2023
All
conversationaboutprimarycarewith residentsofParcExtensioninMontreal
November
PubliclyFunded PrimaryCarefor
A
VisittheOurCarewebsite:ourcare.ca ExploretheOurCaresurveydata:data.ourcare.ca VisittheMASSLBPwebsite:masslbp.com 2 Communitypartner ©2023MAPCentreforUrbanHealth.Thisreportmaybereproducedfor non-profitandeducationalpurposeswithcreditgiventothepublisher.
Contents 3 AbouttheCommunityRoundtable ...................................... 4 WhoWeEngagedandWhy ............................................... 7 WhatWeLearned.......................................................... 10 Themes ............................................................. 10 IdeasforChange................................................... 13 Acknowledgments......................................................... 16 AboutOurCare............................................................. 19
Tableof
AbouttheCommunity Roundtable
OurCareisapan-Canadian conversationwithmembersofthe publicaboutthefutureofprimary care.TheprojectisledbyDr.Tara Kiran,afamilyphysicianand researchscientistbasedatSt. Michael’sHospital,UnityHealth Toronto,andtheUniversityof Toronto.Therearethreephasesto theproject:anationalsurvey, provincialprioritiespanels,and communityroundtables(seeAbout OurCareonpage19formore details).
Inordertodesignaprimarycare systemthatmeetstheneedsofall Canadians,thechallengesand barriersofequity-deserving communitiesmustbecentredinthe conversation.TheaimoftheOurCare communityroundtablesistolearn fromcommunitiesthatare historicallyexcludedorconsistently underservedbytheprimarycare system.
OurCarepartneredwithAfriqueau Féminin,amulti-servicecommunity organizationthathasservedwomen intheParcExtensionneighbourhood ofMontrealsince1990. The organizationwasfoundedin1986by agroupofprofessionalwomenof Africanoriginwhowantedtohelp womenfromAfricancountriesbuild
socialandeconomictiesintheirnew country.Overtime,andbyvirtueofits locationinoneofthemostculturally diverseneighbourhoodsinCanada (over40differentlanguagesare spokeninParkExtension),Afriqueau Fémininhasbecomeasupportand meetingplaceforwomenandtheir familiesfrommanydifferent countries.Theorganizationisrunby andforimmigrantwomen— itisa placeofwelcomeandbelonging, andhasstrongrelationshipswithits community. OurCaredeeply appreciatedthetrustand collaborationextendedbytheAfrique auFémininstaff.Andwethankthe residentsthatjoinedus,sharingtheir timeandtheirinsights.
TheParkExtensionRoundtable convenedonNovember10,2023for sixandahalf hoursinacommunity spaceonAvenueduParc. Participantswereinvitedtospendthe daylearningabouttheprimarycare systeminQuebecandtosharetheir experienceswiththesystemaswell astheirideasforhowthatsame systemmightbeimprovedtobetter meettheneedsofracialized, newcomer,andlow-income residents.
4
Theparticipantsheardfromtwo guestpresenters. Inthemorning,Dr. KimberlyMunro,afamilydoctorin ParcExtensionandanassistant ProfessorwiththeDepartmentof FamilyMedicineatMcGillUniversity, spokeaboutprimarycareinQuebec, whatitis,howtoaccessit,andhow thesystemisorganized.Inthe afternoon,Dr.MylaineBreton, professoratUniversityofSherbrooke, andCanadaResearchChairin ClinicalGovernanceinPrimaryHealth Care,presentedthe recommendationsfromOurCare’s QuebecPrioritiesPanel.
Outsideoflunchandsnackbreaks, participantsspenttherestoftheday inconversationwitheachother. This reportcapturesthethemesand ideasarticulatedbyroundtable participantsduringplenarysessions, aswellasthosethatwererecorded byfacilitatorsinsmallgroup discussions.
5
WhoWeEngaged andWhy
ParcExtensionisthemostdensely populatedneighbourhoodinGreater Montreal,withmorethan28,000 residentslivingin1.6square kilometres.1 Theneighbourhoodhas longbeenalandingspotfor newcomersandenjoysincredible linguisticandculturaldiversity.Itis alsothemosteconomically disadvantagedneighbourhoodinthe citywithapproximately38%2ofits residentslivingonalow-income,and where79%ofitsresidentsrenttheir homes.3 Likemanyneighbourhoods acrossthecountry,ParcExtensionis experiencingdevelopmentpressure thatiscreatingaffordability challengesformanyofitsresidents.
