Author: Samira Prasad

From U of T EPIC

Researchers from the University of Toronto and Nigerian Institute of Medical Research have received $3 million from the federal government to launch an international project that will help inform the clinical and public health response to local and global epidemic of mpox (formerly known as monkeypox).

The new funding from the Canadian Institutes of Health Research (CIHR) and International Development Research Centre builds on the collaborative projects and seed funding from the mpox rapid research response launched by the Emerging and Pandemic Infections Consortium (EPIC) earlier this year.

The Canada-Africa Mpox Partnership (CAMP) brings together 68 researchers with multidisciplinary expertise from Canada, Nigeria, the U.S. and U.K. It is co-led by Darrell Tan, an associate professor in the Temerty Faculty of Medicine and infectious disease physician at St. Michael’s Hospital, a site of Unity Health Toronto, and Rosemary Audu, director of research and head of the microbiology department at the Nigerian Institute of Medical Research. Tan is also the operational co-lead of EPIC’s mpox rapid response efforts.

“Our team is honoured to receive this funding to study this previously overlooked infectious disease, and is excited to launch this work,” said Tan.

“Mpox has caused tremendous suffering, stigma and other harms in Canada and worldwide, most notably among gay, bisexual and other men who have sex with men during the 2022 outbreak. The initial support from EPIC was instrumental in allowing us to launch our research within days of the epidemic arriving in Canada and was pivotal to our securing this large grant.”

The CAMP project focuses on three main topics across diverse epidemiological, geo-social, and health system contexts: mpox transmission, treatment and vaccines.

In the first sub-project, the Mpox Prospective Observational Cohort Study, CAMP researchers are working to understand transmission from multiple angles. This will include looking at how the virus is spread between humans, including those who are asymptomatic or presymptomatic, between humans and animals, and from contaminated surfaces. A key component of this work involves mathematical modelling to study how factors like differences in size and features of sexual and social networks, health care access and vaccines might shape the differences in outbreak dynamics across regions within each country, and differences in outbreaks between the two countries.

For the second sub-project, the team is conducting a randomized controlled trial to assess the safety and effectiveness of the smallpox drug tecovirimat as a treatment for mpox. Currently, no drugs have been directly tested and shown to be effective against mpox in humans. By using the same design and measuring the same outcomes as similar trials in other countries, this trial, which also received funding support from the Public Health Agency of Canada and CIHR Canadian HIV Trials Network, will contribute to global data on the efficacy of tecovirimat.

Similar to the lack of human efficacy data on mpox treatments, there is also a need for high quality data on the safety and effectiveness of the smallpox vaccine Imvamune that is currently being offered to individuals at high-risk to protect against mpox. The last sub-project focuses on evaluating the role of the Imvamune vaccine to prevent mpox infection in humans. The team is using observational data to determine the vaccine’s safety and effectiveness, including how the effectiveness changes based on the number and timing of doses, amount of time since vaccination and patient subgroup.

From The Catholic Register

As Canada’s largest city panics over a series of random stranger attacks, there is sudden media and political attention on Toronto’s exploding homeless population, especially the homeless who appear to be addicted or mentally ill.

“I have no doubt that these incidents have been taking place, but I think they are being over-reported,” Common Table volunteer Paul Pynchoski told The Catholic Register. “Certain aspects of them are repeated over and over again.”

The Common Table at Redeemer Anglican Church in downtown Toronto functions as a kind of community centre for Toronto’s homeless, providing meals, nursing, a book club, art and craft activities and a warm place to sit and talk.

Whether or not the attackers in nine headline-grabbing instances of stranger violence since Dec. 8 are homeless, or mentally ill, or addicted is mostly unknown. In one of the highest-profile cases, a homeless man, Ken Lee, was killed in an alleged swarming attack by eight teenaged girls between the ages of 13 and 16.

Media focus on the homeless, mentally ill and addicted has been everywhere.

