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A comparison of the COVID-19 response for urban underserved patients experiencing healthcare transitions in three Canadian cities.
Salvalaggio, Ginetta; Hyshka, Elaine; Brown, Cara; Pinto, Andrew D; Halas, Gayle; Green, Lee; Kosteniuk, Brynn; Perri, Melissa; Le Chalifoux, Nathaniel; Halas, Garrett; Steiner, Liane; Cavett, Teresa; Montesanti, Stephanie.
  • Salvalaggio G; Department of Family Medicine, University of Alberta, 610 University Terrace, Edmonton, AB, T6G 2T4, Canada. ginetta@ualberta.ca.
  • Hyshka E; School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405 87 Avenue NW, Edmonton, Alberta, T6G 1C9, Canada.
  • Brown C; Department of Occupational Therapy, University of Manitoba, 771 McDermot Ave, Winnipeg, MB, R3E 0T6, Canada.
  • Pinto AD; Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
  • Halas G; Rady Chair, Interprofessional Collaborative Practice, Rady Faculty of Health Sciences, University of Manitoba, P219-770 Bannatyne Ave., Winnipeg, MB, R3E 0W3, Canada.
  • Green L; Department of Family Medicine, University of Alberta, 516 University Terrace, Edmonton, AB, T6G 2T4, Canada.
  • Kosteniuk B; School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405 87 Avenue NW, Edmonton, Alberta, T6G 1C9, Canada.
  • Perri M; Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario, M5T 3M7, Canada.
  • Le Chalifoux N; School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405 87 Avenue NW, Edmonton, Alberta, T6G 1C9, Canada.
  • Halas G; Rady Faculty of Health Sciences, University of Manitoba, 770 Bannatyne University of Manitoba, Winnipeg, R3E 0W3, Canada.
  • Steiner L; Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
  • Cavett T; Department of Family Medicine, University of Manitoba, Northern Connection Medical Centre, 2700 McPhillips St, Winnipeg, MB, R2V 3M3, Canada.
  • Montesanti S; School of Public Health, University of Alberta, 3-266 Edmonton Clinic Health Academy, 11205-87 Avenue NW, Edmonton, Alberta, T6G 1C9, Canada.
Can J Public Health ; 113(6): 846-866, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-1912376
ABSTRACT

OBJECTIVES:

The COVID-19 pandemic and response has highlighted existing strengths within the system of care for urban underserved populations, but also many fault lines, in particular during care transitions. The objectives of this study were to describe COVID-19 response policies for urban underserved populations in three Canadian cities; examine how these policies impact continuity of care for urban underserved populations; determine whether and how urban underserved community members were engaged in policy processes; and develop policy and operational recommendations for optimizing continuity of care for urban underserved populations during public health crises.

METHODS:

Using Walt & Gilson's Policy Triangle framework as a conceptual guide, 237 policy and media documents were retrieved. Five complementary virtual group interview sessions were held with 22 front-line and lived-experience key informants to capture less well-documented policy responses and experiences. Documents and interview transcripts were analyzed inductively for policy content, context, actors, and processes involved in the pandemic response.

RESULTS:

Available documents suggest little focus on care continuity for urban underserved populations during the pandemic, despite public health measures having disproportionately negative impacts on their care. Policy responses were largely reactive and temporary, and community members were rarely involved. However, a number of community-based initiatives were developed in response to policy gaps. Promising practices emerged, including examples of new multi-level and multi-sector collaboration.

CONCLUSION:

The pandemic response has exposed inequities for urban underserved populations experiencing care transitions; however, it has also exposed system strengths and opportunities for improvement to inform future policy direction.
RéSUMé OBJECTIFS La pandémie et la riposte au COVID-19 ont mis en évidence les forces existantes au sein du système de soins pour les populations urbaines mal desservies, mais aussi de nombreuses faillites, en particulier lors des transitions de soins. Les objectifs de cette étude étaient de décrire les politiques de réponse au COVID-19 pour les populations urbaines mal desservies dans trois villes canadiennes; examiner l'impact de ces politiques sur la continuité des soins pour les populations urbaines mal desservies; déterminer si et comment les membres de la communauté urbaine mal desservie ont été impliqués dans les processus politiques; et développer des recommandations politiques et opérationnelles pour optimiser la continuité des soins pour les populations urbaines mal desservies pendant les crises de santé publique. MéTHODES Utilisant le cadre Policy Triangle de Walt et Gilson comme guide conceptuel, 237 documents politiques et des médias ont été récupérés. Cinq séances d'entrevues de groupe virtuelles complémentaires ont été organisées avec 22 informateurs clés de première ligne et d'expérience vécue pour saisir des réponses et des expériences politiques moins bien documentées. Les documents et les transcriptions des entrevues ont été analysés de manière inductive pour le contenu politique, le contexte, les acteurs et les processus impliqués dans la riposte à la pandémie. RéSULTATS Les documents disponibles suggèrent que l'accent est peu mis sur la continuité des soins pour les populations urbaines mal desservies pendant la pandémie, malgré les mesures de santé publique ayant des impacts négatifs disproportionnés sur leurs soins. Les réponses politiques étaient en grande partie réactives et temporaires, et les membres de la communauté étaient rarement impliqués. Cependant, un certain nombre d'initiatives communautaires ont été élaborées en réponse aux lacunes des politiques. Des pratiques prometteuses ont émergé, y compris des exemples de nouvelles collaborations multiniveaux et multisectorielles.

CONCLUSION:

La réponse à la pandémie a révélé des inégalités pour les populations urbaines mal desservies qui subissent des transitions de soins, mais elle a également exposé les forces du système et les possibilités d'amélioration pour éclairer l'orientation future des politiques.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Transition to Adult Care / COVID-19 Type of study: Observational study / Qualitative research / Randomized controlled trials Limits: Humans Country/Region as subject: North America Language: English Journal: Can J Public Health Year: 2022 Document Type: Article Affiliation country: S41997-022-00651-7

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Transition to Adult Care / COVID-19 Type of study: Observational study / Qualitative research / Randomized controlled trials Limits: Humans Country/Region as subject: North America Language: English Journal: Can J Public Health Year: 2022 Document Type: Article Affiliation country: S41997-022-00651-7