Twenty-threeresidentsparticipated intheday.Collectively,the participantsrepresented22different countriesfromAngolatoVenezuela.4 TheparticipantshadlivedinCanada forvaryinglengthsoftime, some werepermanentresidentsorcitizens andafewwereasylumseekers.Most ofthedays’participantswerefemale
1 Centraide of Greater Montreal, 2019 - 2020.
andthegroupwasfairlyevenlysplit betweenthosewhoexpresseda desiretoworkinEnglishandthose whopreferredtoworkinFrench. InterpretationinEnglishandFrench wasprovidedfortheallplenary discussionandthesmalltable discussionswerefacilitatedinEnglish, French,andSpanish.Participants weregivenanhonorariumtothank themfortheirtimeandwerealso offeredneeds-basedsupportsuch astransitticketsandmoneytocover thecostofchildcare.
https://www.centraide-mtl.org/wp-content/uploads/2021/01/Territorial-profiles-Montreal-Villeray-Saint-Michel-Parc-Extension-2019-2020.pdf
2 Centraide of Greater Montreal, 2019 - 2020.
https://www.centraide-mtl.org/wp-content/uploads/2021/01/Territorial-profiles-Montreal-Villeray-Saint-Michel-Parc-Extension-2019-2020.pdf
3 Ibid.
4 Countries of origin included Mexico, Burkino-Faso, Haïti, Venezuela, Cameroun, Colombie, Angola, France, Chile, Morocco, Uganda, Hungary, Canada (Greek), Mauritanie, India, Pakistan, Ghana, Bangladesh, Pakistan, China, Nicaragua, Russia, Sri Lanka and Indonesia.
Thisroundtablewasconvenedto receiveinputfromlow-income residents,newcomersandasylum seekersinQuebecwhosevoicesare oftenmissinginthepublicrealm,in spiteofthefactthattheseresidents aretheamongtheleastlikelytohave accesstoregular,high-quality primarycare.Researchindicatesthat newcomerstoCanadaareata disadvantagewhenitcomesto accessingprimarycareservicesdue, 7
inpart,toculturalandlinguistic barriers.5Studiessuggestthatthose whoarenewtoCanadaare less-likelytohaveaccesstoprimary careatall.6InQuebec,only56%of refugeeclaimantsreportedhavinga regularfamilydoctor.7 Parc Extension,likemanyneighbourhoods withahighproportionoflowincome residents,doesnothaveenough servicestomeettheneedsofits residents.Approximately10 communityorganizations8servea populationofabout28,000.
AfriqueauFémininisamulti-service agencythatoffersservicestoits clientsthatrangefromafoodbank anddaycaretolanguagetraining, computerclasses,andorganised socialoutingsforisolatedwomen. Theorganizationisalsoapartnerin theParcExtensionNeighbourhood Table,amulti-sectorinitiativethat workswithresidentsandlocal stakeholderstoimprovethelivesfor everyoneintheneighbourhood.
5 Ahmed, S. et al. 2016. “Barriers to access of primary healthcare by immigrant populations in Canada: a literature review.” Journal of Immigrant and Minority Health, 18(6), 1522-1540.
6 Tara Kiran, Alexander Kopp and Richard H. Glazier, 2016. “Those left behind from voluntary medical home reforms in Ontario, Canada.” The Annals of Family Medicine, 14 (6) 517-525.
7 Directrice régionale de Santé Publique https://santemontreal.qc.ca/fileadmin/user_upload/Uploads/tx_asssmpublications/pdf/publications /Rap-Portrait_demandeurs_asile_Mtl.pdf
8 Centraide of Greater Montreal, 2019 - 2020.
https://www.centraide-mtl.org/wp-content/uploads/2021/01/Territorial-profiles-Montreal-Villeray-S aint-Michel-Parc-Extension-2019-2020.pdf
8
WhatWeLearned
DuringtheParcExtensionRoundtable, participantsspenttimeinsmall groupdiscussions,sharingtheir experiencesandideasforchange. Participantswereprovidedwiththe followingpromptstoframetheir conversations:
● Whatdoesprimarycaremean tous?
● Whatisworkingwelland positivelycontributingtoour health?
● Whatisn’tworkingwell?What barriersaffectaccessto primarycarefornewcomers andotherresidentsinthis neighbourhood?
● Howcanwemakeprimarycare betterforyouandyour community?
Thecontentsoftheseconversations havebeenorganizedintoThemes thathighlighttheexperiencesand challengesparticipantsidentified,as wellas IdeasforChangethatdetail potentialsolutionssharedbythe participantsduringthesmallgroup discussions.
