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Community-based study leads  to innovative solutions to improve access to primary health care​​

Imagine visiting your family doctor with stomach pains, only to be told “it’s all in your head.” Or having an accident that takes you to an emergency department, and realizing you aren’t being taken seriously after answering questions about your medical history that are unrelated to your injury.

Such scenarios are not uncommon for people living with mental health and/or substance use issues. 

To understand what hinders and helps people from receiving adequate primary care, and to develop practical solutions, a CAMH-led, community-based study team conducted interviews with 85 clients and 17 service providers in Toronto and Ottawa.

The team has identified three major areas where barriers exist – and a unique set of solutions that target these areas to facilitate access to care. A series of interactive skits for health care providers bring to life some of the real, and disheartening, experiences that study participants described. A tip-sheet for clients, policy document and project report were also created. 

The study was led by Dr. Lori Ross, who worked with CAMH’s Empowerment Council, an independent organization that conducts system-wide advocacy on behalf of current and former CAMH clients. The team engaged numerous community partners to collaborate at every stage of the study, including designing the research, reviewing results and developing final recommendations. 

“This issue is part of the experience of most people with mental health or substance use issues,” says Empowerment Council Coordinator Jennifer Chambers.  In the worst cases, the downplaying of physical problems can have severe consequences. She describes one person who was repeatedly turned away from the ED in pain and tears, only to be diagnosed with advanced liver cancer long after the symptoms first appeared.

“We now have the evidence to show that this is a serious problem,” says Chambers. “This study could also help service providers at CAMH and other mental health care centres become advocates around this issue for their patients.”   

Three major knowledge translation activities that emerged from this study are: 

1. Education for Service Providers: Interactive Skits

“Most of the issues that came up in interviews with clients had to do with the rapport and relationships people had with their service providers,” says Myera Waese, research assistant, who conducted most of the client interviews.

To promote attitude change, the team developed an educational intervention with interactive skits, which will be presented as part of the curriculum at nursing schools at the University of Toronto, Ryerson University and York University this academic year.

2. Empowerment for Clients: Tip-sheet  

Some of the challenges people identified were waiting a long time for appointments or not fully understanding what informed consent meant. The team has developed a client tip-sheet that offers practical guidance on what to do to prevent common problems, and how to deal with mistreatment that may violate their rights. 

3. Policy Level Change: Policy Paper and Journal Article

At a broader, systems level, there are issues around shortages of family doctors, or their unwillingness to take on individuals with complex needs, in particular due to funding models that do not adequately compensate them for the extra time that is necessary to properly address the concerns of these patients. A policy paper and academic journal article are being prepared to address this level of change. The focus is on advocating for collaborative models of primary health care, such as family health teams and community health centres, says Dr. Ross. ​

Dr. Lori Ross 

 Related Links

Read more about the Access to Primary Care study 
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