table 10: Summary of Income-related factors and material deprivation for communities within CHN 4 Material Low Income Average Individual Average # of Households 10 Deprivation Families, % Income Family Income Receiving ESIA CDHA n/a 9.9% $36,387 $77,052 11,443 Eastern Shore n/a 7.6% $31,788 $64,635 424 Musquodoboit CHB Community Chezzetcook 4 6.2 $33,695 $67,063 46 Jeddore 4 8 $28,219 $55,712 23 Lake Echo 2 6.3 $35,401 $70,083 29 Middle Musquodoboit 4 9.2 $28,792 $56,333 30 Moser River 5 16 $21,685 $43,978 64 Musquodoboit 3 2.7 $33,334 $72,706 76 Harbour Porters Lake 3 5.4 $38,375 $78,753 55 Sheet Harbour 5 16.2 $24,363 $49,737 39 Ship Harbour 5 11 $26,844 $55,009 30 Upper Musquodoboit 5 12.5 $25,619 $50,968 32 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).
10 ESIA: Employee Support and Income Assistance
Community Health Network 4: Eastern Shore Musquodoboit Page | 24 Capital Health Community Clinical Services / Health System Planning Group (2014) Income Related Factors
Figure 20 depicts average family income, in dollars, across CHN 4. On average, the average family income in CHN 4 is in the low-moderate range.
Within the CHN and also within the district, Moser River has the lowest average family income ($43,978) and the lowest average individual income ($21,685). Upper Musquodoboit and Sheet Harbour are also among the communities in the district with the lowest family income.
Within the CHN, Porters Lake has the higher average family income ($78,753) and Figure 20: Average Family Income in Dollars, by community, in CHN 4 (Canadian Census, the higher average individual 2006). income ($38,375).
Figure 21 represents the percentage of low income families across CHN 4. In CHN 4, there are 7.6% of families classified as low income, which is lower than the district average of 9.9%.
Within the CHN, the community with the highest percentage of low income families is Sheet Harbour (16.2%), followed by Moser River (16.0%). Musquodoboit Harbour has the lowest number of low income families (2.7%) within the CHN.
Figure 21: Percentage of low income families in CHN 4 (Canadian Census, 2006).
Community Health Network 4: Eastern Shore Musquodoboit Page | 25 Capital Health Community Clinical Services / Health System Planning Group (2014)
Department of Community Services and Primary Health Care/DDFP, Public Health, CDHA
Figure 22: Number of households receiving provincial income assistance/employment support in CHN 4 (ESIA Administrative Data, March 2014)
Within the CHN, the community of Musquodoboit Harbour (n=76), followed by Moser River (n=64), have 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 Figure 22 and 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 comparable across communities given data is reported by number 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
Community Health Network 4: Eastern Shore Musquodoboit Page | 26 Capital Health Community Clinical Services / Health System Planning Group (2014) Employment & Education
Education and employment percentages for CHN 4 are lower than the district average. Table 11 provides a breakdown of the employment and education percentages for the communities within CHN 4. The community with the highest number of citizens without a high school education is Moser River, where 54.2% of citizens are without a high school education, which is the highest proportion in the district. The community with the lowest number of people without a high school education (or highest percentage of high school completion) is Lake Echo (16.1% without a high school education).
Within CHN 4, the community with the highest percentage of the population aged 25 years and older employed is Lake Echo (70.8% employed). The community with the lowest percentage of the population 25 years of age or older employed is Moser River, with only 36.0% employed, which is the lowest employment percentage for a community in the district. For the population aged 15-24 years, the community with the highest percentage employed is Jeddore, with 76.2% of this age demographic reporting employment. Upper Musquodoboit does not report any of the population aged 15-24 to be employed (0.0%).
Table 11: Summary of education, employment, and material deprivation for communities within CHN 4 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% Eastern Shore Musquodoboit n/a 27.1% 59.3% 46.6% CHB By Community Chezzetcook 4 23.6 61.7 47.9 Jeddore 4 22.8 55.4 76.2 Lake Echo 2 16.1 70.8 42.4 Middle 4 30.2 56 51.2 Musquodoboit Moser River 5 54.2 36.0 30.7 Musquodoboit 3 20.7 57.6 52.7 Harbour Porters Lake 3 19.9 70.5 45.6 Sheet Harbour 5 38.8 42.2 36.0 Ship Harbour 5 37.7 52.0 29.4 Upper 5 41.2 48.6 0.0 Musquodoboit
Sources: Material deprivation (Dr. M. Terashima, Dalhousie University; PHSR, Public Health, CDHA, 2013); Education and Employment (Canadian Census Data, 2006)
Community Health Network 4: Eastern Shore Musquodoboit Page | 27 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 average 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 shows the proportion of births by maternal age group in each community. The figure also indicates which communities have a teenage birth rate (births among women age 15 to 19 years) that is higher than the district average. CHN 4 accounts for approximately 3.6% of all births occurring within the district. Within the CHN, the higher number of births occurs within the community of Chezzetcook, which had 34 births in 2013. The community within the CHN with the highest birth rate is Jeddore, with on average, 43.77 births occurring per 1000 women aged 15 to 49 years in 2013. Moser River, Sheet Harbour, and Upper Musquodoboit all had less than five births occurring in 2013. A detailed breakdown of births by community is provided in Table 12.
When looking at births among women age 15 to 19 years, the communities within the CHN that have a birth rate higher than the district average are Jeddore, Musquodoboit Harbour, Ship Harbour, and Lake Echo. Jeddore has a highest rate of births among women aged 15 to 19 years in the CHN and this is among the highest rates for this age group in the district, with 34.09 births occurring per 1000 women aged 15 to 19 years in 2013. Ship Harbour has the higher birth rate per 1000 women aged 20 to 34 years and Chezzetcook has the higher birth rate among women aged 35 to 49 years.
Community Health Network 4: Eastern Shore Musquodoboit Page | 28 Capital Health Community Clinical Services / Health System Planning Group (2014)
Table 12: Birth data by Community for CHN 4 for 2012-2013 Total # of Total Births per ASFR13 per 1000 ASFR per 1000 ASFR per 1000 Community births 1000 women12 women 15-19 women 20-34 women 35-49 Chezzetcook 34 36.06 5.80 66.67 19.07 Jeddore 13 43.77 34.09 90.91 12.27 Lake Echo 26 35.14 14.81 74.07 5.26 Middle 7 17.33 0.00 40.98 9.17 Musquodoboit Moser River <5 8.33 0.00 0.00 13.89 Musquodoboit 19 39.92 12.50 87.50 12.24 Harbour Porters Lake 30 37.17 3.88 85.27 16.06 Sheet Harbour <5 0.00 0.00 0.00 0.00 Ship Harbour 12 36.59 10.53 94.74 11.11 Upper <5 4.83 0.00 0.00 8.47 Musquodoboit CHN 4 Total 143 (3.6%) 31.28 20.16 67.11 11.97 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 4: Eastern Shore Musquodoboit Page | 29 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 4 (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 4, the higher volume of crime occurs in the community of Porters Lake. In terms of types of crimes occurring proportionally within communities in CHN 4, theft <$5000 is the predominant non-violent crime (27.1% of all crimes), followed by mischief (19.4%) and break and enter (19.1%). Refer to Figure 24 and Table 13 for a detailed breakdown by community.
14 Within CHN 4, crimes are captured though both the Halifax Regional Police (HRP), RCMP, and their Integrated Crime Unit.
Community Health Network 4: Eastern Shore Musquodoboit Page | 30 Capital Health Community Clinical Services / Health System Planning Group (2014)
Table 13: Total number of crimes occurring in each community, by type, as reported by Halifax Regional Police Break Impaired/ Theft Theft Youth Total by Community Assaults Drugs Mischief &Enter Alcohol <$5000 >$5000 Crime Community Chezzetcook 70 60 51 39 92 78 10 13 413 Jeddore 27 32 7 14 35 38 4 7 164 Lake Echo 68 79 33 33 127 127 19 30 516 Middle 45 81 27 35 74 66 12 <5 345 Musquodoboit Moser River 10 22 6 7 18 19 6 <5 88 Musquodoboit 39 55 42 23 67 89 10 8 333 Harbour Porters Lake 57 79 71 61 89 376 23 34 790 Sheet Harbour 67 135 32 35 107 81 13 <5 475 Ship Harbour 24 54 14 18 46 51 12 <5 221 Upper 20 73 9 10 28 26 <5 <5 168 Musquodoboit CHN 4 Total 427 670 292 275 683 951 111 104 3513 Type as % of total 12.2% 19.1% 8.3% 7.8% 19.4% 27.1% 3.2% 3.0% 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)
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 4 are Sheet Harbour, Musquodoboit Harbour, and North Central, all 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 reflection of all CHN crime occurrences. Figure 25: RCMP Policing Districts aligned with CHN 4 (RCMP, 2014)
Similarly to the data reported by the Halifax Regional Police, Table 13 indicates that the predominant crimes in the three Policing Districts aligned with CHN 4 are theft under $5000 and mischief.
15 Within CHN 4, crimes are captured though both the Halifax Regional Police (HRP), RCMP, and their Integrated Crime Unit. Communities.
Community Health Network 4: Eastern Shore Musquodoboit Page | 31 Capital Health Community Clinical Services / Health System Planning Group (2014)
Table 14: Total number of crimes occurring by type in RCMP Policing Districts aligned with CHN 4 for 2013 Policing District By Count and % by Type of Total CHN Crime Crime Type Musquodoboit Harbour Sheet Harbour North Central % Assaults 54 24 15 14.4% Arson <5 <5 <5 0.0% Break & Enter (home/business/ other) 33 36 18 13.4% Theft - Over $5000 17 8 7 4.9% Theft - Under $5000 116 24 14 23.8% Possession/Trafficking of stolen goods 6 <5 <5 0.9% Fraud/Identity Theft 28 6 <5 5.2% Mischief 64 28 26 18.2% Drug possession/Trafficking/ 31 10 23 9.9% Production/Import Impaired Operation of Motor 28 <5 12 6.2% vehicle/boat Traffic Offences 7 <5 <5 1.1% Youth Complaint/Crime 13 <5 <5 2.0% CHN 4 Total RCMP Crimes 397 136 120 100% *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.