Themes
A.Publiclyfundedhealthservices arevalued
TheresidentsofParcExtension expressedappreciationforCanada’s healthcaresystemandforthemany servicesthatarefundedthrough RAMQ.Manyoftheday’sparticipants havecometoCanadafromcountries withlittlehealthinfrastructureorwith systemsthatrequirepaymentatthe timeofservice. Whileparticipants sharedchallengestheyencountered whilenavigatingandaccessingthe system,theyalsotookthetimeto recognizethefundamentalvalueof thepublicsystem.Publicserviceslike 811,211,and911werealsomentioned asusefulaccesspointsforhelpand information.
B.Centrelocaldeservices communautaires(CLSC)model meetsawiderangeofneeds
Someoftheparticipantswereclients ofthelocalCLSC,andspokehighlyof thismodelofcare.Manyfeltthat accesstonutritionists,socialworkers, andpharmacistshelpsthemstay healthy,andothersmentioned walk-inaccessasanimportant feature.
10
Participantsvaluedbeingabletoget careintheirneighbourhoodand spokeofhowaregularplaceofcare meantthattheydidnothaveto repeattheirstorywitheveryvisit.The costassociatedwithtravelaswellas thetimeawayfromworkor caregivingresponsibilitieswere explicitlycitedasbarrierstocare whenitwasnotavailablelocally.
Asenseofcommunityfostered throughtheCLSCswasalso mentionedasimportant,oftena resultofresidentsandneighbours volunteeringfordifferentprograms.
C.Languagebarrierscause miscommunicationandleadto healthissues
Participantsspokeabouttheir difficultiesnavigatingthehealth systeminQuebec,andhowtheir inabilitytoaccessinformation, support,andcareintheirprimary languagewasasourceof misunderstandingand miscommunicationthatsometimes ledtonegativehealthoutcomes. Theyfeltthatmedicalterminology canbedifficulttounderstandanda visittothedoctororhospitalis stressfulenoughwithoutthe additionalpressureofhavingto navigateitinanunfamiliarlanguage.
D.Thosewiththeabilitytopayfor carearehealthierandthisisnotfair ParcExtensionhaslongbeenhome formanynewcomerandlow-income residentsofMontreal.While appreciationforQuebec’s single-payer,publiclyfundedhealth caresystemwasnotedearlyinthe day,thechallengesthatlivingona lowincomeposetoaccessingquality medicalcareandsupportfora healthylifestylesurfacedquickly. Specificconcernsincluded:
● Prescriptionsaredifficulttofill becausethecostofmedication istoohighandpricesfluctuate
● Manypeoplecannotafford visionordentalcare
● Peoplewhoaretransgender cannoteasilyfindcarethatis coveredbyRAMQ
● Peoplewhocanaffordtopay toseeadoctorcansee someoneimmediatelybutin thepublicsystem,peoplehave towaitweeksforthesame appointment.Thediscrepancy betweenthepublicandthe privatepayersystemsislarge andneedstobeaddressed.
11
E.Thehealthcaresystemisnot incentivizingprevention
Longwaittimestoseeaclinicianata community-basedclinic/officeorin theemergencydepartmenthave becomeaprominentelementofthe publicdiscourserelatedtothe primarycarecrisis. Roundtable participantsrecognizedthat insufficientstaffnumberscontribute tolongwaittimesbutmanyalso sharedstoriesofhow,onceseenbya clinician,theircarewasrushedand didnotmeettheirneeds.Careina hospitalsettingwasdescribedas chaoticandunpleasant.Some participantsnowavoidseekingcare outsideofcriticalemergency situations.
Onegroupsuggestedthatthe systemitselffurtherexacerbatesthe strainit'sunderbyprioritizing emergenciesorurgentcare. Participantssharedstoriesof clinicianstellingpatientsthattheir symptomswerenotyetserious enoughtowarranttreatment,orof nottakingthetimetoproperlyassess ordiagnoseacomplaint.Theyalso sharedstoriesofnotbeingableto getfollow-upcareforchronic conditionsandaninabilitytosecure post-hospitalizationreferrals.
12
Ideasforchange
TheparticipantsattheParcExtension Roundtableidentifiedseveral challengesbutalsosharedmany ideastheyfeltcouldhelpimprove accesstohighqualityprimarycare forthemselves,theirneighbours,and forotherslikethem.
1.Expandpubliccoverageofhealth servicestoincludedentalcare,vision care,andprescriptions. Expand coveragetoalsoincludeserviceslike physiotherapyandmentalhealth serviceslikecounselling,especiallyif adoctorisreferringsomeonetothis service.
