Author: Samira Prasad

From U of T News

The Temerty Faculty of Medicine’s annual Dean’s Lunch, hosted by Dean Trevor Young to thank and celebrate the Faculty’s most generous donors, is traditionally a relaxed, unrushed occasion. Yet, much of the focus of Kamran Khan’s keynote during the most recent event was the value of speed.

During his talk, Khan (MD’96) provided guests with an overview of his unconventional career path through medicine that ultimately led to him founding and leading BlueDot — a certified B company that seeks to identify, understand and respond to global biological threats faster and more effectively than ever before.

“Epidemics and pandemics move very quickly — spreading inadvertently by people as we travel around the world,” explained Khan, an infectious disease physician at Unity Health’s St. Michael’s Hospital and a Temerty Health Nexus Chair in Health Innovation and Technology at Temerty Medicine. “Today, access to big data and the refinement of machine learning is giving us the ability to get ahead of and move faster than outbreaks.”

After working on the front lines during the 2003 Toronto SARS outbreak, Khan was inspired to study transportation networks that connect people around the planet and are the conduit through which diseases spread geographically.

In the early days of 2009’s H1N1 pandemic, Khan published a predictive article in the New England Journal of Medicine about how the virus was anticipated to spread via airline travel. While his work provided an interesting snapshot of the evolving situation, by the time it was published just two weeks later, the virus had already moved on and his findings were no longer actionable.

That’s what inspired Khan to found BlueDot as a vehicle to translate the work he was doing as a scientist into real world impactful solutions and technologies. Harnessing technology, including artificial intelligence, he and his team have developed a global early warning system that identifies emerging outbreaks around the world, recognizes those that pose the greatest threat, anticipates their local and global trajectories, and disseminates timely, actionable insights to public and private sector decision makers.

Then came the moment everything coalesced: the early days of what would eventually be named COVID-19.

“In December 2019, we were picking up information about an unusual respiratory syndrome circulating in China’s Hubei Province,” says Khan. “We were able to notify all the organizations with whom we work a week ahead of any announcements from the World Health Organization, CDC or other health agencies.”

From Healthy Debate

Despite some improvements, reports published in recent years suggest primary care in Quebec performs poorly compared to other Canadian provinces in terms of accessibility and coordination.

Quebec’s primary-care system is mainly based on the Family Medicine Group (FMG) model, in which patients are registered with a family physician who works with a team of other health-care professionals, such as nurses, social workers and pharmacists. FMGs were introduced in 2002 in response to challenges faced by the community-based CLSC model, including a lack of integration with the broader health-care system and difficulties in attracting and retaining family physicians. Today, 65 per cent of the population is registered with a family physician working in an FMG.

Twenty years later, primary care in Quebec has not caught up with the rest of Canada. The OurCare survey conducted last year that garnered more than 9,000 responses from across Canada, with more than 2,500 coming from Quebec, provides some answers.

In Canada, close to one out of five adults (22 per cent) report not having a family doctor or nurse practitioner they can see regularly. In Quebec, the situation is worse – one in three (31 per cent) report not having a family physician or nurse practitioner. Although this proportion is slightly higher than reported by the Ministère de la Santé et des Services sociaux in April 2023, the fact remains that for more than 2 million Quebecers, the front door to the health-care system is closed. They have no reliable place to turn when they have new, worrisome problems but also no one to help manage chronic conditions, ensure they receive preventive care or coordinate their journey through the complex health system.

From Unity Health Toronto

Family physicians who provided more virtual care did not have more patients visit emergency departments (ED) compared to family physicians who saw more patients in-person, according to new research.

The study, led by researchers at Unity Health Toronto and ICES, showed that even after adjusting for patient characteristics like age, medical conditions and income, physicians who provided more virtual care did not have patients who visited the ED more. However, differences in ED visit rates between physician practices largely mimicked patterns seen before the pandemic.

The findings refute speculation that patients were visiting emergency departments more frequently because family physicians were providing too much virtual care. Physician billing codes for virtual care were introduced in Ontario as an emergency measure at the start of the pandemic and became permanent in October 2022.

