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O'Brien MA, Lofters A, Wall B, Elliott R, Makuwaza T, Pietrusiak MA, Grunfeld E, Riordan B, Snider C, Pinto AD, Manca D, Sopcak N, Cornacchi SD, Huizinga J, Sivayoganathan K, Donnelly PD, Selby P, Kyle R, Rabeneck L, Baxter NN, Tinmouth J, Paszat L. Adaptation and qualitative evaluation of the BETTER intervention for chronic disease prevention and screening by public health nurses in low income neighbourhoods: views of community residents. BMC Health Serv Res 2024; 24:427. [PMID: 38575938 PMCID: PMC10993474 DOI: 10.1186/s12913-024-10853-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 03/11/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND The BETTER intervention is an effective comprehensive evidence-based program for chronic disease prevention and screening (CDPS) delivered by trained prevention practitioners (PPs), a new role in primary care. An adapted program, BETTER HEALTH, delivered by public health nurses as PPs for community residents in low income neighbourhoods, was recently shown to be effective in improving CDPS actions. To obtain a nuanced understanding about the CDPS needs of community residents and how the BETTER HEALTH intervention was perceived by residents, we studied how the intervention was adapted to a public health setting then conducted a post-visit qualitative evaluation by community residents through focus groups and interviews. METHODS We first used the ADAPT-ITT model to adapt BETTER for a public health setting in Ontario, Canada. For the post-PP visit qualitative evaluation, we asked community residents who had received a PP visit, about steps they had taken to improve their physical and mental health and the BETTER HEALTH intervention. For both phases, we conducted focus groups and interviews; transcripts were analyzed using the constant comparative method. RESULTS Thirty-eight community residents participated in either adaptation (n = 14, 64% female; average age 54 y) or evaluation (n = 24, 83% female; average age 60 y) phases. In both adaptation and evaluation, residents described significant challenges including poverty, social isolation, and daily stress, making chronic disease prevention a lower priority. Adaptation results indicated that residents valued learning about CDPS and would attend a confidential visit with a public health nurse who was viewed as trustworthy. Despite challenges, many recipients of BETTER HEALTH perceived they had achieved at least one personal CDPS goal post PP visit. Residents described key relational aspects of the visit including feeling valued, listened to and being understood by the PP. The PPs also provided practical suggestions to overcome barriers to meeting prevention goals. CONCLUSIONS Residents living in low income neighbourhoods faced daily stress that reduced their capacity to make preventive lifestyle changes. Key adapted features of BETTER HEALTH such as public health nurses as PPs were highly supported by residents. The intervention was perceived valuable for the community by providing access to disease prevention. TRIAL REGISTRATION #NCT03052959, 10/02/2017.
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Affiliation(s)
- Mary Ann O'Brien
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Fifth Floor, 500 University Ave, Toronto, ON, M5G 1V7, Canada.
| | - Aisha Lofters
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Fifth Floor, 500 University Ave, Toronto, ON, M5G 1V7, Canada
- Women's College Research Institute, Women's College Hospital, 76 Grenville St, Toronto, ON, M5S 1B2, Canada
- Peter Gilgan Centre for Women's Cancers, Women's College Hospital, 76 Grenville St, Toronto, ON, M5S 1B2, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Suite 424, Toronto, ON, M5T 3M6, Canada
| | - Becky Wall
- Durham Region Health Department, Regional Municipality of Durham, 605 Rossland Road East, Whitby, ON, L1N 6A3, Canada
| | - Regina Elliott
- Durham Region Health Department, Regional Municipality of Durham, 605 Rossland Road East, Whitby, ON, L1N 6A3, Canada
| | - Tutsirai Makuwaza
- Women's College Research Institute, Women's College Hospital, 76 Grenville St, Toronto, ON, M5S 1B2, Canada
| | - Mary-Anne Pietrusiak
- Durham Region Health Department, Regional Municipality of Durham, 605 Rossland Road East, Whitby, ON, L1N 6A3, Canada
| | - Eva Grunfeld
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Fifth Floor, 500 University Ave, Toronto, ON, M5G 1V7, Canada
- Ontario Institute for Cancer Research, 661 University Ave, Suite 510, Toronto, ON, M5G 0A3, Canada
| | - Bernadette Riordan
- Durham Region Health Department, Regional Municipality of Durham, 605 Rossland Road East, Whitby, ON, L1N 6A3, Canada
| | - Cathie Snider
- Durham Region Health Department, Regional Municipality of Durham, 605 Rossland Road East, Whitby, ON, L1N 6A3, Canada
| | - Andrew D Pinto
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Fifth Floor, 500 University Ave, Toronto, ON, M5G 1V7, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Suite 424, Toronto, ON, M5T 3M6, Canada
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
- Department of Family and Community Medicine, St. Michael's Hospital, 61 Queen St E #3, Toronto, ON, M5C 2T2, Canada
| | - Donna Manca
- Department of Family Medicine, Faculty of Medicine & Dentistry, University of Alberta, 6 - 10 University Terrace, Edmonton, AB, T6G 2T4, Canada
| | - Nicolette Sopcak
- Department of Family Medicine, Faculty of Medicine & Dentistry, University of Alberta, 6 - 10 University Terrace, Edmonton, AB, T6G 2T4, Canada
| | - Sylvie D Cornacchi
- Department of Pediatrics, McMaster University, 1280 Main St West, Hamilton, ON, L8S 4K1, Canada
| | - Joanne Huizinga
- Durham Region Health Department, Regional Municipality of Durham, 605 Rossland Road East, Whitby, ON, L1N 6A3, Canada
| | - Kawsika Sivayoganathan
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Peter D Donnelly
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Suite 424, Toronto, ON, M5T 3M6, Canada
- School of Medicine, University of St Andrews, St Andrews, Fife, KY16 9TF, UK
| | - Peter Selby
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Fifth Floor, 500 University Ave, Toronto, ON, M5G 1V7, Canada
- Centre for Addiction and Mental Health, 1025 Queen Street West, 5Th Floor, Toronto, ON, M6J 1H4, Canada
| | - Robert Kyle
- Durham Region Health Department, Regional Municipality of Durham, 605 Rossland Road East, Whitby, ON, L1N 6A3, Canada
| | - Linda Rabeneck
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Suite 424, Toronto, ON, M5T 3M6, Canada
| | - Nancy N Baxter
- Melbourne School of Population & Global Health, University of Melbourne, 207 Bouverie Street, Melbourne, VIC, 3053, Australia
| | - Jill Tinmouth
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Lawrence Paszat
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
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Perri M, Hapsari AP, Craig-Neil A, Ho J, Cattaneo J, Gaspar M, Hunter C, Rueda S, Burchell AN, Pinto AD. An evaluation of an employment assistance program focused on people living with HIV in Toronto, Canada. AIDS Care 2024; 36:500-507. [PMID: 37756653 DOI: 10.1080/09540121.2023.2253505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 08/25/2023] [Indexed: 09/29/2023]
Abstract
Unemployment is more common among people living with HIV (PLWH) compared to the general population. PLWH who are employed have better physical and mental health outcomes compared to unemployed PLWH. The main objective of this mixed-methods study was to conduct a program evaluation of Employment Action (EACT), a community-based program that assists PLWH in Toronto, Ontario, Canada to maintain meaningful employment. We extracted quantitative data from two HIV services databases used by EACT, and collected qualitative data from 12 individuals who had been placed into paid employment through EACT. From 131 clients included in the analysis, 38.1% (n = 50) maintained their job for at least 6 weeks within the first year of enrollment in the EACT program. Gender, ethnicity, age, and first language did not predict employment maintenance. Our interviews highlighted the barriers and facilitators to effective service delivery. Key recommendations include implementing skills training, embedding PLWH as EACT staff, and following up with clients once they gain employment. Investment in social programs such as EACT are essential for strengthening their data collection capacity, active outreach to service users, and sufficient planning for the evaluation phase prior to program implementation.
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Affiliation(s)
- Melissa Perri
- Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Ayu Pinky Hapsari
- Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Canada
| | - Amy Craig-Neil
- Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Canada
| | - Julia Ho
- Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Canada
| | | | - Mark Gaspar
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Charlotte Hunter
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Family and Community Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
| | - Sergio Rueda
- Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Ann N Burchell
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Family and Community Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
| | - Andrew D Pinto
- Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Family and Community Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
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Ho JW, Bellicoso E, Bondy M, Holness DL, Muntaner C, Nisenbaum R, Ruco A, Hassen N, Hanna A, Pinto AD. A Brief Tool to Screen Patients for Precarious Employment: A Validation Study. Ann Fam Med 2024; 22:26-30. [PMID: 38253490 DOI: 10.1370/afm.3053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 08/16/2023] [Accepted: 09/19/2023] [Indexed: 01/24/2024] Open
Abstract
PURPOSE Precarious employment, defined by temporary contracts, unstable employment, or job insecurity, is increasingly common and is associated with inconsistent access to benefits, lower income, and greater exposure to physical and psycholosocial hazards. Clinicians can benefit from a simple approach to screen for precarious employment to improve their understanding of a patient's social context, help with diagnoses, and inform treatment plans and intersectional interventions. Our objective was to validate a screening tool for precarious employment. METHODS We used a 3-item screening tool that covered key aspects of precarious employment: non-standard employment, variable income, and violations of occupational health and safety rights and protections. Answers were compared with classification using the Poverty and Employment Precarity in Southern Ontario Employment Index. Participants were aged 18 years and older, fluent in English, and employed. They were recruited in 7 primary care clinic waiting rooms in Toronto, Canada over 12 months. RESULTS A total of 204 people aged 18-72 years (mean 38 [SD 11.3]) participated, of which 93 (45.6%) identified as men and 119 (58.3%) self-reported as White. Participants who reported 2 or more of the 3 items as positive were almost 4 times more likely to be precariously employed (positive likelihood ratio = 3.84 [95% CI, 2.15-6.80]). CONCLUSIONS A 3-item screening tool can help identify precarious employment. Our tool is useful for starting a conversation about employment precarity and work conditions in clinical settings. Implementation of this screening tool in health settings could enable better targeting of resources for managing care and connecting patients to legal and employment support services.
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Affiliation(s)
- Julia W Ho
- Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario (Ho, Bellicoso, Bondy, Pinto)
| | - Emily Bellicoso
- Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario (Ho, Bellicoso, Bondy, Pinto)
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada (Bellicoso, Holness)
| | - Madeleine Bondy
- Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario (Ho, Bellicoso, Bondy, Pinto)
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (Bondy)
| | - Dorothy Linn Holness
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada (Bellicoso, Holness)
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada (Holness, Muntaner, Pinto)
- Centre for Research Expertise in Occupational Disease, Toronto, Ontario, Canada (Holness)
- Division of Occupational Medicine, Department of Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada (Holness)
| | - Carles Muntaner
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (Bondy)
- Lawrence Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada (Muntaner)
| | - Rosane Nisenbaum
- MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario (Nisenbaum)
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada (Nisenbaum)
| | - Arlinda Ruco
- Interdisciplinary Health Program, St. Francis Xavier University, Antigonish, Nova Scotia, Canada (Ruco, Pinto)
| | - Nadha Hassen
- Faculty of Environmental and Urban Change, York University, Toronto, Ontario, Canada (Hassen)
| | - Andrew Hanna
- Royal College of Surgeons in Ireland - Medical University of Bahrain (Hanna)
| | - Andrew D Pinto
- Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario (Ho, Bellicoso, Bondy, Pinto);
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (Bondy)
- Interdisciplinary Health Program, St. Francis Xavier University, Antigonish, Nova Scotia, Canada (Ruco, Pinto)
- Department of Family and Community Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada (Pinto)
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada (Pinto)
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Shah N, Radford K, Durant S, Shoucri R, Stone J, Persaud N, Pinto AD. Advocating for Policy Change: Examples Emerging From a Medical-Legal Partnership in Primary Care. J Health Care Poor Underserved 2024; 35:8-17. [PMID: 38661856 DOI: 10.1353/hpu.2024.a919804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
Medical-legal partnerships bring legal services directly into clinical settings. Policy advocacy is often opportunistic and varies across partnerships. Our objective was to study policy advocacy that emerged from a medical-legal partnership in Toronto over a four-year period. This study consisted of a document review and thematic analysis, triangulated with data from interviews with legal team members and health providers. We defined policy advocacy as actions associated with attempts to change policy or legislation. The medical-legal partnership engaged in seven distinct cases of policy advocacy: disability support form requirements, changing workplace review, challenging barriers to citizenship, housing, publicly funded medication program (pharma care), safe injection sites, and the need for increased social assistance. Actions taken included presentations at conferences and submissions of briefs to government. We found that a medical-legal partnership resulted in policy advocacy with issues arising from both the health and the legal team with impacts likely greater than if each group had acted alone.
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Adekoya I, Delahunty-Pike A, Howse D, Kosowan L, Seshie Z, Abaga E, Cooney J, Robinson M, Senior D, Zsager A, Aubrey-Bassler K, Irwin M, Jackson L, Katz A, Marshall E, Muhajarine N, Neudorf C, Pinto AD. Screening for poverty and related social determinants to improve knowledge of and links to resources (SPARK): development and cognitive testing of a tool for primary care. BMC Prim Care 2023; 24:247. [PMID: 38007462 PMCID: PMC10675961 DOI: 10.1186/s12875-023-02173-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 10/06/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND Healthcare organizations are increasingly exploring ways to address the social determinants of health. Accurate data on social determinants is essential to identify opportunities for action to improve health outcomes, to identify patterns of inequity, and to help evaluate the impact of interventions. The objective of this study was to refine a standardized tool for the collection of social determinants data through cognitive testing. METHODS An initial set of questions on social determinants for use in healthcare settings was developed by a collaboration of hospitals and a local public health organization in Toronto, Canada during 2011-2012. Subsequent research on how patients interpreted the questions, and how they performed in primary care and other settings led to revisions. We administered these questions and conducted in-depth cognitive interviews with all the participants, who were from Saskatchewan, Manitoba, Ontario, and Newfoundland and Labrador. Cognitive interviewing was used, with participants invited to verbalize thoughts and feelings as they read the questions. Interview notes were grouped thematically, and high frequency themes were addressed. RESULTS Three hundred and seventy-five individuals responded to the study advertisements and 195 ultimately participated in the study. Although all interviews were conducted in English, participants were diverse. For many, the value of this information being collected in typical healthcare settings was unclear, and hence, we included descriptors for each question. In general, the questions were understood, but participants highlighted a number of ways the questions could be changed to be even clearer and more inclusive. For example, more response options were added to the question of sexual orientation and the "making ends meet" question was completely reworded in light of challenges to understand the informal phrasing cited by English as a Second Language (ESL) users of the tool. CONCLUSION In this work we have refined an initial set of 16 sociodemographic and social needs questions into a simple yet comprehensive 18-question tool. The changes were largely related to wording, rather than content. These questions require validation against accepted, standardized tools. Further work is required to enable community data governance, and to ensure implementation of the tool as well as the use of its data is successful in a range of organizations.
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Affiliation(s)
- Itunuoluwa Adekoya
- Upstream Lab, Li Ka Shing Knowledge Institute, MAP Centre for Urban Health Solutions, Unity Health Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | | | - Dana Howse
- Primary Healthcare Research Unit, Memorial University of Newfoundland and Labrador, St. John's, Canada
| | - Leanne Kosowan
- Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Zita Seshie
- Department of Community Health & Epidemiology, University of Saskatchewan, Saskatoon, Canada
| | - Eunice Abaga
- Upstream Lab, Li Ka Shing Knowledge Institute, MAP Centre for Urban Health Solutions, Unity Health Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Jane Cooney
- Upstream Lab, Li Ka Shing Knowledge Institute, MAP Centre for Urban Health Solutions, Unity Health Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Marjeiry Robinson
- Upstream Lab, Li Ka Shing Knowledge Institute, MAP Centre for Urban Health Solutions, Unity Health Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Dorothy Senior
- Upstream Lab, Li Ka Shing Knowledge Institute, MAP Centre for Urban Health Solutions, Unity Health Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Alexander Zsager
- Upstream Lab, Li Ka Shing Knowledge Institute, MAP Centre for Urban Health Solutions, Unity Health Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Kris Aubrey-Bassler
- Primary Healthcare Research Unit, Memorial University of Newfoundland and Labrador, St. John's, Canada
- Faculty of Medicine, Memorial University, St. John's, Canada
| | - Mandi Irwin
- Department of Family Medicine, Dalhousie University, Halifax, Canada
| | - Lois Jackson
- School of Health and Human Performance, Dalhousie University, Halifax, Canada
| | - Alan Katz
- Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Canada
| | - Emily Marshall
- Department of Family Medicine, Dalhousie University, Halifax, Canada
| | - Nazeem Muhajarine
- Saskatchewan Population Health and Evaluation Research Unit, Saskatoon, Canada
- College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Cory Neudorf
- Saskatchewan Population Health and Evaluation Research Unit, Saskatoon, Canada
- College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Andrew D Pinto
- Upstream Lab, Li Ka Shing Knowledge Institute, MAP Centre for Urban Health Solutions, Unity Health Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Canada.
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada.
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
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Brown EM, Moineddin R, Hapsari A, Gozdyra P, Durant S, Pinto AD. Eviction filings during bans on enforcement throughout the COVID-19 pandemic: an interrupted time series analysis. Can J Public Health 2023; 114:745-754. [PMID: 37581748 PMCID: PMC10485221 DOI: 10.17269/s41997-023-00813-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 07/12/2023] [Indexed: 08/16/2023]
Abstract
OBJECTIVE Bans on evictions were implemented to reduce the spread of COVID-19 and to protect vulnerable populations during a public health crisis. Our objective was to examine how three bans on eviction enforcement impacted eviction filings from March 2020 through January 2022 in Ontario, Canada. METHODS Data were derived from eviction application records kept by the Ontario Landlord and Tenant Board. We used segmented regression analysis to model changes in the average weekly filing rates for evictions due to non-payment of rent (L1 filings) and reasons other than non-payment of rent (L2 filings). RESULTS The average number of weekly L1 and L2 applications dropped by 67.5 (95% CI: 55.2, 79.9) and 31.7 (95% CI: 26.7, 36.6) filings per 100,000 rental dwellings, respectively, following the first ban on eviction enforcement (p < 0.0001). Notably, they did not fall to zero. Level changes during the second and third bans were insubstantial and slope changes for L2 applications varied throughout the study period. The L1 filing rate appeared to increase towards the end of the study period (slope change: 1.3; 95% CI: 0.1, 2.6; p = 0.0387). CONCLUSION Our findings suggest that while the first ban on eviction enforcement appeared to substantially reduce filing rates, subsequent bans were less effective and none of them eliminated eviction filings altogether. Enacting upstream policies that tackle the root causes of displacement would better equip jurisdictions during future public health emergencies.
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Affiliation(s)
- Erika M Brown
- California Policy Lab, Institute for Research on Labor & Employment, University of California, Berkeley, Berkeley, CA, USA
- Social Interventions Research & Evaluation Network, University of California, San Francisco, San Francisco, CA, USA
| | - Rahim Moineddin
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Ayu Hapsari
- Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
| | - Peter Gozdyra
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Steve Durant
- Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
| | - Andrew D Pinto
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada.
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, ON, Canada.
