Health Care Services In Canada Research Articles

Accessibility of Gynecological Healthcare Services in Canada Under Immigration Policies

Accessibility of Gynecological Healthcare Services in Canada Under Immigration Policies

Mediators of psychosocial well-being for immigrant women living with breast cancer in Canada: a critical ethnography

Abstract Background: Immigrant women living with breast cancer experience a lack of psychosocial and emotional support, which adds to the complexity of navigating and using health care services in Canada. Aim: To explore the mediators of psychosocial well-being for immigrant women living with breast cancer in Canada. Methods: A critical ethnography was used. The study identified 27 immigrants living with breast cancer, who had been born in a foreign country, migrated to Canada within the past 10 years, and lived in rural communities of British Columbia between August 2021 and March 2022. Institutional research ethics board approval and informed consent were obtained. Results: The findings indicated two significant themes: The immigrant women had limited knowledge, information, and communication and experienced physical, psychological, and emotional distress. Conclusion: There is a significant need for culturally responsive care services for immigrant women living with breast cancer in rural communities. Recommendations include the development of psychosocial oncology, such as integrated counseling and therapies, to reduce cancer-related post-traumatic stress and improve their psychosocial and emotional well-being. Interdisciplinary approaches to psychosocial oncology are particularly crucial for immigrants and rural communities, where women need access to cancer navigation and ongoing support for a better health-related quality of life.

Access to mental health care in Canada

There has been ongoing national discourse about barriers to mental health care services in Canada. The purpose of the study is to better understand these barriers, with a focus on Canadians of color. To that end, this study surveyed 1501 adults representative of the general population, collected by the Angus Reid Institute. Over half of the respondents had sought out mental health care and experienced barriers to access. People of color (visible minorities and Indigenous people) had more difficulty accessing care, as did younger adults and those with lower incomes. The most common difficulties were largely structural: long waitlists (62%), financial barriers (58%), lack of resources/professionals in the area (47%), difficulty finding specialists (41%), and difficulty accessing in-person care during the pandemic (34%). Many noted negative experiences with mental health professionals (35%). More English-speaking than French-speaking Canadians reported barriers to care overall. Race/ethnicity was related to difficulties when trying to access mental health care, as many could not find someone of the same group (25% of Black respondents), someone who spoke their preferred language (22% of South Asian respondents), or they had prior negative experiences (50% of Indigenous respondents). We discuss the implications of these findings, including the critical need to increase the supply and diversity of mental health providers across Canada. This study is one of the first to provide quantitative data on the perceived barriers faced by Canadians in accessing mental health care while exploring the role of language, race, and ethnicity as variables that may influence access.

Integrated case management between primary care clinics and hospitals for people with complex needs who frequently use healthcare services in Canada: A multiple-case embedded study

IntroductionCase management (CM) is recognized to improve care integration and outcomes of people with complex needs who frequently use healthcare services, but challenges remain regarding interaction between primary care clinics and hospitals. This study aimed to implement and evaluate an integrated CM program for this population where nurses in primary care clinics worked with a hospital case manager. MethodsA multiple embedded case study was conducted in the Saguenay-Lac-Saint-Jean region (Québec, Canada), in four dyads including a clinic and a hospital. Mixed data collection included, at baseline and 6 months, interviews and focus groups with stakeholders, patient questionnaires (patient experience of integrated care and self-management), and emergency department (ED) visits in the previous 6 months. ResultsIntegrated CM implementation was optimal when all stakeholders provided collective leadership, and were supportive of the program, particularly the physicians. The 6-month program enabled the observation of positive qualitative outcomes in most clinic-hospital dyads where implementation occurred. Full implementation was associated with improved care integration. Discussion and conclusionIntegrated CM between primary care clinics and hospitals is a promising innovation to improve care integration for people with complex needs who frequently use healthcare services. Collective leadership and physicians’ buy-in to integrated CM are important to foster the implementation.

