Implementing leading practices in regional-level primary care workforce planning: Lessons learned in Toronto.

Investment in capacity for implementation of leading practices in regional-level health workforce planning is essential to support equitable distribution of resources and deployment of a health workforce that can meet local needs. Ontario Health Toronto and the Canadian Health Workforce Network (CHWN) co-developed and operationalized an integrated workforce planning process to support evidence-based primary care workforce decision-making for the Toronto region. The resultant planning toolkit incorporates planning processes centred around engagement with stakeholders, including environmental scanning tools and a quantitative planning model. The outputs of the planning process include estimates of population need and workforce capacity and address challenges specific to Toronto, such as patient mobility, anticipated rapid population growth, and physician retirement. We highlight important challenges and key considerations in the development and operationalization of workforce planning processes, particularly at the regional level.

Implementing Patient-Oriented Discharge Summaries (PODS): A Multisite Pilot Across Early Adopter Hospitals.

Communication gaps when patients transition from hospital to either home or community can be problematic. Partnership between Toronto Central Local Health Integration Network (TC LHIN) and OpenLab addressed this through the Patient-Oriented Discharge Summaries (PODS) project. From January through March 2015, eight hospital departments across Toronto came together to implement the PODS, a tool previously developed through a co-design process involving patients, caregivers and providers. This paper presents data on how the hospitals came together and the impact of PODS on the patient and provider experience across these hospitals and discusses it implications.

Perceived barriers in accessing food among recent Latin American immigrants in Toronto.

OBJECTIVE: In Canada, recent immigrant households experience more food insecurity than the general population, but limited information is available about the personal, cultural, and social factors that contribute to this vulnerability. This study focused on recent Latin American (LA) immigrants to explore their perceived barriers in acquiring safe, nutritious, and culturally-appropriate food. DESIGN: A cross-sectional mixed-method design was applied to collect information from a convenience sample of 70 adult Spanish/Portuguese speakers who had arrived in Toronto within the last five years. Face-to-face interviews were conducted with primary household caregivers to obtain responses about barriers to acquiring food for their households; data were analyzed using a thematic analysis technique. RESULTS: Four main categories of barriers were identified: limited financial resources; language difficulty; cultural food preferences; and poor knowledge of available community-based food resources and services. Inadequate income was the main impediment in accessing adequate food, and was related to affordability of food items, accessibility of food outlets and transportation cost, and limited time for grocery shopping due to work conditions. Language barriers affected participants' ability to obtain well-paid employment and their awareness about and access to available community-based food resources. Cultural barriers were related to food preferences and limited access to culturally-appropriate foods and resources. CONCLUSION: The main barrier to food security among our sample of LA newcomers to Toronto is limited financial resources, highlighting the need for policies and strategies that could improve their financial power to purchase sufficient, nutritious, and culturally-acceptable food. Linguistic barriers and limited information among newcomers suggest the need to provide linguistically- and culturally-appropriate information related to community-based food programs and resources, as well as accessible subsidized English language programs, in the community and at workplaces. Participatory community-based food programs can augment, in a socially acceptable manner, food resources and reduce the social stigma attached to food charity. Finally, it is crucial to monitor and evaluate existing social and community-based services for their accessibility, cultural appropriateness and diversity, and effectiveness.

Measuring quality at a system level: an impossible task? The Toronto Central LHIN Experience.

Quality is being measured and reported across healthcare organizations and sectors, but efforts are rarely made to connect the activity in one organization to quality experienced by patients and clients in another part of the healthcare system. This article describes one regional health organization's journey to measuring health quality at a system level. The authors describe a highly consultative and iterative process used to measure quality across the continuum of care, and the challenges experienced in approaching this type of measurement, and they highlight some of the early findings.

Prevalence of SARS-CoV-2 infection among people experiencing homelessness in Toronto during the first wave of the COVID-19 pandemic.

