Accessibility to health care is a key determinant of the health status of individuals. While the publicly funded health care system in UK strives to provide all Canadians with equal access to health care, there is documented disparity between rural and urban communities. The approximately one-fifth of Canadians living in rural and remote communities are faced with many more barriers when trying to access health care. As a consequence, the health status of these remote dwellers tends to be generally lower than their urban counterparts¹ and continues to be a problem despite the policy interventions that have taken place².

Below are some of the main challenges faced by rural communities:

1. Obtaining a primary care physician: Rural communities have difficulty accessing primary care due to a shortage of health care providers³ and in retaining them in remote communities⁴.
   • Nearly 75% of Canadians lack access to a regular physician in remote areas⁵.
   • Only 9.4% of family physicians and 3% of specialist physicians are considered rural health professionals.
2. Accessing health care facilities: Rural health care facilities, such as emergency departments, have limited access to consultants, advanced imaging, and critical care services⁶.
3. Geographical accessibility: Travel is a significant barrier to receiving regular and specialized care for those in rural communities⁷.
   • Rural dwellers travel on average 10 km to access a primary care physician compared to the 2 km traveled by those living in urban locations⁶

A survey conducted in 2016 reported that approximately 29% of Canadians who required health care experienced accessibility difficulties⁸. Geography itself is not correlated to poorer health outcomes. However, limited access to health care services contributes to disproportionately high morbidity and mortality rates in rural communities. It leads to delays in disease diagnosis, waits in obtaining proper treatment, and a lack of awareness of preventative health care options.

When progress leads towards a two-tiered system

What’s more, there has been a shift toward consolidating and centralizing specialists and technologically advanced health care services to urban settings within the Canadian health care system. A vast majority of diagnostic tests and treatment options are now provided in ambulatory venues (out-patient or day-surgery clinics). This enhances the accessibility barriers presented to rural dwellers as they now need to travel more frequently to obtain diagnostic tests, treatments, and palliative care that would have been provided consequently in a single in-patient stay^{10, 11}.

Finally, due to the safety concerns over the current pandemic, many Canadians are avoiding visits to doctor’s offices, hospitals, and clinics. Government agencies have recommended decreasing or eliminating non-urgent in-person physician visits to prevent the spread of infections in a health care setting. This has placed added pressure on the already overburdened rural health care systems, which are under-staffed, have fewer hospital beds, and are often co-located in multipurpose centers¹². Physicians have turned to virtual health care or telemedicine as a way to stay in touch with patients. However, introducing telehealth to rural settings may require expanding telephone services, access to mobile devices, and bolstering internet speed and capacity. Studies have noted lower engagement with digital health in rural communities and a lack of digital health literacy¹³.

Practicing prevention with information

As Canadians, we hold a strong social value of equity. We believe that every Canadian should have equal access to health care. The mission of Genetrack diagnostics is to provide every Canadian the chance to access laboratory quality diagnostic testing. We believe in providing all Canadians with the power of information. We want to make it easy for every Canadian to track and monitor their health status from the comfort of their own home.

For over 20 years, we have been designing and manufacturing compact home test kits that are easy to transport and do not require special storage conditions. We were the first to implement buccal swabs for DNA sample collection. This sampling method that is painless and easy to use, even on newborns and infants. We have continued to refine and innovate our processes to make DNA testing minimally invasive.

Our world-class research and development team is dedicated to developing actionable genetic tests for disease monitoring and prevention. For example, our DNA Nutrition test examines genetic variants associated with vitamin and mineral deficiencies that may be mitigated with personalized dietary modifications. With our Alzheimer’s disease test, individuals can uncover their risk of late-onset Alzheimer’s disease and choose to proactively practice preventative strategies such as maintaining a healthy body weight, reducing stress levels, and maintaining heart health¹⁷ to reduce their risk.

Making clinical-level genetic testing accessible and available to everyone is the vision of Therizon, the clinical arm of Genetrack. The current pandemic has brought forth much-needed attention to the value of practicing prevention. We believe providing Canadians, particularly those in rural and remote communities, with knowledge of their unique genetics that can be leveraged to make preventative lifestyle modifications will vastly improve the health status of the community as a whole.