2.Expandaccesstoprovincial medicaretoallthepeopleofQuebec, regardlessoftheirresidencystatus.
3.Addresstheshortageofhealth careprofessionalsby:
● Acceleratingthelicensingof andinvestinmentorshipfor internationallytrainedhealth careprofessionals
● Expandingthescopeof practiceofsomehealth professionalssuchasnursesor paramedics.Paramedicscould treatminorissuesthatdon’t requireahospitalsetting.
● InvestinginmoreCLSCsthat offerinterdisciplinarycare underoneroof.
● Makeprimarycareamore attractivefieldtoworkin.
● Expandtheuseofcareworkers andassistantstohelpwith sometaskstoallowphysicians andothercliniciansmoretime withpatients.
4.Increaseawarenessofimportant healthcare-relatedinformation amongresidents.Thisshouldbe offeredinmultiplelanguageand couldinclude:
● Aphonecalltonewcomers, offeredinavarietyof languages,thatprovides informationaboutthehealth caresystemanddirectsthem toresourcesintheirnew community
● Apublicitycampaignthat promoteswellnessby showcasinghealthyeating habitsandotherpreventative measures
● Publicoutreachaboutwhat healthservicesareavailableto Quebecersandhowtofindand accessthem.
13
5.Expandafter-hoursandurgent careoptionsindifferent neighbourhoodstohelpkeeppeople outofhospitalemergencyrooms
6.Encourageamorewelcoming environmentandbettercarein clinicsandathospitalsby:
● Ensuringthereislanguage interpretationavailableatall timesineverymedicalsetting. Thisisimportantfor Anglophones,aswellas AllophoneslivinginQuebec.
● Trainreceptionstafftobe sensitiveandwelcomingtoall
7.Increasetheintegrationbetween primarycareandcommunity servicestobetteraddressthesocial determinantsofhealthandtheir effectsonpeople’swell-beingand health.Specificconcernsparticipants mentionedincluded:
● Accesstonutritiousfood
● Substandardorunaffordable housing
● Accesstohomecareorhelpto stayinthehomeforolder residents
8.Createacentralisedpatient medicalfilesopeopledon’thaveto repeatthemselveseverytimetheygo forcare.Aperson’smedicalhistory shouldbedocumentedandheldina centralsystemforallcliniciansto accesssothattheburdenofhaving toremembercomplicatedmedical detailsdoesnotfallonthepatient
9.Fosterresearchandcollaboration betweenthepublicandprivate sectorstofacilitatecross-sector learning
10.Learnaboutwhatworksinother jurisdictionsandwhathasworkedin thepast.Quebec’shealthcare systemseemstohaveworkedbetter inthepast,whyisthis?
15
Acknowledgments
TheOurCareprojectteamgratefullyacknowledgestheleadershipofour communitypartner,AfriqueauFéminin,inthedevelopmentandhosting oftheParcExtensionCommunityRoundtable. Wewouldalsoliketo thankourguestspeakers,Dr.KimberlyMunroandDr.MylaineBretonfor sharingtheirtimeandexpertise.
RoseNdjel,ExecutiveDirector,AfriqueauFéminin
SavitaTaheem,CommunityOrganizerandProjectManager,Afriqueau Féminin
BaljitKaur,AfriqueauFéminin
AfriqueauFémininistheonlywomen’scentreinParc-Extension,oneof themostculturallydiverseneighbourhoodsinCanadawhereover40 languagesarespoken.TheCentreisaplaceofmeeting,belonging, socialization,mutualaid,solidarity,mentorship,andactionforall women,andparticularlythosefromvisibleminoritieswhoare experiencingfinancialandsocialbarrierstointegrationinQuebec societyand/orsocialisolation.AfriqueauFémininisrunbyandfor immigrantwomen.Findoutmoreatafriqueaufeminin.org.
Dr.KimberlyMunro,PrimaryCarePresenter
FamilyPhysician,Montreal;AssistantProfessor,DepartmentofFamily Medicine,McGillUniversity
KimberlyMunroisafamilyphysicianbasedinMontrealandaffiliatedto McGillUniversity’sDepartmentofFamilyMedicine.Shepracticesfull scopeFamilyMedicineatanurbancommunityclinicaswellasinpatient PalliativeCare.
16
RoundtableTeam
TheParcExtensionRoundtablewasdevelopedandmanagedbyMASS LBP.MASSisCanada'srecognizedleaderinthedesignofdeliberative processesthatbridgethedistancebetweencitizens,stakeholders,and government.Formorethanadecade,MASShasbeendesigningand executinginnovativedeliberativeprocessesthathelpgovernments developmoreeffectivepoliciesbyworkingtogetherwiththeirpartners andcommunities.Findoutmoreatmasslbp.com.
