Author: Samira Prasad

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Story by Alyssa Ranieri, Outreach Counsellor with the Navigator Project

I met Mike (not his real name) this past April. He’s in his 30s and lives with schizophrenia, anxiety, fetal alcohol syndrome and PTSD. It’s a lot to carry. I first met him at St. Michael’s Hospital, where he was admitted with an acute illness. He was homeless at the time.

I work in the hospital’s Navigator Program. I am a Homeless Outreach Counsellor, which means I work with patients who are homeless and who have a serious health condition requiring care in the hospital. My job is to make the healthcare experience easier and more comfortable while patients are in hospital, and afterward to help them access healthcare and other services in the community so they can avoid another hospitalization.

I arranged to meet Mike at a shelter shortly after he was discharged. We try to work with people where they are, whether on the street or in shelters. I wish more programs did this. It can be so difficult just to manage basic survival needs when you’re homeless – so we make this part easier. The people we work with don’t do well if they have to show up in an office at exactly the right time. They also often feel stigmatized in traditional healthcare settings and may have experienced discrimination in the past.

When I got to the shelter, Mike wasn’t there. I went to the pharmacy that he had told me he used regularly. He was surprised to see me. I think it convinced him that I really was on his side.

Over the next few months, Mike and I did a lot of work together. When we first met, he was in a bad cycle. People with fetal alcohol syndrome can be an easy target for bullies and thieves. He was using drugs to cope with the stress of being on the street. Then the drugs would make him paranoid and he’d end up in hospital.

Our goal was to break the cycle.

We found him somewhere to live – first in a shelter, then in a rooming house. His drug use was putting him at high risk of an overdose, so we helped him get into a new harm reduction program called Safer Opioid Supply. It’s a mobile team that includes physicians, nurses, nurse practitioners and case workers who visit people who use street drugs; the team administers a weekly supply of safe opioids. And we talked, a lot, as I tried to help him build the confidence he would need to try to overcome the hurdles standing between him and a healthier, safer future. Through all this, I was always impressed by Mike’s courage and resiliency.

I completed my time working with Mike in October, as the Navigator Program is intended to make a difference in people’s lives over a time-limited period. Over the course of several months, Mike made a lot of changes. He got settled in housing. He has supports. He’s safer and, I think, less anxious. He knows there are people who care about him.

The last time I saw Mike, he told me how grateful he was. He said he was really going to miss me. Thousands of people in Canada, just like Mike, need this kind of helping hand to improve their health. I’m doing my best to reach as many as I can.

Mike et moi : surmonter les obstacles à l’accès aux soins de santé

Récit d’Alyssa Ranieri, conseillère communautaire du Projet Navigateur

J’ai fait la connaissance de Mike (nom fictif) en avril dernier. Il a une trentaine d’années et souffre de schizophrénie, d’anxiété, du syndrome d’alcoolisation fœtale et du syndrome de stress post-traumatique. C’est beaucoup de choses à supporter. Je l’ai rencontré pour la première fois à l’Hôpital St. Michael, où il avait été admis pour une courte maladie. Il était alors sans domicile fixe.

Je travaille au sein du programme Navigateur de l’hôpital. Je suis conseillère auprès des sans-abri, ce qui signifie que je travaille avec des patients qui sont sans domicile fixe et qui ont un problème de santé grave nécessitant des soins hospitaliers. Mon travail consiste à rendre l’expérience des soins de santé plus facile et plus confortable pendant que les patients sont hospitalisés et, par la suite, à les aider à accéder aux soins de santé et à d’autres services au sein de la collectivité afin qu’ils puissent éviter une nouvelle hospitalisation.

J’ai organisé une rencontre avec Mike dans un refuge peu après sa sortie de l’hôpital. Nous essayons de travailler avec les gens là où ils se trouvent, que ce soit dans la rue ou dans les centres d’hébergement. J’aimerais que davantage de programmes fonctionnent de la sorte. Il peut être très difficile de répondre aux besoins de base des personnes sans abri; c’est pourquoi nous rendons cette tâche plus facile. Les personnes avec lesquelles nous travaillons ne sont pas très à l’aise lorsqu’elles doivent se présenter dans un bureau à un moment précis. Elles se sentent également souvent stigmatisées dans les environnements de soins traditionnels et elles peuvent avoir été victimes de discrimination dans le passé.

From Healthy Debate

There is no doubt primary care plays a vital role in reducing health inequities. Health systems with strong primary care have been shown in multiple studies to lower both the absolute numbers and the gap between people with low and high incomes when it comes to neonatal mortality, babies with low birth weight and deaths from cancer, stroke, heart and lung disease, while increasing life expectancy at the population level.

Even though health care in Canada is publicly funded, individuals with low incomes too often face barriers when it comes to accessing health-care services, which can adversely impact their overall health. For instance, the life expectancy in Montreal’s poorest neighbourhoods is 10 years shorter than in the richest ones, due to an interplay of unfavourable health determinants, including access barriers to primary-care services that are influenced by cultural, economic and educational factors. For example, recent data from Ontario found that people living in the poorest neighborhoods were the least likely to have a regular family doctor. The COVID-19 pandemic illustrated how low income – and other social determinants of health – coalesced with poor access to services; together these were associated with communities having higher numbers of COVID-19 cases, hospitalizations and deaths.

