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Somé NH, Devlin RA, Mehta N, Sarma S. Primary care payment models and avoidable hospitalizations in Ontario, Canada: A multivalued treatment effects analysis. HEALTH ECONOMICS 2024. [PMID: 38898671 DOI: 10.1002/hec.4872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 03/28/2024] [Accepted: 04/30/2024] [Indexed: 06/21/2024]
Abstract
Improving access to primary care physicians' services may help reduce hospitalizations due to Ambulatory Care Sensitive Conditions (ACSCs). Ontario, Canada's most populous province, introduced blended payment models for primary care physicians in the early- to mid-2000s to increase access to primary care, preventive care, and better chronic disease management. We study the impact of payment models on avoidable hospitalizations due to two incentivized ACSCs (diabetes and congestive heart failure) and two non-incentivized ACSCs (angina and asthma). The data for our study came from health administrative data on practicing primary care physicians in Ontario between 2006 and 2015. We employ a two-stage estimation strategy on a balanced panel of 3710 primary care physicians (1158 blended-fee-for-service (FFS), 1388 blended-capitation models, and 1164 interprofessional team-based practices). First, we account for the differences in physician practices using a generalized propensity score based on a multinomial logit regression model, corresponding to three primary care payment models. Second, we use fractional regression models to estimate the average treatment effects on the treated outcome (i.e., avoidable hospitalizations). The capitation-based model sometimes increases avoidable hospitalizations due to angina (by 7 per 100,000 patients) and congestive heart failure (40 per 100,000) relative to the blended-FFS-based model. Switching capitation physicians into interprofessional teams mitigates this effect, reducing avoidable hospitalizations from congestive heart failure by 30 per 100,000 patients and suggesting better access to primary care and chronic disease management in team-based practices.
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Affiliation(s)
- Nibene Habib Somé
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Rose Anne Devlin
- Department of Economics, University of Ottawa, Ottawa, Ontario, Canada
| | - Nirav Mehta
- Department of Economics, Western University, London, Ontario, Canada
| | - Sisira Sarma
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- ICES, Toronto, Ontario, Canada
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Thomas H, Lynch J, Burch E, Best M, Ball L, Sturgiss E, Sturman N. Where the joy comes from: a qualitative exploration of deep GP-patient relationships. BMC PRIMARY CARE 2023; 24:268. [PMID: 38087212 PMCID: PMC10717859 DOI: 10.1186/s12875-023-02224-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 11/26/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND Relationship-based, whole person care is foundational to quality general practice. Previous research has identified several characteristics of deep General Practitioner (GP)-patient relationships and their association with improved patient concordance, satisfaction and perceived health outcomes. Psychological attachment theory has been used to understand therapeutic relationships, but has only been explored to a limited extent in the general practice context. Additionally, evolving changes in sociocultural and commercial practice contexts may threaten relationship-based care. In view of this, we aimed to explore the nature and experience of deep GP-patient relationships, as identified by patients, from GP and patient perspectives. METHODS Semi-structured interview design. An initial survey assessed patients' perceived depth of their relationship with their GP, using the Health Care Provider Attachment Figure Survey and Patient-Doctor Depth of Relationship Scale. Patients who reported a deep relationship, and their GPs, were purposively selected for individual interviews exploring their experience of these relationships. A post-interview survey assessed interviewees' attachment styles, using the Modified and Brief Experiences in Close Relationships Scale. Patient interviewees also rated the patient-centredness of their GP's clinic using the Person-Centred Primary Care Measure. Transcripts were analysed using thematic analysis. RESULTS Thirteen patients and five GPs were interviewed. Four themes characterised deep relationships: the 'professional'; human connection; trust; and 'above and beyond'. Patient, GP and practice team all contributed to their cultivation. CONCLUSIONS We present a revised conceptual framework of deep GP-patient relationships. Deep relationships come to the fore in times of patient trouble. Like attachment relationships, they provide a sense of safety, caring and support for patients experiencing vulnerability. They can stretch GP boundaries and capacity for self-care, but also provide joy and vocational satisfaction. Patients may not always desire or need deep relationships with their GP. However, findings highlight the importance of enabling and cultivating these for times of patient hardship, and challenges of doing so within current healthcare climates.