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
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Jarvis T, Smith RW, Sandhu HS, Mac-Seing M, O'Neill M, Rosella L, Allin S, Pinto AD. Promise and peril: how health system reforms impacted public health in three Canadian provinces. Can J Public Health 2023; 114:714-725. [PMID: 37410363 PMCID: PMC10484823 DOI: 10.17269/s41997-023-00785-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 05/09/2023] [Indexed: 07/07/2023]
Abstract
OBJECTIVES Several Canadian provinces and territories have reformed their health systems by centralizing power, resources, and responsibilities. Our study explored motivating factors and perceived impacts of centralization reforms on public health systems and essential operations. METHODS A multiple case study design was used to examine three Canadian provinces that have undergone, or are in the process of undergoing, health system reform. Semi-structured interviews were conducted with 58 participants within public health at strategic and operational levels, from Alberta, Ontario, and Québec. Data were analyzed using a thematic analytical approach to iteratively conceptualize and refine themes. RESULTS Three major themes were developed to describe the context and impacts of health system centralization reforms on public health: (1) promising "value for money" and consolidating authority; (2) impacting intersectoral and community-level collaboration; and (3) deprioritizing public health operations and contributing to workforce precarity. Centralization highlighted concerns about the prioritization of healthcare sectors. Some core public health functions were reported to operate more efficiently, with less duplication of services, and improvements in program consistency and quality, particularly in Alberta. Reforms were also reported to have diverted funding and human resources away from core essential functions, and diminished the public health workforce. CONCLUSION Our study highlighted that stakeholder priorities and a limited understanding about public health systems influenced how reforms were implemented. Our findings support calls for modernized and inclusive governance, stable public health funding, and investment in the public health workforce, which may help inform future reforms.
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Affiliation(s)
- Tamika Jarvis
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- North American Observatory On Health Systems and Policies, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Robert W Smith
- Division of Social and Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Harman Singh Sandhu
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Muriel Mac-Seing
- Centre for Global Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Meghan O'Neill
- Population Health Analytics Lab, University of Toronto, Toronto, Ontario, Canada
| | - Laura Rosella
- Population Health Analytics Lab, University of Toronto, Toronto, Ontario, Canada
- Laboratory Medicine and Pathobiology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Sara Allin
- North American Observatory On Health Systems and Policies, Dalla Lana School of Public Health, 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
| | - Andrew D Pinto
- Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada.
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada.
- Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
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Vanden Bossche D, Zhao QJ, Ares-Blanco S, Peña MPA, Decat P, Kondo N, Kroneman M, Nishioka D, Petrazzuoli F, Rortveit G, Schaubroeck E, Stark S, Pinto AD, Willems S. Addressing health inequity during the COVID-19 pandemic through primary health care and public health collaboration: a multiple case study analysis in eight high-income countries. Int J Equity Health 2023; 22:171. [PMID: 37653472 PMCID: PMC10472729 DOI: 10.1186/s12939-023-01968-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 07/19/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic substantially magnified the inequity gaps among vulnerable populations. Both public health (PH) and primary health care (PHC) have been crucial in addressing the challenges posed by the pandemic, especially in the area of vulnerable populations. However, little is known about the intersection between PH and PHC as a strategy to mitigate the inequity gap. This study aims to assess the collaboration between PHC and PH with a focus on addressing the health needs of vulnerable populations during the COVID-19 pandemic across jurisdictions. METHODS We analyzed and compared data from jurisdictional reports of COVID-19 pandemic responses in PHC and PH in Belgium, Canada (Ontario), Germany, Italy, Japan, the Netherlands, Norway, and Spain from 2020 to 2021. RESULTS Four themes emerge from the analysis: (1) the majority of the countries implemented outreach strategies targeting vulnerable groups as a means to ensure continued access to PHC; (2) digital assessment in PHC was found to be present across all the countries; (3) PHC was insufficiently represented at the decision-making level; (4) there is a lack of clear communication channels between PH and PHC in all the countries. CONCLUSIONS This study identified opportunities for collaboration between PHC and PH to reduce inequity gaps and to improve population health, focusing on vulnerable populations. The COVID-19 response in these eight countries has demonstrated the importance of an integrated PHC system. Consequently, the development of effective strategies for responding to and planning for pandemics should take into account the social determinants of health in order to mitigate the unequal impact of COVID-19. Careful, intentional coordination between PH and PHC should be established in normal times as a basis for effective response during future public health emergencies. The pandemic has provided significant insights on how to strengthen health systems and provide universal access to healthcare by fostering stronger connections between PH and PHC.
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Affiliation(s)
- Dorien Vanden Bossche
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
| | - Q Jane Zhao
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada
| | - Sara Ares-Blanco
- Federica Montseny Primary Care Centre, Madrid, Spain
- Patient Safety Working Party of semFYC (Spanish Society for Family and Community Medicine), Madrid, Spain
| | - Maria Pilar Astier Peña
- Patient Safety Working Party of semFYC (Spanish Society for Family and Community Medicine), Madrid, Spain
- Territorial Healthcare Quality Unit, Camp de Tarragona, Health Department Generalitat de Catalunya, Healthcare Institute of Catalonia, Tarragona, Spain
| | - Peter Decat
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Naoki Kondo
- Department of Social Epidemiology, University of Kyoto, Kyoto, Japan
| | - Madelon Kroneman
- Nivel (Netherlands Institute of Health Services Research), Utrecht, the Netherlands
| | - Daisuke Nishioka
- Department of Medical Statistics, Research & Development Center, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Ferdinando Petrazzuoli
- Department of Clinical Sciences, Centre for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Guri Rortveit
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Emmily Schaubroeck
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Institute of General Practice, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Stefanie Stark
- Institute of General Practice, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Andrew D Pinto
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- St Michael's Hospital, Toronto, ON, Canada
| | - Sara Willems
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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Pinto AD, Eissa A, Kiran T, Mashford-Pringle A, Needham A, Dhalla I. Enjeux relatifs à la collecte des données sur la race et l’identité autochtone lors du renouvellement de la carte santé au Canada. CMAJ 2023; 195:E1062-E1064. [PMID: 37580079 PMCID: PMC10426351 DOI: 10.1503/cmaj.221587-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023] Open
Affiliation(s)
- Andrew D Pinto
- Laboratoire Upstream (Pinto, Eissa), Centre MAP pour des solutions de santé urbaine, Institut du savoir Li Ka Shing, Réseau universitaire de santé de Toronto; Institut des politiques, de la gestion et de l'évaluation de la santé (Pinto, Eissa, Mashford-Pringle, Dhalla), École Dalla Lana de santé publique et Département de médecine familiale et communautaire (Pinto, Eissa, Kiran), Faculté de médecine, Université de Toronto; Département de médecine familiale et communautaire (Pinto, Kiran), Hôpital St Michael, Réseau universitaire de santé de Toronto, Toronto, Ont.; Équipe de santé familiale de Barrie (Eissa), Unité d'enseignement en médecine familiale de Barrie, Centre de santé régional Royal Victoria, Barrie, Ont.; ICES Central (Kiran, Dhalla); Centre MAP pour des solutions en santé urbaine (Kiran), Institut du savoir Li Ka Shing, Réseau universitaire de santé de Toronto; Institut Waakebiness-Bryce pour la santé autochtone (Mashford-Pringle), École Dalla Lana de santé publique, Université de Toronto; Direction de la lutte antiraciste, de l'équité et de la responsabilité sociale (Needham, Dhalla) et Département de médecine (Dhalla), Hôpital St Michael, Réseau universitaire de santé de Toronto; Département de médecine (Dhalla), Faculté de médecine, Université de Toronto, Toronto, Ont.
| | - Azza Eissa
- Laboratoire Upstream (Pinto, Eissa), Centre MAP pour des solutions de santé urbaine, Institut du savoir Li Ka Shing, Réseau universitaire de santé de Toronto; Institut des politiques, de la gestion et de l'évaluation de la santé (Pinto, Eissa, Mashford-Pringle, Dhalla), École Dalla Lana de santé publique et Département de médecine familiale et communautaire (Pinto, Eissa, Kiran), Faculté de médecine, Université de Toronto; Département de médecine familiale et communautaire (Pinto, Kiran), Hôpital St Michael, Réseau universitaire de santé de Toronto, Toronto, Ont.; Équipe de santé familiale de Barrie (Eissa), Unité d'enseignement en médecine familiale de Barrie, Centre de santé régional Royal Victoria, Barrie, Ont.; ICES Central (Kiran, Dhalla); Centre MAP pour des solutions en santé urbaine (Kiran), Institut du savoir Li Ka Shing, Réseau universitaire de santé de Toronto; Institut Waakebiness-Bryce pour la santé autochtone (Mashford-Pringle), École Dalla Lana de santé publique, Université de Toronto; Direction de la lutte antiraciste, de l'équité et de la responsabilité sociale (Needham, Dhalla) et Département de médecine (Dhalla), Hôpital St Michael, Réseau universitaire de santé de Toronto; Département de médecine (Dhalla), Faculté de médecine, Université de Toronto, Toronto, Ont
| | - Tara Kiran
- Laboratoire Upstream (Pinto, Eissa), Centre MAP pour des solutions de santé urbaine, Institut du savoir Li Ka Shing, Réseau universitaire de santé de Toronto; Institut des politiques, de la gestion et de l'évaluation de la santé (Pinto, Eissa, Mashford-Pringle, Dhalla), École Dalla Lana de santé publique et Département de médecine familiale et communautaire (Pinto, Eissa, Kiran), Faculté de médecine, Université de Toronto; Département de médecine familiale et communautaire (Pinto, Kiran), Hôpital St Michael, Réseau universitaire de santé de Toronto, Toronto, Ont.; Équipe de santé familiale de Barrie (Eissa), Unité d'enseignement en médecine familiale de Barrie, Centre de santé régional Royal Victoria, Barrie, Ont.; ICES Central (Kiran, Dhalla); Centre MAP pour des solutions en santé urbaine (Kiran), Institut du savoir Li Ka Shing, Réseau universitaire de santé de Toronto; Institut Waakebiness-Bryce pour la santé autochtone (Mashford-Pringle), École Dalla Lana de santé publique, Université de Toronto; Direction de la lutte antiraciste, de l'équité et de la responsabilité sociale (Needham, Dhalla) et Département de médecine (Dhalla), Hôpital St Michael, Réseau universitaire de santé de Toronto; Département de médecine (Dhalla), Faculté de médecine, Université de Toronto, Toronto, Ont
| | - Angela Mashford-Pringle
- Laboratoire Upstream (Pinto, Eissa), Centre MAP pour des solutions de santé urbaine, Institut du savoir Li Ka Shing, Réseau universitaire de santé de Toronto; Institut des politiques, de la gestion et de l'évaluation de la santé (Pinto, Eissa, Mashford-Pringle, Dhalla), École Dalla Lana de santé publique et Département de médecine familiale et communautaire (Pinto, Eissa, Kiran), Faculté de médecine, Université de Toronto; Département de médecine familiale et communautaire (Pinto, Kiran), Hôpital St Michael, Réseau universitaire de santé de Toronto, Toronto, Ont.; Équipe de santé familiale de Barrie (Eissa), Unité d'enseignement en médecine familiale de Barrie, Centre de santé régional Royal Victoria, Barrie, Ont.; ICES Central (Kiran, Dhalla); Centre MAP pour des solutions en santé urbaine (Kiran), Institut du savoir Li Ka Shing, Réseau universitaire de santé de Toronto; Institut Waakebiness-Bryce pour la santé autochtone (Mashford-Pringle), École Dalla Lana de santé publique, Université de Toronto; Direction de la lutte antiraciste, de l'équité et de la responsabilité sociale (Needham, Dhalla) et Département de médecine (Dhalla), Hôpital St Michael, Réseau universitaire de santé de Toronto; Département de médecine (Dhalla), Faculté de médecine, Université de Toronto, Toronto, Ont
| | - Allison Needham
- Laboratoire Upstream (Pinto, Eissa), Centre MAP pour des solutions de santé urbaine, Institut du savoir Li Ka Shing, Réseau universitaire de santé de Toronto; Institut des politiques, de la gestion et de l'évaluation de la santé (Pinto, Eissa, Mashford-Pringle, Dhalla), École Dalla Lana de santé publique et Département de médecine familiale et communautaire (Pinto, Eissa, Kiran), Faculté de médecine, Université de Toronto; Département de médecine familiale et communautaire (Pinto, Kiran), Hôpital St Michael, Réseau universitaire de santé de Toronto, Toronto, Ont.; Équipe de santé familiale de Barrie (Eissa), Unité d'enseignement en médecine familiale de Barrie, Centre de santé régional Royal Victoria, Barrie, Ont.; ICES Central (Kiran, Dhalla); Centre MAP pour des solutions en santé urbaine (Kiran), Institut du savoir Li Ka Shing, Réseau universitaire de santé de Toronto; Institut Waakebiness-Bryce pour la santé autochtone (Mashford-Pringle), École Dalla Lana de santé publique, Université de Toronto; Direction de la lutte antiraciste, de l'équité et de la responsabilité sociale (Needham, Dhalla) et Département de médecine (Dhalla), Hôpital St Michael, Réseau universitaire de santé de Toronto; Département de médecine (Dhalla), Faculté de médecine, Université de Toronto, Toronto, Ont
| | - Irfan Dhalla
- Laboratoire Upstream (Pinto, Eissa), Centre MAP pour des solutions de santé urbaine, Institut du savoir Li Ka Shing, Réseau universitaire de santé de Toronto; Institut des politiques, de la gestion et de l'évaluation de la santé (Pinto, Eissa, Mashford-Pringle, Dhalla), École Dalla Lana de santé publique et Département de médecine familiale et communautaire (Pinto, Eissa, Kiran), Faculté de médecine, Université de Toronto; Département de médecine familiale et communautaire (Pinto, Kiran), Hôpital St Michael, Réseau universitaire de santé de Toronto, Toronto, Ont.; Équipe de santé familiale de Barrie (Eissa), Unité d'enseignement en médecine familiale de Barrie, Centre de santé régional Royal Victoria, Barrie, Ont.; ICES Central (Kiran, Dhalla); Centre MAP pour des solutions en santé urbaine (Kiran), Institut du savoir Li Ka Shing, Réseau universitaire de santé de Toronto; Institut Waakebiness-Bryce pour la santé autochtone (Mashford-Pringle), École Dalla Lana de santé publique, Université de Toronto; Direction de la lutte antiraciste, de l'équité et de la responsabilité sociale (Needham, Dhalla) et Département de médecine (Dhalla), Hôpital St Michael, Réseau universitaire de santé de Toronto; Département de médecine (Dhalla), Faculté de médecine, Université de Toronto, Toronto, Ont
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10
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Pinto AD, Eissa A, Kiran T, Mashford-Pringle A, Needham A, Dhalla I. Considerations for collecting data on race and Indigenous identity during health card renewal across Canadian jurisdictions. CMAJ 2023; 195:E880-E882. [PMID: 37364910 DOI: 10.1503/cmaj.221587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023] Open
Affiliation(s)
- Andrew D Pinto
- Upstream Lab (Pinto, Eissa), MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto; Institute for Health Policy, Management and Evaluation (Pinto, Eissa, Mashford-Pringle, Dhalla), Dalla Lana School of Public Health, and Department of Family and Community Medicine (Pinto, Eissa, Kiran), Faculty of Medicine, University of Toronto; Department of Family and Community Medicine (Pinto, Kiran), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Barrie Family Health Team (Eissa), Barrie Family Medicine Teaching Unit, Royal Victoria Regional Health Centre, Barrie, Ont.; ICES Central (Kiran, Dhalla); MAP Centre for Urban Health Solutions (Kiran), Li Ka Shing Knowledge Institute, Unity Health Toronto; Waakebiness-Bryce Institute for Indigenous Health (Mashford-Pringle), Dalla Lana School of Public Health, University of Toronto; Anti-Racism, Equity and Social Accountability Office (Needham, Dhalla), and Department of Medicine (Dhalla), St. Michael's Hospital, Unity Health Toronto; Department of Medicine (Dhalla), Faculty of Medicine, University of Toronto, Toronto, Ont.