Community Health Network 4: Eastern Shore Musquodoboit Page | 32 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). Eight schools in CHN 4 contributed to the scoring results. CHN 4 schools scored below the provincial average, trending negatively in all testing categories, with the exception of Grade 6 Math. The most noticeable gap between CHN 4 results and the provincial average is in Grade 8 Math, with CHN 4 scoring 16% below the provincial average. 16
Table 15: CHN 4 School Test Scores 2013-2014 Testing Category CHN 4, percentage Nova Scotia, percentage Trend Number of Schools 8 345 2.32% Average of Reading 3 68 69 ↓ Average of Math 4 66 73 ↓ Average of Reading 6 72 74 ↓ Average of Math 6 75 71 ↑ Average of Reading 8 67 69 ↓ Average of Math 8 39 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 4 – 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 4: Eastern Shore Musquodoboit Page | 33 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 Eastern Shore Musquodoboit CHB, n=205 Table 16 indicates the top health Mental Health 31.7% concerns reported through the Access to Health Services & Info 16.1% Eastern Shore Musquodoboit CHB Chronic Conditions 15.1% Community Consultations during the Stress 14.6% preparation of the 2013 Community Health Inequities 13.7% Health Plan. This information is Sense of Belonging 3.4% reported here to provide a qualitative perspective to the data Physical Activity, Healthy Eating, Healthy Weight 2.4% related to health status below. Substance Use and Addictions 2.4% Health Screenings 0.5% 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 4 had the highest proportion of citizens self-reporting high blood pressure and the highest proportion of citizens reporting having a BMI in the overweight range. Residents of CHN 4 have the lowest self-reported intention to improve health in the next year across all CHNs. Together with CHN 5 (West Hants), residents of CHN 4 a lower rate of citizens reporting having a stressful daily life.
Community Health Network 4: Eastern Shore Musquodoboit Page | 34 Capital Health Community Clinical Services / Health System Planning Group (2014)
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 chronic conditions across CHNs, residents of CHN 4 generally self-report higher rates of chronic disease. Specifically, CHN 4 has the highest self-reported rate of diabetes (10.7%) and the highest self- reported rate of heart disease (6.7%).
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 4: Eastern Shore Musquodoboit Page | 35 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 4. 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 4, % CDHA, % Health Status Indicator Nova Scotia, % Canada, % (n = 402) (n = 2819) Positive Physical Health 84.8 87.1 86.8 88.6 Positive Mental Health 93.8 94.5 94.4 94.7 Satisfied with life 93.0 90.8 92.9 92.3 Stressful Daily Life 62.3 64.5 62.2 64.5 Stress at Work 67.5 71.5 64.9 71.1 Sense of Belonging 71.2 68.4 71.2 65.4 Intend on Improving Physical Health in next year: Yes 64.8 68.5 72.8 66.8 Exercise 60.1 58.3 48.2 50.7 Lose Weight 10.1 12.9 13.0 9.4 Improve Eating Habits 11.2 13.1 17.4 19.0 Quit smoking 10.1 8.5 13.5 10.8 No 34.1 30.2 27.2 33.2 Body Mass Index: Normal/Underweight 31.7 36.7 -- -- Overweight 40.2 38.1 36.5 34 Obese 28.1 25.2 24.3 18.3 No Food Security 1.7 1.7 3.4 2.3 Positive Oral Health 85.1 88.1 - - Flu Shot < 1 years ago 44.5 44.8 46.2 29.6 Arthritis 27.9 23.7 22.9 16.2 Back Problems 30.3 7.1 22.9 18.8 High blood Pressure 24.9 20.3 22.6 17.5 Migraine Headaches 14.4 15.8 11.3 10.2 Chronic Bronchitis 14.5 3.7 - - COPD 1.8 2.1 6.3 4.3 Diabetes 10.7 8.5 8.6 6.3 Heart Disease 6.7 5.3 5.8 4.8 Mood Disorder 9.2 9.7 9.0 7.1 Smoking (Daily or Occasionally) 20.4 20.5 22.8 20.1 5 or more drinks once a week or more 6.8 8.7 9.8 8.5 5 or more fruits/vegetables per day 38.7 38.4 34.0 40.5 Source: Canadian Community Health Survey, 2009-2010
When compared to district, provincial, and national rates, CHN 4 has a higher percentage of the population self-reporting being satisfied with life (93.0%), having a BMI that is overweight or obese, having arthritis (27.9%), back problems (30.3%), high blood pressure (24.9%), diabetes (10.7%), and heart disease (6.7%). When compared to district, provincial, and national rates, CHN 4 has a lower percentage of the population self- reporting positive physical health (84.8%), positive mental health (93.8), intending to improve health in the next year (64.8%), COPD (1.8%), and having five or more drinks once a week or more (6.8%).
Community Health Network 4: Eastern Shore Musquodoboit Page | 36 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, CDHA, 2013. The highest and lowest STI incidence rate for each age group in both females and males has been bolded. CHN 4 incidence rates for STIs are generally among the lowest in the district across all age groups for both males and females, with the exception of incidence rates for females aged 20 to 24 years for which CHN 4 has the highest rate in the district.
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 4: Eastern Shore Musquodoboit Page | 37 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 4: Eastern Shore Musquodoboit Page | 38 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. With the exception of Ship Harbour, all communities in CHN 4 have a lower female life expectancy at birth than the district average. Additionally, all communities in CHN 4 have a lower male life expectancy at birth than the district average. A similar trend is observed in the other rural Community Health Network, West Hants.
Life expectancy at birth is highest for females in the community of Ship Harbour (83.8 years) and lowest for females living in the community cluster18 of Upper/Middle Musquodoboit (80.6 years). Life expectancy is highest for males living in the community cluster of Jeddore/Musquodoboit Harbour (78.0 years) and lowest for males living in the community cluster of Upper/Middle Musquodoboit (73.3 years). Refer to Table 21.
Table 21: Life expectancy at birth, by community and by sex Community Female Life Expectancy (years) Male Life Expectancy (years) Chezzetcook 82.2 76.6 Jeddore & Musquodoboit Harbour 81.6 78.0 Lake Echo 82.6 77.5 Upper and Middle Musquodoboit 80.6 73.3 Moser River & Sheet Harbour 80.6 76.8 Porters Lake 81.0 76.6 Ship Harbour 83.8 76.7 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
18 The communities of Upper & Middle Musquodoboit, Sheet Harbour & Moser River, and Jeddore & Musquodoboit Harbour have been clustered together for the purposes of reporting due to population size (clusters created by Dr. M. Terashima, Dalhousie University (2011)).
Community Health Network 4: Eastern Shore Musquodoboit Page | 39 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 4: Eastern Shore Musquodoboit Page | 40 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 in CHN 4 is the highest across all CHNs, with 98.3 citizens per 1000 population receiving care from an
Community Health Network 4: Eastern Shore Musquodoboit Page | 41 Capital Health Community Clinical Services / Health System Planning Group (2014) FP for diabetes (compared to 72.3 per 1000 population across CDHA). Figure 28 shows that the communities of Ship Harbour, Sheet Harbour, and Middle Musquodoboit have among the highest rates of people per 1000 population receiving care from an FP for diabetes in the district.
Specifically, Ship Harbour has the highest rate within the CHN and within the district, with 152.3 people per 1000 population receiving care from a family physician for diabetes, which translates to 15.2% of the population. Moser River has the lower rate of individuals receiving care for diabetes from a family physician within the CHN, with 57.0 citizens per 1000 population receiving care. The average number of visits per patient is higher in CHN 4 than the district average, with Upper Musquodoboit and Moser River having a higher number of visits per person (3.6 visits). 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 Patients Diabetes Patient population Chezzetcook 570.5 232.7 2.5 76.6 Jeddore 237.8 95.9 2.5 82.9 Lake Echo 543.9 180.3 3.0 79.2 Middle 571.0 206.3 2.8 129.3 Musquodoboit Moser River 135.7 37.3 3.6 57.0 Musquodoboit 436.3 173.6 2.5 94.8 Harbour Porters Lake 535.8 217.9 2.5 91.8 Sheet Harbour 627.0 180.6 3.5 139.7 Ship Harbour 730.4 232.2 3.1 152.3 Upper 264.2 74.3 3.6 87.9 Musquodoboit CHN 4 Total 4,652.4 1,631.2 2.9 98.3 District Total 66,043.3 23,951.4 2.8 72.3
Source: Department of Health & Wellness, MSI Billing Data two year average for fiscal 2011/12; 2012/13
Community Health Network 4: Eastern Shore Musquodoboit Page | 42 Capital Health Community Clinical Services / Health System Planning Group (2014) 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)
The number of citizens per 1000 population accessing care from a family physician (FP) for a diagnosis of COPD in CHN 4 is the highest across all CHNs, with 85.9 citizens per 1000 population receiving care from an FP for COPD (compared to 72.3 per 1000 population across CDHA). Figure 29 shows that the communities of Sheet Harbour and Ship Harbour have among the highest rates of people per 1000 population receiving care from an FP for COPD in the district.
Specifically, Sheet Harbour has the highest rate within the CHN, with 122.9 people per 1000 population receiving care from a family physician for COPD, which translates to 12.3% of the population. Jeddore has the lower rate of individuals receiving care for COPD from a family physician within the CHN, with 46.7 citizens per 1000 population receiving care. The average number of visits per patient is higher in CHN 4 than the district average, with Upper Musquodoboit having the higher number of visits per person (2.8 visits). Refer to Table 24 for a detailed breakdown by community.
Community Health Network 4: Eastern Shore Musquodoboit Page | 43 Capital Health Community Clinical Services / Health System Planning Group (2014) Table 24: CHN overview of citizens receiving care for a diagnosis of COPD from a family physician Average Visits per Patients per 1000 Community FP Visits for COPD Patients Patient population Chezzetcook 402.5 232.3 1.7 76.5 Jeddore 102.1 54.1 1.9 46.7 Lake Echo 345.6 217.4 1.6 95.5 Middle Musquodoboit 288.5 135.6 2.1 85.0 Moser River 85.1 35.5 2.4 54.2 Musquodoboit Harbour 256.4 150.8 1.7 82.4 Porters Lake 351.6 219.0 1.6 92.3 Sheet Harbour 414.5 159.0 2.6 122.9 Ship Harbour 422.7 167.4 2.5 109.8 Upper Musquodoboit 151.9 54.0 2.8 63.8 CHN 4 Total 2820.9 1425.0 2.0 85.9 District Total 44,016.6 25,191.6 1.8 76.0
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)
The rate of the population accessing care from a family physician (FP) for a diagnosis of CHF in CHN 4 is higher than the district rate, with 10.2 citizens per 1000 population receiving care from an FP for CHF (compared to 9.0 per 1000 population across CDHA). Figure 30 shows that the communities of Sheet Harbour and Ship Harbour have among the highest rates of CHF across the district.
