Introduction
Access to primary health care
Methods
Study design and participants
Variable | Champlain LHIN |
---|---|
Total population (census 2016), n | 1,292,639 |
15 to 64 years % | 66.8 |
Speak French only % | 1.9 |
Male sex (census 2016) % | 48.8 |
Unemployment % | 7.1 |
Immigrants % | 18.7 |
Prevalence of low income based on the Low-income cut-offs, after tax (LICO-AT) (%) | 9.1 |
No certificate, diploma or degree (15 years and above, living in private households %) | 14.3 |
Data collection
Focus group | Participants |
---|---|
Focus Group Participants | |
FG1: Mental Health System Clients and Caregivers | 4 participants (1 family member of a person with schizophrenia, 1 mental health counsellor, 1 person with an addiction, 1 family caregiver and recipient of home care services) |
FG2: Urban Community Health Centre | 11 participants (CHC staff with various community roles: chronic disease prevention management, primary care outreach for seniors, nurse practitioner, community health worker) |
FG3: Rural CHC | 11 participants (1 manager of health services, 2 nurses, 2 nurse practitioners, 2 family physicians, 2 clerks, 1 social worker, 1 respiratory therapist) |
FG4: Multicultural Health Navigation | 6 participants (navigators who provide services to immigrants and refugees to help them connect to health care providers in their community) |
FG5: Members of primary care practice and Community Members | 3 participants (patient, family member, addictions counsellor) |
FG6: Primary Care Staff | 5 participants (1 clinic manager, 2 physicians from a family health team, 1 nurse practitioner and 1 social worker from a community health centre) |
Interview Participants | |
All participants were family physicians; 5 practiced in an urban centre and 1 practiced in a rural community. |
Data analysis
Access Dimension/Category | Theme | Sub-theme | Explanation and Examples. |
---|---|---|---|
1.0 APPROACHABILITY/ ABILITY TO PERCEIVE (Levesque, 2013): People facing health needs can actually identify that some form of services exists, can be reached, and have an impact on the health of the individual. | 1.1. Approachability - System Level (Levesque, 2013): Services can make themselves more or less known among various social or geographical population groups. Various elements such as transparency, information regarding available treatments and services and outreach activities could contribute to make the services more or less approachable. | 1.1.1 Transparency | Do primary health care resources make themselves known to providers or the eligible population? |
1.2 Ability to Perceive - Individual/ Population Level (Levesque, 2013): The notion of ability to perceive need for care among populations is crucial and determined by such factors such as health literacy, knowledge about health and beliefs related to health and sickness. | 1.2.1 Health literacy; technology literacy; knowledge and beliefs about health | Patients’ health beliefs influence their action to prevent illness, reduce severity or symptoms, or have other positive outcomes. Patients’ knowledge of information about their health (e.g., causes, disease processes or progression). Includes patients’ ability to assess and acquire information in a digital environment (use health information technology). |
Findings
Theme | Sub-theme | Focus group participants |
---|---|---|
Approachability The communication used by community resource providers and programs to promote awareness of their services. | Information | “When I was looking for information a lot of it is delivered at a university and only at an information level, not on something practical…[on an] application level.” (Mental Health System Clients and Caregivers) |
“If you go on and you regularly find things that are out of date and therefore useless information, you’re going to stop using it quickly.” (Primary Care Staff) | ||
Transparency | “Well in order for people to use it, they have to know it exists, so it needs to be out there in your face, in different places, all the time and where are those places going to be?” (Rural Community Health Centre) | |
“It’s not like we don’t have any services. We have tons of services. The question is people don’t always know where they are or how to get to them.” (Primary Care Staff) | ||
Outreach | “We do outreach, we’ll go to apartment buildings and… [meet with clients] there so try to get rid of that barrier of getting them here [to the community health centre].” (Urban Community Health Centre) | |
“We did a community health week…so we were all at the mall promoting our services and we were giving coupons to people who wanted to come for a tour of the [community health] centre.” (Urban Community Health Centre) | ||
Ability to Perceive Individuals identify a need for care, influenced by their capacity to interact with service providers. | Health Literacy | “Because when you have a newcomer, whether they’ve been here for thirty years, which was one of my client’s case, she was here since 1984. And she didn’t have a family doctor. She didn’t know how to navigate the system. Although she understands English, and she speaks English.” (Multicultural Health navigation) |
Trust and Expectations | “If the doctor tells the patient about that certain program, it holds a lot more weight than if, if the nurse does or, you know, or the receptionist does. I mean they believe; they believe in their doctor.” (Primary care staff) | |
Acceptability Elements of the patient-provider relationship comprise interpersonal communication, respect and sensitivity. | Patient-Provider Relationship | “For most people they need someone very approachable as the first place of contact when they phone one of these places.” (Primary care staff) |
Ability to Seek Individuals’ capacity to seek care. | Autonomy | “If you’ve got a mental health issue or you’re struggling with an addiction issue…these people are not equipped to be able to do that kind of searching on their own, and [are] easily frustrated.” (Mental Health Systems Clients and caregivers) |
“To educate [people with addictions] on their own illness, to make them aware enough so that …they can present themselves in a way that leaves them with their dignity and demands to be treated properly. So we’re now trying to teach them how to be people accessing services that can demand access and demand respect.” (Mental Health Clients and Caregivers) | ||
