TAIBU Community Health Centre's Proportionate Response to a Disproportionate Pandemic.

Data from the City of Toronto indicate that the majority of COVID-19 cases and hospitalizations as of December 2021 were among individuals who identified with a racialized group. In this paper, we summarize how TAIBU Community Health Centre, an organization mandated to serve the Black and Francophone communities in the Greater Toronto Area, prioritized and embedded race-based data collection in order to highlight the specific experiences of Black and racialized communities during the COVID-19 pandemic. Lessons learned from this work can be used to help support race-based data collection.

Using Trusted Relationships and Community-Led Approaches to Promote COVID-19 Vaccine Confidence and Uptake across Ontario.

Data underscore how challenging it can be for populations that experience systemic and historical barriers to access necessary health information and services, including COVID-19 vaccinations and testing. In this paper, we describe the initiatives used by member centres of Alliance for Healthier Communities to promote vaccine confidence and uptake, highlight specific examples that applied a health equity lens, describe some of the challenges that centres faced and explore the key enablers for these initiatives. Lessons learned here can be used to engage in other health promoting activities including population health efforts currently under way across the country.

A Rapid Primary Healthcare Response to COVID-19: An Equity-Based and Systems-Thinking Approach to Care Ensuring that No One Is Left Behind.

Recent data from across the globe show that COVID-19 is disproportionately affecting those who are already adversely impacted by social determinants of health. In this paper, we explore how members of the Alliance for Healthier Communities - comprehensive, salary-based primary care organizations in Ontario - anticipated the same and rapidly responded by adapting their services to ensure continued equitable access to primary care services. Lessons from this project could be adapted in other primary care team-based models or partnerships to ensure ongoing support for populations that are most at risk from COVID-19 and the consequences of restricted access to services.

The impact of leadership style in team-based primary care - staff satisfaction and motivation.

BACKGROUND: Leadership styles, beliefs, and behaviours are an important and critical component to the delivery of quality care in any primary care organisation. The health human resource crisis has resulted in greater investments in team-based care however some leaders may not have experience working in team-based settings. AIM: This study aimed to explore what leadership characteristics, styles and behaviours were most conducive to employee satisfaction, motivation, and delivery of care in a team-based primary care setting. DESIGN & SETTING: 21 Community Health Centre staff from six Community Health Centres across Ontario, Canada. METHOD: Thematic analysis of qualitative interviews with using a framework based on transformational leadership theory. RESULTS: Three themes emerged from our findings as having a significant impact on staff motivation, morale, delivery of care and client outcomes: transparent and open communication, opportunities to collaborate in decision-making, and staff recognition and appreciation. The results of our study indicate it is critical that leaders adopt leadership styles and approaches in which every team member is informed, heard, and appreciated. CONCLUSION: This study described the leadership styles and characteristics that lead to improved employee satisfaction, motivation and morale in a team-based primary care setting, and the impact this could and does have on quality and delivery of care. Future research is needed to better understand the impact of leadership in a variety of roles within a team-based environment, specifically in a multi-disciplinary setting.

The Alliance for Healthier Communities' journey to a learning health system in primary care.

Introduction: The Alliance for Healthier Communities represents community-governed healthcare organizations in Ontario, Canada including Community Health Centres, which provide primary care to more disadvantaged populations. Methods: In this experience report, we describe the Alliance's journey towards becoming a learning health system using examples for organizational culture, data and analytics, people and partnerships, client engagement, ethics and oversight, evaluation and dissemination, resources, identification and prioritization, and deliverables and impact. Results: Many of the foundational elements for a learning health system were already in place at the Alliance including an integrated and accessible data platform. Leadership championed and embraced the movement towards a learning health system, which led to restructuring of the organization. This included role changes for data support personnel, better communication, and dissemination plans, strategies to engage clinicians and other front-line staff, restructuring of committees for more collaborative planning and prioritization of quality improvement and research initiatives, and the development of a new Practice-Based Learning Network for more opportunities to use the data for research and evaluation. Conclusions: Next steps will focus on continued clinical engagement and partnerships as well as ongoing reflection on the transition and success of the learning health system work.

Virtual care in Ontario community health centres: a cross-sectional study to understand changes in care delivery.

