2016 University of Victoria Health Services

2017 Annual Summary

Respectfully submitted by

Judith Burgess, RN, PhD Director of Health Services

2016-2017 University of Victoria Health Services Annual Summary

About the University of Victoria Student Population The University of Victoria (UVic) enrollment exceeded 21,500 students, with 85% undergraduates and 15% graduate students. UVic welcomes diversity and attracts international students (16%), students with disability (0.5%), indigenous students (4%), and students of all genders and identities. More than 75% of students move to Victoria to attend school, which means they do not have ready access to a family physician, and come to rely on University Health Services for their care.

About the University Health Services (UHS) UHS is a unit within the Student Services department in the Division of Student Affairs and is located in the Petersen Health Centre. The Centre is home to an interprofessional team of practitioners, staff, and visiting specialists who provide primary health care, population health, and focused specialized medicine for the student population, as well as urgent care for the local campus community. Funding revenues are obtained in cost sharing from Island Health for Physician Compensation, Primary Health Care, and Psychiatry support, along with UVic commitments, contributions, and small grants.

Patient Health Care Delivery UHS is a first point of contact for comprehensive and confidential student health care. And with each year UHS manages a large number of new patient intakes (2705 for 2016-17). Practitioners use a shared-care approach to address a full range of health concerns including health screening, medical assessments, self-care education/coaching, pharmacology, treatments and therapy, care coordination, and referral to on-site psychiatry or other community specialists. We collaborate with and refer students to campus and community resources and to Island Health for specialized programs and hospital care.

UHS Interprofessional Team: Director of Health Services 1 FTE Physicians 5.0 FTE (10) Nurses 3 FTE (5) Health & Wellness 1.2 FTE (2) Nurse Practitioner Faculty 0.1 FTE (2)

Admin Staff 2 FTE Office staff 6 FTE (6) Psychiatrists 1.4 FTE (3) Counsellor 1 FTE Visiting Eating Disorder counsellors 2 weekly

UHS Patient Encounters UHS offers rapid access, scheduled and urgent care appointments Monday to Friday 8:30-4:30 plus Wednesday evening clinic and a physician on call for after hours. During fall/spring semesters 5-6 physicians are present each day and 2-3 during the summer.

• Physician service hours totalled 9483, exceeding the required 8215 hours/year • Physician/nurse team provided 20,561 billed visits, in 8901 patient care hours, • UHS served 6730 active patients (3.1 visits/patient) and had 2705 new patient intakes • Demand exceeded capacity, requiring 2451 students to be triage/rerouted to local walk-in clinics • Patient acute care deferral: 150 ER deferrals; 249 major wound deferrals; 112 Daybed care. IN TOTAL FOR 2016-17: UHS practitioners provided 25,368 in-clinic patient visits

Critical incidence and acuity is common at UHS. Responsive care is provided for critical illness and hospitalizations, physical injuries and accidents, complex mental health crisis, and alcohol / drug over-use.

We also work closely with IH Public Health to provide campus wide immunizations and campaigns, and help manage communicable disease outbreaks and communication responses.

Practice Profile: • 29% of episodic care visits (rapid access) • 87% of continuing care visits (2 or more visits) • 25% of mental health visits (MH diagnostics)

Population Health Approach UHS coordinates initiatives and fosters partnerships to promote a healthy student campus. Using a population health approach, we focus on specific student groups or health issues to provide targeted programs and interventions. For population health, we report here on mental health/psychiatry, substance use, sexual health, public health, injury care, and health and wellness. We also use various evaluation tools to better understand the unique health issues of students and young adults. This past year we undertook the NCHA-2016 study.

National College Health Assessment UHS coordinated the 2016 National College Health Assessment (NCHA) Canadian version. This is an online-validated survey managed by the American College Health Association. UVic participated in the spring of 2016, along with 41 other Canadian post secondary institutions, and built upon the previous 2013 NCHA study and database. NCHA offers a snapshot of the health habits, behaviours and perceptions of students, and is helpful in providing evidence for policy, program and service development, as well as identifying student patterns and trends overtime. See the UHS website for a PowerPoint outlining our data analytics: http://www.uvic.ca/services/health/ Mental Health and Psychiatry Students typically experience stress in competitive academic environments, including such stressors as moving to a new city or academic setting, forming new relationships, managing finances, and handling lifestyle decisions. As stress increases, students develop signs and symptoms of distress, including sleep disturbance, headaches, fatigue, sadness, irritability, weight gain or loss, poor coping or decision-making, and academic troubles. Students with these resultant health problems and mental health concerns need access to health care resources. UHS partners with Island Health for physician services and access to campus psychiatry as well as partners with Ministry for Children and Family Development for a campus eating disorder clinic. Physicians refer students to psychiatrists and on-site counsellors when mental health conditions, such as mood, anxiety, bipolar illness, eating disorders, and emotional dysregulation, become complex or exacerbate. We also coordinate student care with hospital when patient illness requires a step-up approach and with campus resources such as Counselling Services and Resource Centre for Students with Disability when illness is stabilized and step down care is suitable.