At the same time, the COVID-19 pandemic has significantly accelerated the adoption of virtual care in Canada, leading to major investments by the federal government and the emergence of multiple privately operated virtual-only services, some of which are not part of the publicly funded system.

But income plays a significant role in virtual care adoption and interest.

According to the OurCare survey, 69 per cent of individuals with an income of $150,000 or more say that they are not at all or not very willing to use virtual services that charge fees for services they could obtain for free through regular doctor or nurse practitioner visits. In comparison, 88 per cent of those with an income less than $20,000 say the same. If improperly regulated, the development of new private-pay virtual care services could potentially exacerbate existing disparities in access to care.

From CTV News

Overall health-care costs could be reduced in Canada by providing free prescription drugs to patients, according to a new study.

Led by a researcher from the University of Toronto’s medical school, the three-year study aimed to see how eliminating out-of-pocket medication fees would impact health-care system spending, particularly for patients who reported delaying or not taking prescription drugs due to costs.

“There are millions of Canadians who report not taking medications because of the costs,” lead author and University of Toronto associate professor Dr. Nav Persaud told CTVNews.ca. “We were trying to measure the effects of providing people with free access to medicines, as would happen in a national pharmacare program.”

The study tracked 786 adult patients at nine primary care sites in Ontario who were taking 128 different essential medicines that covered everything from diabetes to depression. In addition to prescriptions, total health-care cost calculations included emergency room trips, hospitalizations, home care, and visits with doctors and specialists.

From CBC News

Manitoba researchers looking for people to take part in a national HIV Stigma Index project are only about halfway to their goal of hearing from at least 75 people living with a positive diagnosis.

The international peer-driven research project helps understand the stigma associated with HIV and supports those living with a diagnosis.

“I wouldn’t say that anybody ran out and said ‘I’m gonna go get HIV today and see how that happens.’ Things happen to people and it’s our duty as human beings to support people no matter what they’re going through,” research co-ordinator Arthur Miller told CBC Information Radio Wednesday.

The Canadian HIV Stigma Index is a community-led and community-based research study, part of the international implementation of the People Living with HIV Stigma Index project

Participants are interviewed by another person living with a positive diagnosis. Interviews are about an hour-and-a-half long and can be done in person, by phone or through a video conferencing platform, said Miller, a Mi’kmaw HIV activist based out of Nova Scotia and research co-ordinator of the project with REACH Nexus, under the MAP Centre for Urban Health Solutions at Unity Health Toronto.

The national project has been done in Ontario, Quebec, Atlantic Canada and British Columbia, and this is the second time it’s being done in Manitoba, with an updated survey.

Researchers collect information related to stigma, discrimination and human rights, with the aim of better understanding the social determinants and stigma across systems like health care, schools and legal fields. The research aims to help people develop supports and policies at both local and national levels.

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From CBC News

Results from an experimental program that provides free prescription drugs to hundreds of people in Ontario suggest covering the cost of medication produces overall savings for the health-care system, according to a new study.

The research, published Friday in the journal JAMA Health Forum, tracked a total of 747 patients who reported that the high cost of drugs has forced them to leave prescriptions unfilled or stretch out the time between doses. About half were randomly selected to have their drugs fully covered.

After three years, the researchers found that providing prescriptions free of charge to these patients saved the public health-care system an average of $1,488 per patient per year, by helping to prevent such things as unexpected trips to the hospital.

“I was surprised by the magnitude of the savings,” said Dr. Nav Persaud, one of the study’s authors, a Canada Research Chair in Health Justice and a staff physician at St. Michael’s Hospital in Toronto.

“It seems like eliminating medication costs both saves money in avoided hospitalizations, avoided emergency room visits, makes people healthier and addresses health inequities — it makes access to health more fair.”

The study comes as Canadians wait to see if legislation enabling a universal pharmacare plan will be tabled by the end of 2023, as promised under the confidence-and-supply agreement between the federal Liberals and New Democrats. 

Une nouvelle étude suggère que la gratuité des médicaments permet de réaliser des économies globales en matière de soins de santé dans le cadre d’un essai mené en Ontario

Tiré de CBC News

Les conclusions d’un programme expérimental qui fournit gratuitement des médicaments sur ordonnance à des centaines de personnes en Ontario suggèrent que la prise en charge du coût des médicaments permet de réaliser des économies globales pour le système de santé, selon une nouvelle étude.

La recherche, publiée vendredi dans la revue JAMA Health Forum, portait sur 747 patients qui ont déclaré que le coût élevé des médicaments les avait contraints à ne pas renouveler leurs ordonnances ou à espacer les prises. Environ la moitié d’entre eux ont été sélectionnés au hasard et ils ont vu leurs médicaments entièrement pris en charge.

Après trois ans, les chercheurs ont constaté que le fait de fournir gratuitement des ordonnances à ces patients permettait au système de santé public d’économiser en moyenne 1 488 $ par patient et par an, notamment en évitant des déplacements imprévus à l’hôpital.

« J’ai été surpris par l’ampleur des économies réalisées », a déclaré le D^r Nav Persaud, l’un des auteurs de l’étude, titulaire d’une chaire de recherche du Canada sur la justice en santé et médecin à l’Hôpital St. Michael de Toronto.

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.