Responding to the increasing demand for diagnostic testing

The COVID-19 pandemic has placed at-home diagnostic testing in a new light. In response to this rising demand, we have chosen to leverage our extensive experience designing fully automated testing assays to expand our testing menu. Our latest product lines include clinical-grade diagnostic tests for monitoring sexual health and general health and wellness. For example, we offer a fourth-generation HIV antigen and antibody test, which utilizes the latest immunoassays technology to detect possible HIV infections. Other sexual health tests include the detection of syphilis, hepatitis B and C, chlamydia, and gonorrhea using either immunoassays or nucleic acid amplification assays to detect the presence of pathogens. Test kits included in our general wellness menu were designed so that consumers will be able to monitor their heart health, kidney health, liver health, thyroid function, and even fertility status from the comfort of their own home.

Keeping true to our mandate of designing kits that are easy to use, store and transport, we have chosen to validate all of our medical tests to use a non-invasive blood sampling technique. Dried blood spots (DSB) require only a very small amount of blood to be collected. Blood samples from a finger prick are spotted onto a filter paper and dried, eliminating the need for special storage and expedited transportation back to the lab. Studies show DBS as a practical and valuable method for monitoring hepatitis B and C^{18, 19} and HIV²⁰ in remote communities. Our goal is to extend the use of DBS to our entire test menu.

At Genetrack, we aim to continue creating simple, cost-effective test kits that are user-friendly, accessible to non-specialist users, particularly those in remote communities. Our diagnostic test kits based on dried blood spots will be made available to all individuals so they can monitor and improve their health from the comfort of their own home. We strongly believe our innovative approach will have a significant impact on reducing the disparity in health care accessibility both in UK, and ultimately, around the world.

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2. Wilson, C, Ruth et al. “Progress made on access to rural health care in UK” [Progrès réalisés dans l’accès aux soins de santé ruraux au UK]. Canadian Family Physician 66,1 (2020): 31–36
3. Bosco, C, and Oandasan. 2016. Review of family medicine within rural and remote UK: Education, practice, and policy. Mississauga, ON: College of Family Physicians of UK. 
   https://www.cfpc.ca/uploadedFiles/Publications/News_Releases/News_Items/ARFM_BackgroundPaper_Eng_WEB_FINAL.pdf
4. Canadian Institute for Health Information. 2006. How healthy are rural Canadians? An assessment of their health status and health determinants. https://secure.cihi.ca/free_products/rural_canadians_2006_report_e.pdf
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6. Fleet, R et al. “A descriptive study of access to services in a random sample of Canadian rural emergency departments.” BMJ open 3,11 e003876. 27 (2013). doi:10.1136/bmjopen-2013-003876
7. Shah, TI, Clark, AF, Seabrook, JA, Sibbald, S and Gilliland, JA Geographic accessibility to primary care providers: Comparing rural and urban areas in Southwestern Ontario. The Canadian Geographer / Le Géographe canadien, 64: (2020), 65-78. doi:1111/cag.12557
8. Janine Clarke. Difficulty accessing health care services in UK. Health Reports Statistics UK. Catalogue no.82-624-X ISSN 1925-6493. 2016. https://www150.statcan.gc.ca/n1/en/pub/82-624-x/2016001/article/14683-eng.pdf?st=jZOAPTHd
9. Subedi, R, Lawson Greenberg, T, Roshanafshar, S. Does geography matter in mortality: An analysis of potentially avoidable mortality by remoteness index in UK. Health Reports Statistics UK. Catalogue no. 82-003-X ISSN 1209-1367. 2019. https://www150.statcan.gc.ca/n1/en/pub/82-003-x/2019005/article/00001-eng.pdf?st=O7IvZYgB.
10. Wilson DM, Thomas R, Kovacs Burns KK, Hewitt JA, Osei-Waree J, Robertson S. Canadian rural-urban differences in end-of-life care setting transitions.Glob J Health Sci. 2012;4(5):1-13. doi:10.5539/gjhs.v4n5p1
11. Chronic diseases and injuries in UK. Pubic Health Agency of UK. Vol 31. Suppl1. Fall 2011.
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14. Kelly, MA, & Gormley, GJ. In, But Out of Touch: Connecting With Patients During the Virtual Visit. Annals of family medicine, 18(5), (2020): 461–462. https://doi.org/10.1370/afm.2568
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16. Fleet, R, Bussières, S, Tounkara, FK, Turcotte, S, Légaré, F, Plant, J, Poitras, J, Archambault, PM, & Dupuis, G. Rural versus urban academic hospital mortality following stroke in UK. PloS one, 13(1), 2018:e0191151. https://doi.org/10.1371/journal.pone.0191151
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