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Background: The expansion of the Patient-Centred Medical Home model presents a valuable opportunity to enhance the integration of team-based mental health services in primary care settings, thereby meeting the growing demand for such services. Understanding the organizational context of a Patient-Centred Medical Home is crucial for identifying the facilitators and barriers to integrating mental health care within primary care. The main objective of this paper is to present the findings related to the following research question: "What organizational features shape Family Health Teams' capacity to provide mental health services for depression and anxiety across Ontario, Canada?" Methods: Adopting a constructivist grounded theory approach, we conducted interviews with various mental health care providers, and administrators within Ontario's Family Health Teams, in addition to engaging provincial policy informants and community stakeholders. Data analysis involved a team-based approach, including code comparison and labelling, with a dedicated data analysis subcommittee convening monthly to explore coded concepts influencing contextual factors. Results: From the 96 interviews conducted, involving 82 participants, key insights emerged on the organizational contextual features considered vital in facilitating team-based mental health care in primary care settings. Five prominent themes were identified: i) mental health explicit in the organizational vision, ii) leadership driving mental health care, iii) developing a mature and stable team, iv) adequate physical space that facilitates team interaction, and v) electronic medical records to facilitate team communication. Conclusions: This study underscores the often-neglected organizational elements that influence primary care teams' capacity to deliver quality mental health care services. It highlights the significance of strong leadership complemented by effective communication and collaboration within teams to enhance their ability to provide mental health care. Strengthening relationships within primary care teams lies at the core of effective healthcare delivery and should be leveraged to improve the integration of mental health care. [ABSTRACT FROM AUTHOR]

Background: The onset of the COVID-19 pandemic and introduction of various restrictions resulted in drastic changes to 'traditional' primary healthcare service delivery modalities. Aim: To understand the impact of virtual care on healthcare system performance within the context of Ontario community health centres (CHCs). Design & setting: Thematic analysis of qualitative interviews with 36 providers and 31 patients. Method: Semi-structured phone interviews were conducted in the autumn of 2020. Interviews were recorded, transcribed verbatim, and analysed thematically using the quadruple aim framework. Results: The transition to virtual delivery of services has had both positive and negative impacts on care. Virtual care removed certain barriers to care such as access. However, patients and providers found that phone visits impacted quality of care owing to the inability to read body language and having to rely solely on patient descriptions. Video visits allowed for a similar experience to in-person visits but technical issues constrained this interaction. Depending on the service provided, some providers felt they were not providing the same quality of care. However, providers reported reductions in no-show rates and highlighted the efficiency of virtual appointments. Providers also found they were able to collaborate at a similar level before the pandemic and saw improvements in work--life balance. Overall, patients and providers alike preferred virtual visits with those known to them, and for less complex or transactional aspects of care. Conclusion: The study described positive and negative impacts on patient care, population health, health system costs, and provider experience. These results will be useful for primary care organisations in post-pandemic planning; however, future research is needed for a deeper exploration of the impact on quality of care specifically for more complex health concerns. [ABSTRACT FROM AUTHOR]

We developed and implemented a person-centered navigation model integrated in primary care where patients were referred to the Access to Resources in the Community (ARC) study by their primary care provider (PCP). The purpose of this paper is to explore the lay navigators' learning experience as reflected in their journals and present implications for education and health promotion practice. Sixty-six journal entries from two navigators were analysed. To code the data, we used a newly developed framework based upon the theory-informed lay navigator training programme. Five unique themes were identified: 1) Gaining and Building Trust, 2) Developing Empathy, 3) Experiencing Hope and Optimism, 4) Feeling Helplessness and 5) Celebrating Gains and Successes. The five themes identified paint a sequential picture of the journey of leading individuals from primary care to health and social community resources. This innovative approach has expanded our understanding of how navigators learn in practice, more specifically how they learn from patients and how they develop knowledge and skills in person-centered care. Incorporating reflective journaling as a regular practice provides situational awareness and leads to enhanced learning. Practising person-centered care also develops when a trusting and empathetic relationship is established. [ABSTRACT FROM AUTHOR]

Background: There has been a large-scale adoption of virtual delivery of primary care as a result of the COVID-19 pandemic. Aim: In this descriptive study, an equity lens is used to explore the impact of transitioning to greater use of virtual care in community health centres (CHCs) across Ontario, Canada. Design & setting: A cross-sectional survey was administered and electronic medical record (EMR) data were extracted from 36 CHCs. Method: The survey captured CHCs' experiences with the increased adoption of virtual care. A longitudinal analysis of the EMR data was conducted to evaluate changes in health service delivery. EMR data were extracted monthly for a period of time before the pandemic (April 2019-February 2020) and during (April 2020-February 2021). Results: In comparison with the pre-pandemic period, CHCs experienced a moderate decline in visits made (11%), patients seen (9%), issues addressed (9%), and services provided (15%). During the pandemic period, an average of 54% of visits were conducted virtually, with telephone as the leading virtual modality (96%). Drops in service types ranged from 28%-82%. The distribution of virtual modalities varied according to the provider type. Access to in-person and virtual care did not vary across patient characteristics. Conclusion: The results demonstrate a large shift towards virtual delivery while maintaining in-person care. No meaningful differences were found in virtual versus in-person care related to patient characteristics or rurality of centres. Future studies are needed to explore how to best select the appropriate modality for patients and service types. [ABSTRACT FROM AUTHOR]