Culture | “I find like a lot of my community, as we have issues with language and literacy, so an idea of making an appointment to see a doctor is a very new thing. They’d rather go to a walk-in.” (Multicultural Health Navigators) | |
“There’s different concepts of time and we’ve been told that in some parts of either northern Kenya and southern Somalia there used to be time differences so when you say the appointment is at 9:10 they might think, okay I can come anytime from 9:00 to 10:00.” (Urban Community Health Centre) | ||
Personal and Social Values | “Being able to actually get a family doctor and I think there’s a lot of prejudice around addiction specifically so people with addictions… just have difficulty accessing health care period, because there is a stigma that’s attached to that.” (Mental Health System Clients and Caregivers) | |
“When they say, ‘I don’t want to go to this counsellor because they speak my language, they might know me, I don’t want to go back.’ Like I had a client who was struggling with alcoholism. I couldn’t send him back to the Nepali speaking counsellor because he didn’t want to go.” (Urban Community Health Centre) | ||
Health Care Needs | “I know in the last few years there’s been a lot of focus on teenagers’ mental health, but everything else seems to be forgotten about now… there’s still the rest of the population that has anxieties and problems. And there aren’t enough services for them.” (Mental Health System Clients and Caregivers) | |
Social Support | “We do a lot of advocating. We do sometimes have to get in there and help the patient …do the talking, get the right language, get the right service, get the right things happening for the patient.” (Rural Community Health Centre) | |
“We [as a health navigator] we’re with the client, not to make them depend on us for everything…we’re doing this to empower them and helping them to pass the transition and to say, you can do it yourself.” (Multicultural Health Navigation) | ||
“If it’s anxiety for instance, [the client] may not really discuss the anxiety but they might be able to discuss the fact that they need someone to accompany them.” (Community members) | ||
Availability and Accommodation The existence of resources to meet patient needs including geographic location, physical accessibility of the environment in which services are offered, and the methods of program delivery (e.g. in-person, virtual appointments). | Sustainability | “There are good services in the city and often they don’t get any, financial support whatsoever and or funding and …they’re always about to be axed. There’s nothing more aggravating than the best services in the city are being forced to shut their doors because they can’t get any funding.” (Mental Health System Clients and Caregivers) |
Themes | Sub-theme | PCP participants |
---|---|---|
Approachability The communication used by community resource providers and programs to promote awareness of their services. | Transparency | “I really like that idea of having this information [about health programs] in the waiting room for people to initiate the referral themselves.” (Primary care provider 04) |
“There’s a huge knowledge deficit…people out there probably feel they’ve got wonderful working programs, but unless I’m physically aware of it, it means nothing.” (Primary care provider 01) | ||
Information | “One of the hardest things for a new [medical school] graduate is to know those services that are available if there’s no obvious place to go look for it.” (Primary care provider 02) | |
“Some sort of dedicated web site that [is] maintained actively and well promoted, that any community agency that wanted…could be found on this site and one site only.” (Primary care provider 02) | ||
Availability The existence of resources to meet patient needs including geographic location, physical accessibility of the environment in which services are offered, and the methods of program delivery (e.g. in-person, virtual appointments). | Health care needs | “I only see patients three half days a week. I have maybe thirty appointments available per week…I have nine hundred patients, essentially. There’s no time to bring [a patient] in once a week or once every two weeks [for routine care].” (Primary care provider 03) |
“And why don’t I think I do the follow up [with the patients]? Because I basically have too many competing demands.” (Primary care provider 05) | ||
Appropriateness The alignment between individuals’ needs and characteristics of the community resources. | Service Integration (Referral Processes) | “I create a referral in my electronic medical record. We have a database [with] the various specialists that we commonly use…when that electronic consultation is created then my staff prints it off and faxes it to the specialist that I’ve attached to the referral." (Primary care provider 02) |
“Our clinic refuses to even do forms, like we put everything into the EMR…Very rarely do we actually submit a paper form because it becomes so time consuming with our EMR and then it’s not as readily accessible for us.” (Primary care provider 04) | ||
Information Continuity | “I don’t need to know huge details unless there are some concerns and we need to collaborate [with the community resource] around it, but it would be nice to know about what services [patients are] accessing.” (Primary care provider 04) | |
“I can almost picture developing some kind of standardized feedback form from all these different providers…where the top half might just be patient attended this many visits, this is the scope of what they learned, right.” (Primary care provider 06) | ||
Adequacy/Comprehensiveness | “It seems burdensome for [patients] and it’s because all the services are separated. It’s overwhelming for them to try and access multiple types of services. But if there’s one navigator that helps them kind of triage what’s important, where they can get the most bang for their buck.” (Primary care provider 04) | |
“Navigators are about making the connections and knowing enough to make the best possible connection for the patient at that time. But they’re not really meant to provide care in any way themselves.” (Primary care provider 06) |