| | - Azza Eissa
- Upstream Lab (Pinto, Eissa), MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto; Institute for Health Policy, Management and Evaluation (Pinto, Eissa, Mashford-Pringle, Dhalla), Dalla Lana School of Public Health, and Department of Family and Community Medicine (Pinto, Eissa, Kiran), Faculty of Medicine, University of Toronto; Department of Family and Community Medicine (Pinto, Kiran), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Barrie Family Health Team (Eissa), Barrie Family Medicine Teaching Unit, Royal Victoria Regional Health Centre, Barrie, Ont.; ICES Central (Kiran, Dhalla); MAP Centre for Urban Health Solutions (Kiran), Li Ka Shing Knowledge Institute, Unity Health Toronto; Waakebiness-Bryce Institute for Indigenous Health (Mashford-Pringle), Dalla Lana School of Public Health, University of Toronto; Anti-Racism, Equity and Social Accountability Office (Needham, Dhalla), and Department of Medicine (Dhalla), St. Michael's Hospital, Unity Health Toronto; Department of Medicine (Dhalla), Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Tara Kiran
- Upstream Lab (Pinto, Eissa), MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto; Institute for Health Policy, Management and Evaluation (Pinto, Eissa, Mashford-Pringle, Dhalla), Dalla Lana School of Public Health, and Department of Family and Community Medicine (Pinto, Eissa, Kiran), Faculty of Medicine, University of Toronto; Department of Family and Community Medicine (Pinto, Kiran), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Barrie Family Health Team (Eissa), Barrie Family Medicine Teaching Unit, Royal Victoria Regional Health Centre, Barrie, Ont.; ICES Central (Kiran, Dhalla); MAP Centre for Urban Health Solutions (Kiran), Li Ka Shing Knowledge Institute, Unity Health Toronto; Waakebiness-Bryce Institute for Indigenous Health (Mashford-Pringle), Dalla Lana School of Public Health, University of Toronto; Anti-Racism, Equity and Social Accountability Office (Needham, Dhalla), and Department of Medicine (Dhalla), St. Michael's Hospital, Unity Health Toronto; Department of Medicine (Dhalla), Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Angela Mashford-Pringle
- Upstream Lab (Pinto, Eissa), MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto; Institute for Health Policy, Management and Evaluation (Pinto, Eissa, Mashford-Pringle, Dhalla), Dalla Lana School of Public Health, and Department of Family and Community Medicine (Pinto, Eissa, Kiran), Faculty of Medicine, University of Toronto; Department of Family and Community Medicine (Pinto, Kiran), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Barrie Family Health Team (Eissa), Barrie Family Medicine Teaching Unit, Royal Victoria Regional Health Centre, Barrie, Ont.; ICES Central (Kiran, Dhalla); MAP Centre for Urban Health Solutions (Kiran), Li Ka Shing Knowledge Institute, Unity Health Toronto; Waakebiness-Bryce Institute for Indigenous Health (Mashford-Pringle), Dalla Lana School of Public Health, University of Toronto; Anti-Racism, Equity and Social Accountability Office (Needham, Dhalla), and Department of Medicine (Dhalla), St. Michael's Hospital, Unity Health Toronto; Department of Medicine (Dhalla), Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Allison Needham
- Upstream Lab (Pinto, Eissa), MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto; Institute for Health Policy, Management and Evaluation (Pinto, Eissa, Mashford-Pringle, Dhalla), Dalla Lana School of Public Health, and Department of Family and Community Medicine (Pinto, Eissa, Kiran), Faculty of Medicine, University of Toronto; Department of Family and Community Medicine (Pinto, Kiran), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Barrie Family Health Team (Eissa), Barrie Family Medicine Teaching Unit, Royal Victoria Regional Health Centre, Barrie, Ont.; ICES Central (Kiran, Dhalla); MAP Centre for Urban Health Solutions (Kiran), Li Ka Shing Knowledge Institute, Unity Health Toronto; Waakebiness-Bryce Institute for Indigenous Health (Mashford-Pringle), Dalla Lana School of Public Health, University of Toronto; Anti-Racism, Equity and Social Accountability Office (Needham, Dhalla), and Department of Medicine (Dhalla), St. Michael's Hospital, Unity Health Toronto; Department of Medicine (Dhalla), Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Irfan Dhalla
- Upstream Lab (Pinto, Eissa), MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto; Institute for Health Policy, Management and Evaluation (Pinto, Eissa, Mashford-Pringle, Dhalla), Dalla Lana School of Public Health, and Department of Family and Community Medicine (Pinto, Eissa, Kiran), Faculty of Medicine, University of Toronto; Department of Family and Community Medicine (Pinto, Kiran), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Barrie Family Health Team (Eissa), Barrie Family Medicine Teaching Unit, Royal Victoria Regional Health Centre, Barrie, Ont.; ICES Central (Kiran, Dhalla); MAP Centre for Urban Health Solutions (Kiran), Li Ka Shing Knowledge Institute, Unity Health Toronto; Waakebiness-Bryce Institute for Indigenous Health (Mashford-Pringle), Dalla Lana School of Public Health, University of Toronto; Anti-Racism, Equity and Social Accountability Office (Needham, Dhalla), and Department of Medicine (Dhalla), St. Michael's Hospital, Unity Health Toronto; Department of Medicine (Dhalla), Faculty of Medicine, University of Toronto, Toronto, Ont
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Davis VH, Dainty KN, Dhalla IA, Sheehan KA, Wong BM, Pinto AD. "Addressing the bigger picture": A qualitative study of internal medicine patients' perspectives on social needs data collection and use. PLoS One 2023; 18:e0285795. [PMID: 37285324 DOI: 10.1371/journal.pone.0285795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 04/29/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND There is increasing interest in collecting sociodemographic and social needs data in hospital settings to inform patient care and health equity. However, few studies have examined inpatients' views on this data collection and what should be done to address social needs. This study describes internal medicine inpatients' perspectives on the collection and use of sociodemographic and social needs information. METHODS A qualitative interpretive description methodology was used. Semi-structured interviews were conducted with 18 patients admitted to a large academic hospital in Toronto, Canada. Participants were recruited using maximum variation sampling for diverse genders, races, and those with and without social needs. Interviews were coded using a predominantly inductive approach and a thematic analysis was conducted. RESULTS Patients expressed that sociodemographic and social needs data collection is important to offer actionable solutions to address their needs. Patients described a gap between their ideal care which would attend to social needs, versus the reality that hospital-based teams are faced with competing priorities and pressures that make it unfeasible to provide such care. They also believed that this data collection could facilitate more holistic, integrated care. Patients conveyed a need to have a trusting and transparent relationship with their provider to alleviate concerns surrounding bias, discrimination, and confidentiality. Lastly, they indicated that sociodemographic and social needs data could be useful to inform care, support research to inspire social change, and assist them with navigating community resources or creating in-hospital programs to address unmet social needs. CONCLUSIONS While the collection of sociodemographic and social needs information in hospital settings is generally acceptable, there were varied views on whether hospital staff should intervene, as their priority is medical care. The results can inform the implementation of social data collection and interventions in hospital settings.
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Affiliation(s)
- Victoria H Davis
- Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Katie N Dainty
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Research and Innovation, North York General Hospital, Toronto, Ontario, Canada
| | - Irfan A Dhalla
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kathleen A Sheehan
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Mental Health, University Health Network, Toronto, Ontario, Canada
| | - Brian M Wong
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, Ontario, Canada
| | - Andrew D Pinto
- Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Family & Community Medicine, University of Toronto, Toronto, Ontario, Canada
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Persaud N, Bedard M, Boozary A, Glazier RH, Gomes T, Hwang SW, Jüni P, Law MR, Mamdani M, Manns B, Martin D, Morgan SG, Oh P, Pinto AD, Shah BR, Sullivan F, Umali N, Thorpe KE, Tu K, Wu F, Laupacis A. Effect of Free Medicine Distribution on Health Care Costs in Canada Over 3 Years: A Secondary Analysis of the CLEAN Meds Randomized Clinical Trial. JAMA Health Forum 2023; 4:e231127. [PMID: 37234014 DOI: 10.1001/jamahealthforum.2023.1127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
Importance Few interventions are proven to reduce total health care costs, and addressing cost-related nonadherence has the potential to do so. Objective To determine the effect of eliminating out-of-pocket medication fees on total health care costs. Design, Setting, and Participants This secondary analysis of a multicenter randomized clinical trial using a prespecified outcome took place across 9 primary care sites in Ontario, Canada (6 in Toronto and 3 in rural areas), where health care services are generally publicly funded. Adult patients (≥18 years old) reporting cost-related nonadherence to medicines in the past 12 months were recruited between June 1, 2016, and April 28, 2017, and followed up until April 28, 2020. Data analysis was completed in 2021. Interventions Access to a comprehensive list of 128 medicines commonly prescribed in ambulatory care with no out-of-pocket costs for 3 years vs usual medicine access. Main Outcome and Measures Total publicly funded health care costs over 3 years, including costs of hospitalizations. Health care costs were determined using administrative data from Ontario's single-payer health care system, and all costs are reported in Canadian dollars with adjustments for inflation. Results A total of 747 participants from 9 primary care sites were included in the analysis (mean [SD] age, 51 [14] years; 421 [56.4%] female). Free medicine distribution was associated with a lower median total health care spending over 3 years of $1641 (95% CI, $454-$2792; P = .006). Mean total spending was $4465 (95% CI, -$944 to $9874) lower over the 3-year period. Conclusions and Relevance In this secondary analysis of a randomized clinical trial, eliminating out-of-pocket medication expenses for patients with cost-related nonadherence in primary care was associated with lower health care spending over 3 years. These findings suggest that eliminating out-of-pocket medication costs for patients could reduce overall costs of health care. Trial Registration ClinicalTrials.gov Identifier: NCT02744963.
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Affiliation(s)
- Nav Persaud
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Michael Bedard
- Department of Family Medicine, Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | - Andrew Boozary
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Richard H Glazier
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Tara Gomes
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Applied Health Research Centre, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Stephen W Hwang
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Peter Jüni
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Michael R Law
- Centre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Muhammad Mamdani
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Centre for Healthcare Analytics Research and Training at St Michael's Hospital, Toronto, Ontario, Canada
- Vector Institute, Toronto, Ontario, Canada
| | - Braden Manns
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Danielle Martin
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
| | - Steven G Morgan
- School of Population and Public Health, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Paul Oh
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Andrew D Pinto
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Baiju R Shah
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Frank Sullivan
- North York General Hospital, Toronto Western Family Health Team, University Health Network, Toronto, Ontario, Canada
- Division of Population and Behavioral Science, School of Medicine, University of St Andrews, St Andrews, Scotland, United Kingdom
| | - Norman Umali
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Kevin E Thorpe
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Applied Health Research Centre, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Karen Tu
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- North York General Hospital, Toronto Western Family Health Team, University Health Network, Toronto, Ontario, Canada
| | - Fangyun Wu
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Andreas Laupacis
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Upshaw TL, Craig-Neil A, Macklin J, Gray CS, Chan TCY, Gibson J, Pinto AD. Priorities for Artificial Intelligence Applications in Primary Care: A Canadian Deliberative Dialogue with Patients, Providers, and Health System Leaders. J Am Board Fam Med 2023; 36:210-220. [PMID: 36948537 DOI: 10.3122/jabfm.2022.220171r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 10/14/2022] [Accepted: 12/05/2022] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND Artificial intelligence (AI) implementation in primary care is limited. Those set to be most impacted by AI technology in this setting should guide it's application. We organized a national deliberative dialogue with primary care stakeholders from across Canada to explore how they thought AI should be applied in primary care. METHODS We conducted 12 virtual deliberative dialogues with participants from 8 Canadian provinces to identify shared priorities for applying AI in primary care. Dialogue data were thematically analyzed using interpretive description approaches. RESULTS Participants thought that AI should first be applied to documentation, practice operations, and triage tasks, in hopes of improving efficiency while maintaining person-centered delivery, relationships, and access. They viewed complex AI-driven clinical decision support and proactive care tools as impactful but recognized potential risks. Appropriate training and implementation support were the most important external enablers of safe, effective, and patient-centered use of AI in primary care settings. INTERPRETATION Our findings offer an agenda for the future application of AI in primary care grounded in the shared values of patients and providers. We propose that, from conception, AI developers work with primary care stakeholders as codesign partners, developing tools that respond to shared priorities.
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Affiliation(s)
- Tara L Upshaw
- From the Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada (TLU, CAN, JM, ADP); Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada (TLU); Undergraduate Medical Education, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada (TLU, JM); Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada (CSG); Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada (CSG, ADP); Department of Mechanical and Industrial Engineering, Faculty of Applied Science and Engineering, University of Toronto, Toronto, Ontario, Canada (TCYC); Joint Centre for Bioethics, University of Toronto, Toronto, Ontario, Canada (JG); Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada (JG); Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada (ADP); Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada (ADP)
| | - Amy Craig-Neil
- From the Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada (TLU, CAN, JM, ADP); Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada (TLU); Undergraduate Medical Education, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada (TLU, JM); Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada (CSG); Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada (CSG, ADP); Department of Mechanical and Industrial Engineering, Faculty of Applied Science and Engineering, University of Toronto, Toronto, Ontario, Canada (TCYC); Joint Centre for Bioethics, University of Toronto, Toronto, Ontario, Canada (JG); Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada (JG); Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada (ADP); Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada (ADP)
| | - Jillian Macklin
- From the Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada (TLU, CAN, JM, ADP); Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada (TLU); Undergraduate Medical Education, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada (TLU, JM); Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada (CSG); Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada (CSG, ADP); Department of Mechanical and Industrial Engineering, Faculty of Applied Science and Engineering, University of Toronto, Toronto, Ontario, Canada (TCYC); Joint Centre for Bioethics, University of Toronto, Toronto, Ontario, Canada (JG); Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada (JG); Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada (ADP); Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada (ADP)
| | - Carolyn Steele Gray
- From the Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada (TLU, CAN, JM, ADP); Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada (TLU); Undergraduate Medical Education, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada (TLU, JM); Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada (CSG); Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada (CSG, ADP); Department of Mechanical and Industrial Engineering, Faculty of Applied Science and Engineering, University of Toronto, Toronto, Ontario, Canada (TCYC); Joint Centre for Bioethics, University of Toronto, Toronto, Ontario, Canada (JG); Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada (JG); Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada (ADP); Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada (ADP)
| | - Timothy C Y Chan
- From the Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada (TLU, CAN, JM, ADP); Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada (TLU); Undergraduate Medical Education, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada (TLU, JM); Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada (CSG); Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada (CSG, ADP); Department of Mechanical and Industrial Engineering, Faculty of Applied Science and Engineering, University of Toronto, Toronto, Ontario, Canada (TCYC); Joint Centre for Bioethics, University of Toronto, Toronto, Ontario, Canada (JG); Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada (JG); Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada (ADP); Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada (ADP)
| | - Jennifer Gibson
- From the Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada (TLU, CAN, JM, ADP); Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada (TLU); Undergraduate Medical Education, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada (TLU, JM); Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada (CSG); Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada (CSG, ADP); Department of Mechanical and Industrial Engineering, Faculty of Applied Science and Engineering, University of Toronto, Toronto, Ontario, Canada (TCYC); Joint Centre for Bioethics, University of Toronto, Toronto, Ontario, Canada (JG); Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada (JG); Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada (ADP); Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada (ADP)
| | - Andrew D Pinto
- From the Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada (TLU, CAN, JM, ADP); Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada (TLU); Undergraduate Medical Education, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada (TLU, JM); Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada (CSG); Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada (CSG, ADP); Department of Mechanical and Industrial Engineering, Faculty of Applied Science and Engineering, University of Toronto, Toronto, Ontario, Canada (TCYC); Joint Centre for Bioethics, University of Toronto, Toronto, Ontario, Canada (JG); Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada (JG); Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada (ADP); Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada (ADP).
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Webster F, Connoy L, Sud A, Rice K, Katz J, Pinto AD, Upshur R, Dale C. Chronic Struggle: An Institutional Ethnography of Chronic Pain and Marginalization. J Pain 2023; 24:437-448. [PMID: 36252618 DOI: 10.1016/j.jpain.2022.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 10/03/2022] [Accepted: 10/06/2022] [Indexed: 11/06/2022]
Abstract
There have been several recent calls to re-think chronic pain in response to the growing awareness of social inequities that impact the prevalence of chronic pain and its management. This in turn has resulted in new explorations of suffering as it relates to pain. While laudable, many of these clinically oriented accounts are abstract and often fail to offer a critical theoretical understanding of social and structural inequities. To truly rethink pain, we must also reconsider suffering, beginning in the everyday expert knowledge of people with chronic pain who can offer insights in relation to their bodies and also the organization of the social circumstances in which they live. Our team undertook a sociological approach known as institutional ethnography (IE) to explicate the work of people in managing lives beset by chronic pain and the inequities that stem from marginalization. In keeping with our critical paradigm, we describe participant accounts as situated, rather than lived, to de-emphasize the individual in favour of the social and relational. Through our analysis, we offer a new concept of chronic struggle to capture how pain, illness, economic deprivation, and suffering constitute a knot of experience that people living with chronic pain are obliged to simplify in order to fit existing logics of medicine. Our goal is to identify the social organization of chronic pain care which underpins experience in order to situate the social as political rather than medical or individual. PERSPECTIVE: This article explicates the health work of people living with chronic pain and marginalization, drawing on their situated experience. We offer the concept of chronic struggle as a conceptualization that allows us to bring into clear view the social organization of chronic pain in which the social is visible as political and structural rather than medical or individual.
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Affiliation(s)
- Fiona Webster
- Arthur Labatt School of Nursing, Faculty of Health Sciences, Western University, London, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
| | - Laura Connoy
- Arthur Labatt School of Nursing, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Abhimanyu Sud
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Humber River Hospital, Toronto, Ontario, Canada
| | - Kathleen Rice
- Department of Family Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Joel Katz
- Department of Psychology, York University, Toronto, Ontario, Canada; Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada
| | - Andrew D Pinto
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital of Unity Health, Toronto, Ontario, Canada
| | - Ross Upshur
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Craig Dale
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
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Darcel K, Upshaw T, Craig-Neil A, Macklin J, Steele Gray C, Chan TCY, Gibson J, Pinto AD. Implementing artificial intelligence in Canadian primary care: Barriers and strategies identified through a national deliberative dialogue. PLoS One 2023; 18:e0281733. [PMID: 36848339 PMCID: PMC9970060 DOI: 10.1371/journal.pone.0281733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 01/31/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND With large volumes of longitudinal data in electronic medical records from diverse patients, primary care is primed for disruption by artificial intelligence (AI) technology. With AI applications in primary care still at an early stage in Canada and most countries, there is a unique opportunity to engage key stakeholders in exploring how AI would be used and what implementation would look like. OBJECTIVE To identify the barriers that patients, providers, and health leaders perceive in relation to implementing AI in primary care and strategies to overcome them. DESIGN 12 virtual deliberative dialogues. Dialogue data were thematically analyzed using a combination of rapid ethnographic assessment and interpretive description techniques. SETTING Virtual sessions. PARTICIPANTS Participants from eight provinces in Canada, including 22 primary care service users, 21 interprofessional providers, and 5 health system leaders. RESULTS The barriers that emerged from the deliberative dialogue sessions were grouped into four themes: (1) system and data readiness, (2) the potential for bias and inequity, (3) the regulation of AI and big data, and (4) the importance of people as technology enablers. Strategies to overcome the barriers in each of these themes were highlighted, where participatory co-design and iterative implementation were voiced most strongly by participants. LIMITATIONS Only five health system leaders were included in the study and no self-identifying Indigenous people. This is a limitation as both groups may have provided unique perspectives to the study objective. CONCLUSIONS These findings provide insight into the barriers and facilitators associated with implementing AI in primary care settings from different perspectives. This will be vital as decisions regarding the future of AI in this space is shaped.
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Affiliation(s)
- Katrina Darcel
- Upstream Lab, MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Ontario, Canada
- Undergraduate Medical Education, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tara Upshaw
- Upstream Lab, MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Ontario, Canada
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Amy Craig-Neil
- Upstream Lab, MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Ontario, Canada
| | - Jillian Macklin
- Upstream Lab, MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Ontario, Canada
- Undergraduate Medical Education, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Joint Centre for Bioethics, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Heath, University of Toronto, Toronto, Ontario, Canada
| | - Carolyn Steele Gray
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Timothy C. Y. Chan
- Department of Mechanical and Industrial Engineering, Faculty of Applied Science and Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer Gibson
- Joint Centre for Bioethics, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Heath, University of Toronto, Toronto, Ontario, Canada
| | - Andrew D. Pinto
- Upstream Lab, MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Heath, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- * E-mail:
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16
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Davis VH, Rodger L, Pinto AD. Collection and Use of Social Determinants of Health Data in Inpatient General Internal Medicine Wards: A Scoping Review. J Gen Intern Med 2023; 38:480-489. [PMID: 36471193 PMCID: PMC9905340 DOI: 10.1007/s11606-022-07937-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 11/04/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND There is growing interest in incorporating social determinants of health (SDoH) data collection in inpatient hospital settings to inform patient care. However, there is limited information on this data collection and its use in inpatient general internal medicine (GIM). This scoping review sought to describe the current state of the literature on SDoH data collection and its application to patient care in inpatient GIM settings. METHODS English-language searches on MedLine, Embase, Web of Science, CINAHL, Cochrane, and PsycINFO were conducted from 2000 to April 2021. Studies reporting systematic data collection or use of at least three SDoH, sociodemographic, or social needs variables in inpatient hospital GIM settings were included. Four independent reviewers screened abstracts, and two reviewers screened full-text articles. RESULTS A total of 8190 articles underwent abstract screening and eight were included. A range of SDoH tools were used, such as THRIVE, PRAPARE, WHO-Quality of Life, Measuring Health Equity, and a biopsychosocial framework. The most common SDoH were food security or malnutrition (n=7), followed by housing, transportation, employment, education, income, functional status and disability, and social support (n=5 each). Four of the eight studies applied the data to inform patient care, and three provided community resource referrals. DISCUSSION There is limited evidence to guide the collection and use of SDoH data in inpatient GIM settings. This review highlights the need for integrated care, the role of the electronic health record, and social history taking, all of which may benefit from more robust SDoH data collection. Future research should examine the feasibility and acceptability of SDoH integration in inpatient GIM settings.
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Affiliation(s)
- Victoria H Davis
- Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada.