Specifically, Sheet Harbour has the highest rate of people receiving care for CHF within the CHN and also within the district, with 26.2 people per 1000 population receiving care for CHF. Jeddore has the lower rate of
Community Health Network 4: Eastern Shore Musquodoboit Page | 44 Capital Health Community Clinical Services / Health System Planning Group (2014) individuals receiving care for CHF from a family physician within the CHN, with 4.5 citizens per 1000 population receiving care. The average number of visits per patient is higher in CHN 4 than the district average, with Jeddore having the higher number of visits per person (4.3 visits). 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 Patients CHF Patient population Chezzetcook 61.8 19.6 3.2 6.4 Jeddore 22.6 5.3 4.3 4.5 Lake Echo 53.7 12.7 4.2 5.6 Middle Musquodoboit 88.0 22.3 4.0 14.0 Moser River 38.2 9.8 3.9 14.9 Musquodoboit Harbour 41.1 12.4 3.3 6.7 Porters Lake 50.8 17.5 2.9 7.4 Sheet Harbour 129.9 33.8 3.8 26.2 Ship Harbour 101.6 26.4 3.8 17.3 Upper Musquodoboit 37.7 9.7 3.9 11.4 CHN 4 Total 625.2 169.3 3.7 10.2 District Total 10,407.9 2,994.4 3.5 9.0
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 4: Eastern Shore Musquodoboit Page | 45 Capital Health Community Clinical Services / Health System Planning Group (2014) The rate of the population accessing care from a family physician for a diagnosis of hypertension in CHN 4 is the highest across all CHNs, with 227.7 citizens per 1000 population receiving care from an FP for hypertension (compared to 164.3 per 1000 population across CDHA). Figure 31 shows that the communities of Sheet Harbour and Ship Harbour have among the highest rates of accessing care for hypertension across the district.
Specifically, Sheet Harbour has the highest rate of people receiving care for hypertension within the CHN and also within the district, with 395.7 people per 1000 population receiving care for hypertension, which translates to approximately 40% of the population. Jeddore has the lower rate of individuals receiving care for hypertension from a family physician within the CHN, with 147.2 citizens per 1000 population receiving care. The average number of visits per patient is marginally lower in CHN 4 than the district average, with Sheet Harbour and Moser River having the higher number of visits per person (2.8 visits). 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 Average Visits per Patients per 1000 Community FP Visits for HTN Patients Patient population Chezzetcook 1093.2 529.8 2.1 174.4 Jeddore 316.1 170.3 1.9 147.2 Lake Echo 963.4 402.6 2.4 176.8 Middle Musquodoboit 971.3 444.3 2.2 278.6 Moser River 322.3 114.5 2.8 174.8 Musquodoboit Harbour 724.2 362.1 2.0 197.8 Porters Lake 1093.3 504.4 2.2 212.6 Sheet Harbour 1420.9 511.6 2.8 395.7 Ship Harbour 1383.8 553.0 2.5 362.7 Upper Musquodoboit 493.9 185.0 2.7 218.6 CHN 4 Total 8,782.3 3,777.6 2.32 227.73 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 4: Eastern Shore Musquodoboit Page | 46 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 population of 1000 receiving care from a specialist for a particular chronic condition. Within CHN 4 there is generally a lower rate of the population accessing specialist care compared to the district rate, with the exception of specialist care for diabetes. • Within the CHN, there is a higher rate of patients per 1000 population receiving care from a specialist for a diagnosis of diabetes. Those residing in the community of Porter’s Lake, Lake Echo, and Middle Musquodoboit have among the highest rates per 1000 population for receiving care from a specialist for a diagnosis of diabetes across the CHN and the district. Specifically, those residing in the community of Porter’s Lake have the highest rate within the CHN (34 patients per 1000 population) (Figure 32). • Within the CHN, the rate of patients accessing a specialist for a diagnosis of hypertension is lower than the district average (4.6 patients per 1000 population in CHN 4 compared to 6.0 patients per 1000 population across the district). Those residing in the community of Porter’s Lake have the highest rate within the CHN (7.6 patients per 1000 population) (Figure 33). • Within the CHN, there is a lower rate of patients per 1000 receiving care for COPD than the district rate. The community with the higher rate of the population seeing a specialist for COPD is Middle Musquodoboit, which is among the highest rates in the district (Figure 34). • There is also a lower rate of the population accessing specialist care for a diagnosis of CHF within CHN 4, with the highest rate occurring among those residing in Middle Musquodoboit (Figure 35). • There is generally a lower rate of people accessing specialist care for the four aforementioned chronic conditions in Moser River (data suppressed).
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 Chezzetcook 20.4 4.1 5.9 4.4 Jeddore 19.0 -- 4.7 -- Lake Echo 27.2 5.3 7.3 5.4 Middle Musquodoboit 29.9 4.5 10.0 6.5 Moser River ------Musquodoboit 22.9 4.5 6.3 5.1 Harbour Porters Lake 34.0 7.6 5.8 5.0 Sheet Harbour 16.4 4.0 6.8 5.1 Ship Harbour 23.2 4.4 7.2 5.2 Upper Musquodoboit 9.0 ------CHN 4 Total 23.23 4.64 6.37 4.84 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 4: Eastern Shore Musquodoboit Page | 47 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 4: Eastern Shore Musquodoboit Page | 48 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 4: Eastern Shore Musquodoboit Page | 49 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 4. 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 4 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 Inventory19 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 Diabetes Management Centres, Collaborative Emergency Centres Public Health Drop in Centres, Youth Health Centres, Fluoride Mouthrinse Program, Prenatal Classes, Satellite Office locations Rehabilitation Services Programs offered from hospital sites Hospital Facilities Tri-Facilities (ESMH, TOMH, MVMH)
19 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 4: Eastern Shore Musquodoboit Page | 50 Capital Health Community Clinical Services / Health System Planning Group (2014) Family Practice in CHN 4
Figure 37: Family Practice locations in CHN 4 (DDFP Database (Medical Services Information System; CDHA; DDFP Members; April 2014)
Figure 38: Family physician FTE per 1000 population in CHN 4 (Department of Health and Wellness Physician Resource Plan 2012 Billings)
Community Health Network 4: Eastern Shore Musquodoboit Page | 51 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 4. There are approximately 12 family physician FTEs working in CHN 4 and the rate of family physician FTE per population for each community in CHN 4 is depicted in Figure 38. The highest number of working family physicians per 1000 population practice in Sheet Harbour and Middle Musquodoboit. Middle Musquodoboit, Musquodoboit Harbour, Sheet Harbour, and Porter’s Lake are the only communities in CHN 4 that have family physicians/nurse practitioners practicing in the community. There are three nurse practitioners practicing throughout the CHN in the communities of Middle Musquodoboit, Musquodoboit Harbour/Porter’s Lake, and Sheet Harbour. There is one family practice nurse working in the CHN in Musquodoboit Harbour.
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. There are no reportable volumes for CHN 4 (Source: Primary Health Care, Capital Health, for the period of March 2011 – June 2014.)
Community Health Network 4: Eastern Shore Musquodoboit Page | 52 Capital Health Community Clinical Services / Health System Planning Group (2014) Community Pharmacies
Figure 39: Community-based pharmacy locations in CHN 4 (Pharmacy Association of Nova Scotia (PANS), 2014).
Figure 39 depicts community-based pharmacy locations in CHN 4. There are a limited number of pharmacy locations located in CHN 4 in the communities of Porter’s Lake, Musquodoboit Harbour, Middle Musquodoboit, and Sheet Harbour.
Community Health Network 4: Eastern Shore Musquodoboit Page | 53 Capital Health Community Clinical Services / Health System Planning Group (2014) Nursing Home Locations
Figure 40: Nursing Home and Residential Care Facility locations in CHN 4 (Continuing Care, Capital Health, April 2014, as retrieved from http://novascotia.ca/dhw/ccs/documents/Nursing-Homes-and-Residential-Care-Directories.pdf)
Figure 40 represents the nursing home (NH) and residential care facility (RCF) locations in CHN 4. Table 29 identifies the facilities and number of beds, by community. Nursing home facilities in CHN 4 are co-located with the community hospitals in Middle Musquodoboit, Musquodoboit Harbour, and Sheet Harbour.
Table 29: Nursing Home and RCF locations by Community, indicating number of beds Community Nursing Home(NH)/Residential Care Facility (RCF) Location Number of Beds Middle 1. Musquodoboit Valley Home for Special Care Association 29 NH beds Musquodoboit (NH), 126 Higginsville Road, Middle Musquodoboit Musquodoboit 1. The Birches (NH), 7702 Highway #7, RR #2, 41 NH beds + 1 respite bed Harbour Musquodoboit Harbour Sheet Harbour 1. Harbourview Continuing Care Centre (NH + RCF), 22639 28 NH beds + 4 RCF beds Hwy 7, Sheet Harbour NH beds per 100,000: 462.1 CHN 4 NH and RCF Beds per 100,000 population RCF beds per 100,000: 18.9
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 4: Eastern Shore Musquodoboit Page | 54 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 30 details emergency department (ED) utilization, by community, by type of visit.
Table 30: Emergency Department Utilization by Community for Adults using CDHA Emergency Departments 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 Chezzetcook 421.5 190.5 138.8 62.7 Jeddore 146.1 52.2 126.3 45.1 Lake Echo 487.6 205.5 214.1 90.2 Middle Musquodoboit 544.5 259.2 341.4 162.5 Moser River 37.2 7.0 56.8 10.8 Musquodoboit Harbour 309.8 125.9 169.3 68.8 Porters Lake 570.0 278.9 240.2 117.5 Sheet Harbour 121.5 31.8 93.9 24.6 Ship Harbour 217.6 77.5 142.7 50.8 Upper Musquodoboit 70.4 21.8 83.2 25.8 CHN 4 Total 2,926.2 1,250.3 176.4 73.4 District (CDHA Residents Only) 90,116.6 54,946.9 295.6 151.9 Source: EDIS data for Fiscal Year 2013/14, Capital Health
Note: Data for local emergency departments (known as Collaborative Emergency Centres) in CHN 4 is not captured through the EDIS database; therefore, not represented in the above table, so this data will be an underestimate of the true utilization, particularly for CTAS 4 and 5 visits. This information is reflective of visits to Halifax Infirmary, Dartmouth General Hospital, Hants Community Hospital, and Cobequid Community Health Centre, by residents of CHN 4.
