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Kiran T, Daneshvarfard M, Wang R, Beyer A, Kay J, Breton M, Brown-Shreves D, Condon A, Green ME, Hedden L, Katz A, Keresteci M, Kovacina N, Lavergne MR, Lofters A, Martin D, Mitra G, Newbery S, Stringer K, MacLeod P, van der Linden C. Public experiences and perspectives of primary care in Canada: results from a cross-sectional survey. CMAJ 2024; 196:E646-E656. [PMID: 38772606 PMCID: PMC11104576 DOI: 10.1503/cmaj.231372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND Through medicare, residents in Canada are entitled to medically necessary physician services without paying out of pocket, but still many people struggle to access primary care. We conducted a survey to explore people's experience with and priorities for primary care. METHODS We conducted an online, bilingual survey of adults in Canada in fall 2022. We distributed an anonymous link through diverse channels and a closed link to 122 053 people via a national public opinion firm. We weighted completed responses to mirror Canada's population and adjusted for sociodemographic characteristics using regression models. RESULTS We analyzed 9279 completed surveys (5.9% response rate via closed link). More than one-fifth of respondents (21.8%) reported having no primary care clinician, and among those who did, 34.5% reported getting a same or next-day appointment for urgent issues. Of respondents, 89.4% expressed comfort seeing another team member if their doctor recommended it, but only 35.9%, 9.5%, and 12.4% reported that their practice had a nurse, social worker, or pharmacist, respectively. The primary care attribute that mattered most was having a clinician who "knows me as a person and considers all the factors that affect my health." After we adjusted for respondent characteristics, people in Quebec, the Atlantic region, and British Columbia had lower odds of reporting a primary care clinician than people in Ontario (adjusted odds ratio 0.30, 0.33, and 0.39, respectively; p < 0.001). We also observed large provincial variations in timely access, interprofessional care, and walk-in clinic use. INTERPRETATION More than 1 in 5 respondents did not have access to primary care, with large variation by province. Reforms should strive to expand access to relationship-based, longitudinal care in a team setting.
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Affiliation(s)
- Tara Kiran
- Department of Family and Community Medicine (Kiran, Lofters, Martin), Temerty Faculty of Medicine, University of Toronto; Department of Family and Community Medicine (Kiran), and MAP Centre for Urban Health Solutions (Kiran, Daneshvarfard, Wang), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Kiran, Martin), University of Toronto, Toronto, Ont.; Department of Political Science (Beyer, van der Linden), McMaster University, Hamilton, Ont.; Vox Pop Labs (Beyer, van der Linden); MASS LBP (Kay, MacLeod), Toronto, Ont.; Department of Community Health (Breton), Université de Sherbrooke, Longueuil, Que.; Department of Family Medicine (Brown-Shreves), University of Ottawa; Restore Medical Clinics (Brown-Shreves), Ottawa, Ont.; Department of Family and Community Medicine (Brown-Shreves), Queen's University, Kingston, Ont.; Department of Family Medicine (Condon), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Green), and Health Services and Policy Research Institute (Green), Queens University; ICES Queen's (Green), Kingston, Ont.; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; Departments of Community Health Sciences and Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; Canadian Association for Health Services and Policy Research (Keresteci), Ottawa, Ont.; Department of Family Medicine (Kovacina), McGill University, Montréal, Que.; Department of Family Medicine (Lavergne, Stringer), Dalhousie University, Halifax, NS; Peter Gilgan Centre for Women's Cancers (Lofters), and Department of Family and Community Medicine (Martin), Women's College Hospital, Toronto, Ont.; Department of Family Practice (Mitra), University of British Columbia, Vancouver, BC; Clinical Faculty (Newbery), Section of Family Medicine, NOSM University, Thunder Bay, Ont.
| | - Maryam Daneshvarfard
- Department of Family and Community Medicine (Kiran, Lofters, Martin), Temerty Faculty of Medicine, University of Toronto; Department of Family and Community Medicine (Kiran), and MAP Centre for Urban Health Solutions (Kiran, Daneshvarfard, Wang), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Kiran, Martin), University of Toronto, Toronto, Ont.; Department of Political Science (Beyer, van der Linden), McMaster University, Hamilton, Ont.; Vox Pop Labs (Beyer, van der Linden); MASS LBP (Kay, MacLeod), Toronto, Ont.; Department of Community Health (Breton), Université de Sherbrooke, Longueuil, Que.; Department of Family Medicine (Brown-Shreves), University of Ottawa; Restore Medical Clinics (Brown-Shreves), Ottawa, Ont.; Department of Family and Community Medicine (Brown-Shreves), Queen's University, Kingston, Ont.; Department of Family Medicine (Condon), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Green), and Health Services and Policy Research Institute (Green), Queens University; ICES Queen's (Green), Kingston, Ont.; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; Departments of Community Health Sciences and Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; Canadian Association for Health Services and Policy Research (Keresteci), Ottawa, Ont.; Department of Family Medicine (Kovacina), McGill University, Montréal, Que.; Department of Family Medicine (Lavergne, Stringer), Dalhousie University, Halifax, NS; Peter Gilgan Centre for Women's Cancers (Lofters), and Department of Family and Community Medicine (Martin), Women's College Hospital, Toronto, Ont.; Department of Family Practice (Mitra), University of British Columbia, Vancouver, BC; Clinical Faculty (Newbery), Section of Family Medicine, NOSM University, Thunder Bay, Ont
| | - Ri Wang
- Department of Family and Community Medicine (Kiran, Lofters, Martin), Temerty Faculty of Medicine, University of Toronto; Department of Family and Community Medicine (Kiran), and MAP Centre for Urban Health Solutions (Kiran, Daneshvarfard, Wang), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Kiran, Martin), University of Toronto, Toronto, Ont.; Department of Political Science (Beyer, van der Linden), McMaster University, Hamilton, Ont.; Vox Pop Labs (Beyer, van der Linden); MASS LBP (Kay, MacLeod), Toronto, Ont.; Department of Community Health (Breton), Université de Sherbrooke, Longueuil, Que.; Department of Family Medicine (Brown-Shreves), University of Ottawa; Restore Medical Clinics (Brown-Shreves), Ottawa, Ont.; Department of Family and Community Medicine (Brown-Shreves), Queen's University, Kingston, Ont.; Department of Family Medicine (Condon), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Green), and Health Services and Policy Research Institute (Green), Queens University; ICES Queen's (Green), Kingston, Ont.; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; Departments of Community Health Sciences and Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; Canadian Association for Health Services and Policy Research (Keresteci), Ottawa, Ont.; Department of Family Medicine (Kovacina), McGill University, Montréal, Que.; Department of Family Medicine (Lavergne, Stringer), Dalhousie University, Halifax, NS; Peter Gilgan Centre for Women's Cancers (Lofters), and Department of Family and Community Medicine (Martin), Women's College Hospital, Toronto, Ont.; Department of Family Practice (Mitra), University of British Columbia, Vancouver, BC; Clinical Faculty (Newbery), Section of Family Medicine, NOSM University, Thunder Bay, Ont
| | - Alexander Beyer
- Department of Family and Community Medicine (Kiran, Lofters, Martin), Temerty Faculty of Medicine, University of Toronto; Department of Family and Community Medicine (Kiran), and MAP Centre for Urban Health Solutions (Kiran, Daneshvarfard, Wang), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Kiran, Martin), University of Toronto, Toronto, Ont.; Department of Political Science (Beyer, van der Linden), McMaster University, Hamilton, Ont.; Vox Pop Labs (Beyer, van der Linden); MASS LBP (Kay, MacLeod), Toronto, Ont.; Department of Community Health (Breton), Université de Sherbrooke, Longueuil, Que.; Department of Family Medicine (Brown-Shreves), University of Ottawa; Restore Medical Clinics (Brown-Shreves), Ottawa, Ont.; Department of Family and Community Medicine (Brown-Shreves), Queen's University, Kingston, Ont.; Department of Family Medicine (Condon), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Green), and Health Services and Policy Research Institute (Green), Queens University; ICES Queen's (Green), Kingston, Ont.; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; Departments of Community Health Sciences and Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; Canadian Association for Health Services and Policy Research (Keresteci), Ottawa, Ont.; Department of Family Medicine (Kovacina), McGill University, Montréal, Que.; Department of Family Medicine (Lavergne, Stringer), Dalhousie University, Halifax, NS; Peter Gilgan Centre for Women's Cancers (Lofters), and Department of Family and Community Medicine (Martin), Women's College Hospital, Toronto, Ont.; Department of Family Practice (Mitra), University of British Columbia, Vancouver, BC; Clinical Faculty (Newbery), Section of Family Medicine, NOSM University, Thunder Bay, Ont
| | - Jasmin Kay
- Department of Family and Community Medicine (Kiran, Lofters, Martin), Temerty Faculty of Medicine, University of Toronto; Department of Family and Community Medicine (Kiran), and MAP Centre for Urban Health Solutions (Kiran, Daneshvarfard, Wang), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Kiran, Martin), University of Toronto, Toronto, Ont.; Department of Political Science (Beyer, van der Linden), McMaster University, Hamilton, Ont.; Vox Pop Labs (Beyer, van der Linden); MASS LBP (Kay, MacLeod), Toronto, Ont.; Department of Community Health (Breton), Université de Sherbrooke, Longueuil, Que.; Department of Family Medicine (Brown-Shreves), University of Ottawa; Restore Medical Clinics (Brown-Shreves), Ottawa, Ont.; Department of Family and Community Medicine (Brown-Shreves), Queen's University, Kingston, Ont.; Department of Family Medicine (Condon), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Green), and Health Services and Policy Research Institute (Green), Queens University; ICES Queen's (Green), Kingston, Ont.; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; Departments of Community Health Sciences and Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; Canadian Association for Health Services and Policy Research (Keresteci), Ottawa, Ont.; Department of Family Medicine (Kovacina), McGill University, Montréal, Que.; Department of Family Medicine (Lavergne, Stringer), Dalhousie University, Halifax, NS; Peter Gilgan Centre for Women's Cancers (Lofters), and Department of Family and Community Medicine (Martin), Women's College Hospital, Toronto, Ont.; Department of Family Practice (Mitra), University of British Columbia, Vancouver, BC; Clinical Faculty (Newbery), Section of Family Medicine, NOSM University, Thunder Bay, Ont
| | - Mylaine Breton
- Department of Family and Community Medicine (Kiran, Lofters, Martin), Temerty Faculty of Medicine, University of Toronto; Department of Family and Community Medicine (Kiran), and MAP Centre for Urban Health Solutions (Kiran, Daneshvarfard, Wang), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Kiran, Martin), University of Toronto, Toronto, Ont.; Department of Political Science (Beyer, van der Linden), McMaster University, Hamilton, Ont.; Vox Pop Labs (Beyer, van der Linden); MASS LBP (Kay, MacLeod), Toronto, Ont.; Department of Community Health (Breton), Université de Sherbrooke, Longueuil, Que.; Department of Family Medicine (Brown-Shreves), University of Ottawa; Restore Medical Clinics (Brown-Shreves), Ottawa, Ont.; Department of Family and Community Medicine (Brown-Shreves), Queen's University, Kingston, Ont.; Department of Family Medicine (Condon), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Green), and Health Services and Policy Research Institute (Green), Queens University; ICES Queen's (Green), Kingston, Ont.; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; Departments of Community Health Sciences and Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; Canadian Association for Health Services and Policy Research (Keresteci), Ottawa, Ont.; Department of Family Medicine (Kovacina), McGill University, Montréal, Que.; Department of Family Medicine (Lavergne, Stringer), Dalhousie University, Halifax, NS; Peter Gilgan Centre for Women's Cancers (Lofters), and Department of Family and Community Medicine (Martin), Women's College Hospital, Toronto, Ont.; Department of Family Practice (Mitra), University of British Columbia, Vancouver, BC; Clinical Faculty (Newbery), Section of Family Medicine, NOSM University, Thunder Bay, Ont
| | - Danielle Brown-Shreves
- Department of Family and Community Medicine (Kiran, Lofters, Martin), Temerty Faculty of Medicine, University of Toronto; Department of Family and Community Medicine (Kiran), and MAP Centre for Urban Health Solutions (Kiran, Daneshvarfard, Wang), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Kiran, Martin), University of Toronto, Toronto, Ont.; Department of Political Science (Beyer, van der Linden), McMaster University, Hamilton, Ont.; Vox Pop Labs (Beyer, van der Linden); MASS LBP (Kay, MacLeod), Toronto, Ont.; Department of Community Health (Breton), Université de Sherbrooke, Longueuil, Que.; Department of Family Medicine (Brown-Shreves), University of Ottawa; Restore Medical Clinics (Brown-Shreves), Ottawa, Ont.; Department of Family and Community Medicine (Brown-Shreves), Queen's University, Kingston, Ont.; Department of Family Medicine (Condon), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Green), and Health Services and Policy Research Institute (Green), Queens University; ICES Queen's (Green), Kingston, Ont.; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; Departments of Community Health Sciences and Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; Canadian Association for Health Services and Policy Research (Keresteci), Ottawa, Ont.; Department of Family Medicine (Kovacina), McGill University, Montréal, Que.; Department of Family Medicine (Lavergne, Stringer), Dalhousie University, Halifax, NS; Peter Gilgan Centre for Women's Cancers (Lofters), and Department of Family and Community Medicine (Martin), Women's College Hospital, Toronto, Ont.; Department of Family Practice (Mitra), University of British Columbia, Vancouver, BC; Clinical Faculty (Newbery), Section of Family Medicine, NOSM University, Thunder Bay, Ont
| | - Amanda Condon