“Are Toronto’s attacks linked to homelessness? Not necessarily,” Toronto Star columnist Bruce Arthur wrote in his Jan. 29 take on the situation. “But we know Toronto closed three of its 23 shelter hotels late in 2022 and plans to close five more in 2023; the pandemic increase in funding that accounts for 30 per cent of shelter beds has dried up.”

On Jan. 28, Toronto Sun columnist Warren Kinsella called Toronto “a scene out of Stanley Kubrick’s dystopian Clockwork Orange” and blamed the deinstitutionalization of the mentally ill.

“We have jettisoned the moral duty we owe those fellow citizens who desperately need psychiatric help. People who were protected, and helped, in psychiatric hospitals,” Kinsell wrote. “We’ve dropped them into the back alleys.”

A dangerous increase in the toxicity of street drugs gets the blame in a Jan. 27 Globe and Mail column by Gary Mason, headlined “Random acts of violence? Better get used to it.”

Toronto Mayor John Tory has dispatched 80 more police officers to patrol the transit system. He has called for a national conference on the issue and told CP24 Breakfast he’s “not timid” about drawing connections between mental health and violence in public places. 

Tory’s plan also adds security guards and “Community Safety Ambassadors” working in the TTC system who are directed to deal with the city’s homeless population.

The mayor is pushing to add $48.3 million to Toronto’s police budget to cover about 200 more officers and programs addressing youth violence. The actual link between mental illness, homelessness and violence may not be so straightforward, pointed out psychiatrist Jack Haggarty. People suffering psychosis are at times a risk to others, he said.

“But they actually die from other causes 15 years earlier than the average person, and they have a higher risk of actually being victimized by others,” Haggarty told The Catholic Register.

Their treatment at the hands of others, their vulnerability to physical ailments and the risk of suicide make the mentally ill on the street vulnerable. A media picture of the homeless as a threat to the rest of us bothers Pynchoski, who leads a book club for the homeless.

“I don’t think the media is intentionally doing this, but I think we’re being pushed toward, ‘Oh God, we have to get tough on crime,’” he said. “It’s not a response of ‘What are the needs that are not being met here?’ We want to deal with the symptoms but we never want to deal with the problem.”

Just before the drumbeat of violent incidents grabbed the spotlight, Toronto’s Catholic hospital system put out a note to the city about how they’re dealing with the problem of Toronto’s 8,000 to 10,000 homeless people.

“We are seeing an increasing number of people with cold-related injuries. Routinely, we care for people who are homeless and suffering direct complications of cold weather: hypothermia, frostbite, swelling and infections, and exacerbation of pre-existing conditions,” said the Jan. 17 note on the Unity Health website. “We also see patients who require medical assistance because of the strategies used to survive outside in unpredictable weather. These include injuries from sleeping in unsafe areas or overdoses from substance use. We are also seeing many unhoused patients coming into our emergency departments simply looking for a space to shelter.”

Hospitals can’t solve Toronto’s homelessness problem, said St. Michael’s Hospital research scientist Dr. Stephen Hwang, an internationally renowned expert on health and homelessness.

“There’s no sense in which the health care system, or hospitals, can solve homelessness,” he told The Catholic Register. 

“What we’re seeing is that the failures and gaps in our system are causing people to end up on the doorstep of our hospitals. Hospitals are simply the place of last resort for many people.”

Looking at a problem that has spread and deepened decade after decade since the 1980s, Hwang does not believe Toronto or Canada should just resign itself to the inevitability of tent cities, people in sleeping bags on city streets, open drug use on the subway and thousands in the shelter system with no way out.

“This is a problem that is definitely solvable. We didn’t get into this situation in months, or just 15 years,” said Hwang. “It’s been a problem that’s been building for a long time. It’s going to take us a while to turn this ship around, but it is possible to do so.”

Hwang’s prescription for a solution begins with an honest look at the problem. Even if many homeless people are obviously mentally ill or addicted or both, homelessness is not primarily a mental health issue, he said.