CHN 4 has a lower rate than the district of visits per 1000 population to the above mentioned EDs for visits of both high acuity (CTAS levels 1, 2, and 3) and 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 Porter’s Lake. As a rate per 1000 population, Middle Musquodoboit has the higher rate of visits of high acuity to the ED (341.4 visits per 1000 population) and as well the highest rate of visits to the ED for visits of low acuity (162.5 visits per 1000 population). The rate of CTAS visits of high acuity and low acuity per 1000 population are depicted in Figures 41 and 42, respectively.
Community Health Network 4: Eastern Shore Musquodoboit Page | 55 Capital Health Community Clinical Services / Health System Planning Group (2014)
Figure 41: Number of visits per 1000 population to an ED within Capital Health for a visit of high acuity in CHN 4 (EDIS data for Fiscal Year 2013/14, Capital Health)
Figure 42: Number of visits per 1000 population to an ED within Capital Health for a visit of low acuity in CHN 4 (EDIS data for Fiscal Year 2013/14, Capital Health)
Community Health Network 4: Eastern Shore Musquodoboit Page | 56 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 31 details emergency department (ED) utilization by community, by type of visit.
Table 31: 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 Chezzetcook 48.48 87.49 41.59 82.79 Jeddore 15.72 24.29 38.36 68.83 Lake Echo 48.55 114.41 48.69 111.15 Middle Musquodoboit 41.20 59.85 71.72 119.81 Moser River <5 <5 4.78 21.53 Musquodoboit Harbour 28.71 51.75 48.53 96.38 Porters Lake 66.17 141.13 68.36 131.32 Sheet Harbour 6.75 15.41 21.32 49.48 Ship Harbour 18.86 29.11 44.56 70.27 Upper Musquodoboit 6.59 6.29 24.09 28.74 CHN 4 Total 281.71 533.54 48.06 93.06 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 4 has a lower rate of children/youth per 1000 population visiting the ED for visits of both high and low acuity (CTAS levels 1-5) when compared to the district rate. Within the CHN, the community with the highest volume of IWK ED visits for both levels of acuity is Porter’s Lake. As a rate per 1000 population, Porter’s Lake also has the higher rate of visits of high acuity to the IWK ED (68.36 visits per 1000 population) and low acuity (131.3 visits per 1000 population). Moser River is the community with the lowest total number of visits to the IWK ED. The rate of CTAS visits of high acuity and low acuity per 1000 population are depicted in Figures 43 and 44, respectively.
Community Health Network 4: Eastern Shore Musquodoboit Page | 57 Capital Health Community Clinical Services / Health System Planning Group (2014)
Figure 43: 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 44: 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 4: Eastern Shore Musquodoboit Page | 58 Capital Health Community Clinical Services / Health System Planning Group (2014) Hospital Admissions
Table 32 highlights the top 5 reasons for admission to hospital in CHN 4, according to the Discharge Abstract Database (DAD) for Fiscal Year 2012-2013. CHN 4 has a higher admission rate than the district for all of the top five diagnoses with the exception of acute myocardial infarction.
Table 32: Hospital admissions by diagnosis for CHN 4 (DAD, Fiscal 2012-2013) CHN 4 Admission District Admission NS (per 1000 ICD Code Total Rate per 1000 pop Rate per 1000 pop pop) Z51 Other medical care 62 2.52 1.65 J44 Oth COPD 61 2.48 1.77 Z54 Convalescence 41 1.67 1.33 I21 Acute myocardial infarction 38 1.54 1.82 2.53 J18 Pneumonia, organism unspecified 38 1.54 Not top 5 for district
Table 33 highlights the top 5 reasons for unplanned re-admission to hospital in CHN 4 (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 4, the rate of readmission for all the top five diagnoses is higher than the district rates, with the exception of acute myocardial infarction.
Table 33: Re-admissions by Diagnosis for CHN 4 (DAD, Fiscal 2012-2013) CHN 4 Admission District Admission National Re- ICD Code Total Rate per 1000 pop Rate per 1000 pop admit rate J44 COPD <5 0.16 0.11 18.8% Z51 Other medical care <5 0.16 0.14 12.5% I50 Heart failure <5 0.12 0.19 21% D70 Agranulocytosis <5 0.08 Not top 5 in district - R42 Dizziness and giddiness <5 0.08 Not top 5 in district -
Ambulatory Care Sensitive Conditions
Table 34 describes the top five reasons for admissions for ambulatory care sensitive conditions (ACSCs) in CHN 4 according to the Discharge Abstract Database (DAD) for Fiscal Year 2012-2013. Table 34: Admissions by ambulatory sensitive condition (DAD, Fiscal 2012-2013) CHN 4 Admission Rate per District Admission Rate per Condition Total 1000 pop 1000 pop Heart Failure and Pulmonary Edema 28 1.14 0.88 Diabetes <5 0.04 0.27 Grand mal status/other epileptic 6 0.24 0.18 convulsion COPD 55 2.24 1.62 Asthma <5 0.08 0.13 Angina 5 0.20 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 4 has higher admission rates to hospital heart failure and pulmonary edema, grand mal seizures, and COPD when compared to the district ACSC rates.
20 Provincial and National benchmarks are provided by CIHI, where available.
Community Health Network 4: Eastern Shore Musquodoboit Page | 59 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 45: Number of clients per 1000 population accessing Addictions Community Based Services (Adult – Capital Health) in CHN 4 (STAR and Addictions Assist (Provincial Database) for time period April 2012 – September 2013)
Figure 45 depicts the number of clients per 1000 population accessing Addictions Community Based Services in CHN 4. CHN 4 has a higher number of people utilizing Addictions Community Based Services per 1000 population, with 12.9 clients per 1000 population accessing services compared to the district rate of 11.79 clients per 1000 population. Within the CHN, Middle Musquodoboit has the higher volume of visits, and the highest number of clients per 1000 population accessing Addictions Services, which is among the highest in the district. Porter’s Lake has the higher total number of clients. Chezzetcook, while having the lowest rate of population accessing Addictions Services, has the highest average number of visits per client, with each client having 14.6 visits. A detailed breakdown of Addictions services utilization is provided in Table 35.
Community Health Network 4: Eastern Shore Musquodoboit Page | 60 Capital Health Community Clinical Services / Health System Planning Group (2014)
Table 35: Addictions Community Based Services Utilization (Adults – Capital Health) in CHN 4 Addictions Community Average Visits per # of Clients per Community Clients Based Services Visits21 Client population of 1000 Chezzetcook 311.1 21.3 14.6 7.0 Jeddore 77.9 11.0 7.1 9.5 Lake Echo 224.1 26.8 8.4 11.8 Middle 392.5 34.7 11.3 21.8 Musquodoboit Moser River 37.7 5.4 7.0 8.2 Musquodoboit 213.2 18.1 11.8 9.9 Harbour Porters Lake 382.2 38.0 10.1 16.0 Sheet Harbour 159.5 21.6 7.4 16.7 Ship Harbour 230.1 27.8 8.3 18.2 Upper 96.1 9.9 9.7 11.7 Musquodoboit CHN 4 Total 2,124.4 214.6 9.90 12.94 District Total 50,651.5 3,908.0 12.96 11.79
Source: STAR and Addictions Assist (Provincial Database) for time period April 2012 – Sept 2013
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.
The number of children/youth accessing Addictions Services through the CHOICES program offered by the IWK Health Centre is low for CHN 4 and thus, data is not reportable at the community level. In total, approximately 13 children/youth from CHN 4 received services from CHOICES, resulting in 65 visits, with an average of 5.2 visits per client. The rate per 1000 population for this CHN is 2.7 clients per 1000 youth population22, which is higher than the district rate of 2.5 clients per 1000 youth population (Source: IWK Health Centre, Meditech Registrations for CHOICES for Time Period Fiscal 2012-2013).
21 Note: total number of visits over an 18 month period (not annual) 22 Population of the community/CHN under 20 years of age. 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 4: Eastern Shore Musquodoboit 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 46: Number of clients per 1000 population accessing Community Mental Health in CHN 4 (STAR and Addictions Assist (Provincial Database) April 2012 – Sept 2013)
Figure 46 depicts the number of clients per 1000 population accessing Community Mental Health and Addictions Services in CHN 4. CHN 4 has a similar number of people utilizing Community Mental Health services per 1000 population when compared to the district average with 31.8 clients per 1000 population accessing services.
Within the CHN, the community of Middle Musquodoboit has the highest rate of the population accessing Community Mental Health, having 53.5 clients per 1000 population. This is among the highest rates in the district. Porter’s Lake has the higher number of clients and the higher volume of visits. The average number of visits per client is lower in CHN 4 at 6.1 visits per client, compared to the district average of 7.7 visits per client. Residents of Jeddore have the higher average number of visits to Community Mental Health (7.4 visits per client). Residents of Chezzetcook have the lower rate of Community Mental Health utilization per 1000 population. A detailed breakdown of Community Mental Health services utilization is provided in Table 36.
Community Health Network 4: Eastern Shore Musquodoboit Page | 62 Capital Health Community Clinical Services / Health System Planning Group (2014)
Table 36: Community Mental Health Services Utilization in CHN 4 Community Mental Health Average # of Clients per 1000 Community Clients Visits visits per client population Chezzetcook 421.3 63.7 6.6 21.0 Jeddore 223.8 30.3 7.4 26.2 Lake Echo 453.2 67.6 6.7 29.7 Middle Musquodoboit 466.3 85.3 5.5 53.5 Moser River 73.6 14.1 5.2 21.5 Musquodoboit Harbour 323.1 48.4 6.7 26.4 Porters Lake 589.8 90.1 6.5 38.0 Sheet Harbour 244.7 48.2 5.1 37.3 Ship Harbour 335.8 60.8 5.5 39.9 Upper Musquodoboit 84.9 18.8 4.5 22.2 CHN 4 Total 3,216.5 527.2 6.1 31.8 District Total 81,272.0 10,469.7 7.7 31.6 Source: STAR and Addictions Assist (Provincial Database) for time period April 2012 – Sept 2013
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 47: Number of clients per 1000 youth population accessing IWK Mental Health Diagnostic and Therapeutic Services in CHN 4 (IWK Health Centre, Meditech Registrations for Time Period Fiscal 2012-2013)
Community Health Network 4: Eastern Shore Musquodoboit Page | 63 Capital Health Community Clinical Services / Health System Planning Group (2014) Figure 47 depicts the number of child/youth mental health clients accessing services from the IWK Health Centre as a rate per 1000 youth population (age 0-19). CHN 4 has a lower number of clients per 1000 youth population accessing Mental Health Services from the IWK Health Centre than the district rate, with 34.3 clients per 1000 youth population from CHN 4 accessing services (district rate of 35.6 clients per 1000 youth). CHN 4 has a lower number of visits per client than the district rate, averaging 5.8 visits per client. Residents of CHN 4 account for approximately 4% of the patient population and visit volume for the district.