- Department of Family and Community Medicine (Kiran, Lofters, Martin), Temerty Faculty of Medicine, University of Toronto; Department of Family and Community Medicine (Kiran), and MAP Centre for Urban Health Solutions (Kiran, Daneshvarfard, Wang), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Kiran, Martin), University of Toronto, Toronto, Ont.; Department of Political Science (Beyer, van der Linden), McMaster University, Hamilton, Ont.; Vox Pop Labs (Beyer, van der Linden); MASS LBP (Kay, MacLeod), Toronto, Ont.; Department of Community Health (Breton), Université de Sherbrooke, Longueuil, Que.; Department of Family Medicine (Brown-Shreves), University of Ottawa; Restore Medical Clinics (Brown-Shreves), Ottawa, Ont.; Department of Family and Community Medicine (Brown-Shreves), Queen's University, Kingston, Ont.; Department of Family Medicine (Condon), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Green), and Health Services and Policy Research Institute (Green), Queens University; ICES Queen's (Green), Kingston, Ont.; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; Departments of Community Health Sciences and Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; Canadian Association for Health Services and Policy Research (Keresteci), Ottawa, Ont.; Department of Family Medicine (Kovacina), McGill University, Montréal, Que.; Department of Family Medicine (Lavergne, Stringer), Dalhousie University, Halifax, NS; Peter Gilgan Centre for Women's Cancers (Lofters), and Department of Family and Community Medicine (Martin), Women's College Hospital, Toronto, Ont.; Department of Family Practice (Mitra), University of British Columbia, Vancouver, BC; Clinical Faculty (Newbery), Section of Family Medicine, NOSM University, Thunder Bay, Ont
| | - Michael E Green
- Department of Family and Community Medicine (Kiran, Lofters, Martin), Temerty Faculty of Medicine, University of Toronto; Department of Family and Community Medicine (Kiran), and MAP Centre for Urban Health Solutions (Kiran, Daneshvarfard, Wang), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Kiran, Martin), University of Toronto, Toronto, Ont.; Department of Political Science (Beyer, van der Linden), McMaster University, Hamilton, Ont.; Vox Pop Labs (Beyer, van der Linden); MASS LBP (Kay, MacLeod), Toronto, Ont.; Department of Community Health (Breton), Université de Sherbrooke, Longueuil, Que.; Department of Family Medicine (Brown-Shreves), University of Ottawa; Restore Medical Clinics (Brown-Shreves), Ottawa, Ont.; Department of Family and Community Medicine (Brown-Shreves), Queen's University, Kingston, Ont.; Department of Family Medicine (Condon), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Green), and Health Services and Policy Research Institute (Green), Queens University; ICES Queen's (Green), Kingston, Ont.; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; Departments of Community Health Sciences and Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; Canadian Association for Health Services and Policy Research (Keresteci), Ottawa, Ont.; Department of Family Medicine (Kovacina), McGill University, Montréal, Que.; Department of Family Medicine (Lavergne, Stringer), Dalhousie University, Halifax, NS; Peter Gilgan Centre for Women's Cancers (Lofters), and Department of Family and Community Medicine (Martin), Women's College Hospital, Toronto, Ont.; Department of Family Practice (Mitra), University of British Columbia, Vancouver, BC; Clinical Faculty (Newbery), Section of Family Medicine, NOSM University, Thunder Bay, Ont
| | - Lindsay Hedden
- Department of Family and Community Medicine (Kiran, Lofters, Martin), Temerty Faculty of Medicine, University of Toronto; Department of Family and Community Medicine (Kiran), and MAP Centre for Urban Health Solutions (Kiran, Daneshvarfard, Wang), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Kiran, Martin), University of Toronto, Toronto, Ont.; Department of Political Science (Beyer, van der Linden), McMaster University, Hamilton, Ont.; Vox Pop Labs (Beyer, van der Linden); MASS LBP (Kay, MacLeod), Toronto, Ont.; Department of Community Health (Breton), Université de Sherbrooke, Longueuil, Que.; Department of Family Medicine (Brown-Shreves), University of Ottawa; Restore Medical Clinics (Brown-Shreves), Ottawa, Ont.; Department of Family and Community Medicine (Brown-Shreves), Queen's University, Kingston, Ont.; Department of Family Medicine (Condon), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Green), and Health Services and Policy Research Institute (Green), Queens University; ICES Queen's (Green), Kingston, Ont.; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; Departments of Community Health Sciences and Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; Canadian Association for Health Services and Policy Research (Keresteci), Ottawa, Ont.; Department of Family Medicine (Kovacina), McGill University, Montréal, Que.; Department of Family Medicine (Lavergne, Stringer), Dalhousie University, Halifax, NS; Peter Gilgan Centre for Women's Cancers (Lofters), and Department of Family and Community Medicine (Martin), Women's College Hospital, Toronto, Ont.; Department of Family Practice (Mitra), University of British Columbia, Vancouver, BC; Clinical Faculty (Newbery), Section of Family Medicine, NOSM University, Thunder Bay, Ont
| | - Alan Katz
- Department of Family and Community Medicine (Kiran, Lofters, Martin), Temerty Faculty of Medicine, University of Toronto; Department of Family and Community Medicine (Kiran), and MAP Centre for Urban Health Solutions (Kiran, Daneshvarfard, Wang), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Kiran, Martin), University of Toronto, Toronto, Ont.; Department of Political Science (Beyer, van der Linden), McMaster University, Hamilton, Ont.; Vox Pop Labs (Beyer, van der Linden); MASS LBP (Kay, MacLeod), Toronto, Ont.; Department of Community Health (Breton), Université de Sherbrooke, Longueuil, Que.; Department of Family Medicine (Brown-Shreves), University of Ottawa; Restore Medical Clinics (Brown-Shreves), Ottawa, Ont.; Department of Family and Community Medicine (Brown-Shreves), Queen's University, Kingston, Ont.; Department of Family Medicine (Condon), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Green), and Health Services and Policy Research Institute (Green), Queens University; ICES Queen's (Green), Kingston, Ont.; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; Departments of Community Health Sciences and Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; Canadian Association for Health Services and Policy Research (Keresteci), Ottawa, Ont.; Department of Family Medicine (Kovacina), McGill University, Montréal, Que.; Department of Family Medicine (Lavergne, Stringer), Dalhousie University, Halifax, NS; Peter Gilgan Centre for Women's Cancers (Lofters), and Department of Family and Community Medicine (Martin), Women's College Hospital, Toronto, Ont.; Department of Family Practice (Mitra), University of British Columbia, Vancouver, BC; Clinical Faculty (Newbery), Section of Family Medicine, NOSM University, Thunder Bay, Ont
| | - Maggie Keresteci
- Department of Family and Community Medicine (Kiran, Lofters, Martin), Temerty Faculty of Medicine, University of Toronto; Department of Family and Community Medicine (Kiran), and MAP Centre for Urban Health Solutions (Kiran, Daneshvarfard, Wang), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Kiran, Martin), University of Toronto, Toronto, Ont.; Department of Political Science (Beyer, van der Linden), McMaster University, Hamilton, Ont.; Vox Pop Labs (Beyer, van der Linden); MASS LBP (Kay, MacLeod), Toronto, Ont.; Department of Community Health (Breton), Université de Sherbrooke, Longueuil, Que.; Department of Family Medicine (Brown-Shreves), University of Ottawa; Restore Medical Clinics (Brown-Shreves), Ottawa, Ont.; Department of Family and Community Medicine (Brown-Shreves), Queen's University, Kingston, Ont.; Department of Family Medicine (Condon), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Green), and Health Services and Policy Research Institute (Green), Queens University; ICES Queen's (Green), Kingston, Ont.; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; Departments of Community Health Sciences and Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; Canadian Association for Health Services and Policy Research (Keresteci), Ottawa, Ont.; Department of Family Medicine (Kovacina), McGill University, Montréal, Que.; Department of Family Medicine (Lavergne, Stringer), Dalhousie University, Halifax, NS; Peter Gilgan Centre for Women's Cancers (Lofters), and Department of Family and Community Medicine (Martin), Women's College Hospital, Toronto, Ont.; Department of Family Practice (Mitra), University of British Columbia, Vancouver, BC; Clinical Faculty (Newbery), Section of Family Medicine, NOSM University, Thunder Bay, Ont
| | - Neb Kovacina
- Department of Family and Community Medicine (Kiran, Lofters, Martin), Temerty Faculty of Medicine, University of Toronto; Department of Family and Community Medicine (Kiran), and MAP Centre for Urban Health Solutions (Kiran, Daneshvarfard, Wang), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Kiran, Martin), University of Toronto, Toronto, Ont.; Department of Political Science (Beyer, van der Linden), McMaster University, Hamilton, Ont.; Vox Pop Labs (Beyer, van der Linden); MASS LBP (Kay, MacLeod), Toronto, Ont.; Department of Community Health (Breton), Université de Sherbrooke, Longueuil, Que.; Department of Family Medicine (Brown-Shreves), University of Ottawa; Restore Medical Clinics (Brown-Shreves), Ottawa, Ont.; Department of Family and Community Medicine (Brown-Shreves), Queen's University, Kingston, Ont.; Department of Family Medicine (Condon), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Green), and Health Services and Policy Research Institute (Green), Queens University; ICES Queen's (Green), Kingston, Ont.; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; Departments of Community Health Sciences and Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; Canadian Association for Health Services and Policy Research (Keresteci), Ottawa, Ont.; Department of Family Medicine (Kovacina), McGill University, Montréal, Que.; Department of Family Medicine (Lavergne, Stringer), Dalhousie University, Halifax, NS; Peter Gilgan Centre for Women's Cancers (Lofters), and Department of Family and Community Medicine (Martin), Women's College Hospital, Toronto, Ont.; Department of Family Practice (Mitra), University of British Columbia, Vancouver, BC; Clinical Faculty (Newbery), Section of Family Medicine, NOSM University, Thunder Bay, Ont
| | - M Ruth Lavergne
- Department of Family and Community Medicine (Kiran, Lofters, Martin), Temerty Faculty of Medicine, University of Toronto; Department of Family and Community Medicine (Kiran), and MAP Centre for Urban Health Solutions (Kiran, Daneshvarfard, Wang), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Kiran, Martin), University of Toronto, Toronto, Ont.; Department of Political Science (Beyer, van der Linden), McMaster University, Hamilton, Ont.; Vox Pop Labs (Beyer, van der Linden); MASS LBP (Kay, MacLeod), Toronto, Ont.; Department of Community Health (Breton), Université de Sherbrooke, Longueuil, Que.; Department of Family Medicine (Brown-Shreves), University of Ottawa; Restore Medical Clinics (Brown-Shreves), Ottawa, Ont.; Department of Family and Community Medicine (Brown-Shreves), Queen's University, Kingston, Ont.; Department of Family Medicine (Condon), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Green), and Health Services and Policy Research Institute (Green), Queens University; ICES Queen's (Green), Kingston, Ont.; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; Departments of Community Health Sciences and Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; Canadian Association for Health Services and Policy Research (Keresteci), Ottawa, Ont.; Department of Family Medicine (Kovacina), McGill University, Montréal, Que.; Department of Family Medicine (Lavergne, Stringer), Dalhousie University, Halifax, NS; Peter Gilgan Centre for Women's Cancers (Lofters), and Department of Family and Community Medicine (Martin), Women's College Hospital, Toronto, Ont.; Department of Family Practice (Mitra), University of British Columbia, Vancouver, BC; Clinical Faculty (Newbery), Section of Family Medicine, NOSM University, Thunder Bay, Ont
| | - Aisha Lofters
- Department of Family and Community Medicine (Kiran, Lofters, Martin), Temerty Faculty of Medicine, University of Toronto; Department of Family and Community Medicine (Kiran), and MAP Centre for Urban Health Solutions (Kiran, Daneshvarfard, Wang), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Kiran, Martin), University of Toronto, Toronto, Ont.; Department of Political Science (Beyer, van der Linden), McMaster University, Hamilton, Ont.; Vox Pop Labs (Beyer, van der Linden); MASS LBP (Kay, MacLeod), Toronto, Ont.; Department of Community Health (Breton), Université de Sherbrooke, Longueuil, Que.; Department of Family Medicine (Brown-Shreves), University of Ottawa; Restore Medical Clinics (Brown-Shreves), Ottawa, Ont.; Department of Family and Community Medicine (Brown-Shreves), Queen's University, Kingston, Ont.; Department of Family Medicine (Condon), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Green), and Health Services and Policy Research Institute (Green), Queens University; ICES Queen's (Green), Kingston, Ont.; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; Departments of Community Health Sciences and Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; Canadian Association for Health Services and Policy Research (Keresteci), Ottawa, Ont.; Department of Family Medicine (Kovacina), McGill University, Montréal, Que.; Department of Family Medicine (Lavergne, Stringer), Dalhousie University, Halifax, NS; Peter Gilgan Centre for Women's Cancers (Lofters), and Department of Family and Community Medicine (Martin), Women's College Hospital, Toronto, Ont.; Department of Family Practice (Mitra), University of British Columbia, Vancouver, BC; Clinical Faculty (Newbery), Section of Family Medicine, NOSM University, Thunder Bay, Ont
| | - Danielle Martin
- Department of Family and Community Medicine (Kiran, Lofters, Martin), Temerty Faculty of Medicine, University of Toronto; Department of Family and Community Medicine (Kiran), and MAP Centre for Urban Health Solutions (Kiran, Daneshvarfard, Wang), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Kiran, Martin), University of Toronto, Toronto, Ont.; Department of Political Science (Beyer, van der Linden), McMaster University, Hamilton, Ont.; Vox Pop Labs (Beyer, van der Linden); MASS LBP (Kay, MacLeod), Toronto, Ont.; Department of Community Health (Breton), Université de Sherbrooke, Longueuil, Que.; Department of Family Medicine (Brown-Shreves), University of Ottawa; Restore Medical Clinics (Brown-Shreves), Ottawa, Ont.; Department of Family and Community Medicine (Brown-Shreves), Queen's University, Kingston, Ont.; Department of Family Medicine (Condon), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Green), and Health Services and Policy Research Institute (Green), Queens University; ICES Queen's (Green), Kingston, Ont.; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; Departments of Community Health Sciences and Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; Canadian Association for Health Services and Policy Research (Keresteci), Ottawa, Ont.; Department of Family Medicine (Kovacina), McGill University, Montréal, Que.; Department of Family Medicine (Lavergne, Stringer), Dalhousie University, Halifax, NS; Peter Gilgan Centre for Women's Cancers (Lofters), and Department of Family and Community Medicine (Martin), Women's College Hospital, Toronto, Ont.; Department of Family Practice (Mitra), University of British Columbia, Vancouver, BC; Clinical Faculty (Newbery), Section of Family Medicine, NOSM University, Thunder Bay, Ont