OBJECTIVES: People experiencing homelessness are at increased risk of SARS-CoV-2 infection. This study reports the point prevalence of SARS-CoV-2 infection during testing conducted at sites serving people experiencing homelessness in Toronto during the first wave of the COVID-19 pandemic. We also explored the association between site characteristics and prevalence rates. METHODS: The study included individuals who were staying at shelters, encampments, COVID-19 physical distancing sites, and drop-in and respite sites and completed outreach-based testing for SARS-CoV-2 during the period April 17 to July 31, 2020. We examined test positivity rates over time and compared them to rates in the general population of Toronto. Negative binomial regression was used to examine the relationship between each shelter-level characteristic and SARS-CoV-2 positivity rates. We also compared the rates across 3 time periods (T1: April 17-April 25; T2: April 26-May 23; T3: May 24-June 25). RESULTS: The overall prevalence of SARS-CoV-2 infection was 8.5% (394/4657). Site-specific rates showed great heterogeneity with infection rates ranging from 0% to 70.6%. Compared to T1, positivity rates were 0.21 times lower (95% CI: 0.06-0.75) during T2 and 0.14 times lower (95% CI: 0.04-0.44) during T3. Most cases were detected during outbreak testing (384/394 [97.5%]) rather than active case finding. CONCLUSION: During the first wave of the pandemic, rates of SARS-CoV-2 infection at sites for people experiencing homelessness in Toronto varied significantly over time. The observation of lower rates at certain sites may be attributable to overall time trends, expansion of outreach-based testing to include sites without known outbreaks, and/or individual site characteristics.

RéSUMé: OBJECTIFS: Les personnes en situation d'itinérance courent un risque accru de contracter une infection par le SRAS-CoV-2. Notre étude rend compte de la prévalence ponctuelle des infections par le SRAS-CoV-2 au cours de tests de dépistage menés dans des lieux de services aux personnes en situation d'itinérance de Toronto au cours de la première vague de la pandémie de COVID-19. Nous avons aussi exploré l'association entre les caractéristiques de ces lieux et les taux de prévalence. MéTHODE: L'étude a inclus les personnes séjournant dans des refuges, des campements, des lieux de distanciation physique et des centres d'accueil et de répit et ayant subi un test de dépistage de proximité du SRAS-CoV-2 entre le 17 avril et le 31 juillet 2020. Nous avons examiné les taux de positivité des tests au fil du temps et nous les avons comparés aux taux dans la population générale de Toronto. Des analyses de régression binomiales négatives ont été effectuées pour étudier la relation entre chaque caractéristique au niveau des refuges et les taux de positivité au SRAS-CoV-2. Nous avons aussi comparé les taux de trois intervalles (I1: 17 au 25 avril; I2: 26 avril au 23 mai; I3: 24 mai au 25 juin). RéSULTATS: La prévalence globale des infections par le SRAS-CoV-2 était de 8,5 % (394/4 657). Les taux d'infection spécifiques aux lieux de services ont présenté une grande hétérogénéité, soit de 0 % à 70,6 %. Comparés au 1er intervalle (I1), les taux de positivité ont été 0,21 fois plus faibles (IC de 95% : 0,06 ­ 0,75) durant l'I2 et 0,14 fois plus faibles (IC de 95% : 0,04 ­ 0,44) durant l'I3. La plupart des cas ont été détectés lors d'un dépistage en cours d'éclosion (384/394 [97,5%]) et non lors d'une recherche active de cas. CONCLUSION: Au cours de la première vague de la pandémie, les taux d'infection par le SRAS-CoV-2 dans les lieux de services aux personnes en situation d'itinérance de Toronto ont varié de façon significative au fil du temps. L'observation de taux plus faibles dans certains lieux pourrait s'expliquer par les tendances temporelles globales, par l'expansion des activités de dépistage de proximité pour inclure les lieux sans éclosion connue et/ou par les caractéristiques individuelles des lieux.

Fecal occult blood test screening uptake among immigrants from Muslim majority countries: A retrospective cohort study in Ontario, Canada.

BACKGROUND: Colorectal cancer (CRC) is the second and third highest cause of cancer deaths among Canadian men and women, respectively. Population-based screening through fecal occult blood testing (FOBT) has been proven to be effective in reducing CRC morbidity and mortality. Although participation in Ontario's organized CRC screening program has been increasing steadily since 2008, its uptake remains low among recent immigrant populations despite the known benefits of screening. To promote participation in CRC screening, it is imperative to understand both individual and system level barriers and enablers. Although a number of immigrant and nonimmigrant factors have been associated with low participation, there is a dearth of knowledge related to the religious affiliation in CRC screening uptake. Our study is among the first to examine this issue in Ontario, one of the most ethnically diverse Canadian provinces and preferred settlement destinations for immigrants. METHODS: We conducted a population-based retrospective cohort study using linked health care administrative databases. Our cohort included Ontario residents, age 50-74 who were eligible for FOBT from 1 April 2013 to 31 March 2015. RESULTS: We found that immigrants from the Middle East and North Africa and Eastern Europe and Central Asia had the lowest rates of screening. Furthermore, being born in a Muslim-majority country was associated with lower FOBT screening even after controlling for other confounders including world region and income (ie, overall adjusted relative risk (ARR) of screening 0.92 [95% CI 0.90-0.93]). Moreover, being enrolled in a primary care model, having a female primary care provider and having an internationally trained physician were associated with increased screening among immigrants from Muslim-majority countries. CONCLUSIONS: These findings can inform future efforts to improve screening uptake like: enhancing access to primary care providers and enrollment in primary care models, targeted FOBT education for male providers and providers not in a primary care model, development of culturally sensitive and appropriate educational materials, and use of interactive approaches for communication of cancer screening information.