From Unity Health Toronto

Clinical trial led by University of Alberta and Unity Health Toronto paves way for approval

Federal regulators have approved the licensure of an all-in-one rapid device that allows Canadians to simultaneously be tested for HIV and syphilis. Canada is the first country to approve and implement a dual-target device in North America that can produce results in as little as 60 seconds.

The approval was made possible, in part, by the results of a two-year clinical trial led by researchers at the University of Alberta and St. Michael’s Hospital, a site of Unity Health Toronto. The results were included as part of the device manufacturer’s submission to Health Canada and were necessary for the regulators’ review and approval.

A recent report by the Public Health Agency of Canada showed spiking rates of syphilis in the country, primarily among young women. From 2017 to 2021, rates of syphilis among females increased by 729 per cent, compared with 96 per cent among males. Syphilis infection can increase the risk of HIV acquisition and transmission, and co-infection creates a high risk of neurological problems. Cases of congenital syphilis – which is present at birth – are at crisis levels for young mothers, particularly those from persons of First Nations ethnicity. Ninety-six cases of congenital syphilis were reported in 2021, compared with seven cases in 2017.

“We need urgent actions to mobilize testing, treatment and connections to care for syphilis and HIV that are culturally appropriate, and that can reach and meet people where they are. They won’t come to us because the health and public health system has failed them – we need to go to them,” says Dr. Sean B. Rourke, a scientist at MAP Centre for Urban Health Solutions, a world-leading research centre housed at St. Michael’s Hospital, and the Director of REACH Nexus, a national research group working on how to address access and treatment for HIV, Hepatitis C and other sexually transmitted and blood-borne infections.

Rourke spearheaded the cross-Canada clinical trial which evaluated and proved the accuracy of HIV-self tests. Health Canada approved the tests for use in November 2020 based on the results of the trial.

The Point of care Tests for Syphilis and HIV (PoSH) Study launched in August 2020 and analyzed two different test devices among over 1,500 participants in clinical settings in Edmonton and northern Alberta. The study found both devices to be 100 per cent accurate in identifying HIV infection, and more than 98 per cent accurate in detecting active syphilis. Both test kits provide a test result in under five minutes using a fingerstick blood specimen.

Among the study participants, 24 tested positive for HIV on both devices and were confirmed by a lab test – four of those were new diagnoses. Acting on the device’s instantaneous nature, connecting participants to care and early treatment was a key priority of the study. Of the 20 people previously diagnosed with HIV, nine were on antiretroviral therapy, and all 24 participants were linked or relinked to care. There were 202 cases of infectious syphilis and the majority (87.4 per cent) were treated immediately following point of care test positive results. An additional 32 of 34 (94.1 per cent) participants with infectious syphilis who did not receive treatment at the test visit were treated within a median of four days.

“These extremely rapid point of care tests for the diagnosis of syphilis and HIV are much needed and a game changer for Canada. We were able to save costs associated with an additional clinic visit, reducing the number of cases lost to follow up, and prevent ongoing disease transmission,” says Dr. Ameeta Singh, the study’s principal investigator and an infectious disease physician with the University of Alberta.

Health Canada is approving the INSTI® Multiplex HIV-1/2 Syphilis Antibody Test, which is manufactured by bioLytical Laboratories Inc. in British Columbia. To do the test, a health provider obtains a fingerstick blood specimen, places a single drop of blood with the materials provided in the kit, follows the simple procedure instructions provided in the package, and reads the result in as little as one minute. The health provider can then offer treatment or linkage to care based on the test result. In February 2023, a dual-target device that produces results in 15 minutes was approved in the United States.

The study was jointly funded by Canadian Institutes of Health Research (CIHR) Centre for REACH Nexus at MAP St. Michael’s Hospital, Canadian Foundation for AIDS Research (CANFAR), Indigenous Services Canada, Alberta Health and Alberta Health Services.

