Bonnie O'Sullivan

Canada’s primary care transformation slow, fragmented: Study

Christopher.Sorensen — Wed, 29 Nov 2023 16:36:16 +0000

Canada’s primary care transformation slow, fragmented: Study

Christopher.Sorensen Wed, 11/29/2023 - 11:36

Cutline

A decade-long study that assessed changes in primary care delivery across 13 Canadian jurisdictions found that progress was slow and limited (photo by Cavan Images/Getty Images)

Bonnie O'Sullivan

Topic

Breaking Research

Dalla Lana School of Public Health

Subheadline

The study is the first to compare and evaluate primary care transformation across all of Canada’s provinces and territories

Canada’s primary care system is falling short of high-performance standards despite significant investments to transform the sector, according to a study led by Monica Aggarwal, assistant professor at the University of Toronto’s Dalla Lana School of Public Health.

In a 10-year review of Canada’s primary care performance published in The Milbank Quarterly, the researchers found that Canada lags behind when it comes to providing timely access to doctors and care, developing inter-professional teams and communication across health care settings.

These standards are crucial to improving health outcomes and health equity, lowering mortality rates, and reducing costs, say the researchers, who include Professor G. Ross Baker of Dalla Lana’s Institute of Health Policy, Management and Evaluation (IHPME), research assistant Reham Abdelhalim and Professor Brian Hutchison of McMaster University – with support and input from Professor Rick Glazier of Dalla Lana and the department of family and community medicine at the Temerty Faculty of Medicine.

Monica Aggarwal (supplied image)

“The study found that Canada’s primary care transformation has been slow, piecemeal and incremental, with limited changes to the overall organization and delivery of primary care,” says Aggarwal.

The study, which examined policy changes from 2012 to 2021, is the first to compare and evaluate primary care transformation across all of Canada’s provinces and territories.

The researchers conducted qualitative interviews with experts in each jurisdiction and a literature review of each region’s policies and innovations. The data were then analyzed and assessed using the features of high-performing systems, originally identified by Aggarwal and Hutchison in 2012.

Aggarwal says challenges to transformation include Canada’s “decentralized health systems, pre-existing policy legacies, inadequate accountable investments in primary care innovations, resistance to change among health-care providers, limited evidence on the impetus of change and insufficient performance measurement and accountability.”

Based on the assessment of the key features, the authors noted 10 areas that require significant reflection and action. These include reforms in policy direction, which have varied across jurisdictions, and governance mechanisms, which have been slow to effect change.

Formal patient enrolment was found to be limited, despite initiatives to attach patients to primary care providers and teams. Researchers also noted that significant improvement is required regarding involvement of patients in decisions about their care and planning of health services.

Widespread change has also yet to occur when it comes to implementation of funding and provider payment arrangements to support health system goals.

Building research capacity and productivity in primary care also remains an area of underinvestment across Canada.

Other areas of concern include performance measurement, systematic evaluation of new approaches and innovations, leadership development, and coordination and partnerships between primary care and other health-care and social services.

While progress was slow in these areas, the researchers identified areas that showed improvements over the course of the decade.

The adoption of electronic medical records was noted as a significant change, even if the shift toward integrated health records remains slow. Significant progress was also observed in quality improvement training and support for primary care providers. A growing number of jurisdictions are also credited with launching inter-professional teams or networks, although the degree of spread is variable.

In order to accelerate transformation in Canada and abroad, the authors call for a national strategy and performance measurement framework based on meaningful engagement of patients and other stakeholders. This should be accompanied by targeted investments and the building of strong data infrastructure to measure performance and support research, they say.

The study’s findings show Canada has a long way to go to build high-performance primary care systems.

“Canada and the world have waited long enough for high-performing primary care,” says Aggarwal, calling for national and world leaders to “walk the talk.”

She said the data will enable her and fellow researchers to continue monitoring progress over the years to come.

“I plan to identify best practices and lessons learned in Canada and internationally and hope to create forums by which this knowledge can be available to policymakers so that leaders across the country can learn from each other and work together to build high-performing primary care systems in Canada today and in the future.”

Stars in the same constellation: How the space and health fields benefit from each other’s innovations

siddiq22 — Thu, 26 Jan 2023 20:58:10 +0000

Stars in the same constellation: How the space and health fields benefit from each other’s innovations

siddiq22 Thu, 01/26/2023 - 15:58

Cutline

Astronaut and physician David Saint-Jacques (left) worked with Farhan Asrar, a physician and U of T professor (right), to highlight how health care played an integral role in every human space mission since the 1960s (supplied image)

Bonnie O'Sullivan

Topic

Our Community

Temerty Faculty of Medicine

Dalla Lana School of Public Health

Health

Research & Innovation

Space

New innovations in either space or health care technology can be useful for both sectors, according to a recent research paper by physician Farhan Asrar, professor of clinical health in the University of Toronto's Dalla Lana School of Public Health and assistant professor in the department of family and community medicine at the Temerty Faculty of Medicine.