“The data does not support the allegations that family physicians not seeing people in-person was driving an increase in ED visits,” said Dr. Tara Kiran, lead author of the study and a scientist at the MAP Centre for Urban Health Solutions at St. Michael’s Hospital and ICES.

“The vast majority of family doctors were seeing people in-person, and those that provided more virtual visits did not have more patients who went to the ED,” said Kiran, who is also a family physician with St. Michael’s Academic Family Health Team.

Researchers analyzed data linked to ICES administrative health records from nearly 14,000 Ontario family physicians from February to October 2021 and their nearly 13 million patients. Physicians were categorized into groups based on the percentage of care they delivered virtually. Most physicians provided between 40 and 80 per cent of care virtually. Over 330 physicians (2.4 per cent) delivered 100 per cent care virtually and over 860 physicians (6.2 per cent) delivered no virtual care.

The mean number of ED visits was highest among patients whose physicians provided only in-person care (470 visits per 1,000 patients), and was lowest among patients whose physicians provided more than 80 per cent to less than 100 per cent of care virtually (242 visits per 1,000 patients).

The study also found ED visit rates during the first 18 months of the pandemic were lower than pre-pandemic levels. Between 2019 and 2021, there was an overall 13 per cent decrease in the mean number of ED visits in Ontario. Periods in which the ED visit rates were highest did not coincide with periods when family physicians were providing more care virtually.

“This finding is not to say that emergency departments weren’t overcrowded – but it wasn’t because of increased volumes,” said Dr. Rick Glazier, co-author of the study, a senior scientist at ICES, scientist at the MAP Centre for Urban Health Solutions at St. Michael’s Hospital.

From Healthy Debate

Editor’s note: This interview with Tara Kiran, the Fidani Chair of Improvement and Innovation at the University of Toronto and the lead in the OurCare project, was first published in MedicsVoices.

Tara Kiran: What I love about my job is that it gives me the freedom to think big about what it is that we need to do to make our Primary Care system better and work for everyone.

I spend some of my time at the University of Toronto overseeing the Quality and Innovation program at our Department of Family and Community Medicine.

So, what do we do there? We try to support our teams to measure and improve quality of care. We have 14 Family Medicine teaching units in the Department of Family and Community Medicine, all varying in size and location but we now run the same patient experience survey and we do it in the same way, and our department helps to coordinate all of that, analyze the results, and gives it back to the practices to make it easier to understand what they’re doing, the type of care they’re providing for patients, and how they could do better.

Patient experience is one kind of data that we work with. We also work with electronic medical record data and data from administrative sources that we try to give back.

Another big focus for us is capacity building; we want people to have the knowledge and skills to improve quality in their practice. So, we do a lot of teaching of quality improvement, but we also teach more broadly in continuing professional development. We’re thinking about how people keep up to date on a long-term basis. We’re starting to experiment with ideas like peer-to-peer coaching for example, and we’ve also started to do more forums for family doctors across our province. When COVID began, we started hosting, together with our partner the Ontario College of Family Physicians, a bi-weekly virtual series called the COVID-19 Community of Practice for family doctors. Every two weeks, we now have anywhere from 600 to a 1,000 family doctors join our webinars to learn about the latest on COVID.

A big part of it is learning from each other so it’s become a safe space for people to share their own knowledge and gain knowledge from their peers.

MedicsVoices: Let me take you back a little because you have a lot of experience with Indigenous populations and this is something that is particularly important in Canada. Tell me how that’s influenced your own career.

TK: Trying to advance equity and close equity gaps has been a running theme in my career. It started with me trying to do that as a practicing clinician; I worked in many community health centres in inner city Toronto that worked with more marginalized populations. I also worked in many remote and rural communities, including First Nations reserves in Northern Ontario, as well as Indigenous communities further afield. And I think that shaped my own thinking and ways of understanding health early on and it led me to want to do more.

I ended up doing a Master’s in Public Health that allowed me to understand the concepts of health equity and influence them. I acquired skills in Health Services Research and, in the beginning of my research career, a lot of my work documented inequities between groups.

Moving forward, I’m trying to do more and more, to go beyond just documenting the inequities but trying to close them. And I’ve learned a lot over the last 10 years about how much I don’t know about our own history in Canada when it comes to Indigenous people. When I think about the work that I did with Indigenous people as a young clinician, I think about so much of my own ignorance of the history and legacy of colonialism, and how it shaped the health of the people that I was serving at that time.