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
| | - Laura Rodger
- Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Andrew D Pinto
- Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, ON, Canada
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17
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Craig-Neil A, Ho J, Perri M, Gaspar M, Hunter C, Rachlis B, Kendall CE, Rueda S, Burchell AN, Pinto AD. Healthcare system action on employment as a social determinant of health in people living with HIV: A qualitative study. PLoS One 2023; 18:e0282421. [PMID: 37023048 PMCID: PMC10079099 DOI: 10.1371/journal.pone.0282421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 02/14/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND Employment is a key social determinant of health. People living with HIV (PLWH) have higher unemployment rates than the general population. Vocational rehabilitation services have been shown to have significant and positive impact on employment status for PLWH. Understanding whether integrating vocational rehabilitation with health care services is acceptable, from the perspectives of PLWH and their health care providers, is an area that is understudied. METHODS We conducted a qualitative study and collected data from focus groups and interviews to understand the perspectives of stakeholders regarding the potential for vocational rehabilitation and health care integration. We completed five focus groups with 45 health care providers and one-to-one interviews with 23 PLWHs. Participants were sampled from infectious disease, primary care clinics, and AIDS Service Organizations in Toronto and Ottawa, Canada. Interviews were audio-recorded and transcribed. We conducted a reflexive thematic analysis of the transcripts. FINDINGS We found health care providers have little experience assisting patients with employment and PLWH had little experience receiving employment interventions from their health care team. This lack of integration between health care and vocational services was related to uncertainties around drug coverage, physician role and living with an episodic disability. Health care providers thought that there is potential for a larger role for health care clinics in providing employment interventions for PLWH however patients were divided. Some PLWH suggest that health care providers could provide advice on the disclosure of status, work limitations and act as advocates with employers. INTERPRETATION Health care providers and some PLWH recognize the importance of integrating health services with vocational services but both groups have little experience with implementing these types of interventions. Thus, there needs to be more study of such interventions, including the processes entailed and outcomes they aim to achieve.
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Affiliation(s)
- Amy Craig-Neil
- Li Ka Shing Knowledge Institute, Upstream Lab, MAP/Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
- Li Ka Shing Knowledge Institute, MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
| | - Julia Ho
- Li Ka Shing Knowledge Institute, Upstream Lab, MAP/Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
- Li Ka Shing Knowledge Institute, MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
| | - Melissa Perri
- Li Ka Shing Knowledge Institute, Upstream Lab, MAP/Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
- Li Ka Shing Knowledge Institute, MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Mark Gaspar
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Charlotte Hunter
- Faculty of Medicine, Department of Family and Community Medicine, University of Toronto, Toronto, Canada
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Canada
| | - Beth Rachlis
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
| | - Claire E Kendall
- ICES, Toronto, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Canada
- Bruyère Research Institute, Ottawa, Canada
- Institut du Savoir Montfort, Montfort Hospital, Ottawa, Canada
| | - Sergio Rueda
- Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Ann N Burchell
- Li Ka Shing Knowledge Institute, MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Faculty of Medicine, Department of Family and Community Medicine, University of Toronto, Toronto, Canada
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Canada
| | - Andrew D Pinto
- Li Ka Shing Knowledge Institute, Upstream Lab, MAP/Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
- Li Ka Shing Knowledge Institute, MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Faculty of Medicine, Department of Family and Community Medicine, University of Toronto, Toronto, Canada
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Canada
- University of Toronto Practice-Based Research Network, Toronto, Canada
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O’Neill M, De Prophetis E, Allin S, Pinto AD, Smith RW, Di Ruggiero E, Schwartz R, Pawa J, Ammi M, Rosella LC. “We cobble together a storyline of system performance using a diversity of things”: a qualitative study of perspectives on public health performance measurement in Canada. Arch Public Health 2022; 80:177. [PMID: 35906667 PMCID: PMC9335461 DOI: 10.1186/s13690-022-00931-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/07/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
There have been longstanding calls for public health systems transformations in many countries, including Canada. Core to these calls has been strengthening performance measurement. While advancements have been made in performance measurement for certain sectors of the health care system (primarily focused on acute and primary health care), effective use of indicators for measuring public health systems performance are lacking. This study describes the current state, anticipated challenges, and future directions in the development and implementation of a public health performance measurement system for Canada.
Methods
We conducted a qualitative study using semi-structured interviews with public health leaders (n = 9) between July and August 2021. Public health leaders included researchers, government staff, and former medical officers of health who were purposively selected due to their expertise and experience with performance measurement with relevance to public health systems in Canada. Thematic analysis included both a deductive approach for themes consistent with the conceptual framework and an inductive approach to allow new themes to emerge from the data.
Results
Conceptual, methodological, contextual, and infrastructure challenges were highlighted by participants in designing a performance measurement system for public health. Specifically, six major themes evolved that encompass 1) the mission and purpose of public health systems, including challenges inherent in measuring the functions and services of public health; 2) the macro context, including the impacts of chronic underinvestment and one-time funding injections on the ability to sustain a measurement system; 3) the organizational structure/governance of public health systems including multiple forms across Canada and underdevelopment of information technology systems; 4) accountability approaches to performance measurement and management; and 5) timing and unobservability in public health indicators. These challenges require dedicated investment, strong leadership, and political will from the federal and provincial/territorial governments.
Conclusion
Unprecedented attention on public health due to the coronavirus disease 2019 pandemic has highlighted opportunities for system improvements, such as addressing the lack of a performance measurement system. This study provides actionable knowledge on conceptual, methodological, contextual, and infrastructure challenges needed to design and build a pan-Canadian performance measurement system for public health.
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Sandhu HS, Smith RW, Jarvis T, O'Neill M, Di Ruggiero E, Schwartz R, Rosella LC, Allin S, Pinto AD. Early Impacts of the COVID-19 Pandemic on Public Health Systems and Practice in 3 Canadian Provinces From the Perspective of Public Health Leaders: A Qualitative Study. J Public Health Manag Pract 2022; 28:702-711. [PMID: 36027605 PMCID: PMC9528938 DOI: 10.1097/phh.0000000000001596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
CONTEXT The COVID-19 pandemic has impacted health systems worldwide. Studies to date have largely focused on the health care system with less attention to the impact on public health systems and practice. OBJECTIVE To describe the early impacts of COVID-19 on public health systems and practice in 3 Canadian provinces from the perspective of public health system leaders and synthesize lessons learned. DESIGN A qualitative study using semistructured virtual interviews with public health leaders between October 2020 and April 2021. The World Health Organization's essential public health operations framework guided data collection and analysis. SETTING This study involved the Canadian provinces of Alberta, Ontario, and Québec. These provinces were chosen for their large populations, relatively high COVID-19 burden, and variation in public health systems. PARTICIPANTS Public health leaders from Alberta (n = 21), Ontario (n = 18), and Québec (n = 19) in organizations with a primary mandate of stewardship and/or administration of essential public health operations (total n = 58). RESULTS We found that the COVID-19 pandemic led to intensified collaboration in public health systems and a change in workforce capacity to respond to the pandemic. This came with opportunities but also challenges of burnout and disruption of non-COVID-19 services. Information systems and digital technologies were increasingly used and there was greater proximity between public health leaders and other health system leaders. A renewed recognition for public health work was also highlighted. CONCLUSIONS The COVID-19 pandemic impacted several aspects of public health systems in the provinces studied. Our findings can help public health leaders and policy makers identify areas for further investment (eg, intersectoral collaboration, information systems) and develop plans to address challenges (eg, disrupted services, workforce burnout) that have surfaced.
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Affiliation(s)
- Harman S. Sandhu
- Dalla Lana School of Public Health (Mr Sandhu, Drs Smith, Di Ruggiero, Schwartz, Rosella, Allin, and Pinto, and Ms O'Neill), North American Observatory on Health Systems and Policies (Mr Sandhu and Dr Allin), Population Health Analytics Lab (Ms O'Neill and Dr Rosella), and Department of Family and Community Medicine, Faculty of Medicine (Dr Pinto), University of Toronto, Toronto, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada (Ms Jarvis); Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada (Dr Pinto); and Department of Family and Community Medicine, St Michael's Hospital, Toronto, Ontario, Canada (Dr Pinto)
| | - Robert W. Smith
- Dalla Lana School of Public Health (Mr Sandhu, Drs Smith, Di Ruggiero, Schwartz, Rosella, Allin, and Pinto, and Ms O'Neill), North American Observatory on Health Systems and Policies (Mr Sandhu and Dr Allin), Population Health Analytics Lab (Ms O'Neill and Dr Rosella), and Department of Family and Community Medicine, Faculty of Medicine (Dr Pinto), University of Toronto, Toronto, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada (Ms Jarvis); Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada (Dr Pinto); and Department of Family and Community Medicine, St Michael's Hospital, Toronto, Ontario, Canada (Dr Pinto)
| | - Tamika Jarvis
- Dalla Lana School of Public Health (Mr Sandhu, Drs Smith, Di Ruggiero, Schwartz, Rosella, Allin, and Pinto, and Ms O'Neill), North American Observatory on Health Systems and Policies (Mr Sandhu and Dr Allin), Population Health Analytics Lab (Ms O'Neill and Dr Rosella), and Department of Family and Community Medicine, Faculty of Medicine (Dr Pinto), University of Toronto, Toronto, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada (Ms Jarvis); Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada (Dr Pinto); and Department of Family and Community Medicine, St Michael's Hospital, Toronto, Ontario, Canada (Dr Pinto)
| | - Meghan O'Neill
- Dalla Lana School of Public Health (Mr Sandhu, Drs Smith, Di Ruggiero, Schwartz, Rosella, Allin, and Pinto, and Ms O'Neill), North American Observatory on Health Systems and Policies (Mr Sandhu and Dr Allin), Population Health Analytics Lab (Ms O'Neill and Dr Rosella), and Department of Family and Community Medicine, Faculty of Medicine (Dr Pinto), University of Toronto, Toronto, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada (Ms Jarvis); Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada (Dr Pinto); and Department of Family and Community Medicine, St Michael's Hospital, Toronto, Ontario, Canada (Dr Pinto)
| | - Erica Di Ruggiero
- Dalla Lana School of Public Health (Mr Sandhu, Drs Smith, Di Ruggiero, Schwartz, Rosella, Allin, and Pinto, and Ms O'Neill), North American Observatory on Health Systems and Policies (Mr Sandhu and Dr Allin), Population Health Analytics Lab (Ms O'Neill and Dr Rosella), and Department of Family and Community Medicine, Faculty of Medicine (Dr Pinto), University of Toronto, Toronto, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada (Ms Jarvis); Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada (Dr Pinto); and Department of Family and Community Medicine, St Michael's Hospital, Toronto, Ontario, Canada (Dr Pinto)
| | - Robert Schwartz
- Dalla Lana School of Public Health (Mr Sandhu, Drs Smith, Di Ruggiero, Schwartz, Rosella, Allin, and Pinto, and Ms O'Neill), North American Observatory on Health Systems and Policies (Mr Sandhu and Dr Allin), Population Health Analytics Lab (Ms O'Neill and Dr Rosella), and Department of Family and Community Medicine, Faculty of Medicine (Dr Pinto), University of Toronto, Toronto, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada (Ms Jarvis); Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada (Dr Pinto); and Department of Family and Community Medicine, St Michael's Hospital, Toronto, Ontario, Canada (Dr Pinto)
| | - Laura C. Rosella
- Dalla Lana School of Public Health (Mr Sandhu, Drs Smith, Di Ruggiero, Schwartz, Rosella, Allin, and Pinto, and Ms O'Neill), North American Observatory on Health Systems and Policies (Mr Sandhu and Dr Allin), Population Health Analytics Lab (Ms O'Neill and Dr Rosella), and Department of Family and Community Medicine, Faculty of Medicine (Dr Pinto), University of Toronto, Toronto, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada (Ms Jarvis); Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada (Dr Pinto); and Department of Family and Community Medicine, St Michael's Hospital, Toronto, Ontario, Canada (Dr Pinto)
| | - Sara Allin
- Dalla Lana School of Public Health (Mr Sandhu, Drs Smith, Di Ruggiero, Schwartz, Rosella, Allin, and Pinto, and Ms O'Neill), North American Observatory on Health Systems and Policies (Mr Sandhu and Dr Allin), Population Health Analytics Lab (Ms O'Neill and Dr Rosella), and Department of Family and Community Medicine, Faculty of Medicine (Dr Pinto), University of Toronto, Toronto, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada (Ms Jarvis); Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada (Dr Pinto); and Department of Family and Community Medicine, St Michael's Hospital, Toronto, Ontario, Canada (Dr Pinto)
| | - Andrew D. Pinto
- Dalla Lana School of Public Health (Mr Sandhu, Drs Smith, Di Ruggiero, Schwartz, Rosella, Allin, and Pinto, and Ms O'Neill), North American Observatory on Health Systems and Policies (Mr Sandhu and Dr Allin), Population Health Analytics Lab (Ms O'Neill and Dr Rosella), and Department of Family and Community Medicine, Faculty of Medicine (Dr Pinto), University of Toronto, Toronto, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada (Ms Jarvis); Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada (Dr Pinto); and Department of Family and Community Medicine, St Michael's Hospital, Toronto, Ontario, Canada (Dr Pinto)
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20
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Pinto AD, Gandhi KM, Hapsari A, Sunderji A, Cohen-Silver J. Integrating health and social care for children in Canada. Can Fam Physician 2022; 68:726-728. [PMID: 36241404 PMCID: PMC9833149 DOI: 10.46747/cfp.6810726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Andrew D. Pinto
- Founder and Director of the Upstream Lab at the MAP Centre for Urban Health Solutions in the Li Ka Shing Knowledge Institute at Unity Health Toronto in Ontario, Associate Professor in the Department of Family and Community Medicine at the University of Toronto, a family physician and public health and preventive medicine specialist in the Department of Family and Community Medicine at St Michael’s Hospital, and Associate Professor in the Dalla Lana School of Public Health at the University of Toronto.,Correspondence Dr Andrew D. Pinto; e-mail
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Pinto AD. Intégrer les soins de santé et l’aide sociale pour les enfants au Canada. Can Fam Physician 2022; 68:e279-e282. [PMID: 36241405 PMCID: PMC9833146 DOI: 10.46747/cfp.6810e279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Andrew D. Pinto
- Fondateur et directeur du Laboratoire Upstream au MAP Centre for Urban Health Solutions du Li Ka Shing Knowledge Institute à Unity Health Toronto (Ontario), professeur agrégé au Département de médecine familiale et communautaire de l’Université de Toronto, médecin de famille et spécialiste en santé publique et en médecine préventive au Département de médecine familiale et communautaire de l’Hôpital St Michael’s et professeur agrégé à l’École Dalla Lana de santé publique de l’Université de Toronto
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22
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Terry AL, Kueper JK, Beleno R, Brown JB, Cejic S, Dang J, Leger D, McKay S, Meredith L, Pinto AD, Ryan BL, Stewart M, Zwarenstein M, Lizotte DJ. Is primary health care ready for artificial intelligence? What do primary health care stakeholders say? BMC Med Inform Decis Mak 2022; 22:237. [PMID: 36085203 PMCID: PMC9461192 DOI: 10.1186/s12911-022-01984-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 09/02/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Effective deployment of AI tools in primary health care requires the engagement of practitioners in the development and testing of these tools, and a match between the resulting AI tools and clinical/system needs in primary health care. To set the stage for these developments, we must gain a more in-depth understanding of the views of practitioners and decision-makers about the use of AI in primary health care. The objective of this study was to identify key issues regarding the use of AI tools in primary health care by exploring the views of primary health care and digital health stakeholders.
Methods
This study utilized a descriptive qualitative approach, including thematic data analysis. Fourteen in-depth interviews were conducted with primary health care and digital health stakeholders in Ontario. NVivo software was utilized in the coding of the interviews.
Results
Five main interconnected themes emerged: (1) Mismatch Between Envisioned Uses and Current Reality—denoting the importance of potential applications of AI in primary health care practice, with a recognition of the current reality characterized by a lack of available tools; (2) Mechanics of AI Don’t Matter: Just Another Tool in the Toolbox– reflecting an interest in what value AI tools could bring to practice, rather than concern with the mechanics of the AI tools themselves; (3) AI in Practice: A Double-Edged Sword—the possible benefits of AI use in primary health care contrasted with fundamental concern about the possible threats posed by AI in terms of clinical skills and capacity, mistakes, and loss of control; (4) The Non-Starters: A Guarded Stance Regarding AI Adoption in Primary Health Care—broader concerns centred on the ethical, legal, and social implications of AI use in primary health care; and (5) Necessary Elements: Facilitators of AI in Primary Health Care—elements required to support the uptake of AI tools, including co-creation, availability and use of high quality data, and the need for evaluation.
Conclusion
The use of AI in primary health care may have a positive impact, but many factors need to be considered regarding its implementation. This study may help to inform the development and deployment of AI tools in primary health care.
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23
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Ruco A, Pinto AD, Nisenbaum R, Ho JW, Bellicoso E, Hassen N, Hanna A, Muntaner C, Holness DL. Collecting occupation and hazards information in primary care using O*NET. Am J Ind Med 2022; 65:783-789. [PMID: 35932171 DOI: 10.1002/ajim.23420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 07/14/2022] [Accepted: 07/15/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The objective of this study was to determine the feasibility of collecting occupation and occupational hazard data in a primary care setting, using the Occupational Information Network (O*NET) database to assist with classification. METHODS We collected data from 204 employed adult primary care patients in Toronto, Canada, on their occupation and exposure to occupational hazards, and mapped their job titles to the O*NET database. We compared their self-reported occupational hazard exposures with the likelihood of exposure on O*NET. RESULTS Exposure to repetitive arm movement was reported by 78%, to vapors/gas/dust/fumes by 30%, to noise by 30%, and to heavy loads by 31%. Significant differences in exposure to vapors/gas/dust/fumes were associated with work precarity. We matched the majority of job titles (89%) to O*NET categories. CONCLUSIONS Collecting employment information in primary care setting was feasible, with the majority of job titles mapping onto O*NET classifications.
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Affiliation(s)
- Arlinda Ruco
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.,Peter Gilgan Centre for Women's Cancers, Women's College Hospital, Toronto, ON, Canada
| | - Andrew D Pinto
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Department of Family and Community Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.,Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
| | - Rosane Nisenbaum
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
| | - Julia W Ho
- Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
| | - Emily Bellicoso
- Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Department of Family and Community Medicine, St. Joseph's Health Centre, Unity Health Toronto, Toronto, ON, Canada
| | - Nadha Hassen
- Faculty of Environmental and Urban Change, York University, Toronto, ON, Canada
| | - Andrew Hanna
- Royal College of Surgeons in Ireland, Medical University of Bahrain, Busaiteen, Bahrain
| | - Carles Muntaner
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - D Linn Holness
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Centre for Research Expertise in Occupational Disease, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Department of Medicine, Division of Occupational Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.,Department of Medicine, Division of Occupational Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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24
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Salvalaggio G, Hyshka E, Brown C, Pinto AD, Halas G, Green L, Kosteniuk B, Perri M, Le Chalifoux N, Halas G, Steiner L, Cavett T, Montesanti S. A comparison of the COVID-19 response for urban underserved patients experiencing healthcare transitions in three Canadian cities. Can J Public Health 2022; 113:846-866. [PMID: 35771364 PMCID: PMC9245871 DOI: 10.17269/s41997-022-00651-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 05/10/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The COVID-19 pandemic and response has highlighted existing strengths within the system of care for urban underserved populations, but also many fault lines, in particular during care transitions. The objectives of this study were to describe COVID-19 response policies for urban underserved populations in three Canadian cities; examine how these policies impact continuity of care for urban underserved populations; determine whether and how urban underserved community members were engaged in policy processes; and develop policy and operational recommendations for optimizing continuity of care for urban underserved populations during public health crises. METHODS Using Walt & Gilson's Policy Triangle framework as a conceptual guide, 237 policy and media documents were retrieved. Five complementary virtual group interview sessions were held with 22 front-line and lived-experience key informants to capture less well-documented policy responses and experiences. Documents and interview transcripts were analyzed inductively for policy content, context, actors, and processes involved in the pandemic response. RESULTS Available documents suggest little focus on care continuity for urban underserved populations during the pandemic, despite public health measures having disproportionately negative impacts on their care. Policy responses were largely reactive and temporary, and community members were rarely involved. However, a number of community-based initiatives were developed in response to policy gaps. Promising practices emerged, including examples of new multi-level and multi-sector collaboration. CONCLUSION The pandemic response has exposed inequities for urban underserved populations experiencing care transitions; however, it has also exposed system strengths and opportunities for improvement to inform future policy direction.