The United Nations Conference on the Exploration and Peaceful Uses of Outer Space committed to using space technology to help control infectious diseases in 1999, officially recognizing and pledging knowledge exchange between space engineers and health care experts.

However, in a paper published in Canadian Family Physician, Asrar and his co-authors – astronaut and physician David Saint-Jacques and Dave Williams, CEO of Leap Biosystems and a former astronaut – point out that health care has been an integral part of every human space mission since the 1960s. A physician research lead at Trillium Health Partners, Asrar is also a global faculty member for the France-based International Space University and a regular speaker and organizer of conferences about the connections between space and health care.

“For any human mission that has taken place, those involved have to ensure that they can adequately take care of the humans that are going to space,” he says. “The astronaut’s health must be monitored, maintained and assisted during their mission.”

With this requisite for health care in space comes unique challenges not faced on Earth. This requirement – and the innovations that come from it – results in a cyclical exchange in which current technologies are used and improved upon for space travel, and vice versa.

Asrar says that early examples of telemedicine come from astronauts communicating with health-care professionals back home. Years of space developments in telemedicine also informed remote care during the COVID-19 pandemic. Now, scientists are looking for even more effective ways to provide medical information to space explorers. For instance, if there was a health emergency on Mars, it would take at least 20 minutes or more for the communication to reach Earth. This is where developments in machine learning and artificial intelligence are being used to improve the astronauts’ access to quicker answers, explains Asrar, who is a member of the Temerty Centre for AI Research and Education in Medicine.

In a prior 2021 article in Nature Medicine, Asrar and his co-authors describe the uses of the BIO-MONITOR, developed for the Canadian Space Agency, to store and forward health data from body-worn sensors. They write about how wearable technology offers around-the-clock monitoring of heart rate, breathing, blood pressure, temperature, electrocardiogram, physical activity and blood oxygen levels – which are valuable parameters to monitor in patients with active COVID-19 or long COVID. Another familiar device, the infrared thermometer, was a NASA-developed technology now found in hospitals, clinics and pharmacies.

Remote sensing data is yet another example of space technology being used to improve public health. Satellite technology monitors temperature changes that influence the travel patterns of birds, bugs and other creatures that spread infections. “You can actually monitor and plan out the migratory patterns, which could potentially let us know that there is a high influx of certain vectors in certain regions,” Asrar says.

Such technologies are just some of the many examples in which space and health innovations can be exchanged. And there will be more to come, Asrar says. He notes that professionals from both sectors can benefit from development and collaboration outside their own vocations when faced with a new challenge.

“Whether you’re a surgeon or a public-health professional, whether you focus on the macro level, emergency preparedness, or individual health care, there is space technology that could assist you,” he says.

Changing spaces: Professors work with Elder, youth to create Indigenous garden in urban setting

Christopher.Sorensen — Wed, 05 Oct 2022 16:58:14 +0000

Changing spaces: Professors work with Elder, youth to create Indigenous garden in urban setting

Christopher.Sorensen Wed, 10/05/2022 - 12:58

Cutline

The garden alongside the Dalla Lana School of Public Health features plants native to the land such as serviceberry, staghorn sumac and red osier dogwood (photo courtesy Agata Mrozowski)

Bonnie O'Sullivan

Topic

Our Community

Dalla Lana School of Public Health

Indigenous

John H. Daniels Faculty of Architecture

St. George

Walking north along McCaul Street toward College Street in downtown Toronto, it’s easy to miss the narrow garden alongside of the University of Toronto’s Dalla Lana School of Public Health building – a small sliver of green space surrounded by buildings that compete for, and often win, the attention of passersby. But the small garden is anything but insignificant.

Last year, Angela Mashford-Pringle, associate director of the Waakebiness-Bryce Institute for Indigenous Health and an assistant professor in the Dalla Lana School of Public Health, collaborated with Elder Whabagoon and Associate Professor Liat Margolis – both from the John H. Daniels Faculty of Architecture, Landscape, and Design – to renew the space with plants native to the land.

