Keeping the front door open: ensuring access to primary care for all in Canada

Kiran, Tara

doi:10.1503/cmaj.221563

Cited by 31 publications

(27 citation statements)

References 11 publications

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“…Organizational culture is linked to job satisfaction, and successful recruitment and retention of human resources 40,41 which is of paramount importance during this crisis of worker shortage in primary care. 25,26 In our study, social workers holding formal leadership positions self-reported high confidence in their leadership skills. It would be important to further explore what contributes to attaining high levels of confidence to target capacity development specifically for the primary care context.…”

Section: Discussionmentioning

confidence: 70%

Social workers’ formal and informal leadership in interprofessional primary care teams in Ontario, Canada

Ashcroft

Feryn

Lam

et al. 2023

Healthc Manage Forum

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The development of interprofessional teams in primary care presents opportunities for social workers to take on new leadership positions. This study seeks to describe how social workers engaged in leadership roles in primary care during the COVID-19 pandemic. A cross-sectional on-line survey was disseminated to primary care social workers across Ontario, Canada, with a total of 159 respondents. Most respondents engaged in informal leadership roles and showcased a range of leadership skills promoting team collaboration and consultations, along with adapting to virtual care transitions. Findings suggest there needs to be intentional cultivation of social work leaders through supportive environments and training. Social workers in primary care have leadership capacity and are providing leadership to their primary care teams through formal and informal means. The leadership potential of social workers in primary care teams, however, is being underutilized and can be further developed.

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Section: Discussionmentioning

confidence: 70%

Social workers’ formal and informal leadership in interprofessional primary care teams in Ontario, Canada

Ashcroft

Feryn

Lam

et al. 2023

Healthc Manage Forum

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“…Our findings suggest that access to primary care, as well as the type of primary care model to which one has access, played a crucial role in cancer-screening recovery after the COVID-19 pandemic. These results may make a compelling argument for expanding access to interprofessional, team-based primary care as a method of increasing cancer-screening uptake (and other quality of care 37 ) province-wide. Among interprofessional teams, nonphysician practitioners may play a role in identifying patients who are overdue for screening and who need screening outreach or screening education and in performing and/or ordering screening tests.…”

Section: Discussionmentioning

confidence: 99%

“…However, efforts to expand access to team-based care must center on health equity (ie, ensuring that immigrants and/or people with limited income are prioritized for team-based primary care). [37][38][39] These efforts will require significant investment: although community health centers are designed for people experiencing marginalization, they currently serve less than 2% of the province's population, and family health teams have traditionally been least available in geographic areas with the greatest need. 40 Our results are in line with other literature.…”

Section: Discussionmentioning

confidence: 99%

“…Among interprofessional teams, nonphysician practitioners may play a role in identifying patients who are overdue for screening and who need screening outreach or screening education and in performing and/or ordering screening tests. However, efforts to expand access to team-based care must center on health equity (ie, ensuring that immigrants and/or people with limited income are prioritized for team-based primary care) . These efforts will require significant investment: although community health centers are designed for people experiencing marginalization, they currently serve less than 2% of the province’s population, and family health teams have traditionally been least available in geographic areas with the greatest need …”

Section: Discussionmentioning

confidence: 99%

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Cancer Screening Disparities Before and After the COVID-19 Pandemic

Lofters,

Wu,

Frymire

et al. 2023

JAMA Netw Open

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ImportanceBreast, cervical, and colorectal cancer–screening disparities existed prior to the COVID-19 pandemic, and it is unclear whether those have changed since the pandemic.ObjectiveTo assess whether changes in screening from before the pandemic to after the pandemic varied for immigrants and for people with limited income.Design, Setting, and ParticipantsThis population-based, cross-sectional study, using data from March 31, 2019, and March 31, 2022, included adults in Ontario, Canada, the country’s most populous province, with more than 14 million people, almost 30% of whom are immigrants. At both dates, the screening-eligible population for each cancer type was assessed.ExposuresNeighborhood income quintile, immigrant status, and primary care model type.Main Outcomes and MeasuresFor each cancer screening type, the main outcome was whether the screening-eligible population was up to date on screening (a binary outcome) on March 31, 2019, and March 31, 2022. Up to date on screening was defined as having had a mammogram in the previous 2 years, a Papanicolaou test in the previous 3 years, and a fecal test in the previous 2 years or a flexible sigmoidoscopy or colonoscopy in the previous 10 years.ResultsThe overall cohort on March 31, 2019, included 1 666 943 women (100%) eligible for breast screening (mean [SD] age, 59.9 [5.1] years), 3 918 225 women (100%) eligible for cervical screening (mean [SD] age, 45.5 [13.2] years), and 3 886 345 people eligible for colorectal screening (51.4% female; mean [SD] age, 61.8 [6.4] years). The proportion of people up to date on screening in Ontario decreased for breast, cervical, and colorectal cancers, with the largest decrease for breast screening (from 61.1% before the pandemic to 51.7% [difference, −9.4 percentage points]) and the smallest decrease for colorectal screening (from 65.9% to 62.0% [difference, −3.9 percentage points]). Preexisting disparities in screening for people living in low-income neighborhoods and for immigrants widened for breast screening and colorectal screening. For breast screening, compared with income quintile 5 (highest), the β estimate for income quintile 1 (lowest) was −1.16 (95% CI, −1.56 to −0.77); for immigrant vs nonimmigrant, the β estimate was −1.51 (95% CI, −1.84 to −1.18). For colorectal screening, compared with income quintile 5, the β estimate for quntile 1 was −1.29 (95% CI, 16 −1.53 to −1.06); for immigrant vs nonimmigrant, the β estimate was −1.41 (95% CI, −1.61 to −1.21). The lowest screening rates both before and after the COVID-19 pandemic were for people who had no identifiable family physician (eg, moving from 11.3% in 2019 to 9.6% in 2022 up to date for breast cancer). In addition, patients of interprofessional, team-based primary care models had significantly smaller reductions in β estimates for breast (2.14 [95% CI, 1.79 to 2.49]), cervical (1.72 [95% CI, 1.46 to 1.98]), and colorectal (2.15 [95% CI, 1.95 to 2.36]) postpandemic screening and higher uptake of screening in general compared with patients of other primary care models.Conclusions and RelevanceIn this cross-sectional study in Ontario that included 2 time points, widening disparities before compared with after the COVID-19 pandemic were found for breast cancer and colorectal cancer screening based on income and immigrant status, but smaller declines in disparities were found among patients of interprofessional, team-based primary care models than among their counterparts. Policy makers should investigate the value of prioritizing and investing in improving access to team-based primary care for people who are immigrants and/or with limited income.

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“…It is generally accepted that there is a crisis in the Canadian health care system. 1 Reports of large numbers of Canadians unable to access primary care services, 2 or practitioners’ experiences of occupational stress, burnout and mental health challenges arising from under-resourced workplaces, 3 or anecdotal reports of well-qualified internationally educated health professionals driving taxi cabs or working in factories 4 all highlight gaps and failures in planning, organization, management and administration of Canada’s health care systems. The COVID-19 pandemic stressed health care systems as never before 5 : the fortitude of the health workforce in rising to pandemic-related challenges was truly remarkable and speaks to the motivation and dedication of hundreds of thousands of individuals who work as regulated health professionals and nonregulated health workers.…”

Section: Introductionmentioning

confidence: 99%