Immigrant women cancer survivors’ perceptions of healthcare services in Canada: A phenomenological study

Middle Eastern immigrant women (MEIW) living in Canada have significantly increased. However, this group of women is under-represented in health research, and there is a gap in knowledge about their experiences when they access healthcare services for cancer care in Canada. This qualitative approach was conducted to uncover the meaning of the lived experiences of MEIW with healthcare services in Canada during their cancer survivorship (CS). Data were collected through unstructured interviews and one written description from three MEIW. Data were analyzed using a descriptive phenomenological approach developed by Giorgi. Four themes emerged to represent the essence (or meaning) of the participants’ lived experiences. Their healthcare was accompanied with delays and unmet needs. Yet, they found it helpful when they were provided with knowledge and information. The ability to communicate in English was equal to empowerment for each of them, while they faced cultural stigmatization of mental health issues. Thus, healthcare professionals need to identify immigrant women’s unmet support needs and psychosocial responses during their cancer survivorship. Language-specific and culturally competent cancer-care intervention programs must be developed within the Canadian healthcare system.

Counting what counts: a systematic scoping review of instruments used in primary healthcare services to measure the wellbeing of Indigenous children and youth

BackgroundPrimary healthcare services have principal responsibility for providing child and youth wellbeing and mental health services, but have lacked appropriate measurement instruments to assess the wellbeing of Indigenous children and youth or to evaluate the effectiveness of programs and services designed to meet their needs. This review assesses the availability and characteristics of measurement instruments that have been applied in primary healthcare services in Canada, Australia, New Zealand and the United States (CANZUS countries) to assess the wellbeing of Indigenous children and youth.MethodsFifteen databases and 12 websites were searched in December 2017 and again in October 2021. Pre-defined search terms pertained to Indigenous children and youth, CANZUS country names, and wellbeing or mental health measures. PRISMA guidelines were followed, with eligibility criteria guiding screening of titles and abstracts, and selected full-text papers. Results are presented based on the characteristics of documented measurement instruments assessed according to five desirability criteria: development for Indigenous youth populations, adherence to relational strength-based constructs, administration by child and or youth self-report, reliability and validity, and usefulness for identifying wellbeing or risk levels.ResultsTwenty-one publications were found that described the development and or use by primary healthcare services of 14 measurement instruments, employed across 30 applications. Four of the 14 measurement instruments were developed specifically for Indigenous youth populations, four focused solely on strength-based wellbeing concepts but none included all Indigenous wellbeing domains.ConclusionThere is a diversity of measurement instruments available, but few fit our desirability criteria. Although it is possible that we missed relevant papers and reports, this review clearly supports the need for further research to develop, refine or adapt instruments cross-culturally to measure the wellbeing of Indigenous children and youth.

The Role of Home Care Pharmacists in the Edmonton Zone: A Retrospective Study.

Despite the rising demand for home-based health care services in Canada and the increasing medical complexity of elderly patients, there is limited literature exploring the role of home care pharmacists and the clinical activities they perform. The primary objective was to describe the types and frequencies of clinical activities (both interventions and recommendations) performed by home care pharmacists upon initial consultation. The secondary objective was to determine which patient characteristics resulted in the highest number of clinical activities. This study was a retrospective review of adult patients who had an initial in-person or telemedicine consultation with home care pharmacists from June 2018 to May 2019 in the Edmonton Zone of Alberta Health Services. Of the 355 patients whose records were screened, 318 (89.6%) were included in the analysis. Of these, 191 (60.1%) were female, and the median age was 79 years (interquartile range [IQR] 68-86 years). The median numbers of medical conditions and medications were 6 and 10, respectively. Of the total of 1172 clinical activities, there was a median of 3 (IQR 2-5) per patient, irrespective of the patient's medical conditions, including those with the most common conditions. The most common activities were patient counselling (n = 160, 13.7%), collaboration with another health care professional (n = 157, 13.4%), and deprescribing (n = 140, 11.9%). Across all activities, pharmacists performed a total of 562 interventions and made 610 recommendations. Each additional year of age and each additional medication on a patient's medication list resulted in an increase in the number of clinical activities (by 0.01 for each additional year of age [p = 0.003] and by 0.03 for each additional medication [p < 0.001]). Home care pharmacists in the Edmonton Zone performed a wide range of clinical activities, particularly for older patients and those with more medications. Further research is required to evaluate the outcomes of pharmacist consultations.

