Ambulance Services Attendance for Mental Health and Overdose Before and During COVID-19 in Canada and the United Kingdom: Interrupted Time Series Study.

BACKGROUND: The COVID-19 pandemic impacted mental health and health care systems worldwide. OBJECTIVE: This study examined the COVID-19 pandemic's impact on ambulance attendances for mental health and overdose, comparing similar regions in the United Kingdom and Canada that implemented different public health measures. METHODS: An interrupted time series study of ambulance attendances was conducted for mental health and overdose in the United Kingdom (East Midlands region) and Canada (Hamilton and Niagara regions). Data were obtained from 182,497 ambulance attendance records for the study period of December 29, 2019, to August 1, 2020. Negative binomial regressions modeled the count of attendances per week per 100,000 population in the weeks leading up to the lockdown, the week the lockdown was initiated, and the weeks following the lockdown. Stratified analyses were conducted by sex and age. RESULTS: Ambulance attendances for mental health and overdose had very small week-over-week increases prior to lockdown (United Kingdom: incidence rate ratio [IRR] 1.002, 95% CI 1.002-1.003 for mental health). However, substantial changes were observed at the time of lockdown; while there was a statistically significant drop in the rate of overdose attendances in the study regions of both countries (United Kingdom: IRR 0.573, 95% CI 0.518-0.635 and Canada: IRR 0.743, 95% CI 0.602-0.917), the rate of mental health attendances increased in the UK region only (United Kingdom: IRR 1.125, 95% CI 1.031-1.227 and Canada: IRR 0.922, 95% CI 0.794-1.071). Different trends were observed based on sex and age categories within and between study regions. CONCLUSIONS: The observed changes in ambulance attendances for mental health and overdose at the time of lockdown differed between the UK and Canada study regions. These results may inform future pandemic planning and further research on the public health measures that may explain observed regional differences.

Barriers to and strategies to address COVID-19 testing hesitancy: a rapid scoping review.

BACKGROUND: Testing is a foundational component of any COVID-19 management strategy; however, emerging evidence suggests that barriers and hesitancy to COVID-19 testing may affect uptake or participation and often these are multiple and intersecting factors that may vary across population groups. To this end, Health Canada's COVID-19 Testing and Screening Expert Advisory Panel commissioned this rapid review in January 2021 to explore the available evidence in this area. The aim of this rapid review was to identify barriers to COVID-19 testing and strategies used to mitigate these barriers. METHODS: Searches (completed January 8, 2021) were conducted in MEDLINE, Scopus, medRxiv/bioRxiv, Cochrane and online grey literature sources to identify publications that described barriers and strategies related to COVID-19 testing. RESULTS: From 1294 academic and 97 grey literature search results, 31 academic and 31 grey literature sources were included. Data were extracted from the relevant papers. The most cited barriers were cost of testing; low health literacy; low trust in the healthcare system; availability and accessibility of testing sites; and stigma and consequences of testing positive. Strategies to mitigate barriers to COVID-19 testing included: free testing; promoting awareness of importance to testing; presenting various testing options and types of testing centres (i.e., drive-thru, walk-up, home testing); providing transportation to testing centres; and offering support for self-isolation (e.g., salary support or housing). CONCLUSION: Various barriers to COVID-19 testing and strategies for mitigating these barriers were identified. Further research to test the efficacy of these strategies is needed to better support testing for COVID-19 by addressing testing hesitancy as part of the broader COVID-19 public health response.

Outcomes for Implemented Macroeconomic Policy Responses and Multilateral Collaboration Strategies for Economic Recovery After a Crisis: A Rapid Scoping Review.

To promote postpandemic recovery, many countries have adopted economic packages that include fiscal, monetary, and financial policy measures; however, the effects of these policies may not be known for several years or more. There is an opportunity for decision makers to learn from past policies that facilitated recovery from other disease outbreaks, crises, and natural disasters that have had a devastating effect on economies around the world. To support the development of the United Nations Research Roadmap for COVID-19 Recovery, this review examined and synthesized peer-reviewed studies and gray literature that focused on macroeconomic policy responses and multilateral coalition strategies from past pandemics and crises to provide a map of the existing evidence. We conducted a systematic search of academic and gray literature databases. After screening, we found 22 records that were eligible for this review. The evidence found demonstrates that macroeconomic and multilateral coalition strategies have various impacts on a diverse set of countries and populations. Although the studies were heterogeneous in nature, most did find positive results for macroeconomic intervention policies that addressed investments to strengthen health and social protection systems, specifically cash and unconventional/nonstandard monetary measures, in-kind transfers, social security financing, and measures geared toward certain population groups.

The effect of COVID-19 on emergency medical service call volumes and patient acuity: a cross-sectional study in Niagara, Ontario.

BACKGROUND: The COVID-19 pandemic is a major public health problem. Subsequently, emergency medical services (EMS) have anecdotally experienced fluctuations in demand, with reports across Canada of both increased and decreased demand. Our primary objective was to assess the effect of the COVID-19 pandemic on call volumes for several determinants in Niagara Region EMS. Our secondary objective was to assess changes in paramedic-assigned patient acuity scores as determined using the Canadian Triage and Acuity Scale (CTAS). METHODS: We analyzed data from a regional EMS database related to call type, volume, and patient acuity for January to May 2016-2020. We used statistical methods to assess differences in EMS calls between 2016 and 2019 and 2020. RESULTS: A total of 114,507 EMS calls were made for the period of January 1 to May 26 between 2016 and 2020, inclusive. Overall, the incidence rate of EMS calls significantly decreased in 2020 compared to the total EMS calls in 2016-2019. Motor vehicle collisions decreased in 2020 relative to 2016-2019 (17%), while overdoses relatively increased (70%) in 2020 compared to 2016-2019. Calls for patients assigned a higher acuity score increased (CTAS 1) (4.1% vs. 2.9%). CONCLUSION: We confirmed that overall, EMS calls have decreased since the emergence of COVID-19. However, this effect on call volume was not consistent across all call determinants, as some call types rose while others decreased. These findings indicate that COVID-19 may have led to actual changes in emergency medical service demand and will be of interest to other services planning for future pandemics or further waves of COVID-19.

Patient healthcare experiences in the Northwest Territories, Canada: an analysis of news media articles.

The factors that influence patient healthcare experiences are complex and connected to place. In northern Canada, the socio-historical context and the inequitable distribution of health services are unique influences on patients. The objective of this study was to examine the characteristics of patient healthcare experiences as reported through news media in the Northwest Territories. We used a case series design to examine patient healthcare experiences reported in news media articles. We conducted a systematic search for articles published between 2008 and 2017 in the online database of a media outlet in the Northwest Territories. We used descriptive statistics to summarise the article characteristics and thematic analysis to understand patient experiences in 128 articles related to 71 cases. Most often, cases involved women, concerned mental health, suicidality, or chronic diseases, and were predominantly negative. Patient experiences included problems associated with medical travel, communication difficulties with providers, lack of cultural safety, and barriers in accessing care resulting in poor-quality care, particularly for Indigenous patients. Broadly, these experiences are rooted in the colonial history in the North. Understanding patient experiences and including Indigenous patients in health system decision-making can help focus policies and clinical care on cultural safety and equity.