Toolkit Inspiration 

The Northwest Territories (NWT) is home to 42,000 people spread out over a vast area of 1.3 million square kilometres. There are 11 official languages and 33 communities, many of which do not have consistent road access. Indigenous people make up half the population of NWT and are the majority in 29 of the NWT’s 33 communities. Health care in remote areas relies heavily on community health nurses, with only four larger communities having resident physicians. The tertiary care hospital in Yellowknife serves NWT and western Nunavut, with referrals largely to Alberta for specialized care.

Decisions about health care in the NWT are not just about the test or treatment, they are also about moving people. The importance of addressing low-value care is amplified in rural and remote areas. For every low-value episode of care, the movement required to get the patient to that care has a multiplier effect on cost, as well as the indirect costs of the patient being away from home, work, family, and culture for an extended time. These challenges are amplified even further by the impact of language barriers, need for escorts, unfamiliar systems, and the imperative to provide culturally safe care to people experiencing lasting effects of colonization.

This toolkit draws on the Choosing Wisely Canada recommendations by the Society of Rural Physicians of Canada, focusing on reducing unnecessary patient movement from rural communities for medical care and optimizing transportation when necessary.