Unmet health care needs during the COVID-19 pandemic among adults: a prospective cohort study in the Canadian Longitudinal Study on Aging.

The COVID-19 pandemic affected access to health care services in Canada; however, limited research examines the influence of the social determinants of health on unmet health care needs during the first year of the pandemic. The objectives of this study were to describe unmet health care needs during the first year of the pandemic and to investigate the association of unmet needs with the social determinants of health. We conducted a prospective cohort study of 23 972 adults participating in the Canadian Longitudinal Study on Aging (CLSA) COVID-19 Study (April-December 2020) to identify the social determinants of health associated with unmet health care needs during the pandemic. Using logistic regression, we assessed the association between several social determinants of health on the following 3 outcomes (separately): experiencing any challenges in accessing health care services, not going to a hospital or seeing a doctor when needed, and experiencing barriers to accessing testing for SARS-CoV-2 infection. From September to December 2020, 25% of participants experienced challenges accessing health care services, 8% did not go to a hospital or see a doctor when needed and 4% faced barriers accessing testing for SARS-CoV-2 infection. The prevalence of all 3 unmet need outcomes was lower among older age groups. Differences were observed by sex, region, education, income and racial background. Immigrants (odds ratio [OR] 1.18, 95% confidence interval [CI] 1.09-1.27) or people with chronic conditions (OR 1.35, 95% CI 1.27-1.43) had higher odds of experiencing challenges accessing health care services and had higher odds of not going to a hospital or seeing a doctor (immigrants OR 1.26, 95% CI 1.11-1.43; chronic conditions OR 1.45, 95% CI 1.31-1.61). Prepandemic unmet health care needs were strongly associated with all 3 outcomes. Substantial unmet health care needs were reported by Canadian adults during the first year of the pandemic. The results of this study have important implications for health equity.

Family-centred interventions for Indigenous early childhood well-being by primary healthcare services.

Family-centred interventions for Indigenous early childhood well-being by primary healthcare services.

Symptoms of depression and anxiety, and unmet healthcare needs in adults during the COVID-19 pandemic: a cross-sectional study from the Canadian Longitudinal Study on Aging

BackgroundThe COVID-19 pandemic disrupted access to healthcare services in Canada. Research prior to the pandemic has found that depression and anxiety symptoms were associated with increased unmet healthcare needs. The primary objective of this study was to examine if mental health was associated with perceived access to healthcare during the pandemicMethodsA cross-sectional study was conducted using data from 23,972 participants (aged 50-96) in the Canadian Longitudinal Study on Aging COVID-19 Exit Survey (Sept-Dec 2020). We used logistic regression to estimate how the presence of depression and anxiety symptoms, defined using scores of ≥10 on the Center for Epidemiologic Studies Depression Scale and ≥10 on the Generalized Anxiety Disorder Scale, were associated with the odds of reporting: 1) challenges accessing healthcare, 2) not going to a hospital or seeing a doctor when needed, 3) experiencing barriers to COVID-19 testing. Models were adjusted for sex, age, region, urban/rural residence, racial background, immigrant status, income, marital status, work status, chronic conditions, and pre-pandemic unmet needs.ResultsThe presence of depressive (aOR=1.96; 95% CI=1.82, 2.11) and anxiety symptoms (aOR=2.33; 95% CI=2.04, 2.66) compared to the absence of these symptoms were independently associated with higher odds of challenges accessing healthcare. A statistically significant interaction with sex suggested stronger associations in females with anxiety. Symptoms of depression (aOR=2.88; 95% CI=2.58, 3.21) and anxiety (aOR=3.05; 95% CI=2.58, 3.60) were also associated with increased odds of not going to a hospital or seeing a doctor when needed. Lastly, depressive (aOR=1.99; 95% CI=1.71, 2.31) and anxiety symptoms (aOR=2.01; 95% CI=1.58, 2.56) were associated with higher odds of reporting barriers to COVID-19 testing. There was no significantly significant interaction with sex for the latter two outcomes.ConclusionThe presence of depression and anxiety symptoms were strongly associated with perceived unmet healthcare needs during the COVID-19 pandemic. Interventions to improve healthcare access for adults with depression and anxiety during the pandemic may be necessary.