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Affiliation(s)
- Ginetta Salvalaggio
- Department of Family Medicine, University of Alberta, 610 University Terrace, Edmonton, AB T6G 2T4 Canada
| | - Elaine Hyshka
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405 87 Avenue NW, Edmonton, Alberta T6G 1C9 Canada
| | - Cara Brown
- Department of Occupational Therapy, University of Manitoba, 771 McDermot Ave, Winnipeg, MB R3E 0T6 Canada
| | - Andrew D. Pinto
- Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, 30 Bond Street, Toronto, ON M5B 1W8 Canada
| | - Gayle Halas
- Rady Chair, Interprofessional Collaborative Practice, Rady Faculty of Health Sciences, University of Manitoba, P219-770 Bannatyne Ave., Winnipeg, MB R3E 0W3 Canada
| | - Lee Green
- Department of Family Medicine, University of Alberta, 516 University Terrace, Edmonton, AB T6G 2T4 Canada
| | - Brynn Kosteniuk
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405 87 Avenue NW, Edmonton, Alberta T6G 1C9 Canada
| | - Melissa Perri
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 3M7 Canada
| | - Nathaniel Le Chalifoux
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405 87 Avenue NW, Edmonton, Alberta T6G 1C9 Canada
| | - Garrett Halas
- Rady Faculty of Health Sciences, University of Manitoba, 770 Bannatyne University of Manitoba, Winnipeg, R3E 0W3 Canada
| | - Liane Steiner
- Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, 30 Bond Street, Toronto, ON M5B 1W8 Canada
| | - Teresa Cavett
- Department of Family Medicine, University of Manitoba, Northern Connection Medical Centre, 2700 McPhillips St, Winnipeg, MB R2V 3M3 Canada
| | - Stephanie Montesanti
- School of Public Health, University of Alberta, 3-266 Edmonton Clinic Health Academy, 11205-87 Avenue NW, Edmonton, Alberta T6G 1C9 Canada
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Allana A, Kuluski K, Tavares W, Pinto AD. Building integrated, adaptive and responsive healthcare systems - lessons from paramedicine in Ontario, Canada. BMC Health Serv Res 2022; 22:595. [PMID: 35505321 PMCID: PMC9063622 DOI: 10.1186/s12913-022-07856-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 03/10/2022] [Indexed: 11/25/2022] Open
Abstract
Background Being responsive and adaptive to local population needs is a key principle of integrated care, and traditional top-down approaches to health system governance are considered to be ineffective. There is need for more guidance on taking flexible, complexity-aware approaches to governance that foster integration and adaptability in the health system. Over the past two decades, paramedics in Ontario, Canada have been filling gaps in health and social services beyond their traditional mandate of emergency transport. Studying these grassroots, local programs can provide insight into how health systems can be more integrated, adaptive and responsive. Methods Semi-structured interviews were conducted with people involved in new, integrated models of paramedic care in Ontario. Audio recordings of interviews were transcribed and coded inductively for participants’ experiences, including drivers, enablers and barriers to implementation. Thematic analysis was done to ascertain key concepts from across the dataset. Results Twenty-six participants from across Ontario’s five administrative health regions participated in the study. Participants described a range of programs that included acute, urgent and preventative care driven by local relationship networks of paramedics, hospitals, primary care, social services and home care. Three themes were developed that represent participants’ experiences implementing these programs in the Ontario context. The first theme, adapting and being nimble in tension with system structures, related to distributed versus central control of programs, a desire to be nimble and skepticism towards prohibitive legal and regulatory systems. The second theme, evolving and flexible professional role identity, highlighted the value and challenges of a functionally flexible workforce and interest in new roles amongst the paramedic profession. The third theme, unpredictable influences on program implementation, identified events such as the COVID-19 pandemic and changing government priorities as accelerating, redirecting or inhibiting local program development. Conclusions The findings of this study add to the discourse on governing health systems towards being more integrated, adaptive and responsive to population needs. Governance strategies include: supporting networks of local organizational relationships; considering the role of a functionally flexible health workforce; promoting a shared vision and framework for collaboration; and enabling distributed, local control and experimentation.
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Affiliation(s)
- Amir Allana
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, ON, Toronto, Canada. .,McNally Project for Paramedicine Research, Toronto, Canada. .,Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Canada.
| | - Kerry Kuluski
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, ON, Toronto, Canada.,Institute for Better Health, Trillium Health Partners, Mississauga, Canada
| | - Walter Tavares
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, ON, Toronto, Canada.,McNally Project for Paramedicine Research, Toronto, Canada.,The Wilson Centre and Temerty Faculty of Medicine, University of Toronto
- University Health Network, Toronto, Canada.,York Region Paramedic Services, Community and Health Services Department, The Regional Municipality of York, Canada
| | - Andrew D Pinto
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, ON, Toronto, Canada.,Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Canada.,Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada.,Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Canada
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26
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Pinto AD, Hapsari AP, Ho J, Meaney C, Avery L, Hassen N, Jetha A, Lay AM, Rotondi M, Zuberi D. Precarious work among personal support workers in the Greater Toronto Area: a respondent-driven sampling study. CMAJ Open 2022; 10:E527-E538. [PMID: 35700996 PMCID: PMC9343122 DOI: 10.9778/cmajo.20210338] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has highlighted the role of personal support workers (PSWs) in health care, as well as their work conditions. Our study aimed to understand the characteristics of the PSW workforce, their work conditions and their job security, as well as to explore the health of PSWs and the impact of precarious employment on their health. METHODS Our community-based participatory action research focused on PSWs in the Greater Toronto Area. We administered an online, cross-sectional survey between June and December 2020 using respondent-driven sampling. Data on sociodemographics, employment precarity, worker empowerment and health status were collected. We assessed the association between precarious employment and health using multivariable logistic regression models. RESULTS We contacted 739 PSWs, and 664 consented to participate. Overall, 658 (99.1%) completed at least part of the survey. Using data adjusted for our sampling approach, the participants were predominantly Black (76.5%, 95% confidence interval [CI] 68.2%-84.9%), women (90.1%, 95% CI 85.1%-95.1%) and born outside of Canada (97.4%, 95% CI 94.9%-99.9%). Most worked in home care (43.9%, 95% CI 35.2%-52.5%) or long-term care (34.5%, 95% CI 27.4%-42.0%). Although most participants had at least some postsecondary education (unadjusted proportion = 83.4%, n = 529), more than half were considered low income (55.1%, 95% CI 46.3%-63.9%). Most participants were precariously employed (86.5%, 95% CI 80.7%-92.4%) and lacked paid sick days (89.5%, 95% CI 85.8%-93.3%) or extended health benefits (74.1%, 95% CI 66.8%-81.4%). Nearly half of the participants described their health as less than very good (46.7%, 95% CI 37.9%-55.5%). Employment precarity was significantly associated with higher risk of depression (odds ratio 1.02, 95% CI 1.01-1.03). INTERPRETATION Despite being key members of health care teams, most PSWs were precariously employed with low wages that keep them in poverty; the poor work conditions they faced could be detrimental to their physical and mental health. Equitable strategies are needed to provide decent work conditions for PSWs and to improve their health.
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Affiliation(s)
- Andrew D Pinto
- Upstream Lab (Pinto, Hapsari, Ho), MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto; Department of Family and Community Medicine (Pinto), St. Michael's Hospital; Department of Family and Community Medicine (Pinto, Meaney), Faculty of Medicine; Dalla Lana School of Public Health (Pinto, Avery, Jetha), University of Toronto; Department of Biostatistics (Avery), Princess Margaret Hospital, University Health Network; Faculty of Environmental and Urban Change (Hassen), York University; Institute for Work and Health (Jetha); Institute of Population and Public Health (Lay), Canadian Institutes for Health Research, Ottawa, Ont.; School of Kinesiology and Health Science (Rotondi), York University; Munk School of Global Affairs & Public Policy (Zuberi); Factor-Inwentash Faculty of Social Work (Zuberi), University of Toronto, Toronto, Ont.
| | - Ayu P Hapsari
- Upstream Lab (Pinto, Hapsari, Ho), MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto; Department of Family and Community Medicine (Pinto), St. Michael's Hospital; Department of Family and Community Medicine (Pinto, Meaney), Faculty of Medicine; Dalla Lana School of Public Health (Pinto, Avery, Jetha), University of Toronto; Department of Biostatistics (Avery), Princess Margaret Hospital, University Health Network; Faculty of Environmental and Urban Change (Hassen), York University; Institute for Work and Health (Jetha); Institute of Population and Public Health (Lay), Canadian Institutes for Health Research, Ottawa, Ont.; School of Kinesiology and Health Science (Rotondi), York University; Munk School of Global Affairs & Public Policy (Zuberi); Factor-Inwentash Faculty of Social Work (Zuberi), University of Toronto, Toronto, Ont
| | - Julia Ho
- Upstream Lab (Pinto, Hapsari, Ho), MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto; Department of Family and Community Medicine (Pinto), St. Michael's Hospital; Department of Family and Community Medicine (Pinto, Meaney), Faculty of Medicine; Dalla Lana School of Public Health (Pinto, Avery, Jetha), University of Toronto; Department of Biostatistics (Avery), Princess Margaret Hospital, University Health Network; Faculty of Environmental and Urban Change (Hassen), York University; Institute for Work and Health (Jetha); Institute of Population and Public Health (Lay), Canadian Institutes for Health Research, Ottawa, Ont.; School of Kinesiology and Health Science (Rotondi), York University; Munk School of Global Affairs & Public Policy (Zuberi); Factor-Inwentash Faculty of Social Work (Zuberi), University of Toronto, Toronto, Ont
| | - Christopher Meaney
- Upstream Lab (Pinto, Hapsari, Ho), MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto; Department of Family and Community Medicine (Pinto), St. Michael's Hospital; Department of Family and Community Medicine (Pinto, Meaney), Faculty of Medicine; Dalla Lana School of Public Health (Pinto, Avery, Jetha), University of Toronto; Department of Biostatistics (Avery), Princess Margaret Hospital, University Health Network; Faculty of Environmental and Urban Change (Hassen), York University; Institute for Work and Health (Jetha); Institute of Population and Public Health (Lay), Canadian Institutes for Health Research, Ottawa, Ont.; School of Kinesiology and Health Science (Rotondi), York University; Munk School of Global Affairs & Public Policy (Zuberi); Factor-Inwentash Faculty of Social Work (Zuberi), University of Toronto, Toronto, Ont
| | - Lisa Avery
- Upstream Lab (Pinto, Hapsari, Ho), MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto; Department of Family and Community Medicine (Pinto), St. Michael's Hospital; Department of Family and Community Medicine (Pinto, Meaney), Faculty of Medicine; Dalla Lana School of Public Health (Pinto, Avery, Jetha), University of Toronto; Department of Biostatistics (Avery), Princess Margaret Hospital, University Health Network; Faculty of Environmental and Urban Change (Hassen), York University; Institute for Work and Health (Jetha); Institute of Population and Public Health (Lay), Canadian Institutes for Health Research, Ottawa, Ont.; School of Kinesiology and Health Science (Rotondi), York University; Munk School of Global Affairs & Public Policy (Zuberi); Factor-Inwentash Faculty of Social Work (Zuberi), University of Toronto, Toronto, Ont
| | - Nadha Hassen
- Upstream Lab (Pinto, Hapsari, Ho), MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto; Department of Family and Community Medicine (Pinto), St. Michael's Hospital; Department of Family and Community Medicine (Pinto, Meaney), Faculty of Medicine; Dalla Lana School of Public Health (Pinto, Avery, Jetha), University of Toronto; Department of Biostatistics (Avery), Princess Margaret Hospital, University Health Network; Faculty of Environmental and Urban Change (Hassen), York University; Institute for Work and Health (Jetha); Institute of Population and Public Health (Lay), Canadian Institutes for Health Research, Ottawa, Ont.; School of Kinesiology and Health Science (Rotondi), York University; Munk School of Global Affairs & Public Policy (Zuberi); Factor-Inwentash Faculty of Social Work (Zuberi), University of Toronto, Toronto, Ont
| | - Arif Jetha
- Upstream Lab (Pinto, Hapsari, Ho), MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto; Department of Family and Community Medicine (Pinto), St. Michael's Hospital; Department of Family and Community Medicine (Pinto, Meaney), Faculty of Medicine; Dalla Lana School of Public Health (Pinto, Avery, Jetha), University of Toronto; Department of Biostatistics (Avery), Princess Margaret Hospital, University Health Network; Faculty of Environmental and Urban Change (Hassen), York University; Institute for Work and Health (Jetha); Institute of Population and Public Health (Lay), Canadian Institutes for Health Research, Ottawa, Ont.; School of Kinesiology and Health Science (Rotondi), York University; Munk School of Global Affairs & Public Policy (Zuberi); Factor-Inwentash Faculty of Social Work (Zuberi), University of Toronto, Toronto, Ont
| | - A Morgan Lay
- Upstream Lab (Pinto, Hapsari, Ho), MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto; Department of Family and Community Medicine (Pinto), St. Michael's Hospital; Department of Family and Community Medicine (Pinto, Meaney), Faculty of Medicine; Dalla Lana School of Public Health (Pinto, Avery, Jetha), University of Toronto; Department of Biostatistics (Avery), Princess Margaret Hospital, University Health Network; Faculty of Environmental and Urban Change (Hassen), York University; Institute for Work and Health (Jetha); Institute of Population and Public Health (Lay), Canadian Institutes for Health Research, Ottawa, Ont.; School of Kinesiology and Health Science (Rotondi), York University; Munk School of Global Affairs & Public Policy (Zuberi); Factor-Inwentash Faculty of Social Work (Zuberi), University of Toronto, Toronto, Ont
| | - Michael Rotondi
- Upstream Lab (Pinto, Hapsari, Ho), MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto; Department of Family and Community Medicine (Pinto), St. Michael's Hospital; Department of Family and Community Medicine (Pinto, Meaney), Faculty of Medicine; Dalla Lana School of Public Health (Pinto, Avery, Jetha), University of Toronto; Department of Biostatistics (Avery), Princess Margaret Hospital, University Health Network; Faculty of Environmental and Urban Change (Hassen), York University; Institute for Work and Health (Jetha); Institute of Population and Public Health (Lay), Canadian Institutes for Health Research, Ottawa, Ont.; School of Kinesiology and Health Science (Rotondi), York University; Munk School of Global Affairs & Public Policy (Zuberi); Factor-Inwentash Faculty of Social Work (Zuberi), University of Toronto, Toronto, Ont
| | - Daniyal Zuberi
- Upstream Lab (Pinto, Hapsari, Ho), MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto; Department of Family and Community Medicine (Pinto), St. Michael's Hospital; Department of Family and Community Medicine (Pinto, Meaney), Faculty of Medicine; Dalla Lana School of Public Health (Pinto, Avery, Jetha), University of Toronto; Department of Biostatistics (Avery), Princess Margaret Hospital, University Health Network; Faculty of Environmental and Urban Change (Hassen), York University; Institute for Work and Health (Jetha); Institute of Population and Public Health (Lay), Canadian Institutes for Health Research, Ottawa, Ont.; School of Kinesiology and Health Science (Rotondi), York University; Munk School of Global Affairs & Public Policy (Zuberi); Factor-Inwentash Faculty of Social Work (Zuberi), University of Toronto, Toronto, Ont
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Allana A, Tavares W, Pinto AD, Kuluski K. Designing and Governing Responsive Local Care Systems - Insights from a Scoping Review of Paramedics in Integrated Models of Care. Int J Integr Care 2022; 22:5. [PMID: 35509960 PMCID: PMC9009364 DOI: 10.5334/ijic.6418] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 03/28/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction Programs that fill gaps in fractured health and social services in response to local needs can provide insight on enacting integrated care. Grassroots programs and the changing roles of paramedics within them were analyzed to explore how the health workforce, organizations and governance could support integrated care. Methods A study was conducted following Arksey and O'Malley's method for scoping reviews, using Valentijn's Rainbow Model of Integrated Care as an organizing framework. Qualitative content analysis was done on clinical, professional, organizational, system, functional and normative aspects of integration. Common patterns, challenges and gaps were documented. Results After literature search and screening, 137 documents with 108 unique programs were analysed. Paramedics bridge reactive and preventative care for a spectrum of population needs through partnerships with hospitals, social services, primary care and public health. Programs encountered challenges with role delineation, segregated organizations, regulation and tensions in professional norms. Discussion Five concepts were identified for fostering integrated care in local systems: single point-of-entry care pathways; flexible and mobile workforce; geographically-based cross-cutting organizations; permissive regulation; and assessing system-level value. Conclusion Integrated care may be supported by a generalist health workforce, through cross-cutting organizations that work across silos, and legislation that balances standardization with flexibility.
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Affiliation(s)
- Amir Allana
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, CA
- McNally Project for Paramedicine Research, CA
- Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, CA
| | - Walter Tavares
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, CA
- McNally Project for Paramedicine Research, CA
- The Wilson Centre and Temerty Faculty of Medicine, University of Toronto|University Health Network, CA
- York Region Paramedic Services, Community and Health Services Department, The Regional Municipality of York, CA
| | - Andrew D. Pinto
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, CA
- Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, CA
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, CA
| | - Kerry Kuluski
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, CA
- Institute for Better Health, Trillium Health Partners, CA
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28
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Pinto AD. Can a Focus on Equity, Diversity and Inclusion Transform Health Services Research? Healthc Pap 2022; 20:53-60. [PMID: 35759485 DOI: 10.12927/hcpap.2022.26843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The new Canadian Institutes of Health Research - Institute of Health Services and Policy Research's Strategic Plan 2021-2026 (CIHR IHSPR 2021) holds potential. Barriers are anticipated, including that commitments to equity, diversity and inclusion (EDI) are tokenistic. This commentary provides four recommendations to support EDI as transformative. First, EDI must start with an honest history of the role of institutions in upholding injustice. Second, performative EDI must be replaced by changes in money, power and resources. Third, data collection alone must never be the end goal of EDI. And fourth, for EDI to be transformative, it must be grounded in praxis, taking direction from communities and movements seeking justice.