Background: Widespread policy reforms in Canada, the United States and elsewhere over the last two decades strengthened team models of primary care by bringing together family physicians and nurse practitioners with a range of mental health and other interdisciplinary providers. Understanding how patients with depression and anxiety experience newer team‐based models of care delivery is essential to explore whether the intended impact of these reforms is achieved, identify gaps that remain and provide direction on strengthening the quality of mental health care. Objective: The main study objective was to understand patients' perspectives on the quality of care that they received for anxiety and depression in primary care teams. Methods: This was a qualitative study, informed by constructivist grounded theory. We conducted focus groups and individual interviews with primary care patients about their experiences with mental health care. Focus groups and individual interviews were recorded and transcribed verbatim. Grounded theory guided an inductive analysis of the data. Results: Forty patients participated in the study: 31 participated in one of four focus groups, and nine completed an individual interview. Participants in our study described their experiences with mental health care across four themes: accessibility, technical care, trusting relationships and meeting diverse needs. Conclusion: Greater attention by policymakers is needed to strengthen integrated collaborative practices in primary care so that patients have similar access to mental health services across different primary care practices, and smoother continuity of care across sectors. The research team is comprised of individuals with lived experience of mental health who have participated in all aspects of the research process. [ABSTRACT FROM AUTHOR]

Context: At onset of the COVID-19 pandemic, primary care quickly transitioned to the use of virtual care. Although much is known about the challenges and opportunities of virtual care for providers and practices, little remains known about the patient experience with virtual care in primary care. The involvement of patients and other key stakeholders as partners in the research process is crucial to generate relevant findings to guide policy and decision-makers in a way that enhances quality of care and patient outcomes. Objective: Describe a multi-pronged approach to inform a population based, mixed-methods research study investigating patients' experiences with virtual care in Ontario, Canada. Study Design: Mixed-methods - a province-wide survey and descriptive qualitative interviews running in parallel. Our multi-pronged approach engaged Patients, Researchers, Policy makers and other data users throughout the study. I) Patients: We recruited a Patient Advisory Committee through patient advocacy groups and health-oriented organizations, and selected individuals to maximize geographical, gender, and sociocultural variation. II) Professional Organizations: We integrated the Association of Family Health Teams of Ontario, Alliance for Healthier Communities, and Ontario College of Family Physicians as key members of the research team. III) Primary Care Practices: We partnered with primary care practices who were data users. Practices disseminated the survey to their patients. IV) Policy and Decision-Makers: We conducted ongoing consultations with stakeholders from Ontario Health and Ontario Ministry of Health for a reciprocal dynamic that informed the research process and enabled rapid uptake of research findings by key stakeholders. Our multi-pronged process used a mixture of involvement and collaboration models of engagement. Results: 55 interviews were conducted with patients and 534 survey respondents met eligibility criteria. The multi-pronged approach provided success with rapid dissemination of results to inform immediate system and practice-level decisions on the use of virtual care. We produced a comprehensive report for provincial policy and decision-makers, conducted 3 presentations to provincial policy and decisionmakers, provided each participating practice with detailed practice-specific reports, and participated in an invited panel. Conclusions: Patient and stakeholder engagement is a key component to primary care research. [ABSTRACT FROM AUTHOR]

Context: Home visits at the end of life decrease hospitalizations and hospital deaths, which reduces healthcare costs and aligns with most patients' wishes. In addition to family physicians, nurse practitioners (NPs) play a critical role in meeting the rising demand for home and community-based palliative care. However, very few population-level studies have examined practice patterns of NPs delivering home-based end-of-life care and the collaboration between physicians and NPs. Objective: To describe the characteristics and outcomes of patients receiving home-based palliative care provided by physicians and NPs in the last 90 days of life. Study design and Analysis: Retrospective population-based study with a descriptive analysis of patient characteristics and multivariate logistic regression analyses of end-of-life outcomes controlling for patients' demographics, health, and healthcare use. Setting or Dataset: Healthcare administrative data in Ontario, Canada. Population studied: Adults 19 years and older who died between January 1, 2018, and December 31, 2019, and received home care in their last 90 days of life (N=103,664). Intervention/Instrument: Receipt of home visits by an NP, physician, or both. Outcome measures: Receipt of medications for symptoms (e.g., pain, delirium/agitation, and terminal secretion) in the last 3 weeks of life, acute care use in the last 3 weeks of life, and location of death. Results: Over half (56.9%) of the decedents did not receive any visits from an NP or physician; 3.8% received at least 1 visit from an NP (and no physician visits), 34.5% received at least 1 visit from a physician (but no NP visits), and 4.9% received at least 1 visit from each. NP visits were more prevalent among patients living in rural areas. Patients who received at least 1 home visit were less likely to be hospitalized, more likely to have received medications for symptom management, and more likely to experience a community-based death. These associations were strongest when patients received home visits from both NPs and physicians. Results from multivariable regression are forthcoming. Conclusions: The receipt of at least 1 NP or physician home visit at the end of life can significantly reduce acute care use, improve access to symptom management medications, and mitigate hospital-based deaths. Collaboration between NPs and physicians was associated with greater benefits to patients' outcomes. [ABSTRACT FROM AUTHOR]

