When systems fall apart: the performance of the nursing station model in communities with populations over 2,500 peoples.

Primary healthcare (PHC) providers working in Manitoba First Nations (FNs) communities have anecdotally reported that the workload they face does not match staffing levels, leaving the care they provide comparable to a walk-in clinic, especially in communities with a population over 2,500. The purpose of this study was to evaluate the capacity of Nursing stations to deliver PHC services in FN communities with populations greater than 2,500, compared to smaller FN communities with populations less than 2,500, by analysing markers of chronic kidney disease (CKD) quality care among individuals living with CKD. We also assessed whether different models of care might reduce disparities in health outcomes. This partnership between researchers from the First Nations Health and Social Secretariat of Manitoba and the University of Manitoba used health administrative data held at the Manitoba Centre for Health Policy (2006-2019), linked to the Manitoba First Nations Research File to identify FNs. Data used included: Diagnostic Services Laboratory Data, Medical Claims, Hospital Discharge Abstracts, Drug Program Information Network Data, Public Canadian Census Files, Manitoba Health Insurance Registry and Physician Resource File. All records were de-identified. PHC visits and hospitalisation rates were higher in larger communities, suggesting a tendency to refer patients more readily to a higher level of care. In contrast, FNs living with CKD in smaller communities are more likely to receive follow up kidney function screening. Premature mortality rates for FNs living with CKD remain lower in larger communities. Our findings show that access to responsive PHC in Manitoba's rural and remote communities remains aspirational and may reflect pragmatic adaptations to workload pressures. There is an urgent need to assess the economic and health impact of these adaptations, to ensure that they result in optimal health results and progress equity for FNs, Manitobans, and those living in rural and remote communities.