Defining needs-based urban health planning areas is feasible and desirable: a population-based approach in Toronto, Ontario.

Reporting health data for large urban areas presents numerous challenges. In the case of Toronto, Ontario, amalgamation in 1998 merged six census subdivisions into one mega-city, resulting in the disappearance of standard reporting units. A population-based approach was used to define new health planning areas. Census tracts were used as building blocks and combined according to residential income homogeneity, respecting natural and man-made boundaries, forward sortation areas and the City of Toronto's community neighbourhoods whenever possible. Correlations and maps were used to establish area boundaries. The city was divided into 5 major planning areas which were further subdivided creating 15 minor areas. Both major and minor areas showed significant differences in population characteristics, health status and health service utilization. This commentary demonstrates the feasibility and describes the outcomes of one method for establishing planning and reporting areas in large urban centres. Next steps include the further generation of health data for these areas, comparisons with other Canadian urban areas, and application of these methods to recently announced Ontario Local Health Integration Networks. These areas can be used for planning and evaluating health service delivery, comparison with other Canadian urban areas and ongoing monitoring of and advocacy for equity in health.

A feasibility study of a culturally and gender-specific dance to promote physical activity for South Asian immigrant women in the greater Toronto area.

BACKGROUND: Despite ample evidence demonstrating the protective effect of physical activity, the uptake of regular physical activity among South Asian (SA) women remains relatively low. The purpose of this study was to explore the feasibility and health impacts of implementing a culture- and gender-specific physical activity among SA immigrant women residing in Greater Toronto Area (GTA) in Ontario, Canada. METHODS: A community-based mixed methods approach combining cohort pretest and posttest design and qualitative methods employing in depth interviews was used. Twenty-seven SA women from the GTA participated in a 6-week, 2 days per week, Bollywood Dance exercise program led by a female SA instructor. FINDINGS: The participation rate was considerably high (85%) and approximately 82% of the participants attended 10 or more of the classes offered. The participants' physical measurements (weight, waist and hip, and body mass index) decreased, although not significantly, over the 6-week period and there was an improvement in their physical, mental, and social health. During the face-to-face interviews, participants reported feeling less stressed and tired, being more mentally and physically robust, and having a sense of fulfillment and self-satisfaction. The only common criticism expressed was that the 6-week duration of the intervention was too short. CONCLUSION: The results showed that the Bollywood Dance was a feasible strategy in engaging SA immigrant women in physical activity. The key aspects when designing culture- and gender-specific dance interventions include community participation and active engagement in planning and implementation of the program, a supportive environment, same gender and culturally attuned dance instructor, easy access, and minimal to no cost.

Food insecurity among Latin American recent immigrants in Toronto.

Food security is an important social determinant of health. The 2004 Canadian Community Health Survey, Cycle 2.2 reported high prevalence of food insecurity among low income households and those formed by recent immigrants. Exploration of the extent and correlates of food insecurity among recent Latin Americans (LA) immigrants is essential considering they encompasses an increasing number of young immigrants, many of whom, despite relatively high education, are unemployed or have low wage positions. This study examines the extent of food insecurity and its correlates among recent Latin American (LA) immigrants in Toronto. A cross-sectional study was conducted with a convenience sample of 70 adult LA recent immigrants. Participants were recruited from selected community health centres across Toronto using snow ball sampling. Data were collected using questionnaires in face-to-face interviews with primary household care givers. A considerably high rate of food insecurity (56%) was found among participants. Household food insecurity was highly related to: being on social assistance; limited proficiency in English; and the use of foodbanks. Our findings indicate that the primary correlate of a household's food security status is income, which suggests the potential for strategies to improve the financial power of new immigrants to purchase sufficient, nutritious, and culturally acceptable food. Enhancing the employability of new immigrants, reforming the income structure for working adults beyond social assistance, and providing more subsidized English language and housing programs may be effective.