Virtual Dermatologic Care in Rural and Remote Canadian Indigenous Communities

Balancing Cost, Quality and Access

Abstract

According to Statistics Canada (2021), approximately 18% of Canadians live in rural and remote areas. Although rural population growth is being outpaced by urban growth rates and is decreasing in some provinces, from 2016 to 2021 Canada’s overall rural population growth increased by 0.4%, with the fastest growth observed in Nunavut and Prince Edward Island. Canada’s three territories (Yukon, Northwest Territories and Nunavut), the Atlantic provinces, Manitoba, and Saskatchewan have higher proportions of rural representation than the national average. As skin specialists, dermatologists are most commonly based in urban centres. As a result, geographic disparity exists regarding equitable access to dermatologists for patients from rural and remote areas of Canada, which can result in increased skin disease morbidity.

The degree of remoteness varies within Canada and can be classified by the index of remoteness value, which is considered a fundamental determinant of health access. Examples of this include the fact that remote areas face relatively high shipping costs, and distance and proximity are substantial barriers to healthcare access. Even minor distance travel requirements may be associated with early non-adherence to dermatologic care, as in the case of compliance with appointments for phototherapy. Canadian Indigenous communities tend to be located in remote areas and therefore are disproportionately impacted. The COVID-19 pandemic has created even larger gaps in healthcare access and have increased health disparities for rural and remote Canadian Indigenous communities.