The project stemmed from Answering the Call Wecheehetowin: Final Report of the Steering Committee for the University of Toronto Response to the Truth and Reconciliation Commission of Canada – specifically the Calls to Action related to Indigenous spaces on campus and to demonstrate and advocate for decolonial land-based teaching and environmental stewardship.

Elder Whabagoon is an Ojibway Elder who sits with the Loon Clan. She is a Keeper of Sacred Pipes, a member of the Lac Seul First Nation and a Sixties Scoop survivor. For the past five summers, she and Margolis have led a unique summer access program called Nikibii Dawadinna Giigwag (NDG) that shares traditional teachings with Indigenous youth and shows them how to integrate this knowledge to landscape architecture and ecological design.

During the winter semester in 2021, a group of Margolis’ students produced three concepts for the garden on McCaul Street and, in late summer, the youth prepared the space according to the chosen concept. The garden is now lush with plants such as serviceberry (used for medicinal and edible purposes), staghorn sumac (consumed as tea to treat colds), and red osier dogwood (for basketry, ceremonial pipe tobacco and constructing sweat lodges and fish traps).

From left: Associate Professor Liat Margolis and Assistant Professor Angela Mashford-Pringle (photos by Kasia Peruzzi and Victoria Pringle)

Margolis says that each plant has a fruit that wild animals can eat. “We think about all of our relations, all of our kin,” she explains. “We envisioned this planting along McCaul Street as a place where Angela or other instructors at the Waakebiness-Bryce Institute could visit with an Elder or Knowledge Keeper and share teachings around these plants.”

In addition to traditional medicinal and teaching benefits, native plant gardens are vital as we face a warming world.

“Indigenous people have been on these territories in Canada, the United States and globally for thousands of years,” says Mashford-Pringle. “We were taught our teachings about how to keep the natural world in order. Our languages come from the land, from interactions with the land ... If we really want to get out of this climate emergency, we need to start talking to Indigenous people who know how to deal with it.”

Elder Whabagoon

In Elder Whabagoon’s talks, she has posed a series of questions – What if the trees went to war? What if they stopped breathing for a day? What would happen to us? – that show how the relationship between nature and humans is connected. While that fact can be easily be forgotten when living in downtown Toronto, Indigenous gardens like the one on McCaul serve as reminders of this interdependence.

Elder Whabagoon says that Nikibii Dawadinna Giigwag and programs like it work to educate young people about the inherent agreement humans have with the land.

“We just have to keep working for the next generation,” she says, adding that parents of youth participating in the program have come up to her in the past to say, “What have you done with my daughter or son? They’ve changed. They actually read books. They are trying more.”

After a long history in which Indigenous Peoples in Canada were targeted with colonial campaigns to erase their cultures, languages and beliefs, such programs plant seeds of curiosity in youth to learn more about their heritage.

Many in the next generation are listening. Maggie Devins-Cann, a student at Trent University has attended the Nikibii Dawadinna Giigwag access program since high school and credits it with the educational path she is on.

“I am going into my second year at Trent University in the Indigenous Environmental Studies and Sciences program,” says Devins-Cann. “I was always interested in environmental studies but didn’t know much about my culture when I was younger. Going into this summer program, I gained a really big passion for learning about it.”

Maggie Devins-Cann and peers participate in the Nikibii Dawadinna Giigwag access program
(photo courtesy Agata Mrozowski)

Mashford-Pringle is also working to expand Indigenous practices and teachings inside the course offerings at the Dalla Lana School of Public Health.

For example, she has introduced land-based learning and renovations to Hart House Farm.

“I don’t like our classrooms at St. George. People don’t get to look at each other. We don’t know what circles are,” she says, adding this is why she has developed a course where students live, study and cook together at Hart House Farm in Caledon, Ont.

By learning from Indigenous Elders and Knowledge Keepers while on the farm, students recognize how important courses like these are for urgent issues like environmentalism and reconciliation.

But what about back in the city?

“Often times, you get a little corner somewhere – a little circle area and, again, it’s sadly not unlike the reserve system saying, ‘Well, here’s your spot, here’s your little space where you can gather.’”

This isn’t enough when it comes to addressing truth and reconciliation or Indigenous spaces, adds Mashford-Pringle. “If you look at the map of St. George, let alone the other campuses, we have the incredible capacity and responsibility to make an enormous impact on the landscape in terms of increasing vegetative cover, increasing biodiversity, providing habitat, providing food sources and edible landscapes so that we never go hungry.”

The garden on McCaul Street may be small right now, but with hope and commitment, much more of campus can see the reintroduction of native species and Indigenous ways of learning, says Mashford-Pringle.