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Affiliation(s)
- Andrew D Pinto
- Director, Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto; Associate Professor, Department of Family and Community Medicine, Faculty of Medicine, Dalla Lana School of Public Health, University of Toronto, Toronto, ON
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29
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Shakory S, Eissa A, Kiran T, Pinto AD. Best Practices for COVID-19 Mass Vaccination Clinics. Ann Fam Med 2022; 20:149-156. [PMID: 35346931 PMCID: PMC8959732 DOI: 10.1370/afm.2773] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 08/13/2021] [Accepted: 09/08/2021] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The coronavirus disease 2019 (COVID-19) pandemic is an unprecedented global public health crisis. Mass vaccination is the safest and fastest pandemic exit strategy. Mass vaccination clinics are a particularly important tool in quickly achieving herd immunity. Primary care physicians have played a crucial role in organizing and running vaccination clinics. In this special report, we synthesize existing guidelines and peer-reviewed studies to provide physicians with practical guidance on planning and implementing COVID-19 mass vaccination clinics. METHODS PubMed, Ovid MEDLINE and Embase were used to search for relevant literature using search terms that included COVID-19, mass vaccination, and best practice. We also identified and analyzed national and international guidelines. RESULTS Forty-six relevant articles, reports, and guidelines were identified and synthesized. Articles included mass vaccination clinic guidelines and studies before and during the COVID-19 pandemic. Key considerations for COVID-19 mass vaccination clinics include leadership and role designation, site selection, clinic layout and workflow, day-to-day operations, infection prevention, and communication strategies. CONCLUSIONS Planning and implementing a successful COVID-19 mass vaccination clinic requires several key considerations. Primary care plays an important role in organizing clinics and ensuring populations made vulnerable by social and economic policies are being reached. Ongoing data collection is required to evaluate and continuously improve COVID-19 mass vaccination efforts. As the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine rollout occurs in various countries, research will be required to identify the main factors for success to inform future pandemic responses.VISUAL ABSTRACT.
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Affiliation(s)
- Shima Shakory
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada
| | - Azza Eissa
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Family and Community Medicine, St Michael's Hospital, Toronto, Ontario, Canada
| | - Tara Kiran
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Family and Community Medicine, St Michael's Hospital, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada.,Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada
| | - Andrew D Pinto
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada .,Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada.,Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada.,Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada
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Abramovich A, Pang N, Kunasekaran S, Moss A, Kiran T, Pinto AD. Examining COVID-19 vaccine uptake and attitudes among 2SLGBTQ+ youth experiencing homelessness. BMC Public Health 2022; 22:122. [PMID: 35042491 PMCID: PMC8764500 DOI: 10.1186/s12889-022-12537-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 01/06/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES The COVID-19 pandemic has disproportionately impacted 2SLGBTQ+ youth experiencing homelessness. Little is known about vaccine attitudes and uptake among this population. To address this, the objectives of this study were to explore this group's COVID-19 vaccine attitudes, and facilitators and barriers impacting vaccine uptake. METHODS 2SLGBTQ+ youth experiencing homelessness in the Greater Toronto Area were recruited to participate in online surveys assessing demographic characteristics, mental health, health service use, and COVID-19 vaccine attitudes. Descriptive statistics and statistical tests were used to analyze survey data to explore variables associated with vaccine confidence. Additionally, a select group of youth and frontline workers from youth serving organizations were invited to participate in online one-on-one interviews. An iterative thematic content approach was used to analyze interview data. Quantitative and qualitative data were merged for interpretation by use of a convergent parallel analytical design. RESULTS Ninety-two youth completed surveys and 32 youth and 15 key informants participated in one-on-one interviews. Quantitative and qualitative data showed that the majority of 2SLGBTQ+ youth experiencing homelessness were confident in the COVID-19 vaccine; however, numerous youth were non-vaccine confident due to mistrust in the healthcare system, lack of targeted vaccine-related public health information, concerns about safety and side effects, and accessibility issues. Solutions to increase vaccine confidence were provided, including fostering trust, targeted public health messaging, and addressing accessibility needs. CONCLUSION Our study highlights the need for the vaccine strategy and rollouts to prioritize 2SLGBTQ+ youth experiencing homelessness and to address the pervasive health disparities that have been exacerbated by the pandemic.
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Affiliation(s)
- Alex Abramovich
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, ON, M5S 2S1, Canada.
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
| | - Nelson Pang
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, ON, M5S 2S1, Canada
| | - Sharumathy Kunasekaran
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, ON, M5S 2S1, Canada
| | - Amanda Moss
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, ON, M5S 2S1, Canada
| | - Tara Kiran
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Andrew D Pinto
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada
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Persaud N, Woods H, Workentin A, Adekoya I, Dunn JR, Hwang SW, Maguire J, Pinto AD, O'Campo P, Rourke SB, Werb D. Recommandations pour une reprise équitable après la pandémie de COVID-19 au Canada. CMAJ 2022; 194:E60-E72. [PMID: 35039395 PMCID: PMC8900790 DOI: 10.1503/cmaj.210904-f] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Nav Persaud
- Centre MAP pour des solutions en santé urbaine (Persaud, Wood, Workentin, Adekoya, Dunn, Hwang, Maguire, Pinto, O'Campo, Rourke, Werb), Hôpital St. Michael du Réseau hospitalier Unity Health Toronto; Faculté de médecine (Persaud, Hwang, Maguire, Pinto) et Département de psychiatrie (Rourke), Faculté de médecine, Université de Toronto, Toronto, Ont.
| | - Hannah Woods
- Centre MAP pour des solutions en santé urbaine (Persaud, Wood, Workentin, Adekoya, Dunn, Hwang, Maguire, Pinto, O'Campo, Rourke, Werb), Hôpital St. Michael du Réseau hospitalier Unity Health Toronto; Faculté de médecine (Persaud, Hwang, Maguire, Pinto) et Département de psychiatrie (Rourke), Faculté de médecine, Université de Toronto, Toronto, Ont
| | - Aine Workentin
- Centre MAP pour des solutions en santé urbaine (Persaud, Wood, Workentin, Adekoya, Dunn, Hwang, Maguire, Pinto, O'Campo, Rourke, Werb), Hôpital St. Michael du Réseau hospitalier Unity Health Toronto; Faculté de médecine (Persaud, Hwang, Maguire, Pinto) et Département de psychiatrie (Rourke), Faculté de médecine, Université de Toronto, Toronto, Ont
| | - Itunu Adekoya
- Centre MAP pour des solutions en santé urbaine (Persaud, Wood, Workentin, Adekoya, Dunn, Hwang, Maguire, Pinto, O'Campo, Rourke, Werb), Hôpital St. Michael du Réseau hospitalier Unity Health Toronto; Faculté de médecine (Persaud, Hwang, Maguire, Pinto) et Département de psychiatrie (Rourke), Faculté de médecine, Université de Toronto, Toronto, Ont
| | - James R Dunn
- Centre MAP pour des solutions en santé urbaine (Persaud, Wood, Workentin, Adekoya, Dunn, Hwang, Maguire, Pinto, O'Campo, Rourke, Werb), Hôpital St. Michael du Réseau hospitalier Unity Health Toronto; Faculté de médecine (Persaud, Hwang, Maguire, Pinto) et Département de psychiatrie (Rourke), Faculté de médecine, Université de Toronto, Toronto, Ont
| | - Stephen W Hwang
- Centre MAP pour des solutions en santé urbaine (Persaud, Wood, Workentin, Adekoya, Dunn, Hwang, Maguire, Pinto, O'Campo, Rourke, Werb), Hôpital St. Michael du Réseau hospitalier Unity Health Toronto; Faculté de médecine (Persaud, Hwang, Maguire, Pinto) et Département de psychiatrie (Rourke), Faculté de médecine, Université de Toronto, Toronto, Ont
| | - Jonathon Maguire
- Centre MAP pour des solutions en santé urbaine (Persaud, Wood, Workentin, Adekoya, Dunn, Hwang, Maguire, Pinto, O'Campo, Rourke, Werb), Hôpital St. Michael du Réseau hospitalier Unity Health Toronto; Faculté de médecine (Persaud, Hwang, Maguire, Pinto) et Département de psychiatrie (Rourke), Faculté de médecine, Université de Toronto, Toronto, Ont
| | - Andrew D Pinto
- Centre MAP pour des solutions en santé urbaine (Persaud, Wood, Workentin, Adekoya, Dunn, Hwang, Maguire, Pinto, O'Campo, Rourke, Werb), Hôpital St. Michael du Réseau hospitalier Unity Health Toronto; Faculté de médecine (Persaud, Hwang, Maguire, Pinto) et Département de psychiatrie (Rourke), Faculté de médecine, Université de Toronto, Toronto, Ont
| | - Patricia O'Campo
- Centre MAP pour des solutions en santé urbaine (Persaud, Wood, Workentin, Adekoya, Dunn, Hwang, Maguire, Pinto, O'Campo, Rourke, Werb), Hôpital St. Michael du Réseau hospitalier Unity Health Toronto; Faculté de médecine (Persaud, Hwang, Maguire, Pinto) et Département de psychiatrie (Rourke), Faculté de médecine, Université de Toronto, Toronto, Ont
| | - Sean B Rourke
- Centre MAP pour des solutions en santé urbaine (Persaud, Wood, Workentin, Adekoya, Dunn, Hwang, Maguire, Pinto, O'Campo, Rourke, Werb), Hôpital St. Michael du Réseau hospitalier Unity Health Toronto; Faculté de médecine (Persaud, Hwang, Maguire, Pinto) et Département de psychiatrie (Rourke), Faculté de médecine, Université de Toronto, Toronto, Ont
| | - Daniel Werb
- Centre MAP pour des solutions en santé urbaine (Persaud, Wood, Workentin, Adekoya, Dunn, Hwang, Maguire, Pinto, O'Campo, Rourke, Werb), Hôpital St. Michael du Réseau hospitalier Unity Health Toronto; Faculté de médecine (Persaud, Hwang, Maguire, Pinto) et Département de psychiatrie (Rourke), Faculté de médecine, Université de Toronto, Toronto, Ont
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32
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Abrams EM, Greenhawt M, Shaker M, Pinto AD, Sinha I, Singer A. The COVID-19 pandemic: Adverse effects on the social determinants of health in children and families. Ann Allergy Asthma Immunol 2022; 128:19-25. [PMID: 34699969 PMCID: PMC8539831 DOI: 10.1016/j.anai.2021.10.022] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/19/2021] [Accepted: 10/20/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To describe the impact of social determinants on the experience of the coronavirus disease 2019 (COVID-19) pandemic within the pediatric population, how this impact may influence the long-term health and security of children, and what measures can be taken to ameliorate this impact moving forward. DATA SOURCES Nonsystematic review of relevant literature and news sources. STUDY SELECTIONS Relevant literature and news sources. RESULTS There have been increases in housing insecurity and food insecurity during the pandemic, including global increases in poverty. Public policies such as school closures have had a disproportionate impact on those facing adverse social determinants. There has been a dramatic increase in reports of abuse-related injuries and other injuries indicative of child abuse during the pandemic. In addition, there are disproportionate impacts of COVID-19 based on race and ethnicity within the United States. It is clear that children are facing more adverse determinants as a result of this pandemic and that there are both short-term and long-term implications associated. For those living in poverty or with other adverse social determinants of health, the pandemic has made a bad situation worse. Ongoing studies are required to measure the impact of COVID-19 on those with adverse social determinants, in particular among children. CONCLUSION Social determinants of health must be part of pandemic research priorities, public health and vaccination goals, and economic policy implementation. The impact of the COVID-19 pandemic has further served to shed a light on the broad disparities that exist within our society and their direct and indirect impacts on health outcomes.
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Affiliation(s)
- Elissa M. Abrams
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Matthew Greenhawt
- Department of Pediatrics, Section of Allergy-Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado,Reprints: Matthew Greenhawt, MD, MBA, MSc, Section of Allergy and Immunology, Food Challenge and Research Unit, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 E. 16th Avenue, Aurora, CO 80045
| | - Marcus Shaker
- Section of Allergy and Immunology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire,Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Andrew D. Pinto
- Department of Family and Community Medicine, St Michael's Hospital, Toronto, Ontario, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada,The Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Ian Sinha
- Alder Hey Children's Hospital, Liverpool, United Kingdom,Division of Child Health, University of Liverpool, Liverpool, United Kingdom
| | - Alexander Singer
- Department of Family Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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Persaud N, Woods H, Workentin A, Adekoya I, Dunn JR, Hwang SW, Maguire J, Pinto AD, O'Campo P, Rourke SB, Werb D. Recommendations for equitable COVID-19 pandemic recovery in Canada. CMAJ 2021; 193:E1878-E1888. [PMID: 37578741 PMCID: PMC8677581 DOI: 10.1503/cmaj.210904] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Nav Persaud
- MAP Centre for Urban Health Solutions (Persaud, Wood, Workentin, Adekoya, Dunn, Hwang, Maguire, Pinto, O'Campo, Rourke, Werb), St. Michael's Hospital, Unity Health Toronto; Faculty of Medicine (Persaud, Hwang, Maguire, Pinto), and Department of Psychiatry (Rourke), Faculty of Medicine, University of Toronto, Toronto, Ont.
| | - Hannah Woods
- MAP Centre for Urban Health Solutions (Persaud, Wood, Workentin, Adekoya, Dunn, Hwang, Maguire, Pinto, O'Campo, Rourke, Werb), St. Michael's Hospital, Unity Health Toronto; Faculty of Medicine (Persaud, Hwang, Maguire, Pinto), and Department of Psychiatry (Rourke), Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Aine Workentin
- MAP Centre for Urban Health Solutions (Persaud, Wood, Workentin, Adekoya, Dunn, Hwang, Maguire, Pinto, O'Campo, Rourke, Werb), St. Michael's Hospital, Unity Health Toronto; Faculty of Medicine (Persaud, Hwang, Maguire, Pinto), and Department of Psychiatry (Rourke), Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Itunu Adekoya
- MAP Centre for Urban Health Solutions (Persaud, Wood, Workentin, Adekoya, Dunn, Hwang, Maguire, Pinto, O'Campo, Rourke, Werb), St. Michael's Hospital, Unity Health Toronto; Faculty of Medicine (Persaud, Hwang, Maguire, Pinto), and Department of Psychiatry (Rourke), Faculty of Medicine, University of Toronto, Toronto, Ont
| | - James R Dunn
- MAP Centre for Urban Health Solutions (Persaud, Wood, Workentin, Adekoya, Dunn, Hwang, Maguire, Pinto, O'Campo, Rourke, Werb), St. Michael's Hospital, Unity Health Toronto; Faculty of Medicine (Persaud, Hwang, Maguire, Pinto), and Department of Psychiatry (Rourke), Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Stephen W Hwang
- MAP Centre for Urban Health Solutions (Persaud, Wood, Workentin, Adekoya, Dunn, Hwang, Maguire, Pinto, O'Campo, Rourke, Werb), St. Michael's Hospital, Unity Health Toronto; Faculty of Medicine (Persaud, Hwang, Maguire, Pinto), and Department of Psychiatry (Rourke), Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Jonathon Maguire
- MAP Centre for Urban Health Solutions (Persaud, Wood, Workentin, Adekoya, Dunn, Hwang, Maguire, Pinto, O'Campo, Rourke, Werb), St. Michael's Hospital, Unity Health Toronto; Faculty of Medicine (Persaud, Hwang, Maguire, Pinto), and Department of Psychiatry (Rourke), Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Andrew D Pinto
- MAP Centre for Urban Health Solutions (Persaud, Wood, Workentin, Adekoya, Dunn, Hwang, Maguire, Pinto, O'Campo, Rourke, Werb), St. Michael's Hospital, Unity Health Toronto; Faculty of Medicine (Persaud, Hwang, Maguire, Pinto), and Department of Psychiatry (Rourke), Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Patricia O'Campo
- MAP Centre for Urban Health Solutions (Persaud, Wood, Workentin, Adekoya, Dunn, Hwang, Maguire, Pinto, O'Campo, Rourke, Werb), St. Michael's Hospital, Unity Health Toronto; Faculty of Medicine (Persaud, Hwang, Maguire, Pinto), and Department of Psychiatry (Rourke), Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Sean B Rourke
- MAP Centre for Urban Health Solutions (Persaud, Wood, Workentin, Adekoya, Dunn, Hwang, Maguire, Pinto, O'Campo, Rourke, Werb), St. Michael's Hospital, Unity Health Toronto; Faculty of Medicine (Persaud, Hwang, Maguire, Pinto), and Department of Psychiatry (Rourke), Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Daniel Werb
- MAP Centre for Urban Health Solutions (Persaud, Wood, Workentin, Adekoya, Dunn, Hwang, Maguire, Pinto, O'Campo, Rourke, Werb), St. Michael's Hospital, Unity Health Toronto; Faculty of Medicine (Persaud, Hwang, Maguire, Pinto), and Department of Psychiatry (Rourke), Faculty of Medicine, University of Toronto, Toronto, Ont
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Wintemute K, Noor M, Bhatt A, Bloch G, Arackal S, Kalia S, Aliarzadeh B, La Tona S, Lo J, Pinto AD, Greiver M. Implementation of targeted screening for poverty in a large primary care team in Toronto, Canada: a feasibility study. BMC Fam Pract 2021; 22:194. [PMID: 34592935 PMCID: PMC8483428 DOI: 10.1186/s12875-021-01514-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 07/19/2021] [Indexed: 12/18/2022]
Abstract
Background Poverty has a significant influence on health. Efforts to optimize income and reduce poverty could make a difference to the lives of patients and their families. Routine screening for poverty in primary care is an important first step but rarely occurs in Canada. We aimed to implement a targeted screening and referral process in a large, distributed primary care team in Toronto, Ontario, Canada. The main outcome was the proportion of targeted patients screened. Methods This implementation evaluation was conducted with a large community-based primary care team in north Toronto. The primary care team serves relatively wealthy neighborhoods with pockets of poverty. Physicians were invited to participate. We implemented targeted screening by combining census information on neighborhood-level deprivation with postal codes in patient records. For physicians agreeing to participate, we added prompts to screen for poverty to the charts of adult patients living in the most deprived areas. Standardized electronic medical record templates recommended a referral to a team case worker for income optimization, for those patients screening positive. We recorded the number and percentages of participants at each stage, from screening to receiving advice on income optimization. Results 128 targeted patients with at least one visit (25%) were screened. The primary care team included 86 physicians distributed across 19 clinical locations. Thirty-four physicians (39%) participated. Their practices provided care for 27,290 patients aged 18 or older; 852 patients (3%) were found to be living in the most deprived neighborhoods. 509 (60%) had at least one office visit over the 6 months of follow up. 25 patients (20%) screened positive for poverty, and 13 (52%) were referred. Eight patients (62% of those referred) were ultimately seen by a caseworker for income optimization. Conclusions We implemented a targeted poverty screening program combined with resources to optimize income for patients in a large, distributed community-based primary care team. Screening was feasible; however, only a small number of patients were linked to the intervention Further efforts to scale and spread screening and mitigation of poverty are warranted; these should include broadening the targeted population beyond those living in the most deprived areas. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01514-9.