BACKGROUND: There has been a large-scale adoption of virtual delivery of primary care as a result of the COVID-19 pandemic. AIM: In this descriptive study, an equity lens is used to explore the impact of transitioning to greater use of virtual care in community health centres (CHCs) across Ontario, Canada. DESIGN & SETTING: A cross-sectional survey was administered and electronic medical record (EMR) data were extracted from 36 CHCs. METHOD: The survey captured CHCs' experiences with the increased adoption of virtual care. A longitudinal analysis of the EMR data was conducted to evaluate changes in health service delivery. EMR data were extracted monthly for a period of time before the pandemic (April 2019-February 2020) and during (April 2020-February 2021). RESULTS: In comparison with the pre-pandemic period, CHCs experienced a moderate decline in visits made (11%), patients seen (9%), issues addressed (9%), and services provided (15%). During the pandemic period, an average of 54% of visits were conducted virtually, with telephone as the leading virtual modality (96%). Drops in service types ranged from 28%-82%. The distribution of virtual modalities varied according to the provider type. Access to in-person and virtual care did not vary across patient characteristics. CONCLUSION: The results demonstrate a large shift towards virtual delivery while maintaining in-person care. No meaningful differences were found in virtual versus in-person care related to patient characteristics or rurality of centres. Future studies are needed to explore how to best select the appropriate modality for patients and service types.

Using the quadruple aim to understand the impact of virtual delivery of care within Ontario community health centres: a qualitative study.

BACKGROUND: The onset of the COVID-19 pandemic and introduction of various restrictions resulted in drastic changes to 'traditional' primary healthcare service delivery modalities. AIM: To understand the impact of virtual care on healthcare system performance within the context of Ontario community health centres (CHCs). DESIGN & SETTING: Thematic analysis of qualitative interviews with 36 providers and 31 patients. METHOD: Semi-structured phone interviews were conducted in the autumn of 2020. Interviews were recorded, transcribed verbatim, and analysed thematically using the quadruple aim framework. RESULTS: The transition to virtual delivery of services has had both positive and negative impacts on care. Virtual care removed certain barriers to care such as access. However, patients and providers found that phone visits impacted quality of care owing to the inability to read body language and having to rely solely on patient descriptions. Video visits allowed for a similar experience to in-person visits but technical issues constrained this interaction. Depending on the service provided, some providers felt they were not providing the same quality of care. However, providers reported reductions in no-show rates and highlighted the efficiency of virtual appointments. Providers also found they were able to collaborate at a similar level before the pandemic and saw improvements in work-life balance. Overall, patients and providers alike preferred virtual visits with those known to them, and for less complex or transactional aspects of care. CONCLUSION: The study described positive and negative impacts on patient care, population health, health system costs, and provider experience. These results will be useful for primary care organisations in post-pandemic planning; however, future research is needed for a deeper exploration of the impact on quality of care specifically for more complex health concerns.

Using self-determination theory to understand the social prescribing process: a qualitative study.

BACKGROUND: Social prescribing (SP) assists patients to engage in social activities and connect to community supports as part of a holistic approach to primary care. Rx: Community was a SP project, which was implemented within 11 community health centres (CHCs) situated across Ontario, Canada. AIM: To explore how SP as a process facilitates positive outcomes for patients. DESIGN & SETTING: Qualitative methods were used. Eighteen focus groups were conducted at CHCs or by video-conferencing, and involved 88 patients. In addition, eight in-depth telephone interviews were undertaken. METHOD: Interviews and focus groups were transcribed verbatim, and analysed thematically using a theoretical framework based on self-determination theory (SDT). RESULTS: Participants who had received social prescriptions described SP as an empathetic process that respects their needs and interests. SP facilitated the patient's voice in their care, helped patients to develop skills in addressing needs important to them, and fostered trusting relationships with staff and other participants. Patients reported their social support networks were expanded, and they had improved mental health and ability in self-management of chronic conditions. Patients who became involved in SP as voluntary 'health champions' reported this was a positive experience and they gained a sense of purpose by giving back to their communities in ways that felt meaningful for them. CONCLUSION: SP produced positive outcomes for patients, and it fits well within the community health centre model of primary care. Future research should examine the impact on health outcomes and examine the return on investment of developing and implementing SP programmes.