“We need to think about what our role is as an urban campus to environmental stewardship. That to me is the core of foundational and Indigenous thinking.”

'Brilliant and exceptionally dedicated': Undergrads secure funding for research on community outreach programs

Christopher.Sorensen — Wed, 21 Sep 2022 14:10:20 +0000

'Brilliant and exceptionally dedicated': Undergrads secure funding for research on community outreach programs

Christopher.Sorensen Wed, 09/21/2022 - 10:10

Cutline

U of T Scarborough undergraduate students Maha Kahn and Maimuna Akhter, who began their post-secondary journey via a U of T outreach program, are leading a funded research project focused on The Neighbourhood Organization (photo by Diana Tyszko)

Bonnie O'Sullivan

Topic

Our Community

Dalla Lana School of Public Health

U of T Scarborough

Undergraduate Students

Maimuna Akhter and Maha Khan – both undergraduate students in biological sciences at the University of Toronto Scarborough – have come full circle.

The pair got their post-secondary start as members of a Dalla Lana School of Public Health outreach program that seeks to introduce underrepresented high school students to health careers. Now, with the help of a $33,000 grant, they are studying which programs and services high school students in the community find most valuable.

Akhter says the idea for the project – which is focused on The Neighbourhood Organization (TNO), an agency that provides services to communities such as Toronto’s Thorncliffe Park – came from her and Khan’s own experiences as teenagers.

“I grew up in the communities of Flemingdon Park and Thorncliffe Park, and I was a high school student at Marc Garneau Collegiate Institute,” Akhter says. “Throughout my years there, I felt quite supported by The Neighbourhood Organization.”

She adds that teachers and parents would share their opinions on TNO programming, but she and Khan saw an opportunity for youth voices to be heard. Starting this fall, Akhter and Khan will conduct focus groups and surveys to determine which programs and services Thorncliffe Park youth benefit from the most. Their findings could help TNO can refine its offerings.

“I wanted to give students the opportunity to speak out about what programs would be helpful to them and how TNO could better facilitate their completion of high school,” Akhter says.

Akhter, who is in her second year of studies, and Khan, who is in her third year, received the research funding from Mitacs, a non-profit national research organization that supports innovation through partnerships with Canadian academia, government and industry – a rare accomplishment in the early stages of a post-secondary journey.

The roots of the research project can be traced to the Dalla Lana School of Public Health’s outreach program.

Ryan Hinds, the school’s director of equity, diversity and inclusion, describes Akhter and Khan as “brilliant and exceptionally dedicated.”

A few years ago while still in high school, Akhter and Khan met Hinds through the school’s outreach and access program and have been participants ever since that first meeting. The program introduces high school students from underrepresented communities to various career options within public health and provides mentorship, enrichment opportunities and other supports as they progress at U of T.

Last year, program leaders challenged Akhter and Khan to pursue a research topic and the TNO project was born.

Hinds says one advantage to the pair’s research project is that youth may feel more comfortable opening up to younger researchers. “The idea is that talking to other students, they [the participants] can be more transparent and more open around what has not been working.”

The students’ research supervisor, Julia O’Sullivan, a professor at the Institute of Health Policy, Management and Evaluation, says some of Akhter and Khan’s data collection methods are innovative.

“A lot of what they had proposed was new to me,” she says. “They taught me a lot, especially about word cloud polls and Instagram accounts.”

O’Sullivan says that because of the particular research design involved, they enlisted the advice of Maggie Dunlop, director of monitoring evaluation and learning at the Martin Family Initiative.

Khan says that it was sometimes challenging preparing a proposal for the ethics board and funding. “Sometimes it would feel tedious because you would have to wait a long time for the responses to come in, and then you’d be on the edge wondering, are they going to approve it?”

While part of the funding supports subscriptions to data collection tools, Akhter says the award will also fund gift card incentives that show participants their involvement is valued. “We want to thank them for their time and so we’re providing gift cards and lunch for the day,” she says. “If they’re missing out on volunteering or work, they’ll know we appreciate their time.”

Akhter and Khan say they are grateful to have been introduced to new opportunities through the Dalla Lana School of Public Health’s outreach and access program. “It was the most meaningful club that I joined in high school,” says Khan, adding that the program has “helped me make a goal for myself that, whatever career that I choose, I want to make sure I enjoy what I am doing.”

Although it is too early to tell where the students’ paths may lead, Akhter and Khan both say that the experience allowed them to discover new passions in research, communications and community relations.

In fact, Khan says research has “become a solid-running career option for me now.”