Implementation of targeted screening for poverty in a large primary care team in Toronto, Canada: a feasibility study

Abstract Background Poverty has a significant influence on health. Efforts to optimize income and reduce poverty could make a difference to the lives of patients and their families. Routine screening for poverty in primary care is an important first step but rarely occurs in Canada. We aimed to implement a targeted screening and referral process in a large, distributed primary care team in Toronto, Ontario, Canada. The main outcome was the proportion of targeted patients screened. Methods This implementation evaluation was conducted with a large community-based primary care team in north Toronto. The primary care team serves relatively wealthy neighborhoods with pockets of poverty. Physicians were invited to participate. We implemented targeted screening by combining census information on neighborhood-level deprivation with postal codes in patient records. For physicians agreeing to participate, we added prompts to screen for poverty to the charts of adult patients living in the most deprived areas. Standardized electronic medical record templates recommended a referral to a team case worker for income optimization, for those patients screening positive. We recorded the number and percentages of participants at each stage, from screening to receiving advice on income optimization. Results 128 targeted patients with at least one visit (25%) were screened. The primary care team included 86 physicians distributed across 19 clinical locations. Thirty-four physicians (39%) participated. Their practices provided care for 27,290 patients aged 18 or older; 852 patients (3%) were found to be living in the most deprived neighborhoods. 509 (60%) had at least one office visit over the 6 months of follow up. 25 patients (20%) screened positive for poverty, and 13 (52%) were referred. Eight patients (62% of those referred) were ultimately seen by a caseworker for income optimization. Conclusions We implemented a targeted poverty screening program combined with resources to optimize income for patients in a large, distributed community-based primary care team. Screening was feasible; however, only a small number of patients were linked to the intervention Further efforts to scale and spread screening and mitigation of poverty are warranted; these should include broadening the targeted population beyond those living in the most deprived areas.

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Implementation of Targeted Screening for Poverty in a Large Primary Care Team in Toronto, Canada: a feasibility study

10.21203/rs.3.rs-206360/v2 ◽

2021 ◽

Author(s):

Kimberly Wintemute ◽

Meh Noor ◽

Aashka Bhatt ◽

Gary Bloch ◽

Suja Arackal ◽

...

Keyword(s):

Primary Care ◽

Screening Program ◽

Office Visit ◽

Care Team ◽

Primary Care Team ◽

Community Based ◽

Implementation Evaluation ◽

Number Of Patients ◽

Targeted Screening ◽

Deprived Areas

Abstract Background Poverty has a significant influence on health. Efforts to optimize income and reduce poverty could make a difference to the lives of patients and their families. Routine screening for poverty in primary care is an important first step but rarely occurs in Canada. We aimed to implement a targeted screening and referral process in a large, distributed primary care team in Toronto, Ontario, Canada.Methods This implementation evaluation was conducted with a large community-based primary care team in north Toronto. The primary care team serves relatively wealthy neighborhoods that contain pockets of poverty. Physicians were invited to participate. We implemented targeted screening by combining census information on neighborhood-level deprivation with postal codes in patient records. For physicians agreeing to participate, we added prompts to screen for poverty to the charts of adult patients living in the most deprived areas. Standardized electronic medical record templates recommended a referral to a team case worker for income optimization, for those patients screening positive. We recorded the number and percentages of participants at each stage, from screening to receiving advice on income optimization. Results The primary care team included 86 physicians distributed across 19 clinical locations. Thirty-four physicians (39%) participated. Their practices provided care for 27,290 patients aged 18 or older; 852 patients (3%) were found to be living in the most deprived neighborhoods. 509 (60%) had at least one office visit over the 6 months of follow up, and 128 (25%) of those seen were screened. Only 25 (20%) of these patients screened positive for poverty, and 13 (52%) were referred. Eight patients (62% of those referred) were ultimately seen by a caseworker for income optimization.Discussion & Conclusions We implemented a targeted poverty screening program combined with resources to optimize income for patients in a large, distributed community-based primary care team. However, only a small number of patients were identified and linked to the intervention Further efforts to scale and spread screening and mitigation of poverty are warranted; these should include broadening the targeted population beyond those living in the most deprived areas.