About St. Michael’s Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in more than 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the Hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael’s Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.

About Unity Health Toronto

Unity Health Toronto, comprised of Providence Healthcare, St. Joseph’s Health Centre and St. Michael’s Hospital, works to advance the health of everyone in our urban communities and beyond. Our health network serves patients, residents and clients across the full spectrum of care, spanning primary care, secondary community care, tertiary and quaternary care services to post-acute through rehabilitation, palliative care and long-term care, while investing in world-class research and education. For more information, visit www.unityhealth.to.

About the University of Alberta

The University of Alberta in Edmonton is one of the top teaching and research universities in Canada, with an international reputation for excellence across the humanities, sciences, creative arts, business, engineering and health sciences. The university and its people remain dedicated to the promise made in 1908 by founding president Henry Marshall Tory that knowledge shall be used for “uplifting the whole people.” www.ualberta.ca

From the Toronto Star article

More than three homeless Torontonians died every week last year, new public health data shows — a total of 187 lives lost while battling with housing precarity in Canada’s largest city.

Lives were taken by cancers and cardiovascular diseases, by pneumonia and accidents. More than anything, people died because of toxic drug supply — identified as the cause of 47 per cent of the deaths among the homeless population that were known to public health in 2022.

The new numbers underscore a grim reality — that, if you are homeless in Toronto, your life expectancy is decades less than the general population. For men, Toronto Public Health found the median age of deaths among people facing homelessness last year was 55 years of age, versus 79 years in the overall city population. For women, the median age of deaths amid housing precarity was just 42 years old, versus an overall life expectancy citywide of 84.

And at least three of the deaths last year were people age 19 or younger, the data shows. “The idea that people are dying without housing as teenagers, I think it speaks to structural failures, systemic failures,” said Greg Cook, an outreach worker with Sanctuary Toronto. “For someone to die a preventable death as a teenager I think is really, really unjust — it’s not just tragic.”

Overall, he sees the death toll as evidence of a crisis that has mounted for years, as Toronto’s homeless population has soared to more than 10,800 people. “Everybody should be able to have housing that they feel secure and safe in, and that’s obviously not the case,” he said.

The worst year for homeless deaths in recent memory was 2021, when Toronto set a despairing record of 223 deaths, or more than four a week. While last year had slightly fewer, the toll is still worse than it was in the recent past, with 144 deaths in 2020, 128 in 2019 and 94 in 2018.

With far more deaths owing to overdoses than any other single cause, Cook urged all levels of government to adopt more urgency on addressing the city’s toxic street drug supply. Toronto’s drug checking service, which measures the contents of illicit substances, has warned that almost all their recent samples of fentanyl are mixed with other highly potent opioids like carfentanil as well as benzodiazepine-related drugs.

Harm reduction advocate Zoe Dodd said current responses to Toronto’s drug toxicity have felt like “a patchwork,” and urged mandatory training on prevention and responses in homeless service settings. “It’s devastating, because death brings more death, and grief brings more grief.”

Op-ed in The Globe and Mail by Dr. Sloane Freeman

The OurCare national research survey estimates that 6.5 million Canadians over the age of 18 lack a primary-care physician, and a significant number of these people are parents with newborns.

Without a primary-care provider, newborns are especially vulnerable to falling through the cracks within our health care system. This is an even greater problem for newcomer families and those who are not familiar with navigating the Canadian health system.

Newborns require multiple doctor visits in the first days and weeks of life to monitor feeding, weight gain and possible jaundice. Babies born prematurely or with a low birth weight need even closer surveillance. Without close monitoring and follow-up babies are at risk of dehydration, jaundice, serious infections and unrecognized congenital health problems.

Many parents bring their newborns to emergency departments and urgent-care centres because they have nowhere else to turn. Some provinces have set up mobile clinics for newborns who don’t have a family doctor.

