Abstract
Background: Close to 20% Canadians lack a family physician, with provincial variations. The need to improve access to cancer and chronic disease screening for a growing population without a PCP has become increasingly relevant as we face a national health human resource primary care crisis.
Approach: Population based approaches towards cancer screening (breast, colon, cervical cancer) exist at provincial levels in Canada but are not consistent and rely on family physicians providing access to screening. There is a lack of population based screening for chronic diseases such as diabetes and hypertension.
We share examples from east and west Canada that may benefit other communities as we continue to struggle with replenishing the PCP workforce: In Toronto, a large urban centre with 2 initiatives:
(1) Community Health and Information Fairs (CHIFs) were designed by the North York Toronto Health Partners to increase access to cancer and chronic disease screening, in communities with poor access to a PCP. CHIFs are co-designed with community partners and health ambassadors, and held directly in equity-deserving locations to provide culturally sensitive and informed care. Follow up of results is provided by PCPs to ensure continuity of care.
(2) Health Access Taylor Massey (HATM) was established by the the East Toronto Family Practice Network together with its Ontario Health Team, to increase access to primary care in a novel model that involved integration of health and social care services in an equity-deserving community which experienced a huge drop of family physicians due to retirements during the COVID pandemic.
Similarly, in Victoria, the capital of British Columbia in the west, Island Health as the regional health authority oversees 6 Urgent and Primary Care Centres (UPCC) to increase access to care for close to 100,000 residents lacking a family physician. Patients seeking urgent medical needs are offered nurse-lead cancer and cardiovascular screening and follow up, and in partnership with the provincial cancer agency, people without a PCP can be redirected to the UPCCs for cancer screening.
Results: To date, 34 multidisciplinary CHIFs have occurred, providing unattached and equity-deserving patients access to cancer screening, education and blood pressure/sugar checks in Toronto. As trusted members of the community, health ambassadors provide community engagement/outreach and connect individuals to services. HATM resulted in 2500 patients gaining access to primary care within a year of establishing the integrated care program; a significant accomplishment as funding was limited to 0.8 full time equivalent of family physician coverage working with an integrated interprofessional health and social care team. Similarly, in a 6 month pilot evaluation of the nurse-led metabolic screening initiative in Victoria offered to patients without a PCP, 100 patients opted into screening for hypertension/diabetes/hypercholesterolemia, and 20% were identified at higher risk with 15% requiring medical intervention.
Implications: As Canada struggles with dwindling numbers of family physicians and increasing numbers of people without a PCP, we share examples across Canada of how to improve access to preventative health interventions particularly in equity deserving neighbourhoods and populations.