Legal needs of patients attending an urban family practice in Hamilton, Ontario, Canada: an observational study of a legal health clinic

Abstract Background Individuals living in poverty often visit their primary care physician for health problems resulting from unmet legal needs. Providing legal services for those in need may therefore improve health outcomes. Poverty is a social determinant of health. Impoverished areas tend to have poor health outcomes, with higher rates of mental illness, chronic disease, and comorbidity. This study reports on a medical-legal collaboration delivered in a healthcare setting between health professionals and lawyers as a novel way to approach the inaccessibility of legal services for those in need. Methods In this observational study, patients aged 18 or older were either approached or referred to complete a screening tool to identify areas of concern. Patients deemed to have a legal problem were offered an appointment at the Legal Health Clinic, where lawyers provided legal advice, referrals, and services for patients of the physicians. Fisher’s exact test was used to compare populations. Binary logistic regression was used to determine the factors predicting booking an appointment with the clinic. Results Eighty-four percent (n = 648) of the 770 patients screened had unmet legal needs and could benefit from the intervention, with an average of 3.44 (SD = 3.42) legal needs per patient screened. Patients with legal needs had significantly higher odds of attending the Legal Health Clinic if they were an ethnicity that was not white (OR = 2.48; 95% CI 1.14–5.39), did not have Canadian citizenship (OR = 4.40; 95% CI 1.48–13.07), had housing insecurity (OR = 3.33; 95% CI 1.53–7.24), and had difficulty performing their usual activities (OR = 2.83; 95% CI 1.08–7.43). As a result of the clinic consultations, 58.0% (n = 40) were referred to either Legal Aid Ontario or Hamilton Community Legal Clinic, 21.74% (n = 15) were referred to a private lawyer; one case was taken on by the clinic lawyer. Conclusion The Legal Health Clinic was found to fulfill unmet legal needs which were abundant in this urban family practice. This has important implications for the future health of patients and clinical practice. Utilizing a Legal Health Clinic could translate into improved health outcomes for patients by helping overcome barriers in accessing legal services and addressing social causes of adverse health outcomes.

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Reactions to Diversity: Using Theater to Teach Medical Students about Cultural Diversity

Journal of Medical Education and Curricular Development ◽

10.4137/jmecd.s37986 ◽

2016 ◽

Vol 3 ◽

pp. JMECD.S37986 ◽

Cited By ~ 2

Author(s):

Kimberley D Ivory ◽

Paul Dwyer ◽

Georgina Luscombe

Keyword(s):

Medical Students ◽

Health Outcomes ◽

Diversity Training ◽

Social Determinant ◽

Cultural Humility ◽

Future Health ◽

Perceptions And Attitudes ◽

Interactive Exercises ◽

Social Determinant Of Health

Training medical students to understand the effects of culture and marginalization on health outcomes is important to the future health of increasingly diverse populations. We devised and evaluated a short training module on working with diversity to challenge students’ thinking about the role of both patient and practitioner culture in health outcomes. The workshop combined didactic teaching about culture as a social determinant of health using the cultural humility model, interactive exercises, and applied theater techniques. We evaluated changes in the students’ perceptions and attitudes over time using the Reaction to Diversity Inventory. There was initial significant improvement. Women and students with no past diversity training responded best. However, scores largely reverted to baseline over 12 months.

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The impact of multimorbidity on foot health outcomes in podiatry patients with musculoskeletal foot pain: a prospective observational study

Journal of Foot and Ankle Research ◽

10.1186/s13047-019-0346-x ◽

2019 ◽

Vol 12 (1) ◽

Author(s):

Gordon J. Hendry ◽

Linda Fenocchi ◽

Helen Mason ◽

Martijn Steultjens

Keyword(s):

Observational Study ◽

Health Outcomes ◽

Prospective Observational Study ◽

Foot Pain ◽

Foot Health ◽

The Impact

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Description of a Multi-faceted COVID-19 Pandemic Physician Workforce Plan at a Multi-site Academic Health System

Journal of General Internal Medicine ◽

10.1007/s11606-020-06543-1 ◽

2021 ◽

Author(s):

Sachin R. Pendharkar ◽

Evan Minty ◽

Caley B. Shukalek ◽

Brendan Kerr ◽

Paul MacMullan ◽

...

Keyword(s):