| | - Goldis Mitra
- Department of Family and Community Medicine (Kiran, Lofters, Martin), Temerty Faculty of Medicine, University of Toronto; Department of Family and Community Medicine (Kiran), and MAP Centre for Urban Health Solutions (Kiran, Daneshvarfard, Wang), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Kiran, Martin), University of Toronto, Toronto, Ont.; Department of Political Science (Beyer, van der Linden), McMaster University, Hamilton, Ont.; Vox Pop Labs (Beyer, van der Linden); MASS LBP (Kay, MacLeod), Toronto, Ont.; Department of Community Health (Breton), Université de Sherbrooke, Longueuil, Que.; Department of Family Medicine (Brown-Shreves), University of Ottawa; Restore Medical Clinics (Brown-Shreves), Ottawa, Ont.; Department of Family and Community Medicine (Brown-Shreves), Queen's University, Kingston, Ont.; Department of Family Medicine (Condon), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Green), and Health Services and Policy Research Institute (Green), Queens University; ICES Queen's (Green), Kingston, Ont.; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; Departments of Community Health Sciences and Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; Canadian Association for Health Services and Policy Research (Keresteci), Ottawa, Ont.; Department of Family Medicine (Kovacina), McGill University, Montréal, Que.; Department of Family Medicine (Lavergne, Stringer), Dalhousie University, Halifax, NS; Peter Gilgan Centre for Women's Cancers (Lofters), and Department of Family and Community Medicine (Martin), Women's College Hospital, Toronto, Ont.; Department of Family Practice (Mitra), University of British Columbia, Vancouver, BC; Clinical Faculty (Newbery), Section of Family Medicine, NOSM University, Thunder Bay, Ont
| | - Sarah Newbery
- Department of Family and Community Medicine (Kiran, Lofters, Martin), Temerty Faculty of Medicine, University of Toronto; Department of Family and Community Medicine (Kiran), and MAP Centre for Urban Health Solutions (Kiran, Daneshvarfard, Wang), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Kiran, Martin), University of Toronto, Toronto, Ont.; Department of Political Science (Beyer, van der Linden), McMaster University, Hamilton, Ont.; Vox Pop Labs (Beyer, van der Linden); MASS LBP (Kay, MacLeod), Toronto, Ont.; Department of Community Health (Breton), Université de Sherbrooke, Longueuil, Que.; Department of Family Medicine (Brown-Shreves), University of Ottawa; Restore Medical Clinics (Brown-Shreves), Ottawa, Ont.; Department of Family and Community Medicine (Brown-Shreves), Queen's University, Kingston, Ont.; Department of Family Medicine (Condon), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Green), and Health Services and Policy Research Institute (Green), Queens University; ICES Queen's (Green), Kingston, Ont.; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; Departments of Community Health Sciences and Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; Canadian Association for Health Services and Policy Research (Keresteci), Ottawa, Ont.; Department of Family Medicine (Kovacina), McGill University, Montréal, Que.; Department of Family Medicine (Lavergne, Stringer), Dalhousie University, Halifax, NS; Peter Gilgan Centre for Women's Cancers (Lofters), and Department of Family and Community Medicine (Martin), Women's College Hospital, Toronto, Ont.; Department of Family Practice (Mitra), University of British Columbia, Vancouver, BC; Clinical Faculty (Newbery), Section of Family Medicine, NOSM University, Thunder Bay, Ont
| | - Katherine Stringer
- Department of Family and Community Medicine (Kiran, Lofters, Martin), Temerty Faculty of Medicine, University of Toronto; Department of Family and Community Medicine (Kiran), and MAP Centre for Urban Health Solutions (Kiran, Daneshvarfard, Wang), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Kiran, Martin), University of Toronto, Toronto, Ont.; Department of Political Science (Beyer, van der Linden), McMaster University, Hamilton, Ont.; Vox Pop Labs (Beyer, van der Linden); MASS LBP (Kay, MacLeod), Toronto, Ont.; Department of Community Health (Breton), Université de Sherbrooke, Longueuil, Que.; Department of Family Medicine (Brown-Shreves), University of Ottawa; Restore Medical Clinics (Brown-Shreves), Ottawa, Ont.; Department of Family and Community Medicine (Brown-Shreves), Queen's University, Kingston, Ont.; Department of Family Medicine (Condon), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Green), and Health Services and Policy Research Institute (Green), Queens University; ICES Queen's (Green), Kingston, Ont.; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; Departments of Community Health Sciences and Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; Canadian Association for Health Services and Policy Research (Keresteci), Ottawa, Ont.; Department of Family Medicine (Kovacina), McGill University, Montréal, Que.; Department of Family Medicine (Lavergne, Stringer), Dalhousie University, Halifax, NS; Peter Gilgan Centre for Women's Cancers (Lofters), and Department of Family and Community Medicine (Martin), Women's College Hospital, Toronto, Ont.; Department of Family Practice (Mitra), University of British Columbia, Vancouver, BC; Clinical Faculty (Newbery), Section of Family Medicine, NOSM University, Thunder Bay, Ont
| | - Peter MacLeod
- Department of Family and Community Medicine (Kiran, Lofters, Martin), Temerty Faculty of Medicine, University of Toronto; Department of Family and Community Medicine (Kiran), and MAP Centre for Urban Health Solutions (Kiran, Daneshvarfard, Wang), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Kiran, Martin), University of Toronto, Toronto, Ont.; Department of Political Science (Beyer, van der Linden), McMaster University, Hamilton, Ont.; Vox Pop Labs (Beyer, van der Linden); MASS LBP (Kay, MacLeod), Toronto, Ont.; Department of Community Health (Breton), Université de Sherbrooke, Longueuil, Que.; Department of Family Medicine (Brown-Shreves), University of Ottawa; Restore Medical Clinics (Brown-Shreves), Ottawa, Ont.; Department of Family and Community Medicine (Brown-Shreves), Queen's University, Kingston, Ont.; Department of Family Medicine (Condon), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Green), and Health Services and Policy Research Institute (Green), Queens University; ICES Queen's (Green), Kingston, Ont.; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; Departments of Community Health Sciences and Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; Canadian Association for Health Services and Policy Research (Keresteci), Ottawa, Ont.; Department of Family Medicine (Kovacina), McGill University, Montréal, Que.; Department of Family Medicine (Lavergne, Stringer), Dalhousie University, Halifax, NS; Peter Gilgan Centre for Women's Cancers (Lofters), and Department of Family and Community Medicine (Martin), Women's College Hospital, Toronto, Ont.; Department of Family Practice (Mitra), University of British Columbia, Vancouver, BC; Clinical Faculty (Newbery), Section of Family Medicine, NOSM University, Thunder Bay, Ont
| | - Clifton van der Linden
- Department of Family and Community Medicine (Kiran, Lofters, Martin), Temerty Faculty of Medicine, University of Toronto; Department of Family and Community Medicine (Kiran), and MAP Centre for Urban Health Solutions (Kiran, Daneshvarfard, Wang), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Kiran, Martin), University of Toronto, Toronto, Ont.; Department of Political Science (Beyer, van der Linden), McMaster University, Hamilton, Ont.; Vox Pop Labs (Beyer, van der Linden); MASS LBP (Kay, MacLeod), Toronto, Ont.; Department of Community Health (Breton), Université de Sherbrooke, Longueuil, Que.; Department of Family Medicine (Brown-Shreves), University of Ottawa; Restore Medical Clinics (Brown-Shreves), Ottawa, Ont.; Department of Family and Community Medicine (Brown-Shreves), Queen's University, Kingston, Ont.; Department of Family Medicine (Condon), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Green), and Health Services and Policy Research Institute (Green), Queens University; ICES Queen's (Green), Kingston, Ont.; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; Departments of Community Health Sciences and Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; Canadian Association for Health Services and Policy Research (Keresteci), Ottawa, Ont.; Department of Family Medicine (Kovacina), McGill University, Montréal, Que.; Department of Family Medicine (Lavergne, Stringer), Dalhousie University, Halifax, NS; Peter Gilgan Centre for Women's Cancers (Lofters), and Department of Family and Community Medicine (Martin), Women's College Hospital, Toronto, Ont.; Department of Family Practice (Mitra), University of British Columbia, Vancouver, BC; Clinical Faculty (Newbery), Section of Family Medicine, NOSM University, Thunder Bay, Ont
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Hong M, Devlin RA, Zaric GS, Thind A, Sarma S. Primary care services and emergency department visits in blended fee-for-service and blended capitation models: evidence from Ontario, Canada. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2024; 25:363-377. [PMID: 37154832 DOI: 10.1007/s10198-023-01591-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 04/19/2023] [Indexed: 05/10/2023]
Abstract
INTRODUCTION It is well-known that the way physicians are remunerated can affect delivery of health care services to the population. Fee-for-service (FFS) generally leads to oversupply of services, while capitation leads to undersupply of services. However, little evidence exists on the link between remuneration and emergency department (ED) visits. We fill this gap using two popular blended models introduced in Ontario, Canada: the Family Health Group (FHG), an enhanced/blended FFS model, and Family Health Organization (FHO), a blended capitation model. We compare primary care services and rates of emergency department ED visits between these two models. We also evaluate whether these outcomes vary by regular- and after-hours, and patient morbidity status. METHODS Physicians practicing in an FHG or FHO between April 2012 and March 2017 and their enrolled adult patients were included for analyses. The covariate-balancing propensity score weighting method was used to remove the influence of observable confounding and negative-binomial and linear regression models were used to evaluate the rates of primary care services, ED visits, and the dollar value of primary care services delivered between FHGs and FHOs. Visits were stratified as regular- and after-hours. Patients were stratified into three morbidity groups: non-morbid, single-morbid, and multimorbid (two or more chronic conditions). RESULTS 6184 physicians and their patients were available for analysis. Compared to FHG physicians, FHO physicians delivered 14% (95% CI 13%, 15%) fewer primary care services per patient per year, with 27% fewer services during after-hours (95% CI 25%, 29%). Patients enrolled to FHO physicians made 27% more less-urgent (95% CI 23%, 31%) and 10% more urgent (95% CI 7%, 13%) ED visits per patient per year, with no difference in very-urgent ED visits. Differences in the pattern of ED visits were similar during regular- and after-hours. Although FHO physicians provided fewer services, multimorbid patients in FHOs made fewer very-urgent and urgent ED visits, with no difference in less-urgent ED visits. CONCLUSION Primary care physicians practicing in Ontario's blended capitation model provide fewer primary care services compared to those practicing in a blended FFS model. Although the overall rate of ED visits was higher among patients enrolled to FHO physicians, multimorbid patients of FHO physicians make fewer urgent and very-urgent ED visits.
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Affiliation(s)
- Michael Hong
- Department of Epidemiology and Biostatistics, Western Centre for Public Health and Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Rose Anne Devlin
- Department of Economics, University of Ottawa, Ottawa, ON, Canada
| | - Gregory S Zaric
- Department of Epidemiology and Biostatistics, Western Centre for Public Health and Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Ivey Business School, Western University, London, ON, Canada
| | - Amardeep Thind
- Department of Epidemiology and Biostatistics, Western Centre for Public Health and Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Interfaculty Program in Public Health, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Sisira Sarma
- Department of Epidemiology and Biostatistics, Western Centre for Public Health and Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
- Institute for Clinical Evaluative Sciences (ICES), Toronto, ON, Canada.
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Leslie M, Hansen B, Abboud R, Claussen C, Aghajafari F. Thinking and Enacting the Patient Medical Home Under Pandemic Conditions: A Qualitative Study From Primary Care in Alberta, Canada. J Prim Care Community Health 2024; 15:21501319241236007. [PMID: 38627966 PMCID: PMC11022528 DOI: 10.1177/21501319241236007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND The COVID-19 (C19) pandemic shocked primary care systems around the world. Those systems responded by supporting patients in the community, and acute care facilities in crisis. In Canada, the Patient Medical Home (PMH) is a widely adopted care model that aims to operationalize the tenets and principles of Primary Health Care (PHC) as developed since the Alma-Ata Declaration. This paper describes how personnel working in and with Primary Care Networks (PCNs) in Alberta, Canada deployed the PMH model and its underlying PHC principles to frame and respond to the C19 shock. METHODS Using purposive and snowball sampling techniques, we interviewed 57 participants who worked in public health and primary care, including community-based family physicians. We used interpretive description to analyze the interviews. RESULTS PCN staff and physicians described how the PMH model was foundational to normal operations, and how C19 responses were framed by the patient-centric, team-delivered, and continuous care principles the model shares with PHC. Specifically, participants described ensuring access to care, addressing the social determinants of health, being patient centered, and redeploying and expanding PHC teams to accomplish these goals. DISCUSSION Delivering PHC through the PMH allowed physicians and allied health staff to deliver patient-centered, team-based, holistic bio-medical services to Albertans. In tailoring services to meet the specific social and health needs of the populations served by each PCN, healthcare providers were able to ensure relevant support remained available and accessible.