As hospital-based pediatricians in the downtown core, my colleagues and I ask every parent of a newborn if they have access to a primary-care doctor for their child. Most of the time the answer is a resounding “No.” Even for parents who do have primary-care providers for their newborns, long travel times and challenges in scheduling appointments make it difficult for them to access care within the first few days of life.

This crisis was heightened during the pandemic, when in-person health care access was restricted. Virtual care falls short for newborns who require physical examinations and weight checks to assess hydration status and growth. Another important consideration is that routine immunizations begin at two months of age, leaving little time for families to secure a primary-care provider for their infants to begin vaccinations.

Lire cet article en français

Op-ed in the Toronto Star by Vicky Stergiopolous and Stephen Hwang

Riding transit to work or school shouldn’t be a scary proposition, but that’s unfortunately the daily reality for far too many who take transit as a daily necessity.

This is not an issue of a subway station, or any other public space, being inherently unsafe. The issues that are plaguing our society are migrating onto the TTC. Violent incidents don’t occur in a vacuum.

The leading factors that increase the risk of violent behaviour are trauma, victimization and abuse. Inadequate income, loss of employment and lack of access to basic necessities, such as housing and food, are also key predictors. When coupled with substance use or certain mental health conditions, these stressors increase the likelihood that an individual will commit acts of violence.

Underfunding of social services, abdication of mental health supports and housing by senior levels of government, lack of supports for people who use drugs, and trauma from the pandemic are just some of the root causes that have led to the behaviours we are witnessing.

Research shows that communities that provide early years programs, supports for at-risk youth, job training and employment, and decent affordable housing as well as other measures that address the social determinants of health have lower crime rates. But you don’t need a PhD to know that people who have access to opportunities and are thriving and connected to their communities are less likely to commit a violent crime. Ensuring that our most vulnerable are safe will make everyone safer.

Il faut revoir l’intervention en cas de crise au sein de la Commission de transport de Toronto (TTC)

Article d’opinion du Toronto Star par Vicky Stergiopolous et Stephen Hwang

Prendre les transports en commun pour se rendre au travail ou à l’école ne devrait pas être une démarche angoissante; c’est pourtant la réalité quotidienne d’un trop grand nombre de personnes pour qui les transports en commun sont une nécessité quotidienne.

La question n’est pas de savoir si une station de métro ou tout autre espace public sont fondamentalement dangereux. Les problèmes qui affligent notre société se répercutent sur la TTC. Les incidents violents ne surviennent pas en vase clos.

Les principaux facteurs qui augmentent le risque de comportement violent sont les traumatismes, la victimisation et les sévices. L’insuffisance des revenus, la perte d’emploi et le manque d’accès aux produits de première nécessité, comme le logement et la nourriture, sont également des facteurs prédictifs importants. Lorsqu’ils sont associés à l’utilisation de substances ou à certains troubles mentaux, ces facteurs de stress augmentent la probabilité qu’une personne commette des actes violents.

Le sous-financement des services sociaux, le renoncement aux aides à la santé mentale et au logement de la part des ordres supérieurs de gouvernement, le manque de soutien aux personnes qui utilisent des drogues et les traumatismes causés par la pandémie ne sont que quelques-unes des causes profondes qui ont provoqué les comportements dont nous sommes témoins.

La recherche révèle que les collectivités qui proposent des programmes pour la petite enfance, des aides aux jeunes à risque, des formations professionnelles et des emplois, des logements décents et abordables, ainsi que d’autres mesures portant sur les déterminants sociaux de la santé ont des taux de criminalité plus faibles. Mais nul besoin de posséder un doctorat pour savoir que les personnes qui ont accès à des avantages, qui s’épanouissent et qui sont impliquées dans leur collectivité sont moins susceptibles de commettre des crimes violents. En garantissant la sécurité des personnes les plus vulnérables, nous assurerons la sécurité de tous.

From the Toronto Star

On Tuesday, British Columbia will begin a three-year decriminalization experiment, allowing drug users 18 and over to carry a up to 2.5 grams of opioids, such as heroin and fentanyl, as well as cocaine, methamphetamine and MDMA.