Mental Health Metrics 2016-17 Unique patient data Practice - visit data

Mental Health patient profile 25.26% of unique patients with MH diagnosis

26.41% of physician visits were MH related

Specific to anxiety and depression Codes 3000, 300, 296, 311 1294 unique patients 3820 visits (425 had 4+ visits)

Psychiatry patient profile PIT collaborative appointments

367 unique patients 150 unique patients

2013 visits 163 visits

UHS counsellor visits (referred by physician/psychiatry for individual CBT 190 unique patients 769 visits

Group clinic programs • Eating Disorder clinic patients • ADHD group clinic patients • Managing Emotions group patients

64 unique patients

391 visits 57 visits 189 visits

The PIT project: To enhance and evaluate a mental health team in a university setting The Psychiatric Interdisciplinary Team (PIT) Project is coming to completion this summer. Dissemination of team experiences and findings are underway (e.g., conferences, webinars, and publications). Several benefits have been documented by the project study. Students wait significantly less time to see a psychiatrist due to implementation of pit appointments that consist of a collaborative consultation with psychiatrist, physician and patient. Additional and enhanced services have also been made available for suitable students, such as access to a mental health nurse care coordinator for on and off campus services, short-term cognitive behavioural therapy for anxiety and depression, as well as a program for students with emotional dysregulation. Funding for this initiative was provided by the Specialist Services Committee (SSC), a joint collaborative committee of Doctors of BC and the BC Ministry of Health. Island Health, University of Victoria’s Health Services and the School of Health Information Science also supported this project with contributions in kind. Substance Use Going forward, the ‘Changing the Culture of Substance Use’ project work will be included as part of the UVic’s ‘Student Mental Health Strategy’, and the ‘Sexualized Violence policy and planning’, in order to strengthen an institutional response to substance use. Residence Services will continue to apply our collective learning and strategies. UHS has focused this year on harm reduction, including training of Campus Security first responders to carry naloxone nasal spray for overdose incidences; holding a student event on fentanyl related harms, offering dinner basket conversations to students, and opening a harm reduction supply cupboard with student volunteers located in the Student Union Building. Sexual Health The sexual health clinics function with structured time for physicians to see patients for IUD insertions, paps and STIs, while nurses provide contraceptive and sexual health counselling, pre-teaching for IUDs, STI screening, and pregnancy tests.

Sexual Health Metrics 2016-17 Unique patient data Practice - visit data Sexual health patient profile 1824 3158

Contraceptive care: IUD insertions

909 228

1227 n/a

STI testing 455 607

Public Health Nurses oversee the campus immunization program and hold specific vaccine campaigns. This year the Flu Shot campaign engaged the help of xxx students from Island Medical Program and School of Nursing. We held a first Meningitis clinic to close the gap between the improved BC program (quadrivalent) offered in grade 9 and those older students not yet vaccinated.

Public Health Metrics 2016-17 Unique patient data Practice - visit data

Flu vaccine 1045 n/a

Other vaccines given n/a 671

Health and Wellness The SHAPE health and wellness initiative has grown into a thriving paraprofessional program. With trained student ambassadors, UHS planned and delivered orientation events, the October Health and Wellness Challenge, and De-Stress Fest events during exam periods. The student volunteers developed a healthy relationships workshop, offered harm reduction education and connected students to campus and community services. Health and Wellness programming also included Student Health 101, a monthly e-magazine for students, a fall influenza vaccination campaign, Conversations on Health, and planning for FitConnect, a prescription exercise program for students with depression and anxiety. These programs served to strengthen the health of people who lived, worked, and learned on our campus in 2016.

Health and Wellness Metrics 2016-17 # sessions # participants Outreach education 14 282

Outreach events 25 4023

Student Health website visit # unique visitor # website visits Health 101 e-magazine 15089 24623