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Affiliation(s)
| | | | - Rida Abboud
- Co-RIG Project Consultant, Calgary, AB, Canada
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Grierson L, Elma A, Aggarwal M, Bakker D, Johnston N, Agarwal G. Understanding the influence of medical education on physician geographic disposition: A qualitative study of family physician perspectives in Canada. J Eval Clin Pract 2023; 29:1261-1270. [PMID: 37904616 DOI: 10.1111/jep.13936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 10/09/2023] [Indexed: 11/01/2023]
Abstract
RATIONALE Primary care access challenges are experienced by many communities. In several jurisdictions, including Canada, family physicians (FP) have the professional autonomy to organize their practice in alignment with professional and personal interests. Although system-level interventions are tremendously important, investment in upstream interventions associated with the medical education of graduating FPs is a promising strategy for ameliorating primary healthcare access challenges. AIMS AND OBJECTIVES This study investigates the medical education experiences that influence FP's decisions about practice locations in Canada. METHODS We conducted semistructured interviews with FPs who completed undergraduate and postgraduate medical training in Canada and now have a practice in Ontario, Canada. Interview data were coded and analysed using an unconstrained descriptive approach. RESULTS FPs preferred practice locations are intimately tied to their desired practice scope. Practice preferences were shaped through training experiences with patient populations, heightened clinical responsibilities, practice models and locations, professional mentorships and networks. Proximity to family, partner and lifestyle preferences, cultural connections and the available practice opportunities also shaped practice location decisions. CONCLUSION Medical education influences the identification and refinement of professional family practice preferences. Health workforce policies and interventions should leverage medical education to promote more equitable primary healthcare access.
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Affiliation(s)
- Lawrence Grierson
- Department of Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- McMaster Program for Education Research, Innovation, and Theory, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- McMaster Community and Rural Education Program, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Asiana Elma
- Department of Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Monica Aggarwal
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Dorothy Bakker
- Department of Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- McMaster Community and Rural Education Program, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Neil Johnston
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Gina Agarwal
- Department of Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
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Rudoler D, Austin N, Allin S, Bjerre LM, Dolovich L, Glazier RH, Grudniewicz A, Laporte A, Martin E, Schultz S, Sirois C, Strumpf E. The impact of team-based primary care on medication-related outcomes in older adults: A comparative analysis of two Canadian provinces. Prev Med Rep 2023; 36:102512. [PMID: 38116285 PMCID: PMC10728440 DOI: 10.1016/j.pmedr.2023.102512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 09/29/2023] [Accepted: 11/08/2023] [Indexed: 12/21/2023] Open
Abstract
Objective To evaluate if access to team-based primary care is related to medication management outcomes for older adults. Methods We completed two retrospective cohort studies using administrative health data for older adults (66+) in Ontario (n = 428,852) and Québec (n = 310,198) who were rostered with a family physician (FP) between the 2001/02 and 2017/18 fiscal years. We generated matched comparison groups of older adults rostered to an FP practicing in a team-based model, and older adults rostered to an FP in a non-team model. We compared the following outcomes between these groups: any adverse drug reactions (ADRs), any potentially inappropriate prescription (PIP), and polypharmacy. Average treatment effects of access to team-based care were estimated using a difference-in-differences estimator. Results The risk of an ADR was 22 % higher (RR = 1.22, 95 % CI = 1.18, 1.26) for older adults rostered to a team-based FP in Québec and 6 % lower (RR = 0.943, 95 % CI = 0.907, 0.978) in Ontario. However, absolute risk differences were less than 0.5 %. Differences in the risk of polypharmacy were small in Québec (RR = 1.005, 95 % CI = 1.001, 1.009) and Ontario (RR = 1.004, 95 % CI = 1.001, 1.007) and had absolute risk differences of less than 1 % in both provinces. Effects on PIP were not statistically or clinically significant in adjusted models. Interpretation We did not find evidence that access to team-based primary care in Ontario or Québec meaningfully improved medication management outcomes for older adults.
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Affiliation(s)
- David Rudoler
- Ontario Shores Centre for Mental Health Sciences, Whitby, Ontario, Canada
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Nichole Austin
- School of Health Administration, Dalhousie University, Halifax, Canada
| | - Sara Allin
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Lise M. Bjerre
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Lisa Dolovich
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Richard H. Glazier
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Family and Community Medicine, St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Agnes Grudniewicz
- Telfer School of Management, University of Ottawa, Ottawa, Ontario, Canada
| | - Audrey Laporte
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Canadian Centre for Health Economics, University of Toronto, Toronto, Ontario, Canada
| | - Elisabeth Martin
- Faculty of Nursing Sciences, Université Laval, Québec City, Québec, Canada
| | | | - Caroline Sirois
- Faculty of Pharmacy, Université Laval, Québec, Québec, Canada
| | - Erin Strumpf
- Canadian Centre for Health Economics, University of Toronto, Toronto, Ontario, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
- Department of Economics, McGill University, Montréal, Québec, Canada
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Rodrigues R, Reid JNS, Wiener JC, Archie S, Booth RG, Cheng C, MacDougall AG, Palaniyappan L, Ryan BL, Voineskos A, Kurdyak P, Jan SH, Anderson KK. Access to a regular primary care physician among young people with early psychosis in Ontario, Canada. Early Interv Psychiatry 2023. [PMID: 38036458 DOI: 10.1111/eip.13487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 09/29/2023] [Accepted: 11/19/2023] [Indexed: 12/02/2023]
Abstract
AIM Access to a primary care physician in early psychosis facilitates help-seeking and engagement with psychiatric treatment. We examined access to a regular primary care physician in people with early psychosis, compared to the general population, and explored factors associated with access. METHODS Using linked health administrative data from Ontario (Canada), we identified people aged 14-35 years with a first diagnosis of nonaffective psychotic disorder (n = 39 449; 2005-2015). We matched cases to four randomly selected general population controls based on age, sex, neighbourhood, and index date (n = 157 796). We used modified Poisson regression to estimate prevalence ratios (PR) for access to a regular primary care physician in the year prior to first diagnosis of psychotic disorder, and the sociodemographic and clinical factors associated with access. RESULTS A larger proportion of people with early psychosis had a regular primary care physician, relative to the general population (89% vs. 68%; PR = 1.30, 95%CI = 1.30-1.31). However, this was accounted for by a higher prevalence of comorbidities among people with psychosis, and this association was no longer present after adjustment (PR = 0.97, 95%CI = 0.97, 0.98). People with early psychosis who were older, male, refugees and those residing in lower income or high residential instability neighbourhoods were less likely to have a regular primary care physician. CONCLUSION Approximately one in ten young people with early psychosis in Ontario lack access to a regular primary care physician. Strategies to improve primary care physician access are needed for management of physical comorbidities and to ensure continuity of care.
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Affiliation(s)
- Rebecca Rodrigues
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | | | - Joshua C Wiener
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Suzanne Archie
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Richard G Booth
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
| | - Chiachen Cheng
- Department of Psychiatry, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Arlene G MacDougall
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Lena Palaniyappan
- Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
- Centre for Youth Mental Health, Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Bridget L Ryan
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Centre for Studies in Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Aristotle Voineskos
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Paul Kurdyak
- ICES, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Saadia Hameed Jan
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Kelly K Anderson
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
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Elma A, Yang L, Chang I, Grierson L. Training in Team-Based Practices: A Descriptive Analysis of Family Medicine Postgraduate Site Distribution across Canada. Healthc Policy 2023; 19:48-62. [PMID: 38105667 PMCID: PMC10751758 DOI: 10.12927/hcpol.2023.27233] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023] Open
Abstract
Background College of Family Physicians of Canada accreditation policies contemplate exemplary ratings for postgraduate family medicine programs that train residents in sites aligned with the Patient's Medical Home (PMH) vision. This may overrepresent the PMH in training relative to what is available in independent practice. Methods We appraised training sites to describe the degree to which PMH features are present in family medicine education across the country. Results More than half (70.7%) of Canadian training sites reflect PMH features. Conclusion Education policy that incentivizes PMH in training may create downstream tension for physicians who find these practices unavailable upon graduation.
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Affiliation(s)
- Asiana Elma
- Research Coordinator, Department of Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, PhD Student, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON
| | - Laurie Yang
- Medical Student, Michael G. DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON
| | - Irene Chang
- Medical Student, Temerty Faculty of Medicine, University of Toronto, Toronto, ON
| | - Lawrence Grierson
- Associate Professor, Department of Family Medicine, Faculty of Health Sciences, McMaster University, Scientist, McMaster Education Research, Innovation and Theory, Faculty of Health Sciences, McMaster University, Hamilton, ON
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Vader K, Donnelly C, Lane T, Newman G, Tripp DA, Miller J. Delivering Team-Based Primary Care for the Management of Chronic Low Back Pain: An Interpretive Description Qualitative Study of Healthcare Provider Perspectives. Can J Pain 2023; 7:2226719. [PMID: 37701549 PMCID: PMC10494733 DOI: 10.1080/24740527.2023.2226719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 06/12/2023] [Accepted: 06/14/2023] [Indexed: 09/14/2023]
Abstract
Background Chronic low back pain (LBP) is a prevalent and disabling health issue. Team-based models of primary care are ideally positioned to provide comprehensive care for patients with chronic LBP. A better understanding of primary care team perspectives can inform future efforts to improve how team-based care is provided for patients with chronic LBP in this practice setting. Aims The aim of this study was to understand health care providers' experiences, perceived barriers and facilitators, and recommendations when providing team-based primary care for the management of chronic LBP. Methods We conducted an interpretive description qualitative study based on focus group discussions with health care providers from team-based primary care settings in Ontario, Canada. Data were analyzed using thematic analysis. Results We conducted five focus groups with five different primary care teams, including a total of 31 health care providers. We constructed four themes (each with subthemes) related to experiences, perceived barriers and facilitators, and recommendations to providing team-based primary care for the management of chronic LBP, including (1) care pathways and models of service delivery, (2) team processes and organization, (3) team culture and environment, and (4) patient needs and readiness. Conclusions Primary care teams are implementing diverse care pathways and models of service delivery for the management of patients with chronic LBP, which can be influenced by patient, team, and organizational factors. Results have potential implications for future research and practice innovations to improve how team-based primary care is delivered for patients with chronic LBP.
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Affiliation(s)
- Kyle Vader
- School of Rehabilitation Therapy, Queen’s University, Kingston, Ontario, Canada
| | - Catherine Donnelly
- School of Rehabilitation Therapy, Queen’s University, Kingston, Ontario, Canada
| | - Therese Lane
- Chronic Pain Network, McMaster University, Hamilton, Ontario, Canada
- Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada
| | - Gillian Newman
- Patient Engagement Research Ambassadors, Institute of Musculoskeletal Health and Arthritis, Canadian Institutes of Health Research, Toronto, Ontario, Canada
- Curvy Girls Scoliosis, Toronto, Ontario, Canada
| | - Dean A. Tripp
- Department of Psychology, Queen’s University, Kingston, Ontario, Canada
- Department of Anesthesiology, Queen’s University, Kingston, Ontario, Canada
- Department of Urology, Queen’s University, Kingston, Ontario, Canada
| | - Jordan Miller
- School of Rehabilitation Therapy, Queen’s University, Kingston, Ontario, Canada
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Manis DR, Katz P, Lane NE, Rochon PA, Sinha SK, Andel R, Heckman GA, Kirkwood D, Costa AP. Rates of Hospital-Based Care among Older Adults in the Community and Residential Care Facilities: A Repeated Cross-Sectional Study. J Am Med Dir Assoc 2023; 24:1341-1348. [PMID: 37549887 DOI: 10.1016/j.jamda.2023.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/14/2023] [Accepted: 06/16/2023] [Indexed: 08/09/2023]
Abstract
OBJECTIVE We examine annual rates of emergency department (ED) visits, hospital admissions, and alternate levels of care (ALC) days (ie, the number of days that an older adult remained in hospital when they could not be safely discharged to an appropriate setting in their community) among older adults. DESIGN Repeated cross-sectional study. SETTING AND PARTICIPANTS Linked, individual-level health system administrative data on community-dwelling persons, home care recipients, residents of assisted living facilities, and residents of nursing homes aged 65 years and older in Ontario, Canada, from January 1, 2013, to December 31, 2019. METHODS We calculated rates of ED visits, hospital admissions, and ALC days per 1000 individuals per older adult population per year. We used a generalized linear model with a gaussian distribution, log link, and year fixed effects to obtain rate ratios. RESULTS There were 1,655,656 older adults in the community, 237,574 home care recipients, 42,600 older adults in assisted living facilities, and 94,055 older adults in nursing homes in 2013; there were 2,129,690 older adults in the community, 281,028 home care recipients, 56,975 older adults in assisted living facilities, and 95,925 older adults in nursing homes in 2019. Residents of assisted living facilities had the highest rates of ED visits (1260.692019 vs 1174.912013), hospital admissions (482.632019 vs 480.192013), and ALC days (1905.572019 vs 1443.032013) per 1000 individuals. Residents of assisted living facilities also had significantly higher rates of ED visits [rate ratio (RR) 3.30, 95% CI 3.20, 3.41), hospital admissions (RR 6.24, 95% CI 6.01, 6.47), and ALC days (RR 25.68, 95% CI 23.27, 28.35) relative to community-dwelling older adults. CONCLUSIONS AND IMPLICATIONS The disproportionate use of ED visits, hospital admissions, and ALC days among residents of assisted living facilities may be attributed to the characteristics of the population and fragmented licensing and regulation of the sector, including variable models of care. The implementation of interdisciplinary, after-hours, team-based approaches to home and primary care in assisted living facilities may reduce the potentially avoidable use of ED visits, hospital admissions, and ALC days among this population and optimize resource allocation in health care systems.