It’s an experiment that’s likely to influence drug policy across Canada.

The approach is a “monumental shift” in drug policy, says Carolyn Bennett, the federal minister of mental health and addictions, adding that it’s meant to foster “trusting and supportive relationships” rather than criminalization.

“Through this exemption we will be able to reduce the stigma, the fear and shame that keep people who use drugs silent about their use,” she told a Vancouver news conference Monday.

“And help more people access life-saving supports and treatment.”

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Daniel Werb, director at the Toronto-based Centre on Drug Policy Evaluation, which helped the city with its initial request, said Health Canada appears to be “slow-walking” decriminalization in Toronto.

“My opinion is that the decision on Toronto is going to be based on whether what happens in B.C. appears, politically, to make sense,” Werb said in an interview.

The caution amid a deadly overdose epidemic is rooted, said the addictions researcher at Unity Health, in the stigmatization of drug users over a century of criminalization.

“I think it’s symptomatic of a society wide issue, which is that people don’t really care whether other people are dying of overdoses,” he said.

From the Toronto Star’s This Matter’s podcast

Guest: Dr. Sean B. Rourke, neuropsychologist at St. Michael’s Hospital

Smart vending machines have launched on Canada’s East coast. They’re the first of what will be 100 nationwide. But instead of dispensing chocolate or candy, these machines hold life-saving supplies like HIV tests, naloxone kits and unused needles. They’re called Our Healthbox and they’re designed to reach communities underserved by traditional health care. Today, we’re joined by Dr. Sean Rourke, a clinical neuropsychologist and scientist with MAP Centre for Urban Health Solutions at St. Michael’s Hospital, who is leading the initiative. You can learn more about OurHealthbox and whether your community is eligible for a Healthbox here.

CBC’s White Coat Black Art podcast

Having the option to speak with her doctor over the phone for basic check-ins and requests has freed up Shawna Ford’s energy for tasks she’d prefer doing.

“Normally, to go into the city, I don’t do anything the day before. I don’t do anything a few days after because it totally drains me. So having those phone appointments is amazing,” the Alberta woman, 62, told White Coat, Black Art.

“The Zoom appointments with a psychiatrist have also just freed up so much of my energy that I can use, you know, on things that I want to do,” she added. “Functional energy, I guess.”

Ford, who has diagnoses of major depressive disorder and myalgic encephalomyelitis, the latter causing extreme fatigue, still visits her doctor in person when necessary. But the pandemic-driven shift toward virtual health care has opened doors that Ford says she doesn’t want to see closed — and she’s not alone in raising concerns about access to quality virtual health care.

While British Columbia and Alberta have embraced access to virtual health care, Ontario and Manitoba have scaled back funding for services not paired with in-person doctor visits. 

“I don’t think the system has their finger on the pulse of what patients need and want, because if it did, we wouldn’t be in this predicament,” said Dr. Aviva Lowe, a Toronto-based pediatrician and lactation consultant.

‘Two classes of Ontarians’

Until December, when a new billing framework came into effect in Ontario and lowered what health-care professionals can get paid for some virtual appointments, Lowe saw patients on KixCare, a virtual, app-based health-care service for children and teens. KixCare, Lowe argues, offers a way to address health inequities by making doctors more accessible for those without a family physician or pediatrician.

“These changes have really created two classes of Ontarians when it comes to accessing virtual care,” Lowe told White Coat, Black Art host Dr. Brian Goldman.

“By that I mean there’s the group of patients who can continue to access it, and those are patients who can access it with their own doctor or with a consultation to another doctor.”

The other group are those without a regular family doctor who may now be limited in accessing health care virtually, she said.

Changes to provincial billing schemes

When the pandemic began, doctors across the country rapidly shifted their practices to phone and video calls, rather than in-person appointments. 