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Affiliation(s)
- Kimberly Wintemute
- Department of Family and Community Medicine, North York General Hospital, 4001 Leslie street, LE140, M2K 1E1, Toronto, Ontario, Canada.,Department of Family and Community Medicine, University of Toronto Practice-Based Research Network, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, M5G 1V7, Toronto, Ontario, Canada.,North York Family Health Team, 240 Duncan Mill road, M3B 3S6, Toronto, Ontario, Canada
| | - Meh Noor
- Department of Family and Community Medicine, University of Toronto Practice-Based Research Network, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, M5G 1V7, Toronto, Ontario, Canada.
| | - Aashka Bhatt
- Department of Family and Community Medicine, University of Toronto Practice-Based Research Network, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, M5G 1V7, Toronto, Ontario, Canada
| | - Gary Bloch
- Department of Family and Community Medicine, University of Toronto Practice-Based Research Network, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, M5G 1V7, Toronto, Ontario, Canada.,Department of Family and Community Medicine, St Michael's Hospital, 36 Queen's street East, M5B 1W8, Toronto, Ontario, Canada
| | - Suja Arackal
- North York Family Health Team, 240 Duncan Mill road, M3B 3S6, Toronto, Ontario, Canada
| | - Sumeet Kalia
- Department of Family and Community Medicine, University of Toronto Practice-Based Research Network, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, M5G 1V7, Toronto, Ontario, Canada
| | - Babak Aliarzadeh
- Department of Family and Community Medicine, University of Toronto Practice-Based Research Network, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, M5G 1V7, Toronto, Ontario, Canada
| | - Sabrina La Tona
- North York Family Health Team, 240 Duncan Mill road, M3B 3S6, Toronto, Ontario, Canada
| | - Joyce Lo
- North York Family Health Team, 240 Duncan Mill road, M3B 3S6, Toronto, Ontario, Canada
| | - Andrew D Pinto
- Department of Family and Community Medicine, University of Toronto Practice-Based Research Network, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, M5G 1V7, Toronto, Ontario, Canada.,Department of Family and Community Medicine, St Michael's Hospital, 36 Queen's street East, M5B 1W8, Toronto, Ontario, Canada.,Upstream Lab, MAP Centre for Urban Health Solutions, St. Michael's Hospital, 36 Queen Street East, M5B 1W8, Toronto, Ontario, Canada
| | - Michelle Greiver
- Department of Family and Community Medicine, North York General Hospital, 4001 Leslie street, LE140, M2K 1E1, Toronto, Ontario, Canada.,Department of Family and Community Medicine, University of Toronto Practice-Based Research Network, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, M5G 1V7, Toronto, Ontario, Canada.,North York Family Health Team, 240 Duncan Mill road, M3B 3S6, Toronto, Ontario, Canada
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Lofters AK, O'Brien MA, Sutradhar R, Pinto AD, Baxter NN, Donnelly P, Elliott R, Glazier RH, Huizinga J, Kyle R, Manca D, Pietrusiak MA, Rabeneck L, Riordan B, Selby P, Sivayoganathan K, Snider C, Sopcak N, Thorpe K, Tinmouth J, Wall B, Zuo F, Grunfeld E, Paszat L. Correction to: Building on existing tools to improve chronic disease prevention and screening in public health: a cluster randomized trial. BMC Public Health 2021; 21:1714. [PMID: 34548061 PMCID: PMC8456665 DOI: 10.1186/s12889-021-11700-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- A K Lofters
- Department of Family & Community Medicine, University of Toronto, Toronto, Canada. .,Women's College Hospital Research Institute, Toronto, Canada. .,Peter Gilgan Centre for Women's Cancers, Women's College Hospital, Toronto, Canada. .,Ontario Health (Cancer Care Ontario), Toronto, Canada. .,ICES, Toronto, Canada.
| | - M A O'Brien
- Department of Family & Community Medicine, University of Toronto, Toronto, Canada
| | - R Sutradhar
- ICES, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - A D Pinto
- Department of Family & Community Medicine, University of Toronto, Toronto, Canada.,MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Canada.,Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - N N Baxter
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Melbourne School of Global and Population Health, University of Melbourne, Melbourne, Australia
| | - P Donnelly
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,University of St. Andrews, Scotland, UK
| | - R Elliott
- Durham Region Health Department, Whitby, Canada
| | - R H Glazier
- Department of Family & Community Medicine, University of Toronto, Toronto, Canada.,ICES, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - J Huizinga
- Durham Region Health Department, Whitby, Canada
| | - R Kyle
- Durham Region Health Department, Whitby, Canada
| | - D Manca
- Department of Family Medicine, University of Alberta, Edmonton, Canada
| | | | - L Rabeneck
- Ontario Health (Cancer Care Ontario), Toronto, Canada
| | - B Riordan
- Durham Region Health Department, Whitby, Canada
| | - P Selby
- Department of Family & Community Medicine, University of Toronto, Toronto, Canada.,Centre for Addiction and Mental Health, Toronto, Canada
| | - K Sivayoganathan
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Canada.,Durham Region Health Department, Whitby, Canada
| | - C Snider
- Durham Region Health Department, Whitby, Canada
| | - N Sopcak
- Department of Family Medicine, University of Alberta, Edmonton, Canada
| | - K Thorpe
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Applied Health Research Centre, St. Michael's Hospital, Toronto, Canada
| | - J Tinmouth
- Ontario Health (Cancer Care Ontario), Toronto, Canada.,Sunnybrook Health Sciences Centre, Toronto, Canada
| | - B Wall
- Durham Region Health Department, Whitby, Canada
| | - F Zuo
- Applied Health Research Centre, St. Michael's Hospital, Toronto, Canada
| | - E Grunfeld
- Department of Family & Community Medicine, University of Toronto, Toronto, Canada.,Women's College Hospital Research Institute, Toronto, Canada.,ICES, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Ontario Institute for Cancer Research, Toronto, Canada
| | - L Paszat
- ICES, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Sunnybrook Health Sciences Centre, Toronto, Canada
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36
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Lofters AK, O'Brien MA, Sutradhar R, Pinto AD, Baxter NN, Donnelly P, Elliott R, Glazier RH, Huizinga J, Kyle R, Manca DM, Pietrusiak MA, Rabeneck L, Riordan B, Selby P, Sivayoganathan K, Snider C, Sopcak N, Thorpe K, Tinmouth J, Wall B, Zuo F, Grunfeld E, Paszat L. Building on existing tools to improve chronic disease prevention and screening in public health: a cluster randomized trial. BMC Public Health 2021; 21:1496. [PMID: 34344340 PMCID: PMC8329623 DOI: 10.1186/s12889-021-11452-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 07/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The BETTER (Building on Existing Tools to Improve Chronic Disease Prevention and Screening in Primary Care) intervention was designed to integrate the approach to chronic disease prevention and screening in primary care and demonstrated effective in a previous randomized trial. METHODS We tested the effectiveness of the BETTER HEALTH intervention, a public health adaptation of BETTER, at improving participation in chronic disease prevention and screening actions for residents of low-income neighbourhoods in a cluster randomized trial, with ten low-income neighbourhoods in Durham Region Ontario randomized to immediate intervention vs. wait-list. The unit of analysis was the individual, and eligible participants were adults age 40-64 years residing in the neighbourhoods. Public health nurses trained as "prevention practitioners" held one prevention-focused visit with each participant. They provided participants with a tailored prevention prescription and supported them to set health-related goals. The primary outcome was a composite index: the number of evidence-based actions achieved at six months as a proportion of those for which participants were eligible at baseline. RESULTS Of 126 participants (60 in immediate arm; 66 in wait-list arm), 125 were included in analyses (1 participant withdrew consent). In both arms, participants were eligible for a mean of 8.6 actions at baseline. At follow-up, participants in the immediate intervention arm met 64.5% of actions for which they were eligible versus 42.1% in the wait-list arm (rate ratio 1.53 [95% confidence interval 1.22-1.84]). CONCLUSION Public health nurses using the BETTER HEALTH intervention led to a higher proportion of identified evidence-based prevention and screening actions achieved at six months for people living with socioeconomic disadvantage. TRIAL REGISTRATION NCT03052959 , registered February 10, 2017.
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Affiliation(s)
- A K Lofters
- Department of Family & Community Medicine, University of Toronto, Toronto, Canada. .,Women's College Hospital Research Institute, Toronto, Canada. .,Peter Gilgan Centre for Women's Cancers, Women's College Hospital, Toronto, Canada. .,Ontario Health (Cancer Care Ontario), Toronto, Canada. .,ICES, Toronto, Canada. .,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. .,MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Canada. .,Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Canada.
| | - M A O'Brien
- Department of Family & Community Medicine, University of Toronto, Toronto, Canada
| | - R Sutradhar
- ICES, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - A D Pinto
- Department of Family & Community Medicine, University of Toronto, Toronto, Canada.,MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Canada.,Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - N N Baxter
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - R Elliott
- Durham Region Health Department, Whitby, Canada
| | - R H Glazier
- Department of Family & Community Medicine, University of Toronto, Toronto, Canada.,ICES, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Canada.,Melbourne School of Global and Population Health, University of Melbourne, Melbourne, Australia
| | - J Huizinga
- Durham Region Health Department, Whitby, Canada
| | - R Kyle
- Durham Region Health Department, Whitby, Canada
| | - D M Manca
- Department of Family Medicine, University of Alberta, Edmonton, Canada
| | | | - L Rabeneck
- Ontario Health (Cancer Care Ontario), Toronto, Canada
| | - B Riordan
- Durham Region Health Department, Whitby, Canada
| | - P Selby
- Department of Family & Community Medicine, University of Toronto, Toronto, Canada.,Centre for Addiction and Mental Health, Toronto, Canada
| | - K Sivayoganathan
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Canada.,Durham Region Health Department, Whitby, Canada
| | - C Snider
- Durham Region Health Department, Whitby, Canada
| | - N Sopcak
- Department of Family Medicine, University of Alberta, Edmonton, Canada
| | - K Thorpe
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Applied Health Research Centre, St. Michael's Hospital, Toronto, Canada
| | - J Tinmouth
- Ontario Health (Cancer Care Ontario), Toronto, Canada.,Sunnybrook Health Sciences Centre, Toronto, Canada
| | - B Wall
- Durham Region Health Department, Whitby, Canada
| | - F Zuo
- Applied Health Research Centre, St. Michael's Hospital, Toronto, Canada
| | - E Grunfeld
- Department of Family & Community Medicine, University of Toronto, Toronto, Canada.,Women's College Hospital Research Institute, Toronto, Canada.,ICES, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Ontario Institute for Cancer Research, Toronto, Canada
| | - L Paszat
- ICES, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Sunnybrook Health Sciences Centre, Toronto, Canada
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37
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Pinto AD, Perri M, Pedersen CL, Aratangy T, Hapsari AP, Hwang SW. Exploring different methods to evaluate the impact of basic income interventions: a systematic review. Int J Equity Health 2021; 20:142. [PMID: 34134715 PMCID: PMC8206888 DOI: 10.1186/s12939-021-01479-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 05/24/2021] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Persistent income inequality, the increase in precarious employment, the inadequacy of many welfare systems, and economic impact of the COVID-19 pandemic have increased interest in Basic Income (BI) interventions. Ensuring that social interventions, such as BI, are evaluated appropriately is key to ensuring their overall effectiveness. This systematic review therefore aims to report on available methods and domains of assessment, which have been used to evaluate BI interventions. These findings will assist in informing future program and research development and implementation. METHODS Studies were identified through systematic searches of the indexed and grey literature (Databases included: Scopus, Embase, Medline, CINAHL, Web of Science, ProQuest databases, EBSCOhost Research Databases, and PsycINFO), hand-searching reference lists of included studies, and recommendations from experts. Citations were independently reviewed by two study team members. We included studies that reported on methods used to evaluate the impact of BI, incorporated primary data from an observational or experimental study, or were a protocol for a future BI study. We extracted information on the BI intervention, context and evaluation method. RESULTS 86 eligible articles reported on 10 distinct BI interventions from the last six decades. Workforce participation was the most common outcome of interest among BI evaluations in the 1960-1980 era. During the 2000s, studies of BI expanded to include outcomes related to health, educational attainment, housing and other key facets of life impacted by individuals' income. Many BI interventions were tested in randomized controlled trials with data collected through surveys at multiple time points. CONCLUSIONS Over the last two decades, the assessment of the impact of BI interventions has evolved to include a wide array of outcomes. This shift in evaluation outcomes reflects the current hypothesis that investing in BI can result in lower spending on health and social care. Methods of evaluation ranged but emphasized the use of randomization, surveys, and existing data sources (i.e., administrative data). Our findings can inform future BI intervention studies and interventions by providing an overview of how previous BI interventions have been evaluated and commenting on the effectiveness of these methods. REGISTRATION This systematic review was registered with PROSPERO (CRD 42016051218).
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Affiliation(s)
- Andrew D. Pinto
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Canada
- Department of Family and Community Medicine, St. Michael’s Hospital, Toronto, Canada
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Melissa Perri
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Cheryl L. Pedersen
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Canada
| | - Tatiana Aratangy
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Canada
| | - Ayu Pinky Hapsari
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Canada
| | - Stephen W. Hwang
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Canada
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Abstract
This cross-sectional study assesses the frequency and thoroughness of reporting of sociodemographic variables in randomized clinical trials published in 5 high-impact health journals from January 2014 to July 2020.
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Affiliation(s)
- Aaron M. Orkin
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada
| | - Gina Nicoll
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada
- Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Ontario, Canada
| | - Navindra Persaud
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Andrew D. Pinto
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Ontario, Canada
- Department of Family and Community Medicine, St Michael’s Hospital, Toronto, Ontario, Canada
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39
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Persaud N, Bedard M, Boozary A, Glazier RH, Gomes T, Hwang SW, Juni P, Law MR, Mamdani M, Manns B, Martin D, Morgan SG, Oh P, Pinto AD, Shah BR, Sullivan F, Umali N, Thorpe KE, Tu K, Laupacis A. Adherence at 2 years with distribution of essential medicines at no charge: The CLEAN Meds randomized clinical trial. PLoS Med 2021; 18:e1003590. [PMID: 34019540 PMCID: PMC8139488 DOI: 10.1371/journal.pmed.1003590] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 03/19/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Adherence to medicines is low for a variety of reasons, including the cost borne by patients. Some jurisdictions publicly fund medicines for the general population, but many jurisdictions do not, and such policies are contentious. To our knowledge, no trials studying free access to a wide range of medicines have been conducted. METHODS AND FINDINGS We randomly assigned 786 primary care patients who reported not taking medicines due to cost between June 1, 2016 and April 28, 2017 to either free distribution of essential medicines (n = 395) or to usual medicine access (n = 391). The trial was conducted in Ontario, Canada, where hospital care and physician services are publicly funded for the general population but medicines are not. The trial population was mostly female (56%), younger than 65 years (83%), white (66%), and had a low income from wages as the primary source (56%). The primary outcome was medicine adherence after 2 years. Secondary outcomes included control of diabetes, blood pressure, and low-density lipoprotein (LDL) cholesterol in patients taking relevant treatments and healthcare costs over 2 years. Adherence to all appropriate prescribed medicines was 38.7% in the free distribution group and 28.6% in the usual access group after 2 years (absolute difference 10.1%; 95% confidence interval (CI) 3.3 to 16.9, p = 0.004). There were no statistically significant differences in control of diabetes (hemoglobin A1c 0.27; 95% CI -0.25 to 0.79, p = 0.302), systolic blood pressure (-3.9; 95% CI -9.9 to 2.2, p = 0.210), or LDL cholesterol (0.26; 95% CI -0.08 to 0.60, p = 0.130) based on available data. Total healthcare costs over 2 years were lower with free distribution (difference in median CAN$1,117; 95% CI CAN$445 to CAN$1,778, p = 0.006). In the free distribution group, 51 participants experienced a serious adverse event, while 68 participants in the usual access group experienced a serious adverse event (p = 0.091). Participants were not blinded, and some outcomes depended on participant reports. CONCLUSIONS In this study, we observed that free distribution of essential medicines to patients with cost-related nonadherence substantially increased adherence, did not affect surrogate health outcomes, and reduced total healthcare costs over 2 years. TRIAL REGISTRATION ClinicalTrials.gov NCT02744963.
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Affiliation(s)
- Nav Persaud
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, St Michael's Hospital, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Michael Bedard
- Department of Family Medicine, Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | - Andrew Boozary
- Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Richard H Glazier
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, St Michael's Hospital, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Tara Gomes
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Applied Health Research Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Stephen W Hwang
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Peter Juni
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Michael R Law
- Centre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Muhammad Mamdani
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Centre for Healthcare Analytics Research and Training at St Michael's Hospital and Vector Institute, Toronto, Ontario, Canada
| | - Braden Manns
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Danielle Martin
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
| | - Steven G Morgan
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Paul Oh
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Andrew D Pinto
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Baiju R Shah
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Frank Sullivan
- Department of Research and Innovation, North York General Hospital, Toronto, Ontario, Canada
- Division of Population and Behavioral Science, University of St Andrews, Scotland
| | - Norman Umali
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Kevin E Thorpe
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Applied Health Research Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Karen Tu
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Research and Innovation, North York General Hospital, Toronto, Ontario, Canada
| | - Andreas Laupacis
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Perri M, Craig-Neil A, Gaspar M, Hunter C, Kendall C, Alexander O, Pinto AD. Correction to: A qualitative study of barriers to employment experienced by people living with HIV in Toronto and Ottawa. Int J Equity Health 2021; 20:97. [PMID: 33827595 PMCID: PMC8028719 DOI: 10.1186/s12939-021-01434-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Melissa Perri
- Upstream Lab, MAP/Centre for Urban Health Solutions, Unity Health Toronto, Li Ka Shing Knowledge Institute, 30 Bond St, Toronto, Ontario, M5B 1W8, Canada.,Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, Ontario, M5T 3M7, Canada
| | - Amy Craig-Neil
- Upstream Lab, MAP/Centre for Urban Health Solutions, Unity Health Toronto, Li Ka Shing Knowledge Institute, 30 Bond St, Toronto, Ontario, M5B 1W8, Canada
| | - Mark Gaspar
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, Ontario, M5T 3M7, Canada
| | - Charlotte Hunter
- Casey House, 119 Isabella St, Toronto, Ontario, M4Y 1P2, Canada.,Department of Family and Community Medicine, St. Michael's Hospital, 500 University Ave, Toronto, Ontario, M5G 1V7, Canada
| | - Claire Kendall
- Department of Family Medicine, University of Ottawa, 600 Peter Morand Crescent Suite 201, Ottawa, Ontario, K1G 5Z3, Canada.,C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, 85 Primrose Ave, Ottawa, Ontario, K1R 6M1, Canada.,Institut du Savoir Montfort, Montfort Hospital, 713 Montreal Rd, Ottawa, Ontario, K1K OT2, Canada.,Ottawa Hospital Research Institute, 501 Smyth Box 511, Ottawa, Ontario, K1H 8L6, Canada.,Li Ka Shing Knowledge Institute, 209 Victoria St, Toronto, Ontario, M5B 1T8, Canada
| | - Ower Alexander
- Upstream Lab, MAP/Centre for Urban Health Solutions, Unity Health Toronto, Li Ka Shing Knowledge Institute, 30 Bond St, Toronto, Ontario, M5B 1W8, Canada
| | - Andrew D Pinto
- Upstream Lab, MAP/Centre for Urban Health Solutions, Unity Health Toronto, Li Ka Shing Knowledge Institute, 30 Bond St, Toronto, Ontario, M5B 1W8, Canada. .,Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, Ontario, M5T 3M7, Canada. .,Department of Family and Community Medicine, St. Michael's Hospital, 500 University Ave, Toronto, Ontario, M5G 1V7, Canada. .,University of Toronto Practice-Based Research Network, 500 University Avenue, Toronto, Ontario, K1H 8L6, Canada.