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Affiliation(s)
- Derek R Manis
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; ICES, Toronto, ON, Canada.
| | - Paul Katz
- Department of Geriatrics, College of Medicine, Florida State University, Tallahassee, FL, USA
| | - Natasha E Lane
- ICES, Toronto, ON, Canada; Department of Internal Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Paula A Rochon
- ICES, Toronto, ON, Canada; Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, ON, Canada; Women's College Research Institute, Toronto, ON, Canada; Division of Geriatric Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Samir K Sinha
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, ON, Canada; Division of General Internal Medicine and Geriatrics, Sinai Health and University Health Network, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada; National Institute on Ageing, Toronto Metropolitan University, Toronto, ON, Canada
| | - Ross Andel
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA; Department of Neurology, Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
| | - George A Heckman
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | | | - Andrew P Costa
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; ICES, Toronto, ON, Canada; Schlegel Research Institute for Aging, Waterloo, ON, Canada; Centre for Integrated Care, St. Joseph's Health System, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada
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10
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Fitzsimon J, Patel K, Peixoto C, Belanger C. Family physicians' experiences with an innovative, community-based, hybrid model of in- person and virtual care: a mixed-methods study. BMC Health Serv Res 2023; 23:573. [PMID: 37270531 DOI: 10.1186/s12913-023-09599-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 05/25/2023] [Indexed: 06/05/2023] Open
Abstract
BACKGROUND Rural, remote, and underserved communities have often struggled to provide adequate access to family physicians. To bridge this gap in Renfrew County, a large, rural region in Ontario, Canada, a community- based, hybrid care model was implemented, combining virtual care from family physicians and in-person care from community paramedics. Studies have demonstrated the clinical and cost effectiveness of this model but its acceptability to physicians has not been examined. This study investigates the experiences of participating family physicians. METHODS A mixed-methods study, combining physician questionnaire response data and qualitative thematic analysis of focus group interview data. RESULTS Data was collected from n = 17 survey respondents and n = 9 participants in two semi-structured focus groups (n = 4 and n = 5 respectively). Physicians reported high satisfaction, driven by skills development and patient gratitude, and felt empowered to reduce ED visits, care for unattached patients, and address simple medical needs. However, physicians found it difficult to provide continuous care and were sometimes unfamiliar with local healthcare resources. CONCLUSION This study found that a hybrid model of in-person and virtual care from family physicians and community paramedics was associated with positive physician experiences in two main areas: clinical impacts, especially avoiding unnecessary ED visits, and physician satisfaction with the service. Potential improvements for this hybrid model were identified, and include better support for patients with complex needs, and more information about local health-system services. Our findings should be of interest to policymakers and administrators seeking to improve access to care through a hybrid model of in-person and virtual care.
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Affiliation(s)
- Jonathan Fitzsimon
- Department of Family Medicine, University of Ottawa, 600 Peter Morand Crescent #201, Ottawa, ON, K1G 5Z3, Canada.
| | - Kush Patel
- Faculty of Medicine, University of Ottawa, Roger Guindon Hall, 451 Smyth Rd #2044, Ottawa, ON, K1H 8M5, Canada
| | - Cayden Peixoto
- Institut du Savoir Montfort, 713 Montréal Rd, Ottawa, ON, K1K 0T2, Canada
| | - Christopher Belanger
- Department of Family Medicine, University of Ottawa, 600 Peter Morand Crescent #201, Ottawa, ON, K1G 5Z3, Canada
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11
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Kiran T, Green ME, Strauss R, Wu CF, Daneshvarfard M, Kopp A, Lapointe-Shaw L, Latifovic L, Frymire E, Glazier RH. Virtual Care and Emergency Department Use During the COVID-19 Pandemic Among Patients of Family Physicians in Ontario, Canada. JAMA Netw Open 2023; 6:e239602. [PMID: 37115549 PMCID: PMC10148195 DOI: 10.1001/jamanetworkopen.2023.9602] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
Importance The COVID-19 pandemic has played a role in increased use of virtual care in primary care. However, few studies have examined the association between virtual primary care visits and other health care use. Objective To evaluate the association between the percentage of virtual visits in primary care and the rate of emergency department (ED) visits. Design, Setting, and Participants This cross-sectional study used routinely collected administrative data and was conducted in Ontario, Canada. The sample comprised family physicians with at least 1 primary care visit claim between February 1 and October 31, 2021, and permanent Ontario residents who were alive as of March 31, 2021. All residents were assigned to physicians according to enrollment and billing data. Exposure Family physicians' virtual visit rate was the exposure. Physicians were stratified by the percentage of total visits that they delivered virtually (via telephone or video) during the study period (0% [100% in person], >0%-20%, >20%-40%, >40%-60%, >60%-80%, >80% to <100%, or 100%). Main Outcomes and Measures Population-level ED visit rate was calculated for each stratum of virtual care use. Multivariable regression models were used to understand the relative rate of patient ED use after adjusting for rurality of practice, patient characteristics, and 2019 ED visit rates. Results Data were analyzed for a total of 13 820 family physicians (7114 males [51.5%]; mean [SD] age, 50 [13.1] years) with 12 951 063 patients (6 714 150 females [51.8%]; mean [SD] age, 42.6 [22.9] years) who were attached to these physicians. Most physicians provided between 40% and 80% of care virtually. A higher percentage of the physicians who provided more than 80% of care virtually were 65 years or older, female individuals, and practiced in big cities. Patient comorbidity and morbidity were similar across strata of virtual care use. The mean (SD) number of ED visits was highest among patients whose physicians provided only in-person care (470.3 [1918.8] per 1000 patients) and was lowest among patients of physicians who provided more than 80% to less than 100% of care virtually (242.0 [800.3] per 1000 patients). After adjustment for patient characteristics, patients of physicians with more than 20% of visits delivered virtually had lower rates of ED visits compared with patients of physicians who provided more than 0% to 20% of care virtually (eg, >80% to <100% vs >0%-20% virtual visits in big cities: relative rate, 0.77%; 95% CI, 0.74%-0.81%). This pattern was unchanged across all rurality of practice strata and after adjustment for 2019 ED visit rates. In urban areas, there was a gradient whereby patients of physicians providing the highest level of virtual care had the lowest ED visit rates. Conclusions and Relevance Findings of this study show that patients of physicians who provided a higher percentage of virtual care did not have higher ED visit rates compared with patients of physicians who provided the lowest levels of virtual care. The findings refute the hypothesis that family physicians providing more care virtually during the pandemic resulted in higher ED use.
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Affiliation(s)
- Tara Kiran
- Department of Family and Community Medicine, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
- ICES Central, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Michael E Green
- Department of Family Medicine, Queen's University, Kingston, Ontario, Canada
- Health Services and Policy Research Institute, Queen's University, Kingston, Ontario, Canada
- ICES Queen's, Kingston, Ontario, Canada
| | | | | | - Maryam Daneshvarfard
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | | | - Lauren Lapointe-Shaw
- ICES Central, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto and University Health Network, Toronto, Ontario, Canada
| | - Lidija Latifovic
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Eliot Frymire
- Health Services and Policy Research Institute, Queen's University, Kingston, Ontario, Canada
- ICES Queen's, Kingston, Ontario, Canada
| | - Richard H Glazier
- Department of Family and Community Medicine, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
- ICES Central, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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12
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Lapointe-Shaw L, Kiran T, Salahub C, Austin PC, Berthelot S, Desveaux L, Lofters A, Maclure M, Martin D, McBrien KA, McCracken RK, Rahman B, Schultz SE, Shuldiner J, Tadrous M, Bird C, Paterson JM, Bhatia RS, Thakkar NA, Na Y, Ivers NM. Walk-in clinic patient characteristics and utilization patterns in Ontario, Canada: a cross-sectional study. CMAJ Open 2023; 11:E345-E356. [PMID: 37171909 PMCID: PMC10139081 DOI: 10.9778/cmajo.20220095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/14/2023] Open
Abstract
BACKGROUND Walk-in clinics are common in North America and are designed to provide acute episodic care without an appointment. We sought to describe a sample of walk-in clinic patients in Ontario, Canada, which is a setting with high levels of primary care attachment. METHODS We performed a cross-sectional study using health administrative data from 2019. We compared the sociodemographic characteristics and health care utilization patterns of patients attending 1 of 72 walk-in clinics with those of the general Ontario population. We examined the subset of patients who were enrolled with a family physician and compared walk-in clinic visits to family physician visits. RESULTS Our study found that 562 781 patients made 1 148 151 visits to the included walk-in clinics. Most (70%) patients who attended a walk-in clinic had an enrolling family physician. Walk-in clinic patients were younger (mean age 36 yr v. 41 yr, standardized mean difference [SMD] 0.24), yet had greater health care utilization (moderate and high use group 74% v. 65%, SMD 0.20) than the general Ontario population. Among enrolled Ontarians, walk-in patients had more comorbidities (moderate and high count 50% v. 45%, SMD 0.10), lived farther from their enrolling physician (median 8 km v. 6 km, SMD 0.21) and saw their enrolling physician less in the previous year (any visit 67% v. 80%, SMD 0.30). Walk-in encounters happened more often after hours (16% v. 9%, SMD 0.20) and on weekends (18% v. 5%, SMD 0.45). Walk-in clinics were more often within 3 km of patients' homes than enrolling physicians' offices (0 to < 3 km: 32% v. 22%, SMD 0.21). INTERPRETATION Our findings suggest that proximity of walk-in clinics and after-hours access may be contributing to walk-in clinic use among patients enrolled with a family physician. These findings have implications for policy development to improve the integration of walk-in clinics and longitudinal primary care.
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Affiliation(s)
- Lauren Lapointe-Shaw
- ICES (Lapointe-Shaw, Kiran, Austin, Schultz, Tadrous, Paterson, Bhatia, Na, Ivers), Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Lapointe-Shaw, Kiran, Austin, Desveaux, Martin, Paterson, Bhatia, Ivers), University of Toronto, Toronto, Ont.; Division of General Internal Medicine and Geriatrics (Lapointe-Shaw), University Health Network and Sinai Health System, Toronto, Ont.; Department of Medicine (Lapointe-Shaw, Bhatia), University of Toronto, Toronto, Ont.; Women's College Institute for Health System Solutions and Virtual Care (Lapointe-Shaw, Martin, Shuldiner, Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Toronto General Hospital Research Institute, University Health Network (Lapointe-Shaw, Salahub), Toronto, Ont.; Peter Munk Cardiac Centre, University Health Network (Bhatia), Toronto, Ont.; Department of Family and Community Medicine (Kiran) and MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Toronto, Ont.; Département de médecine familiale et de médecine d'urgence (Berthelot), Université Laval, Quebec City, Qué.; Institute for Better Health, Trillium Health Partners (Desveaux), Mississauga, Ont.; Department of Family and Community Medicine (Lofters, Martin, Ivers, Kiran), University of Toronto, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology, Pharmacology and Therapeutics (Maclure), University of British Columbia, Vancouver, BC; Department of Family Medicine (Martin, Ivers), Women's College Hospital, Toronto, Ont.; Temerty Faculty of Medicine (Martin), University of Toronto, Toronto, Ont.; Departments of Family Medicine and Community Health Sciences (McBrien), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Family Practice (McCracken), University of British Columbia, Vancouver, BC; Department of Family Medicine (McCracken), Providence Health Care, Vancouver, BC; Primary Health Care Branch (Rahman), Ministry of Health, Toronto, Ont.; patient partner (Bird), Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; College of Nurses of Ontario (Thakkar), Toronto, Ont.; Women's College Hospital Research Institute (Na), Women's College Hospital, Toronto, Ont.