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Affiliation(s)
- Hayley Thomas
- General Practice Clinical Unit, Faculty of Medicine, The University of Queensland, Level 8, UQ Health Sciences Building (Building 16/901), Royal Brisbane and Women's Hospital, Herston, QLD, 4006, Australia.
| | - Johanna Lynch
- General Practice Clinical Unit, Faculty of Medicine, The University of Queensland, Level 8, UQ Health Sciences Building (Building 16/901), Royal Brisbane and Women's Hospital, Herston, QLD, 4006, Australia
| | - Emily Burch
- Faculty of Health, Southern Cross University, Gold Coast, QLD, Australia
| | - Megan Best
- Institute for Ethics and Society, University of Notre Dame Australia, Sydney, NSW, Australia
| | - Lauren Ball
- Centre for Community Health and Wellbeing, The University of Queensland, Springfield, QLD, Australia
| | - Elizabeth Sturgiss
- School of Primary and Allied Health Care, Monash University, Frankston, VIC, Australia
| | - Nancy Sturman
- General Practice Clinical Unit, Faculty of Medicine, The University of Queensland, Level 8, UQ Health Sciences Building (Building 16/901), Royal Brisbane and Women's Hospital, Herston, QLD, 4006, Australia
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Wang W, Zhang J, Loban K, Wei X. High performing primary health care organizations from patient perspective: a qualitative study in China. Glob Health Res Policy 2023; 8:31. [PMID: 37544999 PMCID: PMC10405398 DOI: 10.1186/s41256-023-00315-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 07/26/2023] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND There is a global call to build people-centred primary health care (PHC) systems. Previous evidence suggests that without organization-level reform efforts, the full potential of policy reforms may be limited. This study aimed to generate a profile of high performing PHC organizations from the perspective of patients. METHODS We conducted semi-structured interviews with 58 PHC users from six provinces (Shandong, Zhejiang, Shaanxi, Henan, Shanxi, Heilongjiang) in China using purposive and snowball sampling techniques. Transcription was completed by trained research assistants through listening to the recordings of the interviews and summarizing them in English by 30-s segments to generate the narrative summary. Informed by the Classification System of PHC Organizational Attributes, thematic analysis aimed to identify domains and attributes of high performing PHC organizations. RESULTS A profile of a high performing PHC organization with five domains and 14 attributes was generated. The five domains included: (1) organizational resources including medical equipment, human and information resource; (2) service provision and clinical practice including practice scope, internal integration and external integration; (3) general features including location, environment and ownership; (4) quality and cost; and (5) organizational structure including continuous learning mechanism, administrative structure and governance. CONCLUSIONS A five-domain profile of high performing PHC organizations from the perspective of Chinese PHC users was generated. Organizational resources, service delivery and clinical practices were most valued by the participants. Meanwhile, the participants also had strong expectation of geographical accessibility, high quality of care as well as efficient organizational structure. These organizational elements should be reflected in further reform efforts in order to build high performing PHC organizations.
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Affiliation(s)
- Wenhua Wang
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, People's Republic of China.
| | - Jinnan Zhang
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Katya Loban
- Research Institute of the McGill University Health Centre, McGill University, Montreal, Canada
| | - Xiaolin Wei
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Aggarwal M, Hutchison B, Kokorelias KM, Mehta K, Greenberg L, Moran K, Barber D, Samson K. Impact of remuneration, extrinsic and intrinsic incentives on interprofessional primary care teams: protocol for a rapid scoping review. BMJ Open 2023; 13:e072076. [PMID: 37336539 DOI: 10.1136/bmjopen-2023-072076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
INTRODUCTION Interprofessional teams and funding and payment provider arrangements are key attributes of high-performing primary care. Several Canadian jurisdictions have introduced team-based models with different payment models. Despite these investments, the evidence of impact is mixed. This has raised questions about whether team-based primary care models are being implemented to facilitate team collaboration and effectiveness. Thus, we present a protocol for a rapid scoping review to systematically map, synthesise and summarise the existing literature on the impact of provider remuneration mechanisms and extrinsic and intrinsic incentives in team-based primary care. This review will answer three research questions: (1) What is the impact of provider remuneration models on team, patient, provider and system outcomes in primary care?; (2) What extrinsic and intrinsic incentives have been used in interprofessional primary care teams?; and (3) What is the impact of extrinsic and intrinsic team-based incentives on team, patient, provider and system outcomes? METHODS AND ANALYSIS We will conduct a rapid scoping review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews guidelines. We will search electronic databases (Medline, Embase, CINAHL, PsycINFO, EconLit) and grey literature sources (Google Scholar, Google). This review will consider all empirical studies and full-text English-language articles published between 2000 and 2022. Reviewers will independently perform the literature search, data extraction and synthesis of included studies. The Mixed Methods Appraisal Tool will be used to appraise the quality of evidence. The literature will be synthesised, summarised and mapped to themes that answer the research question of this review. ETHICS AND DISSEMINATION Ethics approval is not required. Findings from this study will be written for publication in an open-access peer-review journal and presented at national and international conferences. Knowledge users are part of the research team and will assist with disseminating findings to the public, clinicians, funders and professional associations.