Legislatively Excluded, Medically Uninsured and Structurally Violated: The Social Organization of HIV Healthcare for African, Caribbean and Black Immigrants with Precarious Immigration Status in Toronto, Canada.

African, Caribbean and Black immigrants face persistent legislative barriers to accessing healthcare services in Canada. This Institutional Ethnography examines how structural violence and exclusionary legislative frameworks restrict the right to HIV healthcare access for many Black immigrants. We conducted semi-structured interviews with Black immigrants living with HIV (n = 20) and healthcare workers in Toronto, Canada (n = 15), and analyzed relevant policy texts. Findings revealed that exclusionary immigration and healthcare legislation shaping and regulating immigrants’ right to health restricted access to public resources, including health insurance and HIV healthcare and related services, subjecting Black immigrants with precarious status to structural violence. Healthcare providers and administrative staff worked as healthcare gatekeepers. These barriers undermine public health efforts of advancing health equity and ending HIV “while leaving no one behind.” We urge continued policy reforms in Canada’s immigration and healthcare systems regarding HIV care access for Canada’s precarious status immigrants.

Provincial variations in not having a regular medical doctor and having unmet healthcare needs among Canadians.

Despite spending 11.0% of the total gross domestic product, the quality of healthcare services in Canada has received mixed reviews. We first separately examined provincial variations in not having a regular medical doctor and having unmet healthcare needs among Canadians. Second, we evaluated provincial variations in the impact of not having a regular medical doctor on having unmet healthcare needs among Canadians. We applied logistic regressions using data from the 2014 and 2017-2018 Canadian Community Health Surveys (CCHS). The total sample size for this study was 120,345 individuals aged 12years and older: 61,240 from the 2014 CCHS and 59,105 from the 2017-2018 CCHS. We found significant provincial variations in not having a regular medical doctor and having unmet healthcare needs among Canadians. People in Quebec and the Territories were more likely not to have a regular medical doctor than their peers in Alberta. People in Quebec and the Territories were also more likely to have unmet healthcare needs than their counterparts in Alberta. Not having a regular medical doctor impacted whether Canadians reported having unmet healthcare needs to varying degrees across provinces. Findings from this study may contribute to designing province-specific policy interventions and inform efforts that seek to address barriers to having a regular medical doctor and reducing unmet healthcare needs among Canadians.

Impact of COVID-19 pandemic on foot care services in Ontario, Canada

BackgroundThe COVID-19 pandemic has directly affected the delivery of health care services in Canada, including foot care. The goal of this descriptive study was to understand the impact of the early COVID-19 pandemic (March 2020 to April 2021) on chiropodists’ and podiatrists’ clinical practices and foot care service delivery in Ontario, Canada.MethodsA web-survey was completed by participating chiropodists and podiatrists registered with the College of Chiropodists of Ontario. The survey consisted of 31 multiple choice and open-ended items on clinical practice characteristics, foot care service delivery changes, perceived barriers during the pandemic, and its impact on clinicians. Descriptive statistics were used to characterize the sample and examine clinicians’ responses, and qualitative content analysis was used to explore opened-ended items.ResultsOf the 773 eligible clinicians, 279 participated for a response rate of 36.1%. Most respondents reported a decline in patient volume, an increase in urgent foot health problems, a financial impact on their clinical practices, an emotional impact, and substantial changes to how they provided foot care services, such as incorporating telehealth/virtual care into patient care. Factors that impact clinicians’ perception of future pandemic preparedness are identified.ConclusionThis study describes foot care service delivery in Ontario, Canada during the COVID-19 pandemic. The COVID-19 pandemic saw an increase in urgent foot health problems, decline in patient volume, and impacted clinicians’ mental health and emotional well-being. Future studies should examine patients’ experiences of foot care service delivery and maintaining their foot health during the pandemic, and further examination of factors that impact clinicians’ perception of pandemic preparedness.