Within the CHN, the community with the higher number of IWK Mental Health clients per 1000 youth population is Middle Musquodoboit, with 71.4 clients per 1000 youth population accessing services, which is among the highest rates in the district. Porter’s Lake has the higher total number of clients and the higher total number of visits within the CHN. The average number of visits per client is higher for those residing Chezzetcook, with each client having an average of 6.8 visits. The communities of Upper Musquodoboit and Moser River have the lower rate of clients per 1000 population accessing services within the CHN (data suppressed). Detailed information by community is provided in Table 37.
Table 37: Mental Health Services Utilization for Children/Youth from IWK Health Centre in CHN 4 Average # of Clients per 1000 Community Mental Health Total Visits Clients visits per client population Chezzetcook 137.9 20.2 6.8 23.9 Jeddore 44.1 8.7 5.0 30.1 Lake Echo 133.3 24.6 5.4 32.0 Middle Musquodoboit 199.4 31.6 6.3 71.4 Moser River -- <5 -- -- Musquodoboit Harbour 89.5 14.0 6.4 32.0 Porters Lake 212.0 32.4 6.6 39.1 Sheet Harbour 11.3 5.8 1.9 21.4 Ship Harbour 57.5 12.4 4.6 36.4 Upper Musquodoboit -- <5 -- -- CHN 4 Total 905.4 156.8 5.8 34.3 District Total 25,684.3 3246.7 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).
The number of women aged 15-45 years accessing IWK Reproductive Mental Health Services is low for CHN 4 and thus, data is not reportable at the community level. In total, approximately 6 women from CHN 4 received services from IWK Reproductive Mental Health, resulting in 21 visits, with an average of 3.6 visits per client. The rate per 1000 population for this CHN is 3.6 clients per 1000 women, which is lower than the district rate of 3.98 clients per 1000 women (Source: IWK Health Centre, Meditech Registrations for Time Period Fiscal 2012-2013).
Community Health Network 4: Eastern Shore Musquodoboit Page | 64 Capital Health Community Clinical Services / Health System Planning Group (2014) Youth Health Centres
Figure 48: Youth Health Centres in CHN 4, 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 three Youth Health Centres located at high schools within CHN 4, locations depicted in Figure 48. 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.
Community Health Teams
The Community Health Teams offer free wellness programs for people who live, work, or have a family doctor in the city of Dartmouth or the Chebucto (Halifax Mainland) area of communities. Wellness Programming, to be offered as part of an integrated chronic disease model, is currently in the development phase for this CHN; however; citizens living in these communities may visit the Dartmouth or Chebucto CHT if they have a family doctor or work in the area.
Community Health Network 4: Eastern Shore Musquodoboit Page | 65 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. 382 of these clients reside in CHN 4, which accounts for 7% of all Integrated Continuing Care clients in the district. Refer to Table 38 for a synopsis, by CHN and by type of client.
Table 38: 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 4 are listed below (Table 39) 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 4, Polling District 2: Preston – Porter’s Lake – Eastern Shore, has the higher number of referrals to community OT/PT in the CHN.
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 from a referral to Integrated Continuing Care, by numbered polling district (Integrated Continuing Care , CDHA, STAR Registrations for time period Fiscal 2013-2014) Community Health Network 4: Eastern Shore Musquodoboit Page | 66 Capital Health Community Clinical Services / Health System Planning Group (2014) Table 39: 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 40. 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 40: 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 41. 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 4: Eastern Shore Musquodoboit Page | 67 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 41: 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 4: Eastern Shore Musquodoboit Page | 68 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 42 describes the utilization of four ambulatory care clinics by residents of CHN 4 as a rate per 1000 population. Table 43 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 clinic types compared to the district average, with the exception being respirology (Table 42). • Residents of Middle Musquodoboit account for the highest total number of visits to all of the Ambulatory Clinics, with the exception of the Hypertension Clinic, for which residents of Porter’s Lake make the most visits (Table 43) • Residents of Middle Musquodoboit have the highest rate of patients per 1000 population accessing all four Ambulatory Clinics and the community of Middle Musquodoboit has among the highest utilization rates in the district for all clinics except for the hypertension clinic (Figures 53-56, below).
Table 42: 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 Chezzetcook 6.26 1.88 5.68 31.83 Jeddore 5.24 -- 4.58 29.12 Lake Echo -- -- 7.62 29.85 Middle Musquodoboit 15.16 5.06 23.46 78.33 Moser River 11.48 -- -- 14.60 Musquodoboit 8.22 -- 8.31 36.94 Harbour Porters Lake 4.20 4.11 9.14 30.99 Sheet Harbour 5.69 -- 5.62 28.11 Ship Harbour 9.38 -- 9.34 41.82 Upper Musquodoboit -- -- 12.28 27.32 CHN 4 Total 6.50 2.12 8.89 36.00 District Total 7.62 3.77 9.15 34.31
Source: STAR registrations, provided by the Department of Medicine and were based on visits during fiscal year 2011/2012 and 2012/2013, averaged to 1 year
Community Health Network 4: Eastern Shore Musquodoboit Page | 69 Capital Health Community Clinical Services / Health System Planning Group (2014)
Table 43: Ambulatory Clinic Usage by Community, total number of visits per clinic Endocrinology Community Hypertension Visits Cardiac Visits Respirology Visits Visits Chezzetcook 17.26 5.70 19.01 96.66 Jeddore 5.29 -- 6.06 33.70 Lake Echo 17.35 -- -- 67.97 Middle Musquodoboit 37.43 8.07 24.18 124.94 Moser River -- -- 7.52 9.56 Musquodoboit 15.20 -- 15.05 67.60 Harbour Porters Lake 21.70 9.75 9.96 73.54 Sheet Harbour 7.27 -- 7.36 36.35 Ship Harbour 14.25 -- 14.30 63.77 Upper Musquodoboit 10.39 -- -- 23.11 CHN 4 Total 147.48 35.19 107.80 597.21 District Total 3,031.15 1,248.82 2,526.25 11,372.75
Source: STAR registrations, provided by the Department of Medicine and were based on visits during fiscal year 2011/2012 and 2012/2013, averaged to 1 year
1. Cardiology
Figure 53: CHN 4 visits per 1000 population to the QEII Cardiology Heart Function Clinic (Department of Medicine, STAR data for fiscal 2011/12 and 2012/13 averaged, CUT Cd: CARHF)
Community Health Network 4: Eastern Shore Musquodoboit Page | 70 Capital Health Community Clinical Services / Health System Planning Group (2014) 2. Hypertension
Figure 54: CHN 4 visits per 1000 population to the QEII Hypertension Clinic. (Department of Medicine, STAR data for fiscal 2011/12 and 2012/13 averaged, CUT Cd: GMHY)
3. Endocrinology
Figure 55: CHN 4 visits per 1000 population to the QEII Endocrinology Clinic (Department of Medicine, STAR data for fiscal 2011/12 and 2012/13 averaged, CUT Cd: EN) Community Health Network 4: Eastern Shore Musquodoboit Page | 71 Capital Health Community Clinical Services / Health System Planning Group (2014) 4. Respirology
Figure 56: CHN 4 visits per 1000 population to QEII, Cobequid, Hants and DGH Respirology Clinics. (Department of Medicine, STAR data for fiscal 2011/12 and 2012/13 averaged, CUT Cd: CPP; RS;
Community Health Network 4: Eastern Shore Musquodoboit Page | 72 Capital Health Community Clinical Services / Health System Planning Group (2014) Ambulatory Care Clinics (Child/Youth – IWK Health Centre)
1. IWK Dentistry Clinic
CHN 4 has a lower rate of children/youth accessing the IWK Dentistry Clinic than the district rate, with 7.0 children/youth per 1000 population receiving care from the IWK Dentistry Clinic compared to 9.5 per 1000 child/youth population for the district23. The higher rate of the youth population accessing services occurs by residents of Middle Musquodoboit, with 13.65 children/youth per 1000 population accessing the Dentistry Clinic. Refer to Figure 57 and Table 44.
Figure 57: Rate of children/youth visits per 1000 population accessing the IWK Dentistry
Clinic for CHN 4 (IWK Health Centre, Meditech Registrations for Time Period Fiscal 2012-
Table 44: Visits to the IWK Ambulatory Dentistry Clinic for Fiscal 2012-2013 Community Visits Average Visits per Patient Patients per 1000 population Chezzetcook 8.88 1.75 6.01 Jeddore - -- -- Lake Echo ------Middle Musquodoboit 9.05 1.50 13.65 Moser River ------Musquodoboit Harbour 6.84 1.66 9.42 Porters Lake ------Sheet Harbour ------Ship Harbour 5.12 1.24 12.12 Upper Musquodoboit ------CHN 4 Total 47.51 1.41 6.99 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 4: Eastern Shore Musquodoboit Page | 73 Capital Health Community Clinical Services / Health System Planning Group (2014) 2. IWK Diabetes Clinic
The number of children/youth accessing the IWK Diabetes Clinic is low for CHN 4 and thus, data is not reportable at the community level. In total, 16 children/youth from CHN 4 received services from the IWK Diabetes Clinic, resulting in 41 visits, with an average of 2.6 visits per patient. The rate per 1000 population for this CHN is 3.4 patients per 1000 youth population24, which is higher than the district rate of 3.1 patients per 1000 youth population (Source: IWK Health Centre, Meditech Registrations for Time Period Fiscal 2012-2013).
3. IWK Chest Clinic (Respiratory and Breathing Conditions)
The number of children/youth accessing the IWK Chest Clinic is low for CHN 4 and thus, data is not reportable at the community level. 12 children/youth from CHN 4 received services from the IWK Chest Clinic, resulting in 23.4 total visits, with an average of 2.0 visits per client. The rate per 1000 population for this CHN 2.6 patients per 1000 youth population25, which is lower than the district rate of 3.1 patients per 1000 youth population (Source: IWK Health Centre, Meditech Registrations for Time Period Fiscal 2012-2013).
4. IWK Primary Health: Halifax Regional School Board (HRSB) Nurse Visits
Within CHN 4, there were 8 children/youth who were registered for a HRSB nursing visit (home or phone visit) from IWK Primary Health. There were a total of 14 visits by this group. Data is not reportable at the community level (Source: IWK Health Centre, Meditech Registrations for Time Period Fiscal 2012-2013).