| | - Tara Kiran
- ICES (Lapointe-Shaw, Kiran, Austin, Schultz, Tadrous, Paterson, Bhatia, Na, Ivers), Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Lapointe-Shaw, Kiran, Austin, Desveaux, Martin, Paterson, Bhatia, Ivers), University of Toronto, Toronto, Ont.; Division of General Internal Medicine and Geriatrics (Lapointe-Shaw), University Health Network and Sinai Health System, Toronto, Ont.; Department of Medicine (Lapointe-Shaw, Bhatia), University of Toronto, Toronto, Ont.; Women's College Institute for Health System Solutions and Virtual Care (Lapointe-Shaw, Martin, Shuldiner, Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Toronto General Hospital Research Institute, University Health Network (Lapointe-Shaw, Salahub), Toronto, Ont.; Peter Munk Cardiac Centre, University Health Network (Bhatia), Toronto, Ont.; Department of Family and Community Medicine (Kiran) and MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Toronto, Ont.; Département de médecine familiale et de médecine d'urgence (Berthelot), Université Laval, Quebec City, Qué.; Institute for Better Health, Trillium Health Partners (Desveaux), Mississauga, Ont.; Department of Family and Community Medicine (Lofters, Martin, Ivers, Kiran), University of Toronto, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology, Pharmacology and Therapeutics (Maclure), University of British Columbia, Vancouver, BC; Department of Family Medicine (Martin, Ivers), Women's College Hospital, Toronto, Ont.; Temerty Faculty of Medicine (Martin), University of Toronto, Toronto, Ont.; Departments of Family Medicine and Community Health Sciences (McBrien), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Family Practice (McCracken), University of British Columbia, Vancouver, BC; Department of Family Medicine (McCracken), Providence Health Care, Vancouver, BC; Primary Health Care Branch (Rahman), Ministry of Health, Toronto, Ont.; patient partner (Bird), Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; College of Nurses of Ontario (Thakkar), Toronto, Ont.; Women's College Hospital Research Institute (Na), Women's College Hospital, Toronto, Ont
| | - Christine Salahub
- ICES (Lapointe-Shaw, Kiran, Austin, Schultz, Tadrous, Paterson, Bhatia, Na, Ivers), Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Lapointe-Shaw, Kiran, Austin, Desveaux, Martin, Paterson, Bhatia, Ivers), University of Toronto, Toronto, Ont.; Division of General Internal Medicine and Geriatrics (Lapointe-Shaw), University Health Network and Sinai Health System, Toronto, Ont.; Department of Medicine (Lapointe-Shaw, Bhatia), University of Toronto, Toronto, Ont.; Women's College Institute for Health System Solutions and Virtual Care (Lapointe-Shaw, Martin, Shuldiner, Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Toronto General Hospital Research Institute, University Health Network (Lapointe-Shaw, Salahub), Toronto, Ont.; Peter Munk Cardiac Centre, University Health Network (Bhatia), Toronto, Ont.; Department of Family and Community Medicine (Kiran) and MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Toronto, Ont.; Département de médecine familiale et de médecine d'urgence (Berthelot), Université Laval, Quebec City, Qué.; Institute for Better Health, Trillium Health Partners (Desveaux), Mississauga, Ont.; Department of Family and Community Medicine (Lofters, Martin, Ivers, Kiran), University of Toronto, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology, Pharmacology and Therapeutics (Maclure), University of British Columbia, Vancouver, BC; Department of Family Medicine (Martin, Ivers), Women's College Hospital, Toronto, Ont.; Temerty Faculty of Medicine (Martin), University of Toronto, Toronto, Ont.; Departments of Family Medicine and Community Health Sciences (McBrien), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Family Practice (McCracken), University of British Columbia, Vancouver, BC; Department of Family Medicine (McCracken), Providence Health Care, Vancouver, BC; Primary Health Care Branch (Rahman), Ministry of Health, Toronto, Ont.; patient partner (Bird), Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; College of Nurses of Ontario (Thakkar), Toronto, Ont.; Women's College Hospital Research Institute (Na), Women's College Hospital, Toronto, Ont
| | - Peter C Austin
- ICES (Lapointe-Shaw, Kiran, Austin, Schultz, Tadrous, Paterson, Bhatia, Na, Ivers), Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Lapointe-Shaw, Kiran, Austin, Desveaux, Martin, Paterson, Bhatia, Ivers), University of Toronto, Toronto, Ont.; Division of General Internal Medicine and Geriatrics (Lapointe-Shaw), University Health Network and Sinai Health System, Toronto, Ont.; Department of Medicine (Lapointe-Shaw, Bhatia), University of Toronto, Toronto, Ont.; Women's College Institute for Health System Solutions and Virtual Care (Lapointe-Shaw, Martin, Shuldiner, Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Toronto General Hospital Research Institute, University Health Network (Lapointe-Shaw, Salahub), Toronto, Ont.; Peter Munk Cardiac Centre, University Health Network (Bhatia), Toronto, Ont.; Department of Family and Community Medicine (Kiran) and MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Toronto, Ont.; Département de médecine familiale et de médecine d'urgence (Berthelot), Université Laval, Quebec City, Qué.; Institute for Better Health, Trillium Health Partners (Desveaux), Mississauga, Ont.; Department of Family and Community Medicine (Lofters, Martin, Ivers, Kiran), University of Toronto, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology, Pharmacology and Therapeutics (Maclure), University of British Columbia, Vancouver, BC; Department of Family Medicine (Martin, Ivers), Women's College Hospital, Toronto, Ont.; Temerty Faculty of Medicine (Martin), University of Toronto, Toronto, Ont.; Departments of Family Medicine and Community Health Sciences (McBrien), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Family Practice (McCracken), University of British Columbia, Vancouver, BC; Department of Family Medicine (McCracken), Providence Health Care, Vancouver, BC; Primary Health Care Branch (Rahman), Ministry of Health, Toronto, Ont.; patient partner (Bird), Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; College of Nurses of Ontario (Thakkar), Toronto, Ont.; Women's College Hospital Research Institute (Na), Women's College Hospital, Toronto, Ont
| | - Simon Berthelot
- ICES (Lapointe-Shaw, Kiran, Austin, Schultz, Tadrous, Paterson, Bhatia, Na, Ivers), Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Lapointe-Shaw, Kiran, Austin, Desveaux, Martin, Paterson, Bhatia, Ivers), University of Toronto, Toronto, Ont.; Division of General Internal Medicine and Geriatrics (Lapointe-Shaw), University Health Network and Sinai Health System, Toronto, Ont.; Department of Medicine (Lapointe-Shaw, Bhatia), University of Toronto, Toronto, Ont.; Women's College Institute for Health System Solutions and Virtual Care (Lapointe-Shaw, Martin, Shuldiner, Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Toronto General Hospital Research Institute, University Health Network (Lapointe-Shaw, Salahub), Toronto, Ont.; Peter Munk Cardiac Centre, University Health Network (Bhatia), Toronto, Ont.; Department of Family and Community Medicine (Kiran) and MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Toronto, Ont.; Département de médecine familiale et de médecine d'urgence (Berthelot), Université Laval, Quebec City, Qué.; Institute for Better Health, Trillium Health Partners (Desveaux), Mississauga, Ont.; Department of Family and Community Medicine (Lofters, Martin, Ivers, Kiran), University of Toronto, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology, Pharmacology and Therapeutics (Maclure), University of British Columbia, Vancouver, BC; Department of Family Medicine (Martin, Ivers), Women's College Hospital, Toronto, Ont.; Temerty Faculty of Medicine (Martin), University of Toronto, Toronto, Ont.; Departments of Family Medicine and Community Health Sciences (McBrien), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Family Practice (McCracken), University of British Columbia, Vancouver, BC; Department of Family Medicine (McCracken), Providence Health Care, Vancouver, BC; Primary Health Care Branch (Rahman), Ministry of Health, Toronto, Ont.; patient partner (Bird), Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; College of Nurses of Ontario (Thakkar), Toronto, Ont.; Women's College Hospital Research Institute (Na), Women's College Hospital, Toronto, Ont
| | - Laura Desveaux
- ICES (Lapointe-Shaw, Kiran, Austin, Schultz, Tadrous, Paterson, Bhatia, Na, Ivers), Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Lapointe-Shaw, Kiran, Austin, Desveaux, Martin, Paterson, Bhatia, Ivers), University of Toronto, Toronto, Ont.; Division of General Internal Medicine and Geriatrics (Lapointe-Shaw), University Health Network and Sinai Health System, Toronto, Ont.; Department of Medicine (Lapointe-Shaw, Bhatia), University of Toronto, Toronto, Ont.; Women's College Institute for Health System Solutions and Virtual Care (Lapointe-Shaw, Martin, Shuldiner, Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Toronto General Hospital Research Institute, University Health Network (Lapointe-Shaw, Salahub), Toronto, Ont.; Peter Munk Cardiac Centre, University Health Network (Bhatia), Toronto, Ont.; Department of Family and Community Medicine (Kiran) and MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Toronto, Ont.; Département de médecine familiale et de médecine d'urgence (Berthelot), Université Laval, Quebec City, Qué.; Institute for Better Health, Trillium Health Partners (Desveaux), Mississauga, Ont.; Department of Family and Community Medicine (Lofters, Martin, Ivers, Kiran), University of Toronto, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology, Pharmacology and Therapeutics (Maclure), University of British Columbia, Vancouver, BC; Department of Family Medicine (Martin, Ivers), Women's College Hospital, Toronto, Ont.; Temerty Faculty of Medicine (Martin), University of Toronto, Toronto, Ont.; Departments of Family Medicine and Community Health Sciences (McBrien), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Family Practice (McCracken), University of British Columbia, Vancouver, BC; Department of Family Medicine (McCracken), Providence Health Care, Vancouver, BC; Primary Health Care Branch (Rahman), Ministry of Health, Toronto, Ont.; patient partner (Bird), Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; College of Nurses of Ontario (Thakkar), Toronto, Ont.; Women's College Hospital Research Institute (Na), Women's College Hospital, Toronto, Ont
| | - Aisha Lofters
- ICES (Lapointe-Shaw, Kiran, Austin, Schultz, Tadrous, Paterson, Bhatia, Na, Ivers), Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Lapointe-Shaw, Kiran, Austin, Desveaux, Martin, Paterson, Bhatia, Ivers), University of Toronto, Toronto, Ont.; Division of General Internal Medicine and Geriatrics (Lapointe-Shaw), University Health Network and Sinai Health System, Toronto, Ont.; Department of Medicine (Lapointe-Shaw, Bhatia), University of Toronto, Toronto, Ont.; Women's College Institute for Health System Solutions and Virtual Care (Lapointe-Shaw, Martin, Shuldiner, Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Toronto General Hospital Research Institute, University Health Network (Lapointe-Shaw, Salahub), Toronto, Ont.; Peter Munk Cardiac Centre, University Health Network (Bhatia), Toronto, Ont.; Department of Family and Community Medicine (Kiran) and MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Toronto, Ont.; Département de médecine familiale et de médecine d'urgence (Berthelot), Université Laval, Quebec City, Qué.; Institute for Better Health, Trillium Health Partners (Desveaux), Mississauga, Ont.; Department of Family and Community Medicine (Lofters, Martin, Ivers, Kiran), University of Toronto, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology, Pharmacology and Therapeutics (Maclure), University of British Columbia, Vancouver, BC; Department of Family Medicine (Martin, Ivers), Women's College Hospital, Toronto, Ont.; Temerty Faculty of Medicine (Martin), University of Toronto, Toronto, Ont.; Departments of Family Medicine and Community Health Sciences (McBrien), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Family Practice (McCracken), University of British Columbia, Vancouver, BC; Department of Family Medicine (McCracken), Providence Health Care, Vancouver, BC; Primary Health Care Branch (Rahman), Ministry of Health, Toronto, Ont.; patient partner (Bird), Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; College of Nurses of Ontario (Thakkar), Toronto, Ont.; Women's College Hospital Research Institute (Na), Women's College Hospital, Toronto, Ont
| | - Malcolm Maclure
- ICES (Lapointe-Shaw, Kiran, Austin, Schultz, Tadrous, Paterson, Bhatia, Na, Ivers), Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Lapointe-Shaw, Kiran, Austin, Desveaux, Martin, Paterson, Bhatia, Ivers), University of Toronto, Toronto, Ont.; Division of General Internal Medicine and Geriatrics (Lapointe-Shaw), University Health Network and Sinai Health System, Toronto, Ont.; Department of Medicine (Lapointe-Shaw, Bhatia), University of Toronto, Toronto, Ont.; Women's College Institute for Health System Solutions and Virtual Care (Lapointe-Shaw, Martin, Shuldiner, Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Toronto General Hospital Research Institute, University Health Network (Lapointe-Shaw, Salahub), Toronto, Ont.; Peter Munk Cardiac Centre, University Health Network (Bhatia), Toronto, Ont.; Department of Family and Community Medicine (Kiran) and MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Toronto, Ont.; Département de médecine familiale et de médecine d'urgence (Berthelot), Université Laval, Quebec City, Qué.; Institute for Better Health, Trillium Health Partners (Desveaux), Mississauga, Ont.; Department of Family and Community Medicine (Lofters, Martin, Ivers, Kiran), University of Toronto, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology, Pharmacology and Therapeutics (Maclure), University of British Columbia, Vancouver, BC; Department of Family Medicine (Martin, Ivers), Women's College Hospital, Toronto, Ont.; Temerty Faculty of Medicine (Martin), University of Toronto, Toronto, Ont.; Departments of Family Medicine and Community Health Sciences (McBrien), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Family Practice (McCracken), University of British Columbia, Vancouver, BC; Department of Family Medicine (McCracken), Providence Health Care, Vancouver, BC; Primary Health Care Branch (Rahman), Ministry of Health, Toronto, Ont.; patient partner (Bird), Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; College of Nurses of Ontario (Thakkar), Toronto, Ont.; Women's College Hospital Research Institute (Na), Women's College Hospital, Toronto, Ont
| | - Danielle Martin