Experiences of Indigenous peoples in Canada with primary health care services: a qualitative systematic review protocol.

The objectives of this review are to aggregate and synthesize experiences of Indigenous peoples in Canada when receiving primary health care services; differentiate experiences from services provided in urban versus rural or remote settings; and identify recommendations to enhance quality of primary health care provision. Primary health care plays a crucial role in overall population health and health equity. In Canada, Indigenous peoples continue to face disproportionate health disparities. Survey and qualitative studies on the experiences of Indigenous populations with primary health care services reveal alarming findings of inadequate health care access, racial discrimination, negligence, and cultural insensitivities. However, these studies do not entirely assess the primary care and essential public health functions component. This protocol will be the first qualitative systematic review to thoroughly synthesize Indigenous peoples' overall primary health care experiences across all Canada, in both rural and urban settings. The population of interest is self-identified Indigenous peoples, who have first- and/or second-hand experience receiving primary health care services in Canada, regardless of their age, gender, or medical condition. Our focus is on patients' experiences in contexts where primary health care services are delivered in Canada. Only qualitative studies in English or French will be considered. MEDLINE, CINAHL, PubMed, PsycINFO, Embase, and Web of Science will be used as information sources in addition to Google Scholar, Bielefeld Academic Search Engine, ProQuest Dissertations and Theses, and other relevant organization websites. Two independent reviewers will perform the screening, critical appraisal, and data extraction of selected articles. Results will then be synthesized using the meta-aggregation approach. PROSPERO CRD42020192353.

Historical Antecedents and Challenges of Racialized Immigrant Women in Access to Healthcare Services in Canada: an Exploratory Review of the Literature.

Examining the historical antecedents of racialized immigrant women are important precursors to understanding the challenges they face in access to quality and timely healthcare in Canada. Changes to immigration policies, structural and systemic racial discrimination perpetuate the feminization of migration in Canada, create structural barriers in labour market integration, increase social exclusion and ultimately create unequal access to healthcare services. Despite their high levels of education, racialized immigrant women in Canada are over-represented in low-paid, low-skill precarious jobs. They also face powerful structural barriers to decent professional employment due to the lack of acceptance of foreign educational and licencing credentials. Ultimately, these challenges negatively impact how they interact with healthcare services. Utilizing an intersectional and socio-ecology framework, this review aims to highlight the historical antecedents of racialized immigrant women in access to healthcare services in Canada and examine the challenges racialized immigrant women face in access to healthcare services in Canada. Findings from this review can be used to open dialogues on possible changes to immigration and social policies in Canada, including changes to labour market practices, and initiatives to address structural and systemic barriers, to enable racialized immigrant women overcome the challenges they face in accessing quality healthcare services in a timely manner.

Comparing Strategies for Providing Child and Youth Mental Health Care Services in Canada, the United States, and The Netherlands.

This paper reviews how child and youth mental health care services in Canada, the United States, and the Netherlands are organized and financed in order to identify systems and individual-level factors that may inhibit or discourage access to treatment for youth with mental health problems, such as public or private health insurance coverage, out-of-pocket expenses, and referral requirements for specialized mental health care services. Pathways to care for treatment of mental health problems among children and youth are conceptualized and discussed in reference to health insurance coverage and access to specialty services. We outline reforms to the organization of health care that have been introduced in recent years, and the basket of services covered by public and private insurance schemes. We conclude with a discussion of country-level opportunities to enhance access to child and youth mental health services using existing health policy levers in Canada, the United States and the Netherlands.

The Future of Precarious Status Migrants' Right to Health Care in Canada

This article examines how health care services in Canada are denied to precarious status migrants, either through outright exclusion based on immigration status, or due to the realities in migrants’ lives that make it difficult for them to access health care services. The author argues that this situation is unfair, given the contribution made by precarious status migrants to Canada’s sociocultural and economic fabric, and exhorts the courts and policymakers to do more to make health care services available to these migrants.

Should Public Drug Plans Be Based on Age or Income?