For many patients, it was a welcome change. A recent Western University study found that the shift reduced barriers to accessing care, particularly for people who rely on public transit, and others who may be unable to take time off work.

Governments across the country quickly implemented emergency billing codes for virtual appointments — often paid at parity with in-person appointments. 

But when the Ontario government introduced permanent billing codes for virtual appointments last year, rates paid to doctors for virtual appointments dropped in some circumstances, leading to outcry from providers.

In Ontario, doctors with an ongoing relationship to their patient — a family physician who provides regular, follow-up care, for example — can bill virtual appointments at the same rate as in-person ones, provided they see the patient in-person once every 24 months.

For services where doctors have a one-off interaction with a patient — as is the case with some virtual “walk-in” services, like Lowe’s KixCare — the rate is much lower: $15 for a phone call, or $20 when it’s over video, compared to $67 or more previously.

“I would conduct a thorough, comprehensive assessment for whatever the matter would be, which would include taking a detailed history, physical examination through a virtual platform,” said Lowe.

“It’s different than in person but, in pediatrics, observation and interaction can give us a lot of important information as to how well or how unwell a child is.”

She added that the “vast majority” of patients did not require a follow-up appointment, and she rarely referred patients to an emergency department.

Since the changes to Ontario’s doctors billing schedule came into effect, KixCare has stopped offering publicly funded appointments and instead are promoting a $29 per month subscription to access its services.

Virtual walk-in services double ER visits: study

An Ontario-based study published last month in the Canadian Medical Association Journal reported that even though in-person appointments with primary-care physicians dropped by 79 per cent in the first year of the pandemic, visits to hospital ERs did not increase due to an increase in virtual appointments.

“We did not find evidence that enrolled patients substituted emergency department visits because of less availability of in-person care,” the study’s authors wrote.

However, a separate study published in the Journal of Medical Internet Research (JMIR) — also published last month and based in Ontario — found that patients who used virtual walk-in services for one-time appointments were twice as likely to visit an ER.

Dr. Tara Kiran, a family doctor and researcher at St. Michael’s Hospital in Toronto, says while virtual appointments are convenient, having a long-term relationship with your doctor can improve survival rates while reducing costs on the health-care system. Kiran, who is also Fidani Chair in Improvement and Innovation at the University of Toronto, was a co-author of the JMIR study.

“Virtual care has its place … but I think the place in an ideal world is within a continuous relationship with the family doctor,” she said.

“That, of course, gets us to the point that many people don’t have a family doctor, nurse practitioner or a primary care team, and we need to address that.”

Op-ed in The Globe and Mail by Dr. Tara Kiran

Access to health care should be based on need and not on one’s ability to pay. Time and again, people in Canada have reaffirmed this as a fundamental value we share.

But, as it stands, too many people don’t have access to care when they need it – especially from a family doctor. This needs to be top of mind for our elected leaders when they meet this week to discuss the future of health care funding.

This past fall, a team of researchers heard from more than 9,000 adults in Canada who responded to the OurCare national research survey about their experiences with family doctor care and what they want to see in a better system. The survey was the first phase of OurCare, a 15-month initiative to engage the public about the future of family physician care in Canada.

More than one in five people reported not having a family doctor or nurse practitioner who they can talk to when they need care or advice about their health. Extrapolated to the population of Canada, that’s more than 6.5 million people aged 18 and over who don’t have access to a family physician.

Family doctors are the gateway to the health care system. We are the first point of contact when something is wrong, we provide care for ongoing illnesses, and prevent problems from developing in the first place. When people don’t have a family doctor, everything else falls apart: Emergency departments become crowded, there are more missed or delayed diagnoses, more illnesses and immense frustration.

The problem is worse for some than others. In our survey, greater numbers of men, people with a low income and people who are racialized reported not having a family doctor. Some of the biggest differences in access to care were by region, with more than 30 per cent of respondents in Quebec and the Atlantic provinces reporting not having a family doctor, compared to 13 per cent in Ontario.