- ICES (Lapointe-Shaw, Kiran, Austin, Schultz, Tadrous, Paterson, Bhatia, Na, Ivers), Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Lapointe-Shaw, Kiran, Austin, Desveaux, Martin, Paterson, Bhatia, Ivers), University of Toronto, Toronto, Ont.; Division of General Internal Medicine and Geriatrics (Lapointe-Shaw), University Health Network and Sinai Health System, Toronto, Ont.; Department of Medicine (Lapointe-Shaw, Bhatia), University of Toronto, Toronto, Ont.; Women's College Institute for Health System Solutions and Virtual Care (Lapointe-Shaw, Martin, Shuldiner, Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Toronto General Hospital Research Institute, University Health Network (Lapointe-Shaw, Salahub), Toronto, Ont.; Peter Munk Cardiac Centre, University Health Network (Bhatia), Toronto, Ont.; Department of Family and Community Medicine (Kiran) and MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Toronto, Ont.; Département de médecine familiale et de médecine d'urgence (Berthelot), Université Laval, Quebec City, Qué.; Institute for Better Health, Trillium Health Partners (Desveaux), Mississauga, Ont.; Department of Family and Community Medicine (Lofters, Martin, Ivers, Kiran), University of Toronto, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology, Pharmacology and Therapeutics (Maclure), University of British Columbia, Vancouver, BC; Department of Family Medicine (Martin, Ivers), Women's College Hospital, Toronto, Ont.; Temerty Faculty of Medicine (Martin), University of Toronto, Toronto, Ont.; Departments of Family Medicine and Community Health Sciences (McBrien), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Family Practice (McCracken), University of British Columbia, Vancouver, BC; Department of Family Medicine (McCracken), Providence Health Care, Vancouver, BC; Primary Health Care Branch (Rahman), Ministry of Health, Toronto, Ont.; patient partner (Bird), Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; College of Nurses of Ontario (Thakkar), Toronto, Ont.; Women's College Hospital Research Institute (Na), Women's College Hospital, Toronto, Ont
| | - Kerry A McBrien
- ICES (Lapointe-Shaw, Kiran, Austin, Schultz, Tadrous, Paterson, Bhatia, Na, Ivers), Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Lapointe-Shaw, Kiran, Austin, Desveaux, Martin, Paterson, Bhatia, Ivers), University of Toronto, Toronto, Ont.; Division of General Internal Medicine and Geriatrics (Lapointe-Shaw), University Health Network and Sinai Health System, Toronto, Ont.; Department of Medicine (Lapointe-Shaw, Bhatia), University of Toronto, Toronto, Ont.; Women's College Institute for Health System Solutions and Virtual Care (Lapointe-Shaw, Martin, Shuldiner, Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Toronto General Hospital Research Institute, University Health Network (Lapointe-Shaw, Salahub), Toronto, Ont.; Peter Munk Cardiac Centre, University Health Network (Bhatia), Toronto, Ont.; Department of Family and Community Medicine (Kiran) and MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Toronto, Ont.; Département de médecine familiale et de médecine d'urgence (Berthelot), Université Laval, Quebec City, Qué.; Institute for Better Health, Trillium Health Partners (Desveaux), Mississauga, Ont.; Department of Family and Community Medicine (Lofters, Martin, Ivers, Kiran), University of Toronto, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology, Pharmacology and Therapeutics (Maclure), University of British Columbia, Vancouver, BC; Department of Family Medicine (Martin, Ivers), Women's College Hospital, Toronto, Ont.; Temerty Faculty of Medicine (Martin), University of Toronto, Toronto, Ont.; Departments of Family Medicine and Community Health Sciences (McBrien), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Family Practice (McCracken), University of British Columbia, Vancouver, BC; Department of Family Medicine (McCracken), Providence Health Care, Vancouver, BC; Primary Health Care Branch (Rahman), Ministry of Health, Toronto, Ont.; patient partner (Bird), Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; College of Nurses of Ontario (Thakkar), Toronto, Ont.; Women's College Hospital Research Institute (Na), Women's College Hospital, Toronto, Ont
| | - Rita K McCracken
- ICES (Lapointe-Shaw, Kiran, Austin, Schultz, Tadrous, Paterson, Bhatia, Na, Ivers), Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Lapointe-Shaw, Kiran, Austin, Desveaux, Martin, Paterson, Bhatia, Ivers), University of Toronto, Toronto, Ont.; Division of General Internal Medicine and Geriatrics (Lapointe-Shaw), University Health Network and Sinai Health System, Toronto, Ont.; Department of Medicine (Lapointe-Shaw, Bhatia), University of Toronto, Toronto, Ont.; Women's College Institute for Health System Solutions and Virtual Care (Lapointe-Shaw, Martin, Shuldiner, Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Toronto General Hospital Research Institute, University Health Network (Lapointe-Shaw, Salahub), Toronto, Ont.; Peter Munk Cardiac Centre, University Health Network (Bhatia), Toronto, Ont.; Department of Family and Community Medicine (Kiran) and MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Toronto, Ont.; Département de médecine familiale et de médecine d'urgence (Berthelot), Université Laval, Quebec City, Qué.; Institute for Better Health, Trillium Health Partners (Desveaux), Mississauga, Ont.; Department of Family and Community Medicine (Lofters, Martin, Ivers, Kiran), University of Toronto, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology, Pharmacology and Therapeutics (Maclure), University of British Columbia, Vancouver, BC; Department of Family Medicine (Martin, Ivers), Women's College Hospital, Toronto, Ont.; Temerty Faculty of Medicine (Martin), University of Toronto, Toronto, Ont.; Departments of Family Medicine and Community Health Sciences (McBrien), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Family Practice (McCracken), University of British Columbia, Vancouver, BC; Department of Family Medicine (McCracken), Providence Health Care, Vancouver, BC; Primary Health Care Branch (Rahman), Ministry of Health, Toronto, Ont.; patient partner (Bird), Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; College of Nurses of Ontario (Thakkar), Toronto, Ont.; Women's College Hospital Research Institute (Na), Women's College Hospital, Toronto, Ont
| | - Bahram Rahman
- ICES (Lapointe-Shaw, Kiran, Austin, Schultz, Tadrous, Paterson, Bhatia, Na, Ivers), Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Lapointe-Shaw, Kiran, Austin, Desveaux, Martin, Paterson, Bhatia, Ivers), University of Toronto, Toronto, Ont.; Division of General Internal Medicine and Geriatrics (Lapointe-Shaw), University Health Network and Sinai Health System, Toronto, Ont.; Department of Medicine (Lapointe-Shaw, Bhatia), University of Toronto, Toronto, Ont.; Women's College Institute for Health System Solutions and Virtual Care (Lapointe-Shaw, Martin, Shuldiner, Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Toronto General Hospital Research Institute, University Health Network (Lapointe-Shaw, Salahub), Toronto, Ont.; Peter Munk Cardiac Centre, University Health Network (Bhatia), Toronto, Ont.; Department of Family and Community Medicine (Kiran) and MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Toronto, Ont.; Département de médecine familiale et de médecine d'urgence (Berthelot), Université Laval, Quebec City, Qué.; Institute for Better Health, Trillium Health Partners (Desveaux), Mississauga, Ont.; Department of Family and Community Medicine (Lofters, Martin, Ivers, Kiran), University of Toronto, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology, Pharmacology and Therapeutics (Maclure), University of British Columbia, Vancouver, BC; Department of Family Medicine (Martin, Ivers), Women's College Hospital, Toronto, Ont.; Temerty Faculty of Medicine (Martin), University of Toronto, Toronto, Ont.; Departments of Family Medicine and Community Health Sciences (McBrien), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Family Practice (McCracken), University of British Columbia, Vancouver, BC; Department of Family Medicine (McCracken), Providence Health Care, Vancouver, BC; Primary Health Care Branch (Rahman), Ministry of Health, Toronto, Ont.; patient partner (Bird), Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; College of Nurses of Ontario (Thakkar), Toronto, Ont.; Women's College Hospital Research Institute (Na), Women's College Hospital, Toronto, Ont
| | - Susan E Schultz
- ICES (Lapointe-Shaw, Kiran, Austin, Schultz, Tadrous, Paterson, Bhatia, Na, Ivers), Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Lapointe-Shaw, Kiran, Austin, Desveaux, Martin, Paterson, Bhatia, Ivers), University of Toronto, Toronto, Ont.; Division of General Internal Medicine and Geriatrics (Lapointe-Shaw), University Health Network and Sinai Health System, Toronto, Ont.; Department of Medicine (Lapointe-Shaw, Bhatia), University of Toronto, Toronto, Ont.; Women's College Institute for Health System Solutions and Virtual Care (Lapointe-Shaw, Martin, Shuldiner, Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Toronto General Hospital Research Institute, University Health Network (Lapointe-Shaw, Salahub), Toronto, Ont.; Peter Munk Cardiac Centre, University Health Network (Bhatia), Toronto, Ont.; Department of Family and Community Medicine (Kiran) and MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Toronto, Ont.; Département de médecine familiale et de médecine d'urgence (Berthelot), Université Laval, Quebec City, Qué.; Institute for Better Health, Trillium Health Partners (Desveaux), Mississauga, Ont.; Department of Family and Community Medicine (Lofters, Martin, Ivers, Kiran), University of Toronto, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology, Pharmacology and Therapeutics (Maclure), University of British Columbia, Vancouver, BC; Department of Family Medicine (Martin, Ivers), Women's College Hospital, Toronto, Ont.; Temerty Faculty of Medicine (Martin), University of Toronto, Toronto, Ont.; Departments of Family Medicine and Community Health Sciences (McBrien), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Family Practice (McCracken), University of British Columbia, Vancouver, BC; Department of Family Medicine (McCracken), Providence Health Care, Vancouver, BC; Primary Health Care Branch (Rahman), Ministry of Health, Toronto, Ont.; patient partner (Bird), Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; College of Nurses of Ontario (Thakkar), Toronto, Ont.; Women's College Hospital Research Institute (Na), Women's College Hospital, Toronto, Ont
| | - Jennifer Shuldiner
- ICES (Lapointe-Shaw, Kiran, Austin, Schultz, Tadrous, Paterson, Bhatia, Na, Ivers), Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Lapointe-Shaw, Kiran, Austin, Desveaux, Martin, Paterson, Bhatia, Ivers), University of Toronto, Toronto, Ont.; Division of General Internal Medicine and Geriatrics (Lapointe-Shaw), University Health Network and Sinai Health System, Toronto, Ont.; Department of Medicine (Lapointe-Shaw, Bhatia), University of Toronto, Toronto, Ont.; Women's College Institute for Health System Solutions and Virtual Care (Lapointe-Shaw, Martin, Shuldiner, Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Toronto General Hospital Research Institute, University Health Network (Lapointe-Shaw, Salahub), Toronto, Ont.; Peter Munk Cardiac Centre, University Health Network (Bhatia), Toronto, Ont.; Department of Family and Community Medicine (Kiran) and MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Toronto, Ont.; Département de médecine familiale et de médecine d'urgence (Berthelot), Université Laval, Quebec City, Qué.; Institute for Better Health, Trillium Health Partners (Desveaux), Mississauga, Ont.; Department of Family and Community Medicine (Lofters, Martin, Ivers, Kiran), University of Toronto, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology, Pharmacology and Therapeutics (Maclure), University of British Columbia, Vancouver, BC; Department of Family Medicine (Martin, Ivers), Women's College Hospital, Toronto, Ont.; Temerty Faculty of Medicine (Martin), University of Toronto, Toronto, Ont.; Departments of Family Medicine and Community Health Sciences (McBrien), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Family Practice (McCracken), University of British Columbia, Vancouver, BC; Department of Family Medicine (McCracken), Providence Health Care, Vancouver, BC; Primary Health Care Branch (Rahman), Ministry of Health, Toronto, Ont.; patient partner (Bird), Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; College of Nurses of Ontario (Thakkar), Toronto, Ont.; Women's College Hospital Research Institute (Na), Women's College Hospital, Toronto, Ont
| | - Mina Tadrous
- ICES (Lapointe-Shaw, Kiran, Austin, Schultz, Tadrous, Paterson, Bhatia, Na, Ivers), Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Lapointe-Shaw, Kiran, Austin, Desveaux, Martin, Paterson, Bhatia, Ivers), University of Toronto, Toronto, Ont.; Division of General Internal Medicine and Geriatrics (Lapointe-Shaw), University Health Network and Sinai Health System, Toronto, Ont.; Department of Medicine (Lapointe-Shaw, Bhatia), University of Toronto, Toronto, Ont.; Women's College Institute for Health System Solutions and Virtual Care (Lapointe-Shaw, Martin, Shuldiner, Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Toronto General Hospital Research Institute, University Health Network (Lapointe-Shaw, Salahub), Toronto, Ont.; Peter Munk Cardiac Centre, University Health Network (Bhatia), Toronto, Ont.; Department of Family and Community Medicine (Kiran) and MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Toronto, Ont.; Département de médecine familiale et de médecine d'urgence (Berthelot), Université Laval, Quebec City, Qué.; Institute for Better Health, Trillium Health Partners (Desveaux), Mississauga, Ont.; Department of Family and Community Medicine (Lofters, Martin, Ivers, Kiran), University of Toronto, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology, Pharmacology and Therapeutics (Maclure), University of British Columbia, Vancouver, BC; Department of Family Medicine (Martin, Ivers), Women's College Hospital, Toronto, Ont.; Temerty Faculty of Medicine (Martin), University of Toronto, Toronto, Ont.; Departments of Family Medicine and Community Health Sciences (McBrien), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Family Practice (McCracken), University of British Columbia, Vancouver, BC; Department of Family Medicine (McCracken), Providence Health Care, Vancouver, BC; Primary Health Care Branch (Rahman), Ministry of Health, Toronto, Ont.; patient partner (Bird), Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; College of Nurses of Ontario (Thakkar), Toronto, Ont.; Women's College Hospital Research Institute (Na), Women's College Hospital, Toronto, Ont
| | - Cherryl Bird