5. IWK Primary Health: Extra Supports for Parents (Groups/Classes)
Within CHN 4, there were no people registered for extra support for parents services from IWK Primary Health (includes community clinics/sessions/groups, home visits) (Source: IWK Health Centre, Meditech Registrations for Time Period Fiscal 2012-2013).
24 Population of the community/CHN under 20 years of age. 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) 25 Population of the community/CHN under 20 years of age. 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 4: Eastern Shore Musquodoboit Page | 74 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.
Chezzetcook Total Deprivation: 4 Population: 3,916 Rurality: Rural Family Physicians: 0.0 FTE Material: 4 | Social: 4
What is distinctive about this community?
• Within the CHN, the higher number of births occurs within the community of Chezzetcook, which had 34 births in 2013. • Chezzetcook has the higher birth rate among women aged 35 to 49 years within the CHN • One of the communities in CHN 4 without a primary care provider practicing in the community • Chezzetcook, while having the lowest rate of population accessing Addictions Services, has the highest average number of visits per client, with each client having 14.6 visits
Community Health Network 4: Eastern Shore Musquodoboit Page | 75 Capital Health Community Clinical Services / Health System Planning Group (2014) Jeddore Total Deprivation: 3 Population: 1,445 Rurality: Rural Family Physicians: 0.0 FTE Material: 4 | Social: 4
What is distinctive about this community?
• For the population aged 15-24 years, the community with the highest percentage employed is Jeddore, with 76.2% of this age demographic reporting employment. • The community within the CHN with the highest birth rate is Jeddore, with on average, 43.77 births occurring per 1000 women aged 15 to 49 years in 2013 • When looking at births among women age 15 to 19 years, the communities within the CHN that have a birth rate higher than the district average are Jeddore, Musquodoboit Harbour, Ship Harbour, and Lake Echo. Jeddore has a highest rate of births among women aged 15 to 19 years in the CHN and this is among the highest rates for this age group in the district, with 34.09 births occurring per 1000 women aged 15 to 19 years in 2013. • Within the CHN, life expectancy is highest for males living in the community cluster of Jeddore/ Musquodoboit Harbour (78.0 years) • Jeddore has the lower rate of individuals receiving care from a family physician within the CHN for COPD, hypertension, and CHF • Although Jeddore has the lower rate of individuals receiving care for CHF from a family physician within the CHN, residents of Jeddore that do access care from an FP for CHF have a higher number of visits per patient (4.3 visits each, on average) • One of the communities in CHN 4 without a primary care provider practicing in the community
Community Health Network 4: Eastern Shore Musquodoboit Page | 76 Capital Health Community Clinical Services / Health System Planning Group (2014) Lake Echo Rurality: Rural (higher Total Deprivation: 1 Population: 3,044 Family Physicians: 0.0 FTE population density) Material: 2 | Social: 2
What is distinctive about this community?
• Generally speaking, CHN 4 has an older average age. The communities with the youngest average age include Lake Echo, Porters Lake and Middle Musquodoboit. • In CHN 4, Porters Lake (25.8%), followed by Lake Echo (25.3%) have the highest rate of the youth population (<20 years of age). • All communities within the CHN have a population density of less than 34 people per km2, with the exception of Lake Echo, which has the highest population density in the CHN (98.9 people per km2). • The communities with the higher percentage of residents speaking languages other than English at home are Porter’s Lake and Lake Echo, both having 2.2% of residents reporting speaking a language other than English at home. • Within CHN 4, the communities with the highest total deprivation are Moser River, Sheet Harbour, and Ship Harbour. The community with the lowest total deprivation is Lake Echo. • Within the CHN, the community with the higher percentage of lone parent families is Lake Echo (18.1%). • The community of Lake Echo has a lower material deprivation score within the CHN (2). • The community with the lowest number of people without a high school education (or highest percentage of high school completion) is Lake Echo (16.1% without a high school education). • Those residing in the community of Porter’s Lake, Lake Echo, and Middle Musquodoboit have among the highest rates per 1000 population for receiving care from a specialist for a diagnosis of diabetes across the CHN and the district. • One of the communities in CHN 4 without a primary care provider practicing in the community
Community Health Network 4: Eastern Shore Musquodoboit Page | 77 Capital Health Community Clinical Services / Health System Planning Group (2014) Middle Musquodoboit Family Physicians: 4.0 FTE + Total Deprivation: 4 Population: 2,055 Rurality: Rural 1.0 Nurse Practitioner Material: 4 | Social: 3
What is distinctive about this community?
• Within the CHN, the community that is projected to have the highest percentage of population growth over the next five and ten years is Middle Musquodoboit; the community’s population will increase by 67% by 2019 and will result in a 64% increase over a ten year period by 2024. • In addition to experiencing the largest population growth by percentage, Middle Musquodoboit will also see the higher percentage of growth in both the senior and youth populations, each increasing by 29% and 184%, respectively, by 2024. • Generally speaking, CHN 4 has an older average age. The communities with the youngest average age include Lake Echo, Porters Lake and Middle Musquodoboit. • Within the CHN, the higher percentage of people identifying as a visible minority reside in Musquodoboit Harbour (3.8%), Porter's Lake (3%), and Middle Musquodoboit (2.9%). • In the CHN, life expectancy at birth is lowest for females (80.6 years) and males (73.3 years) living in the community cluster of Upper/Middle Musquodoboit • The communities of Ship Harbour, Sheet Harbour, and Middle Musquodoboit have among the highest rates of the population receiving care from an FP for diabetes in the district. • Those residing in the community of Porter’s Lake, Lake Echo, and Middle Musquodoboit have among the highest rates per 1000 population for receiving care from a specialist for a diagnosis of diabetes across the CHN and the district. • The community with the higher rate of the population seeing a specialist for COPD is Middle Musquodoboit, which is among the highest rates in the district. • There is a lower rate of the population accessing specialist care for a diagnosis of CHF within CHN 4, with the higher rate occurring among those residing in Middle Musquodoboit • The highest number of working family physicians per 1000 population practice in Sheet Harbour and Middle Musquodoboit. • As a rate per 1000 population, Middle Musquodoboit has the higher rate of visits of high acuity to the ED (341.4 visits per 1000 population) and as well the highest rate of visits to the ED for visits of low acuity (162.5 visits per 1000 population) within the CHN. • Within the CHN, Middle Musquodoboit has the higher volume of visits, and the highest number of clients per 1000 population accessing Addictions Services, which is among the highest in the district. • Residents of Middle Musquodoboit account for the highest total number of visits to all of the Ambulatory Clinics, with the exception of the Hypertension Clinic, for which residents of Porter’s Lake make the most visits. Residents of Middle Musquodoboit have the highest rate of patients per 1000 population accessing all four Ambulatory Clinics and the community of Middle Musquodoboit has among the highest utilization rates in the district for all clinics except for the hypertension clinic. • The higher rate of the child/youth population in the CHN accessing the IWK Dentistry Clinic occurs by residents of Middle Musquodoboit, with 13.65 children/youth per 1000 population accessing the Dentistry Clinic. • Within the CHN, the community of Middle Musquodoboit has the highest rate of the population accessing Community Mental Health, having 53.5 clients per 1000 population. This is among the highest rates in the district. • Within the CHN, the community with the higher number of IWK Mental Health clients per 1000 youth population is Middle Musquodoboit, with 71.4 clients per 1000 youth population accessing services, which is among the highest rates in the district
Community Health Network 4: Eastern Shore Musquodoboit Page | 78 Capital Health Community Clinical Services / Health System Planning Group (2014) Moser River Total Deprivation: 5 Population: 794 Rurality: Rural Family Physicians: 0.0 FTE Material: 5 | Social: 5
What is distinctive about this community?
• The community within the CHN that will experience the greatest decrease in population is Moser River; the community’s population is expected to drop by 58% by the year 2024. In addition to experiencing the largest population decline by percentage, Moser River will also see the higher percentage of decline in both the senior and youth populations, each decreasing by 72% and 38%, respectively, by 2024. • The majority of residents in the CHN report ‘vehicle’ as their predominant method of transportation to and from work (94.6%, highest in the district). Of note is Moser River, where 11.5% of residents report walking to work. • The communities with the oldest average include Ship Harbour, Sheet Harbour, and Moser River. • The communities in CHN 4 that have the highest percentage of people who identify as Aboriginal are Moser River (6.1%) and Sheet Harbour (6.0%). • The communities within the CHN with the higher percentage of the population aged 65 and above are Moser River (28.0%), Sheet Harbour (27.7%), Ship Harbour (24.1%), and Musquodoboit Harbour (20.1%) all of which are much higher percentages than the district average of 13.3%. • Within CHN 4, the communities with the highest total deprivation are Moser River, Sheet Harbour, and Ship Harbour. • Within the CHN, the community of highest social deprivation is Moser River. • Within the CHN, the communities of the highest material deprivation are Moser River, Sheet Harbour, Ship Harbour, and Upper Musquodoboit. • Within the CHN and also within the district, Moser River has the lowest average family income ($43,978) and the lowest average individual income ($21,685). • Within the CHN, the community with the highest percentage of low income families is Sheet Harbour (16.2%), followed by Moser River (16.0%). • Within the CHN, the community of Musquodoboit Harbour (n=76), followed by Moser River (n=64), have the greatest number of households receiving employment support and income assistance provincially • The community within the CHN with the highest number of citizens without a high school education is Moser River, where 54.2% of citizens are without a high school education, which is the highest proportion in the district. • The community with the lowest percentage of the population 25 years of age or older employed is Moser River, with only 36.0% employed, which is the lowest employment percentage for a community in the district. • Moser River has the lower rate of individuals receiving care for diabetes from a family physician within the CHN, with 57.0 citizens per 1000 population receiving care; however, for those accessing services, they have a higher number of visits per patients when compared to other communities across the CHN. • There is generally a lower rate of people accessing specialist care for the four aforementioned chronic conditions in Moser River • One of the communities in CHN 4 without a primary care provider practicing in the community
Community Health Network 4: Eastern Shore Musquodoboit Page | 79 Capital Health Community Clinical Services / Health System Planning Group (2014) Musquodoboit Harbour Total Deprivation: 3 Population: 2,251 Rurality: Rural Family Physicians: 2.4 FTE Material: 3 | Social: 3
What is distinctive about this community?