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Upshaw TL, Brown C, Smith R, Perri M, Ziegler C, Pinto AD. Social determinants of COVID-19 incidence and outcomes: A rapid review. PLoS One 2021; 16:e0248336. [PMID: 33788848 PMCID: PMC8011781 DOI: 10.1371/journal.pone.0248336] [Citation(s) in RCA: 81] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 02/24/2021] [Indexed: 02/06/2023] Open
Abstract
Early reports indicate that the social determinants of health are implicated in COVID-19 incidence and outcomes. To inform the ongoing response to the pandemic, we conducted a rapid review of peer-reviewed studies to examine the social determinants of COVID-19. We searched Ovid MEDLINE, Embase, PsycINFO, CINAHL and Cochrane Central Register of Controlled Trials from December 1, 2019 to April 27, 2020. We also searched the bibliographies of included studies, COVID-19 evidence repositories and living evidence maps, and consulted with expert colleagues internationally. We included studies identified through these supplementary sources up to June 25, 2020. We included English-language peer-reviewed quantitative studies that used primary data to describe the social determinants of COVID-19 incidence, clinical presentation, health service use and outcomes in adults with a confirmed or presumptive diagnosis of COVID-19. Two reviewers extracted data and conducted quality assessment, confirmed by a third reviewer. Forty-two studies met inclusion criteria. The strongest evidence was from three large observational studies that found associations between race or ethnicity and socioeconomic deprivation and increased likelihood of COVID-19 incidence and subsequent hospitalization. Limited evidence was available on other key determinants, including occupation, educational attainment, housing status and food security. Assessing associations between sociodemographic factors and COVID-19 was limited by small samples, descriptive study designs, and the timeframe of our search. Systematic reviews of literature published subsequently are required to fully understand the magnitude of any effects and predictive utility of sociodemographic factors related to COVID-19 incidence and outcomes. PROSPERO: CRD4202017813.
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Affiliation(s)
- Tara L. Upshaw
- Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada
- Translational Research Program, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Chloe Brown
- Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada
- Undergraduate Medical Education, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Robert Smith
- Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, Toronto, Canada
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Melissa Perri
- Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Carolyn Ziegler
- Health Sciences Library, Unity Health Toronto, Toronto, Canada
| | - Andrew D. Pinto
- Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, Toronto, Canada
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Family and Community Medicine, St. Michael’s Hospital, Toronto, Canada
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Abstract
The role of paramedics, including select paramedics providing primary and preventive care in homes and community settings, is evolving in health systems around the world. These developments are associated with improvements in health outcomes, improved access to services and reduced emergency department use. Building on these existing trends in paramedicine, and because social conditions contribute to illness and are strong predictors of future health service use, addressing patients' social needs should be integrated into core paramedic practice in Canada. We discuss how paramedic education, culture and governance could better enable paramedics to address the social determinants of health.
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Affiliation(s)
- Amir Allana
- MSc Candidate, Health Services Research, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto; Fellow, McNally Project for Paramedicine Research; Graduate Student, Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON
| | - Andrew D Pinto
- Associate Professor, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto; Scientist and Director, Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto; Clinician Scientist, Department of Family and Community Medicine, Faculty of Medicine, University of Toronto; Staff Physician, Department of Family and Community Medicine, St. Michael's Hospital, Toronto, ON
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Perri M, Craig-Neil A, Gaspar M, Hunter C, Kendall C, Alexander O, Pinto AD. A qualitative study of barriers to employment experienced by people living with HIV in Toronto and Ottawa. Int J Equity Health 2021; 20:36. [PMID: 33446215 PMCID: PMC7807879 DOI: 10.1186/s12939-020-01356-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 12/10/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Effective treatment has extended the life expectancy and reduced disability in people living with HIV (PLWH). However, previous research has found 45-65% of working-age PLWH were unemployed compared to 5-10% in the general public of North America and Europe. We examined the barriers to gaining employment among PLWH. METHODS Thirty-five in-depth interviews were conducted in person or over the phone with PLWH living in Toronto or Ottawa. This included PLWH who were unemployed but actively seeking employment, as well as PLWH who had successfully gained employment through an agency that specifically supported PLWH funded by the AIDS Committee of Toronto. Interviews were conducted between February 2019 and March 2020. All interviews were audio-recorded, transcribed and analyzed using thematic analysis. RESULTS The majority of participants were between the ages of 40-55 and identified as male. Participants shared many common barriers when describing their attempts to attain or maintain employment. Although varying in employment status at the time of the study, consistent barriers included experiencing HIV stigma in workplaces, challenges overcoming mental health illnesses, and difficulties in navigating social assistance and unemployment insurance programs when pursuing a return to work. CONCLUSIONS PLWH face significant barriers when attempting to engage with employment opportunities. Health providers and organizations can do more to support campaigns to end HIV stigma, to support individuals in pursuing employment, and to advocate for policy change that supports reentry into the workforce for PLHA.
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Affiliation(s)
- Melissa Perri
- Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, 30 Bond St, Toronto, Ontario, M5B 1W8, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, Ontario, M5T 3M7, Canada
| | - Amy Craig-Neil
- Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, 30 Bond St, Toronto, Ontario, M5B 1W8, Canada
| | - Mark Gaspar
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, Ontario, M5T 3M7, Canada
| | - Charlotte Hunter
- Casey House, 119 Isabella St, Toronto, Ontario, M4Y 1P2, Canada
- Department of Family and Community Medicine, St. Michael's Hospital, 500 University Ave, Toronto, Ontario, M5G 1V7, Canada
| | - Claire Kendall
- Department of Family Medicine, University of Ottawa, 600 Peter Morand Crescent Suite 201, Ottawa, Ontario, K1G 5Z3, Canada
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, 85 Primrose Ave, Ottawa, Ontario, K1R 6M1, Canada
- Institut du Savoir Montfort, Montfort Hospital, 713 Montreal Rd, Ottawa, Ontario, K1K OT2, Canada
- Ottawa Hospital Research Institute, 501 Smyth Box 511, Ottawa, Ontario, K1H 8L6, Canada
- Li Ka Shing Knowledge Institute, 209 Victoria St, Toronto, Ontario, M5B 1T8, Canada
| | - Ower Alexander
- Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, 30 Bond St, Toronto, Ontario, M5B 1W8, Canada
| | - Andrew D Pinto
- Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, 30 Bond St, Toronto, Ontario, M5B 1W8, Canada.
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, Ontario, M5T 3M7, Canada.
- Department of Family and Community Medicine, St. Michael's Hospital, 500 University Ave, Toronto, Ontario, M5G 1V7, Canada.
- University of Toronto Practice-Based Research Network, 500 University Avenue, Toronto, Ontario, K1H 8L6, Canada.
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Abstract
BACKGROUND Antivirals for the treatment of hepatitis C virus (HCV) infection are effective, but many patients remain untreated and treatment is not yet routine in primary care. We evaluated the characteristics of patients who engaged in HCV treatment, and clinician perspectives on the barriers and facilitators to treatment. METHODS Our mixed-method, parallel-design study was conducted at a multisite primary care centre in downtown Toronto. In a retrospective chart review, we searched records from 2011 to 2017 to collect quantitative data, including HCV infection status and HCV treatment status. To contextualize the data, we conducted in-depth interviews with select physicians between Aug. 1 and Nov. 1, 2017, and analyzed the transcripts using content analysis. RESULTS Of the 40 381 charts reviewed, 727 patients (1.8%, 95% confidence interval [CI] 1.7%-1.9%) were infected with HCV, and 542 (74.6%) had HCV infection requiring treatment. Of those, 255 patients (47.0%) had engaged in treatment. Patients who had engaged in treatment were more likely to be male (odds ratio [OR] 1.63, 95% CI 1.10-2.42), older (OR 1.04 per year increase in age, 95% CI 1.02-1.05) and housed (OR 2.2, 95% CI 1.36-3.75), and they were more likely not to have engaged in injection drug use (OR 1.87, 95% CI 1.33-2.63). Based on interviews with 8 physicians, treatment barriers included a lack of knowledge about HCV treatment, concerns that patients would not adhere to medications and challenges related to medication access. Facilitators of treatment included access to specialist consultation, pharmacist support and primary care treatment guidelines. Common themes that emerged in both quantitative and qualitative components were the roles of unstable housing and intravenous drug use as barriers to engaging in and completing treatment. INTERPRETATION Our study captured provider-identified barriers to HCV care and the key factors related to retention in HCV care, including gender, age, housing status and experience with drug use. Successful primary-care-led HCV treatment programs may incorporate specialist and pharmacy support and focus on younger, female, underhoused populations and people who use drugs.
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Affiliation(s)
- Zoë von Aesch
- Department of Family and Community Medicine (von Aesch, Antoniou, Pinto), St. Michael's Hospital; Department of Family and Community Medicine, Faculty of Medicine (von Aesch, Antoniou, Meaney, Pinto), University of Toronto; Upstream Lab, MAP Centre for Urban Health Solutions (Craig-Neil, Pinto), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Francis Family Liver Clinic, University Health Network, Department of Medicine (Shah); Department of Medicine, Faculty of Medicine (Shah); Li Ka Shing Knowledge Institute (Antoniou), St. Michael's Hospital, Toronto, Ont.
| | - Amy Craig-Neil
- Department of Family and Community Medicine (von Aesch, Antoniou, Pinto), St. Michael's Hospital; Department of Family and Community Medicine, Faculty of Medicine (von Aesch, Antoniou, Meaney, Pinto), University of Toronto; Upstream Lab, MAP Centre for Urban Health Solutions (Craig-Neil, Pinto), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Francis Family Liver Clinic, University Health Network, Department of Medicine (Shah); Department of Medicine, Faculty of Medicine (Shah); Li Ka Shing Knowledge Institute (Antoniou), St. Michael's Hospital, Toronto, Ont
| | - Hemant Shah
- Department of Family and Community Medicine (von Aesch, Antoniou, Pinto), St. Michael's Hospital; Department of Family and Community Medicine, Faculty of Medicine (von Aesch, Antoniou, Meaney, Pinto), University of Toronto; Upstream Lab, MAP Centre for Urban Health Solutions (Craig-Neil, Pinto), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Francis Family Liver Clinic, University Health Network, Department of Medicine (Shah); Department of Medicine, Faculty of Medicine (Shah); Li Ka Shing Knowledge Institute (Antoniou), St. Michael's Hospital, Toronto, Ont
| | - Tony Antoniou
- Department of Family and Community Medicine (von Aesch, Antoniou, Pinto), St. Michael's Hospital; Department of Family and Community Medicine, Faculty of Medicine (von Aesch, Antoniou, Meaney, Pinto), University of Toronto; Upstream Lab, MAP Centre for Urban Health Solutions (Craig-Neil, Pinto), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Francis Family Liver Clinic, University Health Network, Department of Medicine (Shah); Department of Medicine, Faculty of Medicine (Shah); Li Ka Shing Knowledge Institute (Antoniou), St. Michael's Hospital, Toronto, Ont
| | - Christopher Meaney
- Department of Family and Community Medicine (von Aesch, Antoniou, Pinto), St. Michael's Hospital; Department of Family and Community Medicine, Faculty of Medicine (von Aesch, Antoniou, Meaney, Pinto), University of Toronto; Upstream Lab, MAP Centre for Urban Health Solutions (Craig-Neil, Pinto), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Francis Family Liver Clinic, University Health Network, Department of Medicine (Shah); Department of Medicine, Faculty of Medicine (Shah); Li Ka Shing Knowledge Institute (Antoniou), St. Michael's Hospital, Toronto, Ont
| | - Andrew D Pinto
- Department of Family and Community Medicine (von Aesch, Antoniou, Pinto), St. Michael's Hospital; Department of Family and Community Medicine, Faculty of Medicine (von Aesch, Antoniou, Meaney, Pinto), University of Toronto; Upstream Lab, MAP Centre for Urban Health Solutions (Craig-Neil, Pinto), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Francis Family Liver Clinic, University Health Network, Department of Medicine (Shah); Department of Medicine, Faculty of Medicine (Shah); Li Ka Shing Knowledge Institute (Antoniou), St. Michael's Hospital, Toronto, Ont
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Pinto AD, Da Ponte M, Bondy M, Craig-Neil A, Murphy K, Ahmed S, Nair P, Swartz A, Green S. Addressing financial strain through a peer-to-peer intervention in primary care. Fam Pract 2020; 37:815-820. [PMID: 32537646 DOI: 10.1093/fampra/cmaa046] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Financial strain is a key social determinant of health. As primary care organizations begin to explore ways to address social determinants, peer-to-peer interventions hold promise. OBJECTIVE Our objective was to evaluate a peer-to-peer intervention focussed on financial empowerment delivered in primary care, in partnership with a social enterprise. METHODS This intervention was hosted by a large primary care organization in Toronto, Canada. Participants were recruited within the organization and from local services. We organized three separate groups who met over 10 weekly in-person, facilitated sessions: millennials (age 19-29) no longer in school, precariously employed adults (age 30-55) and older adults near retirement (age 55-64). We applied principles of adult education and peer-to-peer learning. We administered surveys at intake, at exit and at 3 months after the intervention, and conducted three focus groups. RESULTS Fifty-nine people took part. At 3 months, participants had sustained higher rates of optimism about their financial situation (54% improved from baseline), their degree of control (55% improved) and stress around finances (50% improved). In focus groups, participants reported greater understanding of their finances, that they were not alone in struggling with finances, and that it was useful to meet with others. One group continued to meet for several months after the intervention. CONCLUSIONS In this study, a peer-to-peer intervention helped address a key social determinant of health, likely through reducing stigma, providing group support and creating a space to discuss solutions. Primary care can host these interventions and help engage potential participants.
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Affiliation(s)
- Andrew D Pinto
- The Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,Department of Family and Community Medicine, St. Michael's Hospital, Toronto, ON, Canada.,Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,University of Toronto Practice-Based Research Network (UTOPIAN), Toronto, ON, Canada
| | - Monica Da Ponte
- Strive, Toronto, ON, Canada.,Shift & Build, Toronto, ON, Canada
| | - Madeleine Bondy
- The Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,Undergraduate Medical Education, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Amy Craig-Neil
- The Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | | | - Suhal Ahmed
- Shelter, Support, and Housing Administration, City of Toronto, ON, Canada
| | | | - Alyssa Swartz
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, ON, Canada
| | - Samantha Green
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, ON, Canada.,Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Pinto AD, Da Ponte M, Bondy M, Craig-Neil A, Murphy K, Ahmed S, Nair P, Swartz A, Green S. Corrigendum to: Addressing financial strain through a peer-to-peer intervention in primary care. Fam Pract 2020; 37:580. [PMID: 32830235 DOI: 10.1093/fampra/cmaa082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Raza D, Brown C, Pinto AD. Supporting patients to shape social determinants of health through democratic engagement. Can Fam Physician 2020; 66:639-641. [PMID: 32933974 PMCID: PMC7491657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Danyaal Raza
- Volunteer Chair of the Board of Canadian Doctors for Medicare.
| | - Chloe Brown
- Medical student at the University of Toronto in Ontario
| | - Andrew D Pinto
- Family physician and public health and preventive medicine specialist in the Department of Family and Community Medicine at St Michael's Hospital in Toronto, the founder and director of the Upstream Lab at the MAP Centre for Urban Health Solutions in the Li Ka Shing Knowledge Institute at St Michael's Hospital, Associate Professor in the Department of Family and Community Medicine and Associate Professor (status only) in the Institute for Health Policy, Management and Evaluation and the Division of Clinical Public Health at the Dalla Lana School of Public Health, and Associate Director for Clinical Research at the University of Toronto Practice-Based Research Network
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48
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Raza D, Brown C, Pinto AD. [Not Available]. Can Fam Physician 2020; 66:644-647. [PMID: 32933976 PMCID: PMC7491654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Danyaal Raza
- Président bénévole du conseil d'administration de Médecins pour le régime public.
| | - Chloe Brown
- Étudiante en médecine à l'Université de Toronto (Ontario)
| | - Andrew D Pinto
- Médecin de famille et spécialiste en santé publique et en médecine préventive au Département de médecine familiale et communautaire de l'Hôpital St Michael's à Toronto, fondateur et directeur de l'Upstream Lab au MAP Centre for Urban Health Solutions du Li Ka Shing Knowledge Institute de l'Hôpital St Michael's, professeur agrégé au Département de médecine familiale et communautaire et professeur agrégé (de statut seulement) à l'Institute for Health Policy, Management and Evaluation et à la Division of Clinical Public Health de l'École Dalla Lana de santé publique, et directeur associé de la recherche clinique du Réseau de recherche fondée sur la pratique de l'Université de Toronto
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Abstract
BACKGROUND In democracies, voting is an important action through which citizens engage in the political process. Although elections are only one aspect of political engagement, voting sends a signal of support or dissent for policies that ultimately shape the social determinants of health. Social determinants subsequently influence who votes and who does not. Our objective is to examine the existing research on voting and health and on interventions to increase voter participation through healthcare organizations. METHODS We conducted a scoping review to examine the existing research on voting, health, and interventions to increase voter participation through healthcare organizations. We carried out a search of the indexed, peer-reviewed literature using Ovid MEDLINE (1946-present), PsychINFO (1806-present), Ebsco CINAHL, Embase (1947-present), Web of Science, ProQuest Sociological Abstracts, and Worldwide Political Science Abstracts. We limited our search to articles published in English. Titles and abstracts were reviewed, followed by a full-text review of eligible articles and data extraction. Articles were required to focus on the connection between voting and health, or report on interventions that occurred within healthcare organizations that aimed to improve voter engagement. RESULTS Our search identified 2041 citations, of which 40 articles met our inclusion criteria. Selected articles dated from 1991-2018 and were conducted primarily in Europe, the USA, and Canada. We identified four interrelated areas explored in the literature: (1) there is a consistency in the association between voting and health; (2) differences in voter participation are associated with health conditions; (3) gaps in voter participation may be associated with electoral outcomes; and (4) interventions in healthcare organizations can increase voter participation. CONCLUSION Voting and health are associated, namely people with worse health tend to be less likely to engage in voting. Differences in voter participation due to social, economic, and health inequities have been shown to have large effects on electoral outcomes. Research gaps were identified in the following areas: long-term effects of voting on health, the effects of other forms of democratic engagement on health, and the broader impact that health providers and organizations can have on voting through interventions in their communities.
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Affiliation(s)
- Chloe L. Brown
- Faculty of Medicine, University of Toronto, Toronto, ON Canada
| | - Danyaal Raza
- Department of Family and Community Medicine, St. Michael’s Hospital, Toronto, ON Canada
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON Canada
| | - Andrew D. Pinto
- Department of Family and Community Medicine, St. Michael’s Hospital, Toronto, ON Canada
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON Canada
- Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON Canada
- Institute for Health Policy, Management and Evaluation and the Division of Clinical Public Health, Dalla Lana School of Public Health, Toronto, ON Canada
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Affiliation(s)
- Fiona Webster
- Arthur and Sonia Labatt Family School of Nursing, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Laura Connoy
- Arthur and Sonia Labatt Family School of Nursing, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Abhimanyu Sud
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Andrew D. Pinto
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, St. Michael’s Hospital, Toronto, Ontario, Canada
- Institute for Health Policy, Management and Evaluation & Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Joel Katz
- Department of Psychology, York University, Toronto, Ontario, Canada
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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