Have Primary Care Renewal Initiatives in Canada Increased Comprehensive Care for Patients with Complex Care Needs? Yes and No.

The First Ministers Health Accords of 2001 through 2003 (Health Canada 2006) launched the renewal of primary care toward more comprehensive care delivery models. We scanned government websites in the 10 Canadian provinces to assess how comprehensive and integrated renewal models were for health and social services in 2018. More comprehensive primary care delivery models were the norm in five out of 10 provinces. The policy approaches were: (1) expanding traditional family practice; (2) creating primary care networks; and (3) increasing the number of community health centres, which provide the broadest range of health and social care. Integration initiatives were limited to medical services. Additional financial and policy investments will be required to meet the comprehensive needs of patients with complex health and social needs at a system level.

Substance use and related harms in the context of COVID-19: a conceptual model. / Consommation de substances et méfaits connexes dans le contexte de la COVID-19 : un modèle conceptuel.

As the effects of COVID-19 have been unfolding, growing attention has been paid to the intersection of COVID-19 and substance use and the related harms. However, there are few theories and little empirical evidence to guide investigations in this area. To advance this emerging area of inquiry, we present a conceptual model that synthesizes evidence, information and knowledge on substance use and related harms in the context of the pandemic. The conceptual model offers a visual representation of the connections between the pandemic and substance use and related harms, and can be used to identify areas for future research.

As of June 2020, substance use and related harms in the context of a pandemic remained largely uninvestigated. The COVID-19 pandemic may impact how Canadians use substances and may present specific challenges and harms among people who use substances. The conceptual model in this paper offers a synthesis of evidence, information and knowledge of the concepts and associations relevant to substance use and harms in the context of the pandemic. Relevant concepts were synthesized into five interrelated domains that can be used to identify areas for future research into substance use and related harms in the context of COVID-19: substance use as a means of coping; changes in social support and networks; availability and accessibility of services; increased risk of COVID-19 transmission among people who use substances; and increased risk of severe outcomes.

En juin 2020, la consommation de substances et les méfaits connexes dans le contexte de la pandémie restaient largement inexplorés. La pandémie de COVID-19 peut avoir une incidence sur la façon dont les Canadiens consomment des substances, ce qui pourrait entraîner des défis et des méfaits particuliers chez ces personnes. Le modèle conceptuel présenté dans le présent document offre une synthèse des données probantes, de l'information et des connaissances sur les concepts et les associations relatifs à la consommation de substances et aux méfaits dans le contexte de la pandémie. Les concepts pertinents ont été synthétisés en cinq domaines interreliés qui peuvent être utilisés pour déterminer les futurs domaines de recherche sur la consommation de substances et les méfaits connexes dans le contexte de la COVID-19, soit la consommation de substances comme stratégie d'adaptation, les changements relatifs au soutien social et aux réseaux; la disponibilité et l'accessibilité des services; le risque accru de transmission de la COVID-19 chez les personnes qui consomment des substances; et le risque accru de conséquences graves.

Determinants of non-vaccination against seasonal influenza in Canadian adults: findings from the 2015-2016 Influenza Immunization Coverage Survey.

OBJECTIVES: The study objectives were to (1) identify determinants of non-vaccination against seasonal influenza in Canadian adults and (2) examine self-reported reasons for non-vaccination. METHODS: The data source was the 2015-2016 Influenza Immunization Coverage Survey, a national telephone survey of Canadian adults. Participants (n = 1950) were divided into three groups: adults aged 18-64 years with (n = 408) and without (n = 1028) chronic medical conditions (CMC) and adults ≥ 65 years (n = 514). Logistic regression was used to measure associations between sociodemographic factors and non-vaccination for the 2015-2016 influenza season. Weighted proportions were calculated to determine the main self-reported reasons for not receiving the influenza vaccine. RESULTS: Younger age was found to be associated with non-vaccination across all groups. In adults ≥ 65 years, elementary- or secondary- vs. university-level education (aOR 1.87, 95% CI 1.14-3.06) was also significantly associated with non-vaccination. Significant variation in vaccine uptake was found for several sociodemographic factors in adults aged 18-64 without CMC. Low perceived susceptibility or severity of influenza and lack of belief in the vaccine's effectiveness were the most commonly reported reasons for not receiving the vaccine. CONCLUSION: In general, our results were consistent with findings from other Canadian and American studies on seasonal influenza vaccine uptake. Belief that the influenza vaccine is not needed was common, even among those at increased risk of influenza-related complications. Additional research is needed to better understand how sociodemographic factors such as income and education may influence uptake and to raise awareness of potential complications from influenza infection in high-risk adults.