Evaluating engagement with equity in Canadian provincial and territorial primary care policies: Results of a jurisdictional scan.

Equitable access to primary care is essential to achieving more equitable health outcomes, yet evidence suggests that structurally marginalized populations are less likely to have benefited from varied primary care reforms in Canada. Our objective is to determine how equity is incorporated in public primary care policy and strategy documents across Canada. We conducted string term and snowball searches for provincial/territorial primary care policy documents published between 01 January 2018 and 30 June 2022, extracted the policy objective, and applied a rubric to evaluate each document's engagement with equity. We performed content analysis of the documents which acknowledged inequities and articulated a related policy response. Of the 224 identified documents that discussed primary care policy: 63 (28 %) identified one or more structurally marginalized group(s) experiencing inequities related to primary care, 64 (29 %) identified a structurally marginalized group and articulated a policy response, and 16 (7 %) articulated a detailed policy response to address inequities. Even where policy responses were articulated, in most cases these did not directly address the acknowledged inequities. The absence of measurable goals, meaningful community consultation, and tenuous connections between the policy response and inequities mentioned may help explain persistent inequities in primary care across Canada.

Disparities in access to primary care are growing wider in Canada.

Canadian provinces and territories have undertaken varied reforms to how primary care is funded, organized, and delivered, but equity impacts of reforms are unclear. We explore disparities in access to primary care by income, educational attainment, dwelling ownership, immigration, racialization, place of residence (metropolitan/non-metropolitan), and sex/gender, and how these have changed over time, using data from the Canadian Community Health Survey (2007/08 and 2015/16 or 2017/18). We observe disparities by income, educational attainment, dwelling ownership, recent immigration, immigration (regular place of care), racialization (regular place of care), and sex/gender. Disparities are persistent over time or increasing in the case of income and racialization (regular medical provider and consulted with a medical professional). Primary care policy decisions that do not explicitly consider existing inequities may continue to entrench them. Careful study of equity impacts of ongoing policy reforms is needed.

Loneliness and social support as key contributors to burnout among Canadians workers in the third wave of the COVID-19 pandemic: A cross-sectional study.

OBJECTIVE: COVID-19 has dramatically affected Western Society's relationship with work and contributed to increased worker burnout. Existing studies on burnout have mostly emphasized workplace culture, leadership, and employee engagement as key contributors to burnout. In this cross-sectional study, we examine the associations between Malach-Pines Short Burnout Measure (MPSBM) scores and participant's self reported personal characteristics, financial strain, workplace conditions, work-life balance, and social inclusion among Canadians living during the third wave of the COVID-19 pandemic. METHODS: To identify the most salient correlates of burnout, Canadian residents, aged 16+, were recruited using paid social media advertisements in French and English to complete a cross-sectional study. Multivariable linear regression and dominance analysis identified the most salient correlates of MPSBM scores. Exposure variables included demographic factors, financial strain, workplace conditions, work-life balance, social support, and loneliness. RESULTS: Among 486 participants, family social support (adjusted ß = -0.14, 95%CI = -0.23, -0.05), emotional loneliness (adjusted ß = 0.26, 95% CI = 0.18, 0.35), insufficient sleep (adjusted ß = 0.38, 95% CI = 0.16, 0.60) and "me time" (adjusted ß = 0.22, 95% CI = 0.03, 0.42), and indicators of financial security (e.g., owning vs renting; adjusted ß = -0.36, 95% CI = -0.54, -0.17; insufficient pay: adjusted ß = -0.36, 95% CI = -0.54, -0.17) were key burnout indicators. People with a bachelor's degree (vs ≤high school diploma; adjusted ß = 0.29, 95% CI = 0.01, 0.58) also had higher burnout scores. CONCLUSION: Interventions addressing workplace culture, leadership, and other proximal workplace stressors, while important, are likely insufficient to meet the needs of workers. Our findings suggest that broader, holistic multicomponent approaches that address multiple upstream dimensions of health-including mental health-are likely necessary to prevent and reduce burnout.

The Impact of Working from Home on Mental Health: A Cross-Sectional Study of Canadian Worker's Mental Health during the Third Wave of the COVID-19 Pandemic.

The COVID-19 pandemic has seen a considerable expansion in the way work settings are structured, with a continuum emerging between working fully in-person and from home. The pandemic has also exacerbated many risk factors for poor mental health in the workplace, especially in public-facing jobs. Therefore, we sought to test the potential relationship between work setting and self-rated mental health. To do so, we modeled the association of work setting (only working from home, only in-person, hybrid) on self-rated mental health (Excellent/Very Good/Good vs. Fair/Poor) in an online survey of Canadian workers during the third wave of COVID-19. The mediating effects of vaccination, masking, and distancing were explored due to the potential effect of COVID-19-related stress on mental health among those working in-person. Among 1576 workers, most reported hybrid work (77.2%). Most also reported good self-rated mental health (80.7%). Exclusive work from home (aOR: 2.79, 95%CI: 1.90, 4.07) and exclusive in-person work (aOR: 2.79, 95%CI: 1.83, 4.26) were associated with poorer self-rated mental health than hybrid work. Vaccine status mediated only a small proportion of this relationship (7%), while masking and physical distancing were not mediators. We conclude that hybrid work arrangements were associated with positive self-rated mental health. Compliance with vaccination, masking, and distancing recommendations did not meaningfully mediate this relationship.

Exploring Privatization in Canadian Primary Care: An Environmental Scan of Primary Care Clinics Accepting Private Payment.

BACKGROUND: Private payment within primary care has not received extensive scrutiny, despite the emergence of "concierge" primary care services. OBJECTIVE: We conducted an environmental scan to explore the nature of private payment for primary care across Canada. METHOD: We extracted data from clinic websites on funding models, range of services provided and whether they were independent or part of a chain. We conducted a thematic analysis of service advertisements. RESULTS: We identified 83 private clinics across six provinces, predominately in urban areas. Private payment-only clinics offered the widest range of services and advertisements emphasised timely, comprehensive care. CONCLUSION: The extent to which these clinics and bundling of primary care with privately paid wellness services impact patients' access to care should be the subject of future research.