Since then, I’ve had the opportunity to take part in Indigenous cultural safety training and learn through other ways that have changed the way that I understand the issues. And what I’ve learned also is that for us to really address it, it’s about me being an ally and trying to amplify the voices of Indigenous colleagues and populations that I work with and serve; working with them to support them to have self-determination about the solutions that would work for their communities.

From CTV News

In Ontario’s poorest neighbourhoods, newborns of non-refugee immigrant mothers face a lower risk of serious illness and death than those born to Canadian-born mothers, according to a study published in the Canadian Medical Association Journal on Monday.

Both immigration status and living in a low-income neighbourhood are associated with worse outcomes for newborns, write researchers from the University of Toronto, two Toronto hospitals, the Institute for Clinical Evaluative Sciences and the University of North Carolina-Chapel Hill.

However, while previous research has looked at the risk of adverse outcomes for newborns in low- versus high-income neighbourhoods, the study’s authors said it has overlooked the comparative risks for babies born to immigrant and non-immigrant parents living in similar low-income neighbourhoods.

“Efforts should be aimed at improving the overall health and well-being of all females residing in low-income areas, and at determining if the risk of adverse birth outcomes can be equitably reduced among immigrant and non-immigrant groups,” wrote co-author Jennifer Jairam.

To compare the risk of severe neonatal illness and death in immigrant- and non-immigrant-born infants, researchers looked at data on all live, in-hospital births of single babies from 20 to 42 weeks’ gestation between 2002 and 2019 in Ontario.

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From Unity Health Toronto

The SPRinG app, designed in partnership with community groups and people who have experienced problem gambling, is a low-barrier, self-management journaling and tracking tool that helps users understand their gambling patterns and urges. It’s a research tool to gain insights into this population, and explore the feasibility of addressing problem gambling with a digital solution.

Problem gambling is associated with a range of health concerns, including substance use, mental illness, chronic illness and disability. Research suggests that prevalence of problem gambling among people experiencing homelessness is up to 58 per cent, nine times higher than the general population.

Dr. Flora Matheson is a Research Scientist, Dr. Arthur McLuhan is a Senior Research Associate, and Madison Ford is a Research Coordinator at MAP Centre for Urban Health Solutions. Dr. Alireza Sadeghian is a professor at the Department of Computer Science at Toronto Metropolitan University. They spoke about leading the SPRinG project, the questions they’re hoping to answer and why they’re passionate about this work.

Q: How does the SPRinG app work?

Ford: The app centres around users journaling about their gambling urges and gambling events, and the circumstances surrounding those urges and events. All of this information is collected through the app, allowing users to learn about their behaviour. For example, users can track their location during a gambling urge, how much money they’ve lost in gambling events for the past week, and how this compares to previous weeks. All of these variables help users identify triggers and high-risk situations and develop strategies for managing them.

When users are experiencing an urge, the app offers them four options to deter them from gambling: 1) engage in a distraction, 2) contact a friend, 3) engage in alternate activities and 4) contact a 24/7 crisis line.

Q: How did you develop the app?

Matheson: It started with initial funding from the Ontario Ministry of Health to develop a prototype about five years ago, and now we’re at the recruitment stage. We’ve received subsequent funding from the Natural Sciences and Engineering Research Council of Canada, and the Canadian Institutes of Health Research through the Collaborative Health Research Projects Initiative.

At MAP, we have a research program that looks at the connections between problem gambling, homelessness and poverty.

In Ontario, there are not enough gambling support services for those who need them. These services are often siloed, and many have long wait lists. Our community partners wanted a tool that could bridge these services, and could be accessed outside of normal 9-5 business hours, when a gambling event is likely to occur. This could be at 5 p.m., when a friend calls asking to go to the casino, or on the weekends, when support services might be closed. The app is always there in users’ back pockets, whenever they need it.