• The communities within the CHN with the higher percentage of the population aged 65 and above are Moser River (28.0%), Sheet Harbour (27.7%), Ship Harbour (24.1%), and Musquodoboit Harbour (20.1%) all of which are much higher percentages than the district average of 13.3%. • Within the CHN, the higher percentage of people identifying as a visible minority reside in Musquodoboit Harbour (3.8%), Porter's Lake (3%), and Middle Musquodoboit (2.9%). • Of the communities in CHN 4, the community with the higher percentage of the population identifying as being an immigrant to Canada is Musquodoboit Harbour (5.5% of the population). • Musquodoboit Harbour has the lowest number of low income families (2.7%) within the CHN. • Within the CHN, the community of Musquodoboit Harbour (n=76), followed by Moser River (n=64), have the greatest number of households receiving employment support and income assistance provincially • Within the CHN, life expectancy is highest for males living in the community cluster of Jeddore/ Musquodoboit Harbour (78.0 years)
Community Health Network 4: Eastern Shore Musquodoboit Page | 80 Capital Health Community Clinical Services / Health System Planning Group (2014) Porters Lake Family Physicians: 1.8 FTE + Total Deprivation: 2 Population: 3,202 Rurality: Rural 1.0 Nurse Practitioner Material: 3 | Social: 2
What is distinctive about this community?
• There is no access to regular public transportation in CHN 4, with the exception being a commuter (MetroX) that goes to Porters Lake twice a day. • Generally speaking, CHN 4 has an older average age. The communities with the youngest average age include Lake Echo, Porters Lake and Middle Musquodoboit. • In CHN 4, Porters Lake (25.8%), followed by Lake Echo (25.3%) have the highest rate of the youth population (<20 years of age). • Within the CHN, the higher percentage of people identifying as a visible minority reside in Musquodoboit Harbour (3.8%), Porter's Lake (3%), and Middle Musquodoboit (2.9%). • The communities with the higher percentage of residents speaking languages other than English at home are Porter’s Lake and Lake Echo, both having 2.2% of residents reporting speaking a language other than English at home. • Within the CHN, Porters Lake has the higher average family income ($78,753) and the higher average individual income ($38,375). • Based on data from 2008-2012 from the Halifax Regional Police (HRP) only, in CHN 4, the higher volume of crime occurs in the community of Porters Lake. • Those residing in the community of Porter’s Lake, Lake Echo, and Middle Musquodoboit have among the highest rates per 1000 population for receiving care from a specialist for a diagnosis of diabetes. across the CHN and the district. Specifically, those residing in the community of Porter’s Lake have the highest rate within the CHN (34 patients per 1000 population). • Within the CHN, the rate of patients accessing a specialist for a diagnosis of hypertension is higher in the community of Porter’s Lake (7.6 patients per 1000 population). • Within the CHN, the community with the highest volume of ED visits for both levels of acuity is Porter’s Lake. • Within the CHN, Porter’s Lake is the community with the highest volume of IWK ED visits for both levels of acuity, the community with the higher rate of visits of high acuity (68.36 visits per 1000 population) and low acuity (131.3 visits per 1000 population). • Residents of Middle Musquodoboit account for the highest total number of visits to all of the Ambulatory Clinics, with the exception of the Hypertension Clinic, for which residents of Porter’s Lake make the most visits • Residents of Porter’s Lake make the higher number of clients and account for the higher volume of visits to CDHA Community Mental Health within the CHN
Community Health Network 4: Eastern Shore Musquodoboit Page | 81 Capital Health Community Clinical Services / Health System Planning Group (2014) Sheet Harbour Family Physicians: 3.7 FTE + Total Deprivation: 5 Population: 1,562 Rurality: Rural 1.0 Nurse Practitioner Material: 5 | Social: 4
What is distinctive about this community?
• The communities with the oldest average include Ship Harbour, Sheet Harbour, and Moser River. • Sheet Harbour is the community with the lowest rate of the population under 20 years of age (17.5%). • The communities within the CHN with the higher percentage of the population aged 65 and above are Moser River (28.0%), Sheet Harbour (27.7%), Ship Harbour (24.1%), and Musquodoboit Harbour (20.1%) all of which are much higher percentages than the district average of 13.3%. • Within CHN 4, the communities with the highest total deprivation are Moser River, Sheet Harbour, and Ship Harbour. • Within the CHN, the communities of the highest material deprivation are Moser River, Sheet Harbour, Ship Harbour, and Upper Musquodoboit. • Together with Moser River, Upper Musquodoboit and Sheet Harbour are also among the communities in the district with the lowest family income. • Within the CHN, the community with the highest percentage of low income families is Sheet Harbour (16.2%), followed by Moser River (16.0%). • A general trend observed within the CHN is that Sheet Harbour and Ship Harbour have a higher rate of the population receiving care for chronic conditions • The communities of Ship Harbour, Sheet Harbour, and Middle Musquodoboit have among the highest rates of the population receiving care from an FP for diabetes in the district. • The communities of Sheet Harbour and Ship Harbour have among the highest rates of the population receiving care from an FP for COPD in the district. Specifically, Sheet Harbour has the highest rate within the CHN, with 122.9 people per 1000 population receiving care from a family physician for COPD, which translates to 12.3% of the population. • The communities of Sheet Harbour and Ship Harbour have among the highest rates of the population receiving care from an FP for CHF across the district. Specifically, Sheet Harbour has the highest rate of people receiving care for CHF within the CHN and also within the district, with 26.2 people per 1000 population receiving care for CHF. • The communities of Sheet Harbour and Ship Harbour have among the highest rate of the population accessing care from a family physician for a diagnosis of hypertension across the district. Specifically, Sheet Harbour has the highest rate of people receiving care for hypertension within the CHN and also within the district, with 395.7 people per 1000 population receiving care for hypertension, which translates to approximately 40% of the population. • The highest number of working family physicians per 1000 population practice in Sheet Harbour and Middle Musquodoboit.
Community Health Network 4: Eastern Shore Musquodoboit Page | 82 Capital Health Community Clinical Services / Health System Planning Group (2014) Ship Harbour Total Deprivation: 5 Population: 1,869 Rurality: Rural Family Physicians: 0.0 FTE Material: 5 | Social: 3
What is distinctive about this community?
• The communities with the oldest average include Ship Harbour, Sheet Harbour, and Moser River. • The community within the CHN with the highest percentage of the population aged 50 to 64 years is Ship Harbour (28.5% of the population). • The communities within the CHN with the higher percentage of the population aged 65 and above are Moser River (28.0%), Sheet Harbour (27.7%), Ship Harbour (24.1%), and Musquodoboit Harbour (20.1%) all of which are much higher percentages than the district average of 13.3%. • Within the CHN, the communities of the highest material deprivation are Moser River, Sheet Harbour, Ship Harbour, and Upper Musquodoboit. • Ship Harbour has the higher birth rate per 1000 women aged 20 to 34 years within the CHN • With the exception of Ship Harbour, all communities in CHN 4 have a lower female life expectancy at birth than the district average. Within the CHN, life expectancy at birth is highest for females in the community of Ship Harbour (83.8 years) • A general trend observed within the CHN is that Sheet Harbour and Ship Harbour have a higher rate of the population receiving care for chronic conditions • The communities of Ship Harbour, Sheet Harbour, and Middle Musquodoboit have among the highest rates of the population receiving care from an FP for diabetes in the district. Specifically, Ship Harbour has the highest rate within the CHN and within the district, with 152.3 people per 1000 population receiving care from a family physician for diabetes, which translates to 15.2% of the population. • The communities of Sheet Harbour and Ship Harbour have among the highest rates of people per 1000 population receiving care from an FP for COPD and CHF in the district. • One of the communities in CHN 4 without a primary care provider practicing in the community
Community Health Network 4: Eastern Shore Musquodoboit Page | 83 Capital Health Community Clinical Services / Health System Planning Group (2014) Upper Musquodoboit Total Deprivation: 4 Population: 1,071 Rurality: Rural Family Physicians: 0.0 FTE Material: 5 | Social: 1
What is distinctive about this community?