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Implementation of Targeted Screening for Poverty in a Large Primary Care Team in Toronto, Canada: A Feasibility Study

10.21203/rs.3.rs-206360/v1 ◽

2021 ◽

Author(s):

Kimberly Wintemute ◽

Meh Noor ◽

Aashka Bhatt ◽

Gary Bloch ◽

Suja Arackal ◽

...

Keyword(s):

Primary Care ◽

Screening Program ◽

Office Visit ◽

Care Team ◽

Primary Care Team ◽

Community Based ◽

Implementation Evaluation ◽

Number Of Patients ◽

Targeted Screening ◽

Deprived Areas

Abstract BackgroundPoverty has a significant influence on health. Efforts to optimize income and reduce poverty could make a difference to the lives of patients and their families. Routine screening for poverty in primary care is an important first step but rarely occurs in Canada. We aimed to implement a targeted screening and referral process in a large, distributed primary care team in Toronto, Ontario, Canada.MethodsThis implementation evaluation was conducted with a large community-based primary care team in north Toronto. The primary care team serves relatively wealthy neighborhoods that contain pockets of poverty. Physicians were invited to participate. We implemented targeted screening by combining census information on neighborhood-level deprivation with postal codes in patient records. For physicians agreeing to participate, we added prompts to screen for poverty to the charts of adult patients living in the most deprived areas. Standardized electronic medical record templates recommended a referral to a team case worker for income optimization, for those patients screening positive. We recorded the number and percentages of participants at each stage, from screening to receiving advice on income optimization. ResultsThe primary care team included 86 physicians distributed across 19 clinical locations. Thirty-four physicians (39%) participated. Their practices provided care for 27,290 patients aged 18 or older; 852 patients (3%) were found to be living in the most deprived neighborhoods. 509 (60%) had at least one office visit over the 6 months of follow up, and 128 (25%) of those seen were screened. Only 25 (20%) of these patients screened positive for poverty, and 13 (52%) were referred. Eight patients (62% of those referred) were ultimately seen by a caseworker for income optimization.Discussion & ConclusionsWe implemented a targeted poverty screening program combined with resources to optimize income for patients in a large, distributed community-based primary care team. However, only a small number of patients were identified and linked to the intervention Further efforts to scale and spread screening and mitigation of poverty are warranted; these should include broadening the targeted population beyond those living in the most deprived areas.

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A project in re-inforcing the effectiveness of the primary care team in the area of mental health

Psychiatric Bulletin ◽

10.1192/pb.15.8.469 ◽

1991 ◽

Vol 15 (8) ◽

pp. 469-471

Author(s):

Maria Rosen

Keyword(s):

Mental Health ◽

Primary Care ◽

Hospital Setting ◽

Care Team ◽

Primary Care Team ◽

Primary Care Teams ◽

Number Of Patients ◽

Health Centres ◽

One Year

It seems that increasingly patients are being referred to primary care teams and GPs in health centres rather than to psychiatrists in a hospital setting. With the growth in the number of patients being maintained in the community, it is becoming more important to pay attention to this sphere and to aid primary care teams to be clinically effective. It was from this perspective that I became involved as facilitator to a primary care team on a one year project.

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Family Physician’s and Primary Care Team’s Perspectives on Supporting Family Caregivers in Primary Care Networks

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18063293 ◽

2021 ◽

Vol 18 (6) ◽

pp. 3293

Author(s):

Jasneet Parmar ◽

Sharon Anderson ◽

Marjan Abbasi ◽

Saeed Ahmadinejad ◽

Karenn Chan ◽

...

Keyword(s):

Primary Care ◽

Family Caregivers ◽

Healthcare Providers ◽

Family Physicians ◽

Care Team ◽

Primary Care Team ◽

Caregiver Support ◽

Team Members ◽

Primary Care Teams ◽

Support Family

Background. Research, practice, and policy have focused on educating family caregivers to sustain care but failed to equip healthcare providers to effectively support family caregivers. Family physicians are well-positioned to care for family caregivers. Methods. We adopted an interpretive description design to explore family physicians and primary care team members’ perceptions of their current and recommended practices for supporting family caregivers. We conducted focus groups with family physicians and their primary care team members. Results. Ten physicians and 42 team members participated. We identified three major themes. “Family physicians and primary care teams can be a valuable source of support for family caregivers” highlighted these primary care team members’ broad recognition of the need to support family caregiver’s health. “What stands in the way” spoke to the barriers in current practices that precluded supporting family caregivers. Primary care teams recommended, “A structured approach may be a way forward.” Conclusion. A plethora of research and policy documents recommend proactive, consistent support for family caregivers, yet comprehensive caregiver support policy remains elusive. The continuity of care makes primary care an ideal setting to support family caregivers. Now policy-makers must develop consistent protocols to assess, and care for family caregivers in primary care.

