A comparison of the COVID-19 response for urban underserved patients experiencing healthcare transitions in three Canadian cities

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.

Family caregivers as essential partners in care: examining the impacts of restrictive acute care visiting policies during the COVID-19 pandemic in Canada

“…Racial disparities and structural racism have been documented across the provision of healthcare in Canada [ 32 – 34 ]. Pandemics also amplify underlying pre-existing health disparities [ 35 , 36 ]. Patient advocacy has been one mechanism to mitigate the potential for structural racism in healthcare for more vulnerable patients.…”

How equitable has the COVID-19 response been in Canada?

“…A selection of papers report on institutional or organizational responses to address social and health inequities experienced by selected groups during the pandemic. Using documentary analysis and virtual group interviews with front-line workers and people with lived experience, Salvalaggio and colleagues (Salvalaggio et al, 2022) provide a quantitative comparative analysis of the COVID-19 healthcare response for urban underserved patients in three Canadian cities. Their findings revealed a lack of organizational interest in providing continuity of care for disadvantaged populations during the pandemic.…”

“…Un ensemble de communications traite des interventions d'établissements ou d'organismes pour contrer les iniquités sociales et sanitaires vécues par certains groupes durant la pandémie. À l'aide d'une analyse documentaire et d'entretiens en groupe virtuels avec des intervenants de première ligne et des personnes ayant une expérience vécue, Salvalaggio et collègues (Salvalaggio et al, 2022) présentent une analyse comparative quantitative de la riposte à la COVID-19 dans les soins de santé aux patients de zones urbaines mal desservies de trois villes canadiennes. Leurs constats révèlent le manque d'intérêt des organisations à assurer le suivi des soins aux populations défavorisées durant la pandémie.…”