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Affiliation(s)
- Monica Aggarwal
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Brian Hutchison
- Department of Family Medicine, Health Research Methods, Evidence, and Impact, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Kristina Marie Kokorelias
- Department of Geriatric Medicine, Sinai Health and University Health Network, Toronto, Ontario, Canada
- Rehabiliation Sciences Institute and Department of Occupational Therapy and Occupational Sciences, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Kavita Mehta
- Association of Family Health Teams of Ontario, Toronto, Ontario, Canada
| | | | - Kimberly Moran
- Ontario College of Family Physicians, Toronto, Ontario, Canada
| | - David Barber
- Department of Family Medicine, Queen's University, Kingston, Ontario, Canada
| | - Kevin Samson
- East Wellington Family Health Team, Erin/Rockwood, Ontario, Canada
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Sylvia LG, Tovey RE, Katz D, Boccagno C, Stromberg AR, Peters AT, Temes CM, Gold AK, Mow J, Puvanich N, Albury EA, Stephan NJ, Faria CM, Nierenberg AA, Kamali MP. A New Treatment Program: Focused Integrated Team-based Treatment Program for Bipolar Disorder (FITT-BD). J Psychiatr Pract 2023; 29:176-188. [PMID: 37185884 DOI: 10.1097/pra.0000000000000703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
OBJECTIVE Bipolar disorder (BD) is complicated by a dynamic, chronic course along with multiple comorbid psychiatric and medical conditions, making it challenging for clinicians to treat and patients to thrive. To efficiently manage the complexity of BD and help patients recover, we developed a Focused Integrated Team-based Treatment Program for Bipolar Disorder (FITT-BD). The purpose of this paper is to describe how we developed this clinic and the lessons we learned. METHODS We developed FITT-BD by integrating strategies from stepped care, collaborative care, and learning health care systems. We describe the rationale, details, and lessons learned in developing FITT-BD. RESULTS By integrating stepped care, collaborative care, and a learning health care system approach, FITT-BD aims to reduce barriers to care, leverage the expertise of a multidisciplinary treatment team, ensure patient-centeredness, and use assessments to inform and continuously improve outcomes in real time. We learned that there are challenges in the creation of a web-based application that tracks the treatment of patients within a network of hospitals. CONCLUSIONS The success of FITT-BD will be determined by the degree to which it can increase treatment access, improve treatment adherence, and help individuals with BD achieve their treatment goals. We expect that FITT-BD will improve outcomes in the context of ongoing clinical care. PUBLIC HEALTH SIGNIFICANCE The treatment of BD is challenging and complex. We propose a new treatment model for BD: FITT-BD. We expect that this program will be a patient-centered approach that improves outcomes in the context of ongoing clinical care for patients with BD.
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Sethuram C, McCutcheon T, Liddy C. An environmental scan of Ontario Health Teams: a descriptive study. BMC Health Serv Res 2023; 23:225. [PMID: 36890556 PMCID: PMC9993364 DOI: 10.1186/s12913-023-09102-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 01/24/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Ontario Health Teams (OHTs) are an integrated care system introduced in Ontario, Canada in 2019 after the 14 Local Health Integrated Networks (LHINs) were dissolved. The objective of this study is to give an overview of the current state of the OHT model's implementation, and what priority populations and transitions of care models were identified by OHTs. METHODS This scan involved a structured search for each approved OHT of publicly available resources with three main sources: the full application submitted by the OHT, the OHT website, and a Google search with the name of the OHT. RESULTS As of July 23, 2021, there were 42 approved OHTs and nine transitions of care programs were identified across nine OHTs. Of the approved OHTs, 38 had identified ten distinct priority populations, and 34 reported partnerships with organizations. CONCLUSIONS While the approved OHTs currently cover 86% of Ontario's population, not all OHTs are at the same stage of activity. Several areas for improvement were identified, including public engagement, reporting, and accountability. Moreover, OHTs' progress and outcomes should be measured in a standardized manner. These findings may be of interest to healthcare policy or decision-makers looking to implement similar integrated care systems and improve healthcare delivery in their jurisdictions.
