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Access to Primary Care: A Qualitative Study


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CAMH Access to Primary Care Report 2015

Overview

It has long been known that people living with mental health and /or substance use issues have difficulty accessing and maintaining primary care. (Bebbington et al. 2000) In fact, these individuals may die a staggering 25 years earlier than adults in the general population.(Parks et al. 2006) The increased rates of morbidity and mortality seen within this population are in part due to poor primary/preventive health care. (Parks et al. 2006) Patients who ‘fall through the cracks’ see great costs to their mental and physical health, and this personal cost translates into both social and financial cost to the health care system. Despite these distressing facts, little research has explored the causes for, or potential solutions to, the lack of primary care access for this population. 

The Centre for Addiction and Mental Health (CAMH) has undertaken research to address this crucial knowledge gap. CAMH partnered with academics, community organizations, mental health and addictions service users, and the Ontario College of Family Physicians to conduct interviews with over 100 service users and providers in Ontario about experiences accessing primary care. Analyzed results illustrate the personal, provider, and systems level barriers which limit access to primary care for people living with mental health and/or substance use issues. Practical barriers (e.g., transportation and stable housing), provider values and attitudes (e.g. discrimination and stigma), and systemic barriers (e.g., waitlists and insufficient services) contribute to poor health outcomes and place strain on the health care system. Community and institutional stakeholders used these results to inform the following policy recommendations, many of which are supported by municipal, provincial and federal government health care strategies. These recommendations are centred on the urgent need for interdisciplinary and collaborative care to improve health outcomes for people living with mental health and/or substance use issues:

Recommendation 1: Increase accessibility of collaborative and interdisciplinary models of primary health care, such as family health teams and community health
centres, for people living with mental health and/or substance use issues.

Recommendation 2: Provide more access to free mental health support services.

Recommendation 3: Explore strategies to improve communication between multiple health care providers working with an individual living with mental health and/or substance use issues.

Recommendation 4: Expand opportunities for physicians to network with, and be
mentored by, mental health and/or substance use specialists.

Recommendation 5: Increase availability of intermediaries between clients living with mental health and/or substance use issues and the health care system. 

Recommendation 6: Investigate the impacts of primary health care funding models on ongoing access for clients with mental health and/or substance use issues. 

Recommendation 7: Continue to support existing client-directed independent advocacy
organizations and promote the development of new ones.

Recommendation 8: Develop a client advocacy system for primary care.

The implementation of the recommendations above will help people with mental health and/or substance use issues to access and maintain the primary care to which they are entitled, thus contributing to better health outcomes for this population. The corresponding health, social, and economic benefits to these recommendations will help ensure a more equitable and efficient health care system for all in Ontario.

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Health System Performance Frameworks: Aligning Frameworks for Sectors and Organizations to Health Systems



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Overview

This report describes how performance frameworks for care delivery organizations or sectors of the health system can be aligned with the system-level Health System Performance (HSP) Measurement Framework developed by CIHI to allow stakeholders to assess the collective contribution of all parts of the health system.

By aligning sectoral and organizational frameworks with the system framework, health service providers can see how each of the system's distinct components (such as hospitals or long-term care facilities) connects to overall system performance. Aligned frameworks can provide a deeper, more specific understanding of how we can build on an HSP Measurement Framework and design complementary frameworks that demonstrate how the inputs, processes and outcomes of any one health service relate to the larger whole.

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Global Strategy on Human Resources for Health: Workforce 2030



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Overview

In May 2014, the Sixty-seventh World Health Assembly adopted resolution WHA67.24 on Follow-up of the Recife Political Declaration on Human Resources for Health: renewed commitments towards universal health coverage. In paragraph 4 of that resolution, Member States requested the Director-General of the World Health Organization (WHO) to develop and submit a new global strategy for human resources for health (HRH) for consideration by the Sixty-ninth World Health Assembly.

The Global Strategy on Human Resources for Health: Workforce 2030 is primarily aimed at planners and policy-makers of WHO Member States, but its contents are of value to all relevant stakeholders in the health workforce area, including public and private sector employers, professional associations, education and training institutions, labour unions, bilateral and multilateral development partners, international organizations, and civil society.

The development of the Global Strategy was informed by a process launched in late 2013 by Member States and constituencies represented on the Board of the Global Health Workforce Alliance, a hosted partnership within WHO (whose mandate came to fruition in May 2016). Over 200 experts from all WHO regions contributed to consolidating the evidence around a comprehensive health labour market framework for universal health coverage (UHC). A synthesis paper was published in February 2015 and informed the initial version of the draft Global Strategy.

An extensive consultation process on the draft version was launched in March 2015. This resulted in inputs from Member States and relevant constituencies such as civil society and health care professional associations. The process also benefited from discussions in the WHO regional committees, technical consultations, online forums and a briefing session to Member States’ permanent missions to the United Nations (UN) in Geneva. Feedback and guidance from the consultation process are reflected in the document, which is also aligned with, and informed by the framework on integrated peoplecentred health services.

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Physicians in Canada, 2014


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Overview

Physicians in Canada, 2014 contains demographic information about the supply of physicians in Canada and information about the payments made to them that are administered through provincial and territorial medical care plans. Data includes the average cost per clinical service for family medicine physicians and other specialists at the national and provincial levels.

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15th Annual National Report Card on Health Care


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Overview

These are the findings of the Canadian Medical Association’s 15th annual National Report Card on the health care system in Canada. Since 2001, the CMA has asked Canadians to assign letter grades to their health care system overall and to a number of key aspects of the system. In addition, each year the National Report Card also examines a specific area of the health care system. This year, Canadians were asked a series of questions about their views on the future of seniors’ health care, including a National Strategy on seniors’ care.

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Health Canadacihr logo1This initiative has been generously funded by grants from Health Canada and the Canadian Institutes of Health Research. The views expressed here do not necessarily reflect those of the funders.