Drugs have become an increasingly critical part of healthcare services in Canada over the last few decades – with nearly $30 billion spent on prescription drugs nationwide in 2013. But it’s not clear that the current design of most provincial drug plans can withstand the financial pressures of an aging population and offer equitable access to public benefits. Owing to budgetary constraints, each province has designed unique, non-universal drug coverage to fill the gaps where private insurance does not exist. Provincial drug plans offer coverage based on an individual’s age, income, availability of private insurance (through one’s employer), or some combination of the three. We look at the most common age-based provincial plans – as well as the trend towards income-based plans. Age-based plans, which usually apply only to seniors, have major drawbacks. These include a cost structure that will be pressured from an aging population and inequities in benefit access: seniors with income and drug needs similar to a working-age family without private drug coverage pay a much smaller share of their drug costs than the family does. Provinces with age-based plans also extend benefits to those on social assistance, making transitioning off welfare difficult for families with drug needs. Further, low-income workers are those most likely to be under- or uninsured in provinces with age-based plans, which include Ontario, Alberta, Prince Edward Island and Nova Scotia. Income-based plans have challenges as well. They must be designed carefully to avoid significantly increasing in public costs and hindering access to prescribed drugs. Plus, provinces must consider how income-tested benefits can have negative incentive effects on work. High marginal tax rates reduce the incentive to work and earn. And when combined with reductions in the plethora of targeted government programs, badly designed income-based plans can create high marginal tax rates. We compare the advantages and pitfalls in moving from an age-based plan to one based on income. Further, we glean lessons from provinces with income-based plans – British Columbia and New Brunswick, which will have a new plan in 2015. On balance, we find that the benefits of an income-based plan make them superior to age-based ones. An income-based plan would apply to all individuals and families without private coverage, including those on social assistance and seniors. Although much of the discussion for reforming Canada’s drug coverage to date has focused on creating a universal federal drug plan, other options must be explored absent political traction in pursuit of this approach. Age-based plans might have been a cost-friendly option decades ago when the ratio of seniors to workers was low, but the wave of retiring baby boomers will rapidly makes these plans less affordable. Income-based plans are a better alternative for cash-constrained provinces.

Evaluation of the implementation of centralized waiting lists for patients without a family physician and their effects across the province of Quebec.

BackgroundMost national and provincial commissions on healthcare services in Canada over the past decade have recommended that primary care services be strengthened in order to guarantee each citizen access to a family physician. Despite these recommendations, finding a family physician continues to be problematic. The issue of enrolment with a family physician is worrying in Canada, where nearly 21% of the country's population reported not having a family physician in the last Commonwealth Fund survey.To respond to this important need, centralized waiting lists have been implemented in four Canadian provinces to help `orphan,' or unaffiliated, patients find a family physician. These organizational mechanisms are intended to better coordinate the demand for and supply of family physicians. The objectives of this study are: to assess the effects of centralized waiting lists for orphan patients (GACOs) implemented in the province of Quebec and to explain the variation among their effects by analyzing factors influencing implementation process.MethodsThis study is based on two complementary and sequential research strategies. The first (objective 1) is a quantitative longitudinal design to assess the effects of all the GACOs (n = 93) in Quebec using clinical-administrative data. The second (objective 2) involves using four case studies to explain variations in effects through in-depth analysis of the various factors contributing to the observed effects. The primary source of data will be key actors involved in the GACOs. We expect to conduct around 40 semi-structured interviews.DiscussionThis will be the first study in Canada to evaluate the implementation of this innovation. It will provide an exhaustive picture of the effects of GACO implementation in Quebec and to assess their potential for generalization elsewhere in Canada. At the theoretical level, this study will produce new knowledge on the factors having the greatest influence on the implementation of primary care innovations in professional environments.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-014-0117-9) contains supplementary material, which is available to authorized users.

Physician opinion of the privatization of health care services in Canada: a survey of Canadian urologists by the Canadian Urological Association Socioeconomic Committee

Physician opinion of the privatization of health care services in Canada: a survey of Canadian urologists by the Canadian Urological Association Socioeconomic Committee