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Affiliation(s)
- Claire Sethuram
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, K1R 6M1, Canada.,Department of Family Medicine, University of Ottawa, Ottawa, ON, K1G 5Z3, Canada
| | - Tess McCutcheon
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, K1R 6M1, Canada
| | - Clare Liddy
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, K1R 6M1, Canada. .,Department of Family Medicine, University of Ottawa, Ottawa, ON, K1G 5Z3, Canada. .,Ontario eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, ON, K1H 7W9, Canada.
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Li M, Tang H, Liu X. Primary care team and its association with quality of care for people with multimorbidity: a systematic review. BMC PRIMARY CARE 2023; 24:20. [PMID: 36653754 PMCID: PMC9850572 DOI: 10.1186/s12875-023-01968-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 01/03/2023] [Indexed: 01/20/2023]
Abstract
BACKGROUND Multimorbidity is posing an enormous burden to health systems, especially for primary healthcare system. While primary care teams (PCTs) are believed to have potentials to improve quality of primary health care (PHC), less is known about their impact on the quality of care for people with multimorbidity. We assessed the characteristics of PCTs and their impact on the quality of care for people with multimorbidity and the mechanisms. METHODS: We searched PubMed, MEDLINE, EMBASE, ProQuest for published studies from January 2000 to October 2021 for studies in English. Following through PRISMA guidelines, two reviewers independently abstracted data and reconciled by consensus with a third reviewer. Titles, abstracts, and full texts were evaluated to identify relevant studies. Studies were categorized by types of interventions, the impact of interventions on outcome measures, and mechanisms of interventions. RESULTS: Seventeen studies (13 RCT, 3 cohort studies, and 1 non-randomized trial) were identified. PCTs were summarized into three types-upward PCTs, downward PCTs and traditional PCTs according to the skill mix. The upward PCTs included primary care workers and specialists from upper-level hospitals, downward PCTs involving primary care workers and lay health workers, and traditional PCTs involving physicians and care managers. PCTs improved patients' mental and psychological health outcomes greatly, and also improved patients' perceptions towards care including satisfaction with care, sense of improvement, and patient-centeredness. PCTs also improved the process of care and changed providers' behaviors. However, PCTs showed mixed effects on clinical outcome measures. CONCLUSIONS PCTs have improved mental and psychological health outcomes, the process of care, patients' care experiences, and satisfaction towards care for patients with multimorbidity. The effect of PCTs on clinical outcomes and changes in patient behaviors need to be further explored.
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Affiliation(s)
- Mingyue Li
- grid.11135.370000 0001 2256 9319Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China ,grid.11135.370000 0001 2256 9319China Center for Health Development Studies, Peking University, 38 Xue Yuan Road, Beijing, 100191 China
| | - Haoqing Tang
- grid.11135.370000 0001 2256 9319Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China ,grid.11135.370000 0001 2256 9319China Center for Health Development Studies, Peking University, 38 Xue Yuan Road, Beijing, 100191 China
| | - Xiaoyun Liu
- grid.11135.370000 0001 2256 9319China Center for Health Development Studies, Peking University, 38 Xue Yuan Road, Beijing, 100191 China
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Abstract
AIM To examine and describe the current evidence about occupational therapy services in primary care. BACKGROUND Interprofessional primary care teams have been introduced to support the changing demographics and provide more comprehensive and coordinated care. Occupational therapists have the opportunity to play an important role in this expanding area of practice. To do so, occupational therapists must develop roles built on evidence and a clear understanding of the care delivery context. METHODS A scoping review was conducted based on the scientific and grey literature. Studies that described or examined the occupational therapy role with clients (individuals, groups, communities, populations) of all ages, conditions or occupational issues in a primary care context and that presented or referred to an occupational therapist working in a primary care setting were included. Studies were excluded if they were not in English or French. The Canadian Model of Occupational Performance and Engagement was used to chart the data. FINDINGS 129 articles were identified, with 62 non-research and 67 research-focussed articles. A total of 268 assessments and 868 interventions were identified. The top interventions offered by occupational therapists were referring to/advocating for/coordinating/linking to and navigating community services (n = 36 articles), chronic disease management (n = 34 articles)/self-management education (n = 28 articles), health promotion (n = 30 articles) and falls prevention (n = 27 articles). The predominant focus in the literature is on adult and older adult populations.
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Cooper IR, Lindsay C, Fraser K, Hill TT, Siu A, Fletcher S, Klimas J, Hamilton MA, Frazer AD, Humphrys E, Koepke K, Hedden L, Price M, McCracken RK. Finding Primary Care—Repurposing Physician Registration Data to Generate a Regionally Accurate List of Primary Care Clinics: Development and Validation of an Open-Source Algorithm. JMIR Form Res 2022; 6:e34141. [PMID: 35731556 PMCID: PMC9496812 DOI: 10.2196/34141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 05/13/2022] [Accepted: 05/19/2022] [Indexed: 11/13/2022] Open
Abstract
Background Some Canadians have limited access to longitudinal primary care, despite its known advantages for population health. Current initiatives to transform primary care aim to increase access to team-based primary care clinics. However, many regions lack a reliable method to enumerate clinics, limiting estimates of clinical capacity and ongoing access gaps. A region-based complete clinic list is needed to effectively describe clinic characteristics and to compare primary care outcomes at the clinic level. Objective The objective of this study is to show how publicly available data sources, including the provincial physician license registry, can be used to generate a verifiable, region-wide list of primary care clinics in British Columbia, Canada, using a process named the Clinic List Algorithm (CLA). Methods The CLA has 10 steps: (1) collect data sets, (2) develop clinic inclusion and exclusion criteria, (3) process data sets, (4) consolidate data sets, (5) transform from list of physicians to initial list of clinics, (6) add additional metadata, (7) create working lists, (8) verify working lists, (9) consolidate working lists, and (10) adjust processing steps based on learnings. Results The College of Physicians and Surgeons of British Columbia Registry contained 13,726 physicians, at 2915 unique addresses, 6942 (50.58%) of whom were family physicians (FPs) licensed to practice in British Columbia. The CLA identified 1239 addresses where primary care was delivered by 4262 (61.39%) FPs. Of the included addresses, 84.50% (n=1047) were in urban locations, and there was a median of 2 (IQR 2-4, range 1-23) FPs at each unique address. Conclusions The CLA provides a region-wide description of primary care clinics that improves on simple counts of primary care providers or self-report lists. It identifies the number and location of primary care clinics and excludes primary care providers who are likely not providing community-based primary care. Such information may be useful for estimates of capacity of primary care, as well as for policy planning and research in regions engaged in primary care evaluation or transformation.
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Affiliation(s)
- Ian R Cooper
- Innovation Support Unit, Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Cameron Lindsay
- Innovation Support Unit, Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Keaton Fraser
- Innovation Support Unit, Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Tiffany T Hill
- Innovation Support Unit, Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Andrew Siu
- Innovation Support Unit, Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Sarah Fletcher
- Innovation Support Unit, Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Jan Klimas
- Innovation Support Unit, Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
| | - Michee-Ana Hamilton
- Innovation Support Unit, Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Amanda D Frazer
- Innovation Support Unit, Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Elka Humphrys
- Innovation Support Unit, Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Kira Koepke
- Innovation Support Unit, Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Lindsay Hedden
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- British Columbia Academic Health Sciences Network, Vancouver, BC, Canada
| | - Morgan Price
- Innovation Support Unit, Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Rita K McCracken
- Innovation Support Unit, Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
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Shah N, Tiwari R, Brar G. Evaluating program planning using an equity framework. Healthc Manage Forum 2022; 35:339-343. [PMID: 35686703 DOI: 10.1177/08404704221102528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
To plan for an expansion of healthcare services in newly developed neighbourhoods, a planning initiative was conducted to better understand the needs of the population. Ensuring equity of care was identified as a priority for this initiative. To evaluate how closely the planning adhered to the principles of health equity, we applied Ontario Health's Equity, Inclusion, Diversity, and Anti-Racism Framework to determine which areas of action were successfully addressed, and which areas of action require further focus. The framework contains 11 components, each delineating a key area of action. Using this framework helped identify areas where the principles of equity were well addressed, as well as pointing to additional areas where further efforts are required. Healthcare organizations must take a leadership role in advancing health equity by planning, delivering, improving, and advocating for the services and systematic changes that will allow its local community members to realize their highest attainable standard of health. Using such a framework can help develop strategic approaches to advancing equity.