Health System ◽

Acute Care ◽

Care Physician ◽

System Capacity ◽

Medical Emergency ◽

Physician Workforce ◽

Future Health ◽

Academic Health ◽

Response Planning ◽

Implementation Period

Abstract Background The evolving COVID-19 pandemic has and continues to present a threat to health system capacity. Rapidly expanding an existing acute care physician workforce is critical to pandemic response planning in large urban academic health systems. Intervention The Medical Emergency-Pandemic Operations Command (MEOC)—a multi-specialty team of physicians, operational leaders, and support staff within an academic Department of Medicine in Calgary, Canada—partnered with its provincial health system to rapidly develop a comprehensive, scalable pandemic physician workforce plan for non-ventilated inpatients with COVID-19 across multiple hospitals. The MEOC Pandemic Plan comprised seven components, each with unique structure and processes. Methods In this manuscript, we describe MEOC’s Pandemic Plan that was designed and implemented from March to May 2020 and re-escalated in October 2020. We report on the plan’s structure and process, early implementation outcomes, and unforeseen challenges. Data sources included MEOC documents, health system, public health, and physician engagement implementation data. Key Results From March 5 to October 26, 2020, 427 patients were admitted to COVID-19 units in Calgary hospitals. In the initial implementation period (March–May 2020), MEOC communications reached over 2500 physicians, leading to 1446 physicians volunteering to provide care on COVID-19 units. Of these, 234 physicians signed up for hospital shifts, and 227 physicians received in-person personal protective equipment simulation training. Ninety-three physicians were deployed on COVID-19 units at four large acute care hospitals. The resurgence of cases in September 2020 has prompted re-escalation including re-activation of COVID-19 units. Conclusions MEOC leveraged an academic health system partnership to rapidly design, implement, and refine a comprehensive, scalable COVID-19 acute care physician workforce plan whose components are readily applicable across jurisdictions or healthcare crises. This description may guide other institutions responding to COVID-19 and future health emergencies.

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Factor product utilization and health outcomes in patients with haemophilia A and B on extended half‐life concentrates: A Canadian observational study of real‐world outcomes

Haemophilia ◽

10.1111/hae.14369 ◽

2021 ◽

Author(s):

Haowei (Linda) Sun ◽

Ming Yang ◽

Man‐Chiu Poon ◽

Adrienne Lee ◽

K. Sue Robinson ◽

...

Keyword(s):

Observational Study ◽

Health Outcomes ◽

Real World ◽

Half Life ◽

Haemophilia A

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Access to Healthcare for Immigrant Children in Canada

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17093320 ◽

2020 ◽

Vol 17 (9) ◽

pp. 3320

Author(s):

Bukola Salami ◽

Alleson Mason ◽

Jordana Salma ◽

Sophie Yohani ◽

Maryam Amin ◽

...

Keyword(s):

Health Outcomes ◽

Service Providers ◽

Social Determinant ◽

Immigrant Children ◽

Access To Healthcare ◽

Cultural Barriers ◽

Immigrant Parents ◽

Financial Barriers ◽

University Of Alberta ◽

The University

Immigrants experience poorer health outcomes than nonimmigrants in Canada for several reasons. A central contributing factor to poor health outcomes for immigrants is access to healthcare. Previous research on access to healthcare for immigrants has largely focused on the experience of immigrant adults. The purpose of this study was to investigate how immigrants access health services for their children in Alberta, Canada. Our study involved a descriptive qualitative design. Upon receiving ethics approval from the University of Alberta Research Ethics Board, we invited immigrant parents to participate in this study. We interviewed 50 immigrant parents, including 17 fathers and 33 mothers. Interviews were audio recorded, transcribed, and analyzed according to the themes that emerged. Findings reveal that systemic barriers contributed to challenges in accessing healthcare for immigrant children. Participants identified several of these barriers—namely, system barriers, language and cultural barriers, relationship with health professionals, and financial barriers. These barriers can be addressed by policymakers and service providers by strengthening the diversity of the workforce, addressing income as a social determinant of health, and improving access to language interpretation services.

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Effectiveness of pretend medical play in improving children’s health outcomes and well-being: a systematic review

BMJ Open ◽

10.1136/bmjopen-2020-041506 ◽

2021 ◽

Vol 11 (1) ◽

pp. e041506

Author(s):

Aneesa Abdul Rashid ◽

Ai Theng Cheong ◽

Ranita Hisham ◽

Nurainul Hana Shamsuddin ◽

Dalila Roslan

Keyword(s):

Systematic Review ◽

Health Outcomes ◽

Healthcare Setting ◽

Well Being ◽

Role Playing ◽

Children's Health ◽

Children’S Health ◽

Positive Outcomes ◽

Case Control Studies ◽

Anxiety Levels

BackgroundThe healthcare setting is stressful for many people, especially children. Efforts are needed to mitigate children’s healthcare-related anxiety. Medical play using the Teddy Bear Hospital (TBH) concept can expose children to healthcare settings and help them develop positive experiences in these settings. In this role-playing game, children bring their soft toys and act as parents to the ‘sick’ teddies in a pretend hospital or clinic play setting. The objective of this systematic review is to evaluate the effectiveness of the TBH in improving children’s health outcomes and well-being.MethodsWe searched the reference lists of included studies from four electronic databases (PubMed, CINAHL, Scopus and Google Scholar) from inception until November 2020. We included pre-post, quasiexperimental and case–control studies, as well as randomised controlled trials (RCTs) that discussed medical play using the TBH concept as an intervention. Studies that involved sick patients and used interventions unlike the TBH were excluded. We assessed the quality of the included studies using the Cochrane Collaboration’s ‘Risk of bias’ tool.ResultsTen studies were included in this systematic review. Five specifically investigated the TBH method, while the others involved the same concept of medical play. Only three studies were RCTs. All of the studies report more than one outcome—mostly positive outcomes. Two report lower anxiety levels after intervention. Two found better healthcare knowledge, with one reporting increased feelings of happiness regarding visiting a doctor. Two studies found no change in anxiety or feelings, while another two found increased levels of fear and lowered mood after the medical play (which involved real medical equipment).ConclusionsThe practice of TBH has mostly positive outcomes, with lower anxiety levels and improved healthcare knowledge. Its effectiveness should be verified in future studies using a more robust methodology.PROSPERO registration numberCRD42019106355.

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