Une application conçue par des chercheurs de St. Michael’s offre un soutien 24 heures sur 24, 7 jours sur 7, aux personnes ayant des problèmes de jeu

Conçue en partenariat avec des groupes communautaires et des personnes ayant connu des problèmes de jeu, l’application SPRinG est un outil convivial d’autogestion qui permet aux utilisateurs de suivre et de consigner des données pour mieux comprendre leurs habitudes et leurs envies de jeu. Il s’agit d’un outil de recherche servant à mieux connaître cette population et à explorer la faisabilité d’une solution numérique pour lutter contre la dépendance au jeu.

La dépendance au jeu est associée à toute une série de problèmes de santé tels que la toxicomanie, les maladies mentales, les maladies chroniques et l’invalidité. Des études suggèrent que la prévalence des problèmes de jeu chez les personnes en situation d’itinérance s’élève à 58 %, ce qui est neuf fois plus élevé que dans la population générale.

Flora Matheson est chercheuse, Arthur McLuhan est associé de recherche principal et Madison Ford est coordonnatrice de la recherche au Centre MAP pour des solutions de santé urbaine. Alireza Sadeghian est professeur au département d’informatique de l’Université métropolitaine de Toronto. Ils nous parlent de la direction du projet SPRinG, des questions auxquelles ils espèrent répondre et des raisons pour lesquelles ce travail les passionne.

From CBC The National

Dr. Sean Rourke speaks to CBC about the alarming increase in syphilis cases in newborn babies in Canada, why rural Indigenous communities are particularly vulnerable, and how a new rapid test could help:

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Letter to the editor in the Toronto Star, by Dr. Patricia O’Campo

Every time we have a public conversation about violence at home, it makes the private conversations possible.

This is why we at MAP Centre for Urban Health Solutions at St. Michael’s Hospital, a site of Unity Health Toronto, were encouraged to see Wendy Gillis and Alyshah Hasham’s article outlining different ways to get support if home is not a safe place.

We would like to update this list with our recently launched WITHWomen suite of apps, available in English, French and Spanish. They can be found at https://maphealth.ca/with-apps/.

It is very hard to recognize the early signs of an unsafe relationship, but when women know their safety status and have access to local resources they are better equipped to take action.

These tools can help women assess safety, rank concerns, and support the creation of a tailored safety plan via connection with local resources across the GTHA. This technology is discreet and easy to use.

For example, the WITHWomen App asks nine questions that screen for a variety of unsafe behaviours. Most importantly, the apps are secure, private and web-based (no download necessary). These apps are available for use on phones, computers, tablets — anywhere you can use the internet. The apps include a quick exit function as a safety feature.

Intimate partner violence is enabled by shame and stigma. Our team created these apps so we can use technology as a tool to keep the conversation going.

L’application WITHWomen aide les femmes à évaluer leur niveau de sécurité

Courrier des lecteurs du Toronto Star, article rédigé par Patricia O’Campo

Chaque conversation publique sur la violence au foyer favorise les conversations privées.

Voilà pourquoi l’équipe du Centre MAP pour des solutions de santé urbaine de l’Hôpital St. Michael’s, un site de Unity Health Toronto, était ravie de lire l’article de Wendy Gillis et d’Alyshah Hasham décrivant différents moyens d’obtenir de l’aide pour les personnes qui ne sont pas en sécurité à la maison.

Nous aimerions ajouter à cette liste notre toute nouvelle série d’applications WITHWomen, disponible en français, en anglais et en espagnol. Ces applications se trouvent au https://maphealth.ca/with-apps/.

Il est très difficile de reconnaître les premiers signes d’une relation dangereuse, mais lorsque les femmes connaissent leur niveau de sécurité et ont accès à des ressources locales, elles sont mieux outillées pour agir.

Ces outils peuvent aider les femmes à évaluer leur niveau de sécurité, à classer leurs préoccupations et à créer un plan de sécurité personnalisé en les mettant en contact avec des ressources locales dans toute la RGTH. Cette technologie est discrète et facile à utiliser.

Par exemple, l’application WITHWomen pose neuf questions qui permettent de détecter divers comportements dangereux. Plus important encore, ce sont des applications sécurisées, privées et accessibles en ligne (aucun téléchargement n’est nécessaire). Elles peuvent être utilisées à partir d’un téléphone, d’un ordinateur, d’une tablette – partout où vous avez accès à Internet. Par souci de sécurité, les applications comprennent une fonction de sortie rapide.