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Affiliation(s)
- Neil Shah
- Queen Square Family Health Team, Brampton, Ontario, Canada
| | - Rahul Tiwari
- Queen Square Family Health Team, Brampton, Ontario, Canada
| | - Gurpreet Brar
- Queen Square Family Health Team, Brampton, Ontario, Canada
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Ashcroft R, Donnelly C, Gill S, Dancey M, Lam S, Grill AK, Mehta K. The Delivery of Patient Care in Ontario's Family Health Teams during the First Wave of the COVID-19 Pandemic. Healthc Policy 2021; 17:72-89. [PMID: 34895411 PMCID: PMC8665725 DOI: 10.12927/hcpol.2021.26656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The objective of this paper was to identify continuations and changes in care delivery methods in primary care teams during the COVID-19 pandemic. DESIGN The study used a cross-sectional, web-based survey comprising close-ended and open-ended questions. SETTING The setting comprised family health teams (FHTs) across Ontario, Canada. PARTICIPANTS The participants included executive directors of FHTs or designates of their choosing. SURVEY Descriptive statistics were derived from responses to close-ended questions, and responses to open-ended questions were coded using thematic analysis. RESULTS With 93 participants, the response rate was 48%. Participants reported the continuation of in-person care, the implementation of virtual care across FHTs and collaboration within these teams and their communities.
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Affiliation(s)
- Rachelle Ashcroft
- Assistant Professor, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON
| | - Catherine Donnelly
- Associate Professor, Faculty of Health Sciences, Queen's University, Kingston, ON
| | - Sandeep Gill
- Quality and Knowledge Translation Manager, Association of Family Health Teams of Ontario, Toronto, ON
| | - Maya Dancey
- Research Intern, Telfer School of Management, University of Ottawa, Ottawa, ON
| | - Simon Lam
- Research Associate, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON
| | - Allan K Grill
- Associate Professor, Department of Family & Community Medicine, University of Toronto, Toronto, ON; Lead Physician, Markham Family Health Team, Chief, Department of Family Medicine, Markham Stouffville Hospital, Markham, ON
| | - Kavita Mehta
- Chief Executive Officer, Association of Family Health Teams of Ontario, Toronto, ON
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Ashcroft R, Donnelly C, Dancey M, Gill S, Lam S, Kourgiantakis T, Adamson K, Verrilli D, Dolovich L, Kirvan A, Mehta K, Sur D, Brown JB. Primary care teams' experiences of delivering mental health care during the COVID-19 pandemic: a qualitative study. BMC FAMILY PRACTICE 2021; 22:143. [PMID: 34210284 PMCID: PMC8248293 DOI: 10.1186/s12875-021-01496-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 06/23/2021] [Indexed: 12/30/2022]
Abstract
Background Integrated primary care teams are ideally positioned to support the mental health care needs arising during the COVID-19 pandemic. Understanding how COVID-19 has affected mental health care delivery within primary care settings will be critical to inform future policy and practice decisions during the later phases of the pandemic and beyond. The objective of our study was to describe the impact of the COVID-19 pandemic on primary care teams’ delivery of mental health care. Methods A qualitative study using focus groups conducted with primary care teams in Ontario, Canada. Focus group data was analysed using thematic analysis. Results We conducted 11 focus groups with 10 primary care teams and a total of 48 participants. With respect to the impact of the COVID-19 pandemic on mental health care in primary care teams, we identified three key themes: i) the high demand for mental health care, ii) the rapid transformation to virtual care, and iii) the impact on providers. Conclusions From the outset of the COVID-19 pandemic, primary care quickly responded to the rising mental health care demands of their patients. Despite the numerous challenges they faced with the rapid transition to virtual care, primary care teams have persevered. It is essential that policy and decision-makers take note of the toll that these demands have placed on providers. There is an immediate need to enhance primary care’s capacity for mental health care for the duration of the pandemic and beyond. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01496-8.
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Affiliation(s)
- Rachelle Ashcroft
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada.
| | | | - Maya Dancey
- Telfer School of Management, University of Ottawa, Ottawa, ON, Canada
| | - Sandeep Gill
- Association of Family Health Teams of Ontario, Toronto, ON, Canada
| | - Simon Lam
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada
| | - Toula Kourgiantakis
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada
| | - Keith Adamson
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada
| | | | - Lisa Dolovich
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Anne Kirvan
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada
| | - Kavita Mehta
- Association of Family Health Teams of Ontario, Toronto, ON, Canada
| | - Deepy Sur
- Ontario Association of Social Workers, Toronto, ON, Canada
| | - Judith Belle Brown
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
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