OurCarePrincipalInvestigator
Dr.TaraKiran
FamilyPhysician,St.Michael'sHospitalAcademicFamilyHealthTeam; Scientist,MAPCentreforUrbanHealthSolutions,St.Michael'sHospital, UnityHealthToronto;FidaniChairofImprovementandInnovation, UniversityofToronto
PrimaryCareCo-LeadsforQuebec
Dr.MylaineBreton
Professor,DepartmentofCommunityHealth,UniversityofSherbrooke CanadaResearchChairinClinicalGovernanceonPrimaryHealthCare.
Dr.NebKovacina
FamilyPhysician,St.Mary'sHospital,Montreal Director,QualityImprovement,DepartmentofFamilyMedicine, McGillUniversity
NationalProjectDirectorandRoundtableModerator
JasminKay
Director,MASSLBP
17
Interpreters
CatKendler
MayraParra
Facilitators
VivianeCottle
JuanGiraldo
LeonoraIndiraKing
JulesLaurent-Allard
Copyediting
JasonWhiting
Translation
ElaineNormandeau
Illustrations
MarijaMladenović
18
AboutOurCare
OurCareisapan-Canadianconversationwitheverydaypeopleaboutthefuture ofprimarycare.TheprojectisledbyDr.TaraKiran,afamilydoctorand renownedprimarycareresearcherbasedinToronto.OurCarehasthreestages:
1. NationalResearchSurvey
ThesurveywasonlinefromSeptember20toOctober25,2022.Morethan 9,200Canadianscompletedthesurvey,sharingtheirperspectivesand experiences.VoxPopLabsco-designedandexecutedthesurvey.
2. PrioritiesPanels
PrioritiesPanelswereheldinfiveprovinces:NovaScotia,Quebec,Ontario, BritishColumbia,andManitoba.MASSLBPco-designedandexecutedthe panelswithOurCareadvisorsandlocaldeliverypartners.
3. CommunityRoundtables
Communityroundtableswerehostedineachofthefiveprovinces, focusingonhistoricallyexcludedgroupsthatwedidnothearenoughfrom duringstages1and2.MASSLBPco-designedandexecutedthe communityroundtableswithOurCareadvisorsandlocalcommunity organizations.
19
OurCareProjectPartners
OurCareisfundedby:
HealthCanada
HealthCanadaistheFederaldepartmentresponsibleforhelpingCanadians maintainandimprovetheirhealth,whilerespectingindividualchoicesand circumstances.Productionofthisdocumenthasbeenmadepossiblethrougha financialcontributionfromHealthCanada.Theviewsexpressedhereindonot necessarilyrepresenttheviewsofHealthCanada.
MaxBellFoundation
MaxBellFoundationbeganmakinggrantstoCanadiancharitiesin1972.Today, theFoundationsupportsinnovativeprojectsthataredesignedtoinformpublic policychangeinfourprogramareas:Education;Environment;Health&Wellness; andCivicEngagement&DemocraticInstitutions.TheFoundationalsodelivers thePublicPolicyTrainingInstitute,aprofessionaldevelopmentprogram designedtohelpparticipantsmoreeffectivelyengageinthepublicpolicy process,andPolicyForward,afuture-orientedspeakerseriesthatbringsthought leaderstogethertodiscusstheintersectionsofpolicy,technology,and innovation.
StaplesCanada—EventheOddsCampaign
StaplesandMAPhavecometogethertocreateEventheOdds:aninitiativeto raiseawarenessofinequityinCanadaandtohelpbuildvibrant,healthy communities.Thepartnershipisbasedonthesharedbeliefthateveryone shouldhavetheopportunitytothrive.EventheOddsfundsresearchand solutionstohelpmakethefuturefairforeveryone.Learnmoreat staples.ca/eventheodds.
20
OurCareSupporters
OurCareisbasedat:
MAPCentreforUrbanHealthSolutions
MAPCentreforUrbanSolutionsisaresearchcentrededicatedtocreatinga healthierfutureforall.Thecentrehasafocusonscientificexcellence,rapid scale-upandlongtermcommunitypartnershipstoimprovehealthandlivesin Canada.MAPisbasedatSt.Michael’sHospitalinToronto.
St.Michael’sHospital,UnityHealthToronto
St.Michael’sHospitalisaCatholicresearchandteachinghospitalindowntown Toronto.ThehospitalispartoftheUnityHealthTorontonetworkofhