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Competing Interests: Intérêts concurrents: Nav Persaud signale être membre du Groupe d’étude canadien sur les soins de santé préventifs, avoir reçu un remboursement de ses frais de déplacement de la part de l’Agence de la santé publique du Canada [ASPC]) et être consultant bénévole auprès du Groupe consultatif pancanadien sur un cadre en vue d’une liste de médicaments. Le Dr Persaud déclare aussi avoir reçu des subventions des Instituts de recherche en santé du Canada (IRSC), du Programme des chaires de recherche du Canada et de l’Ontario Strategy for Patient-Oriented Research (SPOR) SUPPORT Unit. James Dunn signale avoir reçu des honoraires personnels de la Ville de Toronto (Santé publique de Toronto) pour une recherche sur les options en matière de politiques pour des logements salubres. Stephen Hwang signale faire partie à titre bénévole (sans rémunération) du conseil d’administration de Good Shepherd Ministries, être président du comité de surveillance de la sécurité des données pour l’étude Inspire Quitting (financée par le National Cancer Institute, les National Institutes of Health [à titre bénévole, sans rémunération]) et être membre bénévole du Comité de la recherche pour le National Health Care for the Homeless Council (sans rémunération). Le Dr Hwang déclare aussi avoir reçu des honoraires à titre d’investigateur principal (IP) du Programme de subvention Fondation des IRSC pour la recherche sur des interventions concernant, l’itinérance, le logement et la santé et en tant qu’IP d’une étude de cohorte sur la COVID-19 et l’itinérance à Toronto soutenue par une subvention de fonctionnement des IRSC. Le Dr Hwang a reçu des honoraires à titre de professionnel de la santé de la part d’Inner City Health Associates (subventionné par le ministère de la Santé et des soins de longue durée de l’Ontario). Le Dr Jonathon Maguire signale avoir reçu des subventions des Instituts de recherche en santé du Canada (IRSC) et de l’Ontario Strategy for Patient-Oriented Research (SPOR) SUPPORT Unit. Andrew Pinto signale avoir fait partie du comité consultatif de l’Alliance pour des communautés en santé, et avoir été consultant bénévole auprès de Muto Health Solutions. Le Dr Pinto signale aussi avoir reçu des subventions des IRSC, du gouvernement de l’Ontario, notamment du ministère de la Santé et des Soins de longue durée, de la PSIM Foundation, de la Maytree Foundation, de l’Atkinson Foundation; de la Metcalf Foundation, de la Fondation de l’Hôpital St. Michael et de l’Ontario SPOR SUPPORT Unit. Le Dr Pinto a reçu des honoraires pour des présentations au Joint Centre for Bioethics de l’Université de Toronto (2019), de l’Université McMaster (2020) et de l’Université de Gand (2020). Le Dr Pinto déclare avoir reçu un salaire du Département de médecine familiale et communautaire de l’Hôpital St. Michael, du Département de médecine familiale et communautaire de la Faculté de médecine de l’Université de Toronto et de l’Institut du savoir Li Ka Shing de l’Hôpital St. Michael. Le Dr Pinto a été lauréat de la bourse PSI Graham Farquharson Knowledge Translation Fellowhip en 2019. Patricia O’Campo signale faire partie du conseil d’administration de Centraide du Grand Toronto, qui subventionne des agences qui desservent les femmes victimes de violence conjugale. Mme O’Campo signale aussi avoir reçu deux subventions des IRSC comme détentrice de la Chaire de recherche du Canada sur les approches interventionnelles dans le domaine de la santé des populations et du Conseil de recherches en sciences humaines pour des projets sur la violence conjugale. Sean Rourke signale avoir reçu des honoraires de consultation en tant qu’expert de la mise en œuvre stratégique pour la Fondation canadienne de recherche sur le sida. M. Rourke déclare également des subventions des IRSC et de l’ASPC, versées à l’Hôpital St. Michael, et une subvention de l’Annual Foundation, versée à la Fondation canadienne de recherche sur le sida (et non à M. Rourke). Daniel Werb signale avoir reçu une bourse salariale de nouveau chercheur des IRSC et une subvention de la Fondation de l’Hôpital St. Michael. M. Werb est aussi en attente d’un brevet pour un dispositif de vérification des médicaments. Aucun autre intérêt concurrent n’a été déclaré. Déclaration d’intérêts: Nav Persaud est corédacteur pour le CMAJ, mais n’a pas participé au processus ayant mené au choix de cet article.

Canada welcomes a large number of newcomers every year including international students and their families. The over 800,000 international students who arrived in Canada in 2022, are twice as likely to face difficulties in accessing healthcare services compared to those who were born in Canada. Lack of access to healthcare services may jeopardize their full participation in Canadian society. Pharmacists are highly accessible healthcare providers due to their regular contact with the public, extended working hours, and wide distribution of pharmacies. Given the expanding role of pharmacists in Canada, pharmacists can be a great resource for international newcomers to address their healthcare needs when transitioning to the Canadian healthcare system and exploring available services. In this study, we will explore how international students and their families, who make up a significant segment of newcomers to Canada each year, transition to Canada's healthcare system and identify their main challenges related to developing coping skills for managing diseases and navigating the complexities of prescription and nonprescription medication use. To do so, we will conduct virtual interviews with newcomer international students who have lived experience with transitioning to the Canadian healthcare system. This study will help understand the international student experience and identify how pharmacists can deliver a tailored package of pharmaceutical services to this population to best address their healthcare needs when transitioning to the Canadian healthcare system with the goal of reducing healthcare gaps and inequities. By exploring the healthcare challenges faced by these students, our findings will help pinpoint precise areas where pharmacists can practice to their full scope including medication management, patient education, and transitional care. Consequently, the study will offer detailed recommendations on how pharmacists can better support this population and thereby help alleviate the overall strain on the primary healthcare system. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic substantially magnified the inequity gaps among vulnerable populations. Both public health (PH) and primary health care (PHC) have been crucial in addressing the challenges posed by the pandemic, especially in the area of vulnerable populations. However, little is known about the intersection between PH and PHC as a strategy to mitigate the inequity gap. This study aims to assess the collaboration between PHC and PH with a focus on addressing the health needs of vulnerable populations during the COVID-19 pandemic across jurisdictions. Methods: We analyzed and compared data from jurisdictional reports of COVID-19 pandemic responses in PHC and PH in Belgium, Canada (Ontario), Germany, Italy, Japan, the Netherlands, Norway, and Spain from 2020 to 2021. Results: Four themes emerge from the analysis: (1) the majority of the countries implemented outreach strategies targeting vulnerable groups as a means to ensure continued access to PHC; (2) digital assessment in PHC was found to be present across all the countries; (3) PHC was insufficiently represented at the decision-making level; (4) there is a lack of clear communication channels between PH and PHC in all the countries. Conclusions: This study identified opportunities for collaboration between PHC and PH to reduce inequity gaps and to improve population health, focusing on vulnerable populations. The COVID-19 response in these eight countries has demonstrated the importance of an integrated PHC system. Consequently, the development of effective strategies for responding to and planning for pandemics should take into account the social determinants of health in order to mitigate the unequal impact of COVID-19. Careful, intentional coordination between PH and PHC should be established in normal times as a basis for effective response during future public health emergencies. The pandemic has provided significant insights on how to strengthen health systems and provide universal access to healthcare by fostering stronger connections between PH and PHC. [ABSTRACT FROM AUTHOR]

Background: There is increasing interest in collecting sociodemographic and social needs data in hospital settings to inform patient care and health equity. However, few studies have examined inpatients' views on this data collection and what should be done to address social needs. This study describes internal medicine inpatients' perspectives on the collection and use of sociodemographic and social needs information. Methods: A qualitative interpretive description methodology was used. Semi-structured interviews were conducted with 18 patients admitted to a large academic hospital in Toronto, Canada. Participants were recruited using maximum variation sampling for diverse genders, races, and those with and without social needs. Interviews were coded using a predominantly inductive approach and a thematic analysis was conducted. Results: Patients expressed that sociodemographic and social needs data collection is important to offer actionable solutions to address their needs. Patients described a gap between their ideal care which would attend to social needs, versus the reality that hospital-based teams are faced with competing priorities and pressures that make it unfeasible to provide such care. They also believed that this data collection could facilitate more holistic, integrated care. Patients conveyed a need to have a trusting and transparent relationship with their provider to alleviate concerns surrounding bias, discrimination, and confidentiality. Lastly, they indicated that sociodemographic and social needs data could be useful to inform care, support research to inspire social change, and assist them with navigating community resources or creating in-hospital programs to address unmet social needs. Conclusions: While the collection of sociodemographic and social needs information in hospital settings is generally acceptable, there were varied views on whether hospital staff should intervene, as their priority is medical care. The results can inform the implementation of social data collection and interventions in hospital settings. [ABSTRACT FROM AUTHOR]

Background: There is growing interest in incorporating social determinants of health (SDoH) data collection in inpatient hospital settings to inform patient care. However, there is limited information on this data collection and its use in inpatient general internal medicine (GIM). This scoping review sought to describe the current state of the literature on SDoH data collection and its application to patient care in inpatient GIM settings. Methods: English-language searches on MedLine, Embase, Web of Science, CINAHL, Cochrane, and PsycINFO were conducted from 2000 to April 2021. Studies reporting systematic data collection or use of at least three SDoH, sociodemographic, or social needs variables in inpatient hospital GIM settings were included. Four independent reviewers screened abstracts, and two reviewers screened full-text articles. Results: A total of 8190 articles underwent abstract screening and eight were included. A range of SDoH tools were used, such as THRIVE, PRAPARE, WHO-Quality of Life, Measuring Health Equity, and a biopsychosocial framework. The most common SDoH were food security or malnutrition (n=7), followed by housing, transportation, employment, education, income, functional status and disability, and social support (n=5 each). Four of the eight studies applied the data to inform patient care, and three provided community resource referrals. Discussion: There is limited evidence to guide the collection and use of SDoH data in inpatient GIM settings. This review highlights the need for integrated care, the role of the electronic health record, and social history taking, all of which may benefit from more robust SDoH data collection. Future research should examine the feasibility and acceptability of SDoH integration in inpatient GIM settings. [ABSTRACT FROM AUTHOR]

Canada's health care systems do not routinely collect self-reported race and Indigenous identity data and often lack a standardized and consistent approach to data collection that would permit comparisons between organizations or jurisdictions. For example, in Canada, data on Indigenous communities have been sold to researchers and other entities who have potentially used the data without appropriate context and without abiding by principles of Indigenous data governance and sovereignty. [Extracted from the article]

Abstract Introduction Promoting health equity is a key goal of many public health systems. However, little is known about how equity is conceptualized in such systems, particularly as standards of public health practice are established. As part of a larger study examining the renewal of public health in two Canadian provinces, Ontario and British Columbia (BC), we undertook an analysis of relevant public health documents related to equity. The aim of this paper is to discuss how equity is considered within documents that outline standards for public health. Methods A research team consisting of policymakers and academics identified key documents related to the public health renewal process in each province. The documents were analyzed using constant comparative analysis to identify key themes related to the conceptualization and integration of health equity as part of public health renewal in Ontario and BC. Documents were coded inductively with higher levels of abstraction achieved through multiple readings. Sets of questions were developed to guide the analysis throughout the process. Results In both sets of provincial documents health inequities were defined in a similar fashion, as the consequence of unfair or unjust structural conditions. Reducing health inequities was an explicit goal of the public health renewal process. In Ontario, addressing “priority populations” was used as a proxy term for health equity and the focus was on existing programs. In BC, the incorporation of an equity lens enhanced the identification of health inequities, with a particular emphasis on the social determinants of health. In both, priority was given to reducing barriers to public health services and to forming partnerships with other sectors to reduce health inequities. Limits to the accountability of public health to reduce health inequities were identified in both provinces. Conclusion This study contributes to understanding how health equity is conceptualized and incorporated into standards for local public health. As reflected in their policies, both provinces have embraced the importance of reducing health inequities. Both concepualized this process as rooted in structural injustices and the social determinants of health. Differences in the conceptualization of health equity likely reflect contextual influences on the public health renewal processes in each jurisdiction.

Background: Poverty is associated with increased morbidity related to multiple child and adult health conditions and increased risk of premature death. Despite robust evidence linking income and health, and some recommendations for universal screening, poverty screening is not routinely conducted in clinical care. Methods: We conducted an exploratory study of implementing universal poverty screening and intervention in family medicine and a range of pediatric care settings (primary through tertiary). After attending a training session, health care providers (HCPs) were instructed to perform universal screening using a clinical poverty tool with the question "Do you ever have difficulty making ends meet at the end of the month?" for the three-month implementation period. HCPs tracked the number of patients screened and a convenience sample of their patients were surveyed regarding the acceptability of being screened for poverty in a healthcare setting. HCPs participated in semi-structured focus groups to explore barriers to and facilitators of universal implementation of the tool. Results: Twenty-two HCPs (10 pediatricians, 9 family physicians, 3 nurse practitioners) participated and 150 patients completed surveys. Eighteen HCPs participated in focus groups. Despite the self-described motivation of the HCPs, screening rates were low (9% according to self-reported numbers). The majority of patients either supported (72%) or were neutral (22%) about the appropriateness of HCPs screening for and intervening on poverty. HCPs viewed poverty as relevant to clinical care but identified time constraints, physician discomfort, lack of expertise and habitual factors as barriers to implementation of universal screening. Conclusions: Poverty screening is important and acceptable to clinicians and patients. However, multiple barriers need to be addressed to allow for successful implementation of poverty screening and intervention in health care settings. [ABSTRACT FROM AUTHOR]