La violence conjugale est alimentée par la honte et la stigmatisation. Notre équipe a créé ces applications pour nous permettre de poursuivre la conversation au moyen de la technologie.

From the Toronto Star

The number of people in Toronto who do not have a family doctor jumped significantly during the first two years of the pandemic, with at least 72,000 losing access to their physician, according to new data that underscores the worsening state of primary care in Ontario.

At least 415,000 Toronto residents lacked a family physician as of March 2022, instead turning to emergency departments and walk-in clinics for their health care.

And while there are residents across the city who don’t have access to a family physician, the latest findings from the INSPIRE Primary Health Care project reveal a pattern of inequity, including a higher proportion of residents with the lowest incomes lacking a doctor compared to those with high incomes.

The data shows that at least 120,700 residents with the lowest incomes don’t have regular access to a family physician, with neighbourhoods located in Toronto’s west end, areas north of the downtown and Scarborough most affected by the discrepancy.

“It’s incredibly concerning to see those who are living in the lowest income brackets are more likely to be without a family physician,” said Dr. Mekalai Kumanan, president of the Ontario College of Family Physicians (OCFP).

“We know that socioeconomic factors like access to food and safe housing drive health outcomes. And when you add to this a lack of access to a physician, this will absolutely negatively impact the health of those individuals.”

The new Toronto data mirrors provincial findings from INSPIRE released earlier this year that revealed more than 2.2 million Ontarians lacked a family doctor as of March 2022 — up from about 1.8 million in March 2020.

Health-care leaders, medical organizations and physician groups have been calling for further investments in primary care and warning that targeted reforms are needed to ensure every Canadian is connected to a family doctor or nurse practitioner.

They caution that a lack of access to primary care not only puts an individual’s health at risk, it also puts additional pressure on an already strained health-care system.

“We need bold reform to get us out of this crisis,” said Dr. Tara Kiran, who leads a national research project called OurCare that is gathering public input on how to reform primary care. According to recent OurCare figures, more than 6.5 million Canadians over the age of 18 — or more than one in five adults — do not have a family doctor or nurse practitioner.

This week, OurCare released a report authored by a panel of 35 “everyday Ontarians” who set out a suite of 23 recommendations to improve Ontario’s primary care system. The panel, randomly selected from more than 1,250 volunteers to represent the demographics of Ontario, with more weight given to equity-seeking groups, spent 39 hours learning about primary care and developing their recommendations.

Kiran, a family physician and scientist at St. Michael’s Hospital, a part of Unity Health Toronto, said the public’s voice has been missing from discussions in primary care reform and that these recommendations provide new directions for government and policymakers.

“These citizens together put forward a vision to change the system so it works for everyone,” she said, noting equity is “a foundational value” in the panel’s recommendations. “They’re thinking not just about themselves, but their families, their communities and the system.”

From CTV

Paper fentanyl test strips are a simple way for people struggling with substance use to determine if fentanyl has been mixed into their drugs, but some advocates say they fail to help the people most at risk of dying from an opioid overdose.

The tests are low-cost and easy to use. Working similarly to a COVID-19 rapid test, a user mixes a very small amount of the drug they want to test with water, and dips the paper test strip into the solution.

“Then you wait for the result so then on your little test strip,” Karen McDonald, head of Toronto’s Drug Checking Service, told CTV’s Your Morning on Tuesday. “One line will present if your drug is positive for fentanyl, two lines will present if your test is negative for fentanyl.”

However, McDonald – who has 15 years of public sector experience, including in health policy – said the tests aren’t beneficial to people who are addicted to opioids and knowingly taking fentanyl. Someone who has no intention of using opioids and detects the presence of fentanyl in their supply of a different drug would likely alter their consumption in response, she said, but these types of contamination cause the minority of opioid overdoses.

For people who intentionally use opioids, knowing their drugs contain fentanyl is a very small piece of the harm-reduction puzzle.

“For over five years now, fentanyl has really saturated the unregulated opioid supply and is really the opioid of choice for most folks using opioids at this point,” McDonald said. “So, simply knowing if there is fentanyl in their fentanyl doesn’t really add value for folks.”