• In addition to Moser River, Upper Musquodoboit will also experience a high percentage of population decline in future years. • The community in CHN 4 with the greater density of public housing units per 1000 population is Upper Musquodoboit. • The community in the lowest category of social deprivation is Upper Musquodoboit. • Within the CHN, the communities of the highest material deprivation are Moser River, Sheet Harbour, Ship Harbour, and Upper Musquodoboit. • Together with Moser River, Upper Musquodoboit and Sheet Harbour are also among the communities in the district with the lowest family income. • In the CHN, life expectancy at birth is lowest for females living in the community cluster of Upper/Middle Musquodoboit (80.6 years) • In the CHN, life expectancy at birth is lowest for females (80.6 years) and males (73.3 years) living in the community cluster of Upper/Middle Musquodoboit • One of the communities in CHN 4 without a primary care provider practicing in the community
Community Health Network 4: Eastern Shore Musquodoboit Page | 84 Capital Health Community Clinical Services / Health System Planning Group (2014)
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 4: Eastern Shore Musquodoboit Page | 85 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
Community Health Network 4: Eastern Shore Musquodoboit Page | 86 Capital Health Community Clinical Services / Health System Planning Group (2014)
• 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 4: Eastern Shore Musquodoboit Page | 87 Capital Health Community Clinical Services / Health System Planning Group (2014) Appendix B: Table of Contents
COMMUNITY PROFILE Overview ...... 1 Table of Contents ...... 1 GEOGRAPHY ...... 1 Community Composition ...... 2 Rurality ...... 3 Population Projections ...... 4 COMMUNITY HEALTH BOARD (CHB) ENGAGEMENT ...... 6 Eastern Shore Musquodoboit Community Health Board findings from 2013 Community Health Plan .....6 COMMUNITY HEALTH NETWORK INVENTORY ...... 7 Food Sources ...... 7 Transportation ...... 9 Recreation Locations ...... 10 Public Housing ...... 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 ...... 25 Employment & Education ...... 27 Birth Data ...... 28 Crime Rates – Halifax Regional Police ...... 30 Crime Rates – RCMP ...... 31 Nova Scotia School Test Results ...... 33 COMMUNITY HEALTH NETWORK HEALTH STATUS ...... 34 Community Engagement – 2013 Community Health Plan ...... 34 2009-2010 Canadian Community Health Survey Data for Self-Reported Health Status...... 34 Sexually Transmitted Infections (STIs) ...... 37 Disability ...... 38 Life Expectancy at Birth ...... 39
Community Health Network 4: Eastern Shore Musquodoboit Page | 88 Capital Health Community Clinical Services / Health System Planning Group (2014) Causes of Death ...... 40 Family Physician Visits by Chronic Disease Diagnosis ...... 41 Specialist Visits for Chronic Disease (Summary) ...... 47 COMMUNITY HEALTH NETWORK SERVICE DELIVERY LOCATIONS ...... 50 Capital Health Community-Based Service Locations ...... 50 Family Practice in CHN 4 ...... 51 Community Pharmacies...... 53 Nursing Home Locations...... 54 COMMUNITY HEALTH SERVICES UTILIZATION ...... 55 Emergency Department Visits (Adult – Capital Health) ...... 55 Emergency Department Visits (Child/Youth – IWK) ...... 57 Hospital Admissions ...... 59 Ambulatory Care Sensitive Conditions ...... 59 Community Mental Health and Addictions Services ...... 60 Youth Health Centres ...... 65 Community Health Teams ...... 65 Integrated Continuing Care ...... 66 1. Integrated Continuing Care Client Summary ...... 66 2. Community Occupational Therapy and Physiotherapy Services ...... 66 3. Home Care and/or Nursing Support Services ...... 67 4. Care Plans, By Type ...... 67 Ambulatory Care Clinics (Adult – Capital Health) ...... 69 Ambulatory Care Clinics (Child/Youth – IWK Health Centre) ...... 73 IWK Primary Health: Halifax Regional School Board (HRSB) Nurse Visits ...... 74 IWK Primary Health: Extra Supports for Parents (Groups/Classes) ...... 74 COMMUNITY SUMMARIES ...... 55 Chezzetcook ...... 75 Jeddore ...... 76 Lake Echo ...... 77 Middle Musquodoboit ...... 78 Moser River ...... 79 Musquodoboit Harbour ...... 80 Porters Lake ...... 81 Sheet Harbour ...... 82 Ship Harbour ...... 83 Upper Musquodoboit ...... 84
Community Health Network 4: Eastern Shore Musquodoboit Page | 89 Capital Health Community Clinical Services / Health System Planning Group (2014) APPENDIX ...... 86 Appendix A: List of Contributors ...... 86 Appendix B: Table of Contents ...... 88 Appendix C: List of Figures ...... 91 Appendix D: List of Tables ...... 93 Appendix E: Community Profiles Data Disclaimer ...... 95 Appendix F: Detailed 2019 (5 Year) and 2024 (10 Year) Population Projections for Capital Health...... 96
Community Health Network 4: Eastern Shore Musquodoboit Page | 90 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 ...... 13 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 ...... 25
Figure 21: Percentage of low income families ...... 25
Figure 22: Number of households receiving provincial income assistance/employment support ...... 26 Figure 23: Birth rate per 1000 women aged 15-49 ...... 28 Figure 24: HRP Crime occurrences by type ...... 30 Figure 25: RCMP Policing Districts aligned with the CHN ...... 31 Community Health Network Health Status ...... 34 Figure 26: Self-reported risk factors reported by Community Health Network ...... 34 Figure 27: Self-reported chronic conditions reported by Community Health Network ...... 35
Community Health Network 4: Eastern Shore Musquodoboit Page | 91 Capital Health Community Clinical Services / Health System Planning Group (2014) Figure 28: Rate of individuals receiving care from a family physician for diabetes ...... 41 Figure 29: Rate of individuals receiving care from a family physician for COPD ...... 43 Figure 30: Rate of individuals receiving care from a family physician for congestive heart failure ...... 44 Figure 31: Rate of individuals receiving care from a family physician for hypertension ...... 45 Figure 32: Rate of the population receiving specialist care for diabetes ...... 48 Figure 33: Rate of the population receiving specialist care for hypertension ...... 48 Figure 34: Rate of the population receiving specialist care for COPD ...... 49 Figure 35: Rate of the population receiving specialist care for congestive heart failure ...... 49 Community Health Network Service Delivery Locations ...... 52 Figure 36: Capital Health Community Based Programs and Services locations ...... 50 Figure 37: Family Practice locations in CHN ...... 51 Figure 38: Family physician FTE per 1000 population ...... 51 Figure 39: Community-based pharmacy locations ...... 53 Figure 40: Nursing Home and Residential Care Facility locations in CHN ...... 54 Community Service Utilization Data ...... 55 Figure 41: Emergency department utilization for a visit of high acuity (adult) ...... 56 Figure 42: Emergency department utilization for a visit of low acuity (adult) ...... 56 Figure 43: Emergency department utilization for a visit of high acuity (child/youth) ...... 58 Figure 44: Emergency department utilization for a visit of low acuity (child/youth) ...... 58 Figure 45: Rate of clients accessing CDHA Addictions Community Based Services (adult) ...... 60 Figure 46: Rate of clients accessing CDHA Community Mental Health Services (adult) ...... 62 Figure 47: Rate of clients accessing IWK Mental Health Services (child/youth) ...... 64 Figure 48: Youth Health Centre locations and reasons for visit ...... 65 Figure 49: Community OT/PT utilization via referral to Integrated Continuing Care (polling district) ... 66 Figure 53: Rate of patients accessing the QEII Cardiology Heart Function Clinic ...... 70 Figure 54: Rate of patients accessing the QEII Hypertension Clinic ...... 71 Figure 55: Rate of patients accessing the QEII Endocrinology Clinic ...... 71 Figure 56: Rate of patients accessing QEII, Cobequid, Hants and DGH Respirology Clinics ...... 72 Figure 57: Rate of children/youth per 1000 accessing the IWK Dentistry Clinic ...... 73
Community Health Network 4: Eastern Shore Musquodoboit Page | 92 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 ...... 14 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 ...... 27 Table 12: Birth data ...... 29 Table 13: Total number of crimes occurring, by type, as reported by Halifax Regional Police ...... 31 Table 14: Total number of crimes occurring, by type, in RCMP Policing Districts ...... 32 Table 15: CHN School Test Scores 2013-2014 ...... 33 Community Health Network Health Status ...... 34 Table 16: Health Concerns – CHB Community Consultations ...... 34 Table 17: Summary of Selected Self-reported Chronic Diseases and Risk Factors ...... 35 Table 18: Health Status indicator by CHN and compared to CDHA and Nova Scotia and Canada ...... 36 Table 19: Incidence Rates of sexually transmitted infections in Capital Health ...... 37 Table 20: Disability Prevalence for Nova Scotia, by age category for the population aged 15+ ...... 38 Table 21: Life expectancy at birth, by community and by sex ...... 39 Table 22: Causes of Death for NS and CDHA ...... 40 Table 23: CHN overview of citizens receiving care for diabetes from a family physician ...... 42 Table 24: CHN overview of citizens receiving care for COPD from a family physician ...... 44 Table 25: CHN overview of citizens receiving care for CHF from a family physician ...... 45
Table 26: CHN overview of citizens receiving care for hypertension from a family physician ...... 46
Community Health Network 4: Eastern Shore Musquodoboit Page | 93 Capital Health Community Clinical Services / Health System Planning Group (2014) Table 27: Rate of specialist utilization for four chronic conditions ...... 47
Community Health Network Service Delivery Locations ...... 50 Table 28: Capital Health Community Based Locations, by Department/Program Area ...... 50 Table 29: Nursing Home and RCF locations and number of beds, by community ...... 54 Community Service Utilization Data ...... 54 Table 30: Emergency Department Utilization for Adults using CDHA Emergency Departments ...... 55 Table 31: Emergency Department Utilization for children/youth at the IWK Health Centre ...... 57 Table 32: Hospital admissions by diagnosis ...... 59 Table 33: Hospital re-admissions by diagnosis ...... 59 Table 34: Ambulatory care sensitive condition rates ...... 59 Table 35: Addictions Community Based Services Utilization (Adults – Capital Health) ...... 61 Table 36: Community Mental Health Services Utilization (Adults – Capital Health) ...... 63 Table 37: Mental Health Services Utilization (Child/youth – IWK Health Centre) ...... 64 Table 38: Integrated Continuing Care client overview by CHN ...... 66 Table 39: Integrated Continuing Care referrals to community OT/PT by polling district ...... 67 Table 40: Home care and/or nursing support client summary ...... 67 Table 41: Care plans created by type and age category for CDHA Continuing Care clients ...... 68 Table 42: Rate of ambulatory care clinic usage by community ...... 69 Table 43: Total number of visits per ambulatory clinic, by community ...... 70 Table 44: IWK Ambulatory Dentistry Clinic Utilization by Children/Youth ...... 73 Summary of Observations by Community ...... 79
Community Health Network 4: Eastern Shore Musquodoboit Page | 94 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.
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Community Health Network 4: Eastern Shore Musquodoboit Page | 95 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 4: Eastern Shore Musquodoboit
2014 2019 2024 Youth years) 2019 % 2019 % Change Change Change Change Change Change Change Change Change Change 2024 % 2024 % 65+ Net 65+ Net Youth % % Youth 65+ % % 2019 Net 2024 Net Projected Projected Projected % Change 2019 (65+ Youth Net Net Youth Net Youth Population Population Population 2014 Youth 2019 Youth 2024 Youth 2014 Seniors 2024 Seniors Community % Change 65+ Chezzetcook 3,916 847 463 2,908 -1,008 -26 452 -395 -47 593 130 28 3,061 -855 -22 457 -390 -46 708 245 53 Jeddore 1,445 290 257 1,047 -398 -28 144 -146 -50 297 40 15 995 -450 -31 127 -163 -56 319 62 24 Lake Echo 3,044 769 269 2,714 -330 -11 596 -173 -23 421 152 56 2,824 -220 -7 599 -170 -22 555 286 106 Middle 2,055 442 347 3,430 1,375 67 604 162 37 870 523 151 3,379 1,324 64 570 128 29 984 637 184 Musquodoboit Moser River 794 145 222 350 -444 -56 48 -97 -67 127 -95 -43 334 -460 -58 41 -104 -72 138 -84 -38 Musquodoboit 2,251 438 453 1,991 -260 -12 278 -160 -36 648 195 43 2,043 -208 -9 274 -164 -38 760 307 68 Harbour Porters Lake 3,202 827 349 4,004 802 25 832 5 1 657 308 88 4,234 1,032 32 847 20 2 854 505 145 Sheet Harbour 1,562 273 433 1,228 -334 -21 156 -117 -43 449 16 4 1,178 -384 -25 137 -136 -50 479 46 11 Ship Harbour 1,869 341 450 1,895 26 1 269 -72 -21 622 172 38 1,811 -58 -3 244 -97 -29 666 216 48 Upper 1,071 203 198 618 -453 -42 97 -106 -52 156 -42 -21 586 -485 -45 88 -115 -57 164 -34 -17 Musquodoboit CHN 4 21,209 4,575 3,441 20,185 -1,024 -5 3,476 -1,099 -24 4,840 1,399 41 20,447 -762 -4 3,383 -1,192 -26 5,625 2,184 63 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 4: Eastern Shore Musquodoboit Page | 96