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Primary Care Team of the Year: Primary care that makes a difference

BMJ ◽

10.1136/bmj.d2118 ◽

2011 ◽

Vol 342 (apr12 1) ◽

pp. d2118-d2118

Author(s):

H. Macdonald ◽

D. MacAuley

Keyword(s):

Primary Care ◽

Care Team ◽

Primary Care Team

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Organisation of diabetes care Role of the primary care team in

Individualized Diabetes Management ◽

10.1201/9781315380667-13 ◽

2016 ◽

pp. 115-122

Keyword(s):

Primary Care ◽

Diabetes Care ◽

Care Team ◽

Primary Care Team

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A Psychiatric Clinic in General Practice

Bulletin of the Royal College of Psychiatrists ◽

10.1192/pb.11.4.114 ◽

1987 ◽

Vol 11 (4) ◽

pp. 114-117 ◽

Cited By ~ 9

Author(s):

Sally M. Browning ◽

Michael F. Ford ◽

Cait A. Goddard ◽

Alexander C. Brown

Keyword(s):

Primary Care ◽

Mental Illness ◽

General Practice ◽

Psychiatric Disorder ◽

Personality Disorders ◽

Psychiatric Service ◽

Significant Degree ◽

Care Team ◽

Primary Care Team ◽

Psychiatric Clinic

Only a minority suffering from mental illness are treated by the specialist psychiatric service. The majority of psychiatrically ill patients seen in general practice suffer from minor neuroses, personality disorders and situational reactions and can be appropriately treated by the primary care team. However, a significant degree of morbidity, some of it severe, fails to be identified in general practice and the identification and treatment of psychiatric disorder varies according to the GP's interest and attitudes.

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Impact of event notification services on timely follow-up and rehospitalization among primary care patients at two Veterans Affairs Medical Centers

Journal of the American Medical Informatics Association ◽

10.1093/jamia/ocab189 ◽

2021 ◽

Author(s):

Brian E Dixon ◽

Kimberly M Judon ◽

Ashley L Schwartzkopf ◽

Vivian M Guerrero ◽

Nicholas S Koufacos ◽

...

Keyword(s):

Primary Care ◽

Usual Care ◽

Acute Care ◽

Health Systems ◽

Veterans Affairs ◽

Care Team ◽

Primary Care Team ◽

Medical Centers ◽

Event Notification

Abstract Objective To examine the effectiveness of event notification service (ENS) alerts on health care delivery processes and outcomes for older adults. Materials and methods We deployed ENS alerts in 2 Veterans Affairs (VA) medical centers using regional health information exchange (HIE) networks from March 2016 to December 2019. Alerts targeted VA-based primary care teams when older patients (aged 65+ years) were hospitalized or attended emergency departments (ED) outside the VA system. We employed a concurrent cohort study to compare postdischarge outcomes between patients whose providers received ENS alerts and those that did not (usual care). Outcome measures included: timely follow-up postdischarge (actual phone call within 7 days or an in-person primary care visit within 30 days) and all-cause inpatient or ED readmission within 30 days. Generalized linear mixed models, accounting for clustering by primary care team, were used to compare outcomes between groups. Results Compared to usual care, veterans whose primary care team received notification of non-VA acute care encounters were 4 times more likely to have phone contact within 7 days (AOR = 4.10, P < .001) and 2 times more likely to have an in-person visit within 30 days (AOR = 1.98, P = .007). There were no significant differences between groups in hospital or ED utilization within 30 days of index discharge (P = .057). Discussion ENS was associated with increased timely follow-up following non-VA acute care events, but there was no associated change in 30-day readmission rates. Optimization of ENS processes may be required to scale use and impact across health systems. Conclusion Given the importance of ENS to the VA and other health systems, this study provides guidance for future research on ENS for improving care coordination and population outcomes. Trial Registration ClinicalTrials.gov NCT02689076. “Regional Data Exchange to Improve Care for Veterans After Non-VA Hospitalization.” Registered February 23, 2016.

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