- ICES (Lapointe-Shaw, Kiran, Austin, Schultz, Tadrous, Paterson, Bhatia, Na, Ivers), Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Lapointe-Shaw, Kiran, Austin, Desveaux, Martin, Paterson, Bhatia, Ivers), University of Toronto, Toronto, Ont.; Division of General Internal Medicine and Geriatrics (Lapointe-Shaw), University Health Network and Sinai Health System, Toronto, Ont.; Department of Medicine (Lapointe-Shaw, Bhatia), University of Toronto, Toronto, Ont.; Women's College Institute for Health System Solutions and Virtual Care (Lapointe-Shaw, Martin, Shuldiner, Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Toronto General Hospital Research Institute, University Health Network (Lapointe-Shaw, Salahub), Toronto, Ont.; Peter Munk Cardiac Centre, University Health Network (Bhatia), Toronto, Ont.; Department of Family and Community Medicine (Kiran) and MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Toronto, Ont.; Département de médecine familiale et de médecine d'urgence (Berthelot), Université Laval, Quebec City, Qué.; Institute for Better Health, Trillium Health Partners (Desveaux), Mississauga, Ont.; Department of Family and Community Medicine (Lofters, Martin, Ivers, Kiran), University of Toronto, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology, Pharmacology and Therapeutics (Maclure), University of British Columbia, Vancouver, BC; Department of Family Medicine (Martin, Ivers), Women's College Hospital, Toronto, Ont.; Temerty Faculty of Medicine (Martin), University of Toronto, Toronto, Ont.; Departments of Family Medicine and Community Health Sciences (McBrien), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Family Practice (McCracken), University of British Columbia, Vancouver, BC; Department of Family Medicine (McCracken), Providence Health Care, Vancouver, BC; Primary Health Care Branch (Rahman), Ministry of Health, Toronto, Ont.; patient partner (Bird), Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; College of Nurses of Ontario (Thakkar), Toronto, Ont.; Women's College Hospital Research Institute (Na), Women's College Hospital, Toronto, Ont
| | - J Michael Paterson
- ICES (Lapointe-Shaw, Kiran, Austin, Schultz, Tadrous, Paterson, Bhatia, Na, Ivers), Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Lapointe-Shaw, Kiran, Austin, Desveaux, Martin, Paterson, Bhatia, Ivers), University of Toronto, Toronto, Ont.; Division of General Internal Medicine and Geriatrics (Lapointe-Shaw), University Health Network and Sinai Health System, Toronto, Ont.; Department of Medicine (Lapointe-Shaw, Bhatia), University of Toronto, Toronto, Ont.; Women's College Institute for Health System Solutions and Virtual Care (Lapointe-Shaw, Martin, Shuldiner, Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Toronto General Hospital Research Institute, University Health Network (Lapointe-Shaw, Salahub), Toronto, Ont.; Peter Munk Cardiac Centre, University Health Network (Bhatia), Toronto, Ont.; Department of Family and Community Medicine (Kiran) and MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Toronto, Ont.; Département de médecine familiale et de médecine d'urgence (Berthelot), Université Laval, Quebec City, Qué.; Institute for Better Health, Trillium Health Partners (Desveaux), Mississauga, Ont.; Department of Family and Community Medicine (Lofters, Martin, Ivers, Kiran), University of Toronto, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology, Pharmacology and Therapeutics (Maclure), University of British Columbia, Vancouver, BC; Department of Family Medicine (Martin, Ivers), Women's College Hospital, Toronto, Ont.; Temerty Faculty of Medicine (Martin), University of Toronto, Toronto, Ont.; Departments of Family Medicine and Community Health Sciences (McBrien), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Family Practice (McCracken), University of British Columbia, Vancouver, BC; Department of Family Medicine (McCracken), Providence Health Care, Vancouver, BC; Primary Health Care Branch (Rahman), Ministry of Health, Toronto, Ont.; patient partner (Bird), Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; College of Nurses of Ontario (Thakkar), Toronto, Ont.; Women's College Hospital Research Institute (Na), Women's College Hospital, Toronto, Ont
| | - R Sacha Bhatia
- ICES (Lapointe-Shaw, Kiran, Austin, Schultz, Tadrous, Paterson, Bhatia, Na, Ivers), Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Lapointe-Shaw, Kiran, Austin, Desveaux, Martin, Paterson, Bhatia, Ivers), University of Toronto, Toronto, Ont.; Division of General Internal Medicine and Geriatrics (Lapointe-Shaw), University Health Network and Sinai Health System, Toronto, Ont.; Department of Medicine (Lapointe-Shaw, Bhatia), University of Toronto, Toronto, Ont.; Women's College Institute for Health System Solutions and Virtual Care (Lapointe-Shaw, Martin, Shuldiner, Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Toronto General Hospital Research Institute, University Health Network (Lapointe-Shaw, Salahub), Toronto, Ont.; Peter Munk Cardiac Centre, University Health Network (Bhatia), Toronto, Ont.; Department of Family and Community Medicine (Kiran) and MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Toronto, Ont.; Département de médecine familiale et de médecine d'urgence (Berthelot), Université Laval, Quebec City, Qué.; Institute for Better Health, Trillium Health Partners (Desveaux), Mississauga, Ont.; Department of Family and Community Medicine (Lofters, Martin, Ivers, Kiran), University of Toronto, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology, Pharmacology and Therapeutics (Maclure), University of British Columbia, Vancouver, BC; Department of Family Medicine (Martin, Ivers), Women's College Hospital, Toronto, Ont.; Temerty Faculty of Medicine (Martin), University of Toronto, Toronto, Ont.; Departments of Family Medicine and Community Health Sciences (McBrien), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Family Practice (McCracken), University of British Columbia, Vancouver, BC; Department of Family Medicine (McCracken), Providence Health Care, Vancouver, BC; Primary Health Care Branch (Rahman), Ministry of Health, Toronto, Ont.; patient partner (Bird), Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; College of Nurses of Ontario (Thakkar), Toronto, Ont.; Women's College Hospital Research Institute (Na), Women's College Hospital, Toronto, Ont
| | - Niels A Thakkar
- ICES (Lapointe-Shaw, Kiran, Austin, Schultz, Tadrous, Paterson, Bhatia, Na, Ivers), Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Lapointe-Shaw, Kiran, Austin, Desveaux, Martin, Paterson, Bhatia, Ivers), University of Toronto, Toronto, Ont.; Division of General Internal Medicine and Geriatrics (Lapointe-Shaw), University Health Network and Sinai Health System, Toronto, Ont.; Department of Medicine (Lapointe-Shaw, Bhatia), University of Toronto, Toronto, Ont.; Women's College Institute for Health System Solutions and Virtual Care (Lapointe-Shaw, Martin, Shuldiner, Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Toronto General Hospital Research Institute, University Health Network (Lapointe-Shaw, Salahub), Toronto, Ont.; Peter Munk Cardiac Centre, University Health Network (Bhatia), Toronto, Ont.; Department of Family and Community Medicine (Kiran) and MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Toronto, Ont.; Département de médecine familiale et de médecine d'urgence (Berthelot), Université Laval, Quebec City, Qué.; Institute for Better Health, Trillium Health Partners (Desveaux), Mississauga, Ont.; Department of Family and Community Medicine (Lofters, Martin, Ivers, Kiran), University of Toronto, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology, Pharmacology and Therapeutics (Maclure), University of British Columbia, Vancouver, BC; Department of Family Medicine (Martin, Ivers), Women's College Hospital, Toronto, Ont.; Temerty Faculty of Medicine (Martin), University of Toronto, Toronto, Ont.; Departments of Family Medicine and Community Health Sciences (McBrien), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Family Practice (McCracken), University of British Columbia, Vancouver, BC; Department of Family Medicine (McCracken), Providence Health Care, Vancouver, BC; Primary Health Care Branch (Rahman), Ministry of Health, Toronto, Ont.; patient partner (Bird), Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; College of Nurses of Ontario (Thakkar), Toronto, Ont.; Women's College Hospital Research Institute (Na), Women's College Hospital, Toronto, Ont
| | - Yingbo Na
- ICES (Lapointe-Shaw, Kiran, Austin, Schultz, Tadrous, Paterson, Bhatia, Na, Ivers), Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Lapointe-Shaw, Kiran, Austin, Desveaux, Martin, Paterson, Bhatia, Ivers), University of Toronto, Toronto, Ont.; Division of General Internal Medicine and Geriatrics (Lapointe-Shaw), University Health Network and Sinai Health System, Toronto, Ont.; Department of Medicine (Lapointe-Shaw, Bhatia), University of Toronto, Toronto, Ont.; Women's College Institute for Health System Solutions and Virtual Care (Lapointe-Shaw, Martin, Shuldiner, Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Toronto General Hospital Research Institute, University Health Network (Lapointe-Shaw, Salahub), Toronto, Ont.; Peter Munk Cardiac Centre, University Health Network (Bhatia), Toronto, Ont.; Department of Family and Community Medicine (Kiran) and MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Toronto, Ont.; Département de médecine familiale et de médecine d'urgence (Berthelot), Université Laval, Quebec City, Qué.; Institute for Better Health, Trillium Health Partners (Desveaux), Mississauga, Ont.; Department of Family and Community Medicine (Lofters, Martin, Ivers, Kiran), University of Toronto, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology, Pharmacology and Therapeutics (Maclure), University of British Columbia, Vancouver, BC; Department of Family Medicine (Martin, Ivers), Women's College Hospital, Toronto, Ont.; Temerty Faculty of Medicine (Martin), University of Toronto, Toronto, Ont.; Departments of Family Medicine and Community Health Sciences (McBrien), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Family Practice (McCracken), University of British Columbia, Vancouver, BC; Department of Family Medicine (McCracken), Providence Health Care, Vancouver, BC; Primary Health Care Branch (Rahman), Ministry of Health, Toronto, Ont.; patient partner (Bird), Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; College of Nurses of Ontario (Thakkar), Toronto, Ont.; Women's College Hospital Research Institute (Na), Women's College Hospital, Toronto, Ont
| | - Noah M Ivers
- ICES (Lapointe-Shaw, Kiran, Austin, Schultz, Tadrous, Paterson, Bhatia, Na, Ivers), Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Lapointe-Shaw, Kiran, Austin, Desveaux, Martin, Paterson, Bhatia, Ivers), University of Toronto, Toronto, Ont.; Division of General Internal Medicine and Geriatrics (Lapointe-Shaw), University Health Network and Sinai Health System, Toronto, Ont.; Department of Medicine (Lapointe-Shaw, Bhatia), University of Toronto, Toronto, Ont.; Women's College Institute for Health System Solutions and Virtual Care (Lapointe-Shaw, Martin, Shuldiner, Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Toronto General Hospital Research Institute, University Health Network (Lapointe-Shaw, Salahub), Toronto, Ont.; Peter Munk Cardiac Centre, University Health Network (Bhatia), Toronto, Ont.; Department of Family and Community Medicine (Kiran) and MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Toronto, Ont.; Département de médecine familiale et de médecine d'urgence (Berthelot), Université Laval, Quebec City, Qué.; Institute for Better Health, Trillium Health Partners (Desveaux), Mississauga, Ont.; Department of Family and Community Medicine (Lofters, Martin, Ivers, Kiran), University of Toronto, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology, Pharmacology and Therapeutics (Maclure), University of British Columbia, Vancouver, BC; Department of Family Medicine (Martin, Ivers), Women's College Hospital, Toronto, Ont.; Temerty Faculty of Medicine (Martin), University of Toronto, Toronto, Ont.; Departments of Family Medicine and Community Health Sciences (McBrien), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Family Practice (McCracken), University of British Columbia, Vancouver, BC; Department of Family Medicine (McCracken), Providence Health Care, Vancouver, BC; Primary Health Care Branch (Rahman), Ministry of Health, Toronto, Ont.; patient partner (Bird), Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; College of Nurses of Ontario (Thakkar), Toronto, Ont.; Women's College Hospital Research Institute (Na), Women's College Hospital, Toronto, Ont
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Kiran T. Garder la porte d’entrée ouverte : assurer l’accès aux soins primaires à toute la population canadienne. CMAJ 2023; 195:E251-E253. [PMID: 36781196 PMCID: PMC9928439 DOI: 10.1503/cmaj.221563-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Affiliation(s)
- Tara Kiran
- Département de médecine familiale et communautaire, Hôpital St. Michael, Réseau hospitalier Unity Health Toronto; Département de médecine familiale et communautaire, Université de Toronto; Centre MAP pour des solutions de santé urbaine, Institut du savoir Li Ka Shing, Hôpital St. Michael; Institut de recherche en services de santé ICES Central; Institut des politiques, de la gestion et de l'évaluation de la santé, Université de Toronto, Toronto, Ont.
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14
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Affiliation(s)
- Tara Kiran
- Department of Family and Community Medicine, St. Michael's Hospital, Unity Health Toronto; Department of Family and Community Medicine, University of Toronto; MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital; ICES Central; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont.
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15
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Bearss E, Bhate TD, Hulme J, Landes M, Jones MK. To save emergency medicine, we must collaborate, innovate, and advocate. CAN J EMERG MED 2022; 24:459. [PMID: 35297007 DOI: 10.1007/s43678-022-00296-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 03/09/2022] [Indexed: 11/02/2022]
Affiliation(s)
- Erin Bearss
- Division of Emergency Medicine, Department of Family & Community Medicine, University of Toronto, Toronto, ON, Canada. .,Sinai Health Emergency & Family Medicine, Toronto, ON, Canada.
| | - Tahara D Bhate
- Division of Emergency Medicine, Department of Family & Community Medicine, University of Toronto, Toronto, ON, Canada.,University Health Network Emergency Medicine, Toronto, ON, Canada
| | - Jennifer Hulme
- Division of Emergency Medicine, Department of Family & Community Medicine, University of Toronto, Toronto, ON, Canada.,University Health Network Emergency Medicine, Toronto, ON, Canada
| | - Megan Landes
- Division of Emergency Medicine, Department of Family & Community Medicine, University of Toronto, Toronto, ON, Canada.,University Health Network Emergency Medicine, Toronto, ON, Canada
| | - Marcella K Jones
- Division of Emergency Medicine, Department of Family & Community Medicine, University of Toronto, Toronto, ON, Canada.,University Health Network Emergency Medicine, Toronto, ON, Canada
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