Context: Community resources are often required in addition to primary care to effectively address a variety of health and social needs. However, access to these resources is influenced by various system and individual level factors. Little is known about the factors that enhance and prevent access to community resources. Objective: To investigate the facilitators and barriers to accessing community resources. Study Design, Intervention, Setting, and Population: A randomized control trial of 326 primary care patients compared the Access to Resources in the Community (ARC) navigation model to the Ontario 211 Community and Social Services Help line in supporting individuals' access to community resources in Ottawa and Sudbury, Ontario (Canada). The patient experience was captured through 32 interviews (24 conducted in English and 8 in French) using a semi-structured approach. Purposeful sampling was used to maximize participant variability. Interviews were recorded, transcribed and analyzed applying a deductive approach with a uniquely developed coding scheme adapted from Levesque et al's 2013 Access to Primary Health Care Framework. Data was coded in QSR NVivo® 9 by two independent coders to ensure reliability and consensus. This analysis focuses exclusively on the facilitators and barriers that patients reported experiencing and does not include the impact of the navigation services on these factors. Results: System level facilitators to access included resources making themselves known through outreach activities, provision of whole-person care, high quality of care, and good follow-up. Individual level facilitators involved patients' autonomy in seeking resources, adequate social support, access to insurance, feeling empowered to access resources and high selfefficacy. System level barriers faced by patients included inadequate advertising of available resources, lack of cultural sensitivity, distance from resources, long wait times, and resources not meeting patient health and social needs. Individual level barriers included limited access and knowledge of technology, poor mental and physical health, lack of transportation, inability to pay, lack of adherence, and low motivation. Conclusion: Strategies to enhance facilitators and address barriers are required to achieve equitable access to community resources. [ABSTRACT FROM AUTHOR]

Context: The onset of COVID-19 has required the rapid adoption of virtual services in primary care (PC) practices, and virtual care delivery is likely to continue to some extent post-pandemic. Objective: To understand patient experience with synchronous virtual (telephone (Tel)/Video) appointments and elicit recommendations for its future use. Design: Mixed method, including patient survey co-developed with stakeholders and implemented online Feb-Mar 2021 with large promotional efforts through social media, patient and caregiver organizations, and other networks. We report on the survey results. Eligibility: 1+ virtual encounter in PC. Outcome measures: A) Patient experience scale (12/17 questions for Tel/Video) covering 4 sub-dimensions; B) Access related questions. Questions had 5-point Likert scale items (strongly disagree (-2) to strongly agree (+2)) and were converted into percentage (potential range -100%, +100%) Setting : Ontario, Canada which offers universal coverage for PC visits with no co-payment. Results: 534 eligible respondents (402/18/114 had Tel/Video/both): Females (78%), < 55 years (61%), white (75%), employed (61%), bachelor's degree (74%), family income > 100k (52%). Encounters evaluated were with family physicians (vs other health professionals) for 75%/46% of Tel/Video encounters. A) Patient Experience (Tel/Video) overall score: 75%/78%; Sub-dimensions: technology: 92%/84%, patient-provider relationship: 83%/86%, quality of care: 66%/66%, whole-person care: 43%/53%. Factors associated with a statistically significant(*) > 10% higher overall score in tel and/or video were: non-females: (8%*/14%*), French speaking (13%*/16%*), patient-provider relationship >1 year (16%*/7%), provider age < 50 (5%/15%*), having the choice of appointment time (15%*/21%*). Wanting to show problem to the provider was associated with a lower scores (-23%*/NA). B) Access Respondents overwhelmingly reported that Tel/Video visits reduced time (97%/97%), costs (81%/85%), and was more convenient (91%/91%). The majority wanted Tel (69%) and Video (71%) visits at least as often as in person visits post-covid. Only 5% did not want any future virtual care. Conclusions: Patient experience was largely positive and is influenced by patient/provider factors. Patients and providers may benefit from support/training to optimize care experience. We are now evaluating whether the reasons for visits influences care experience., Competing Interests: Authors report none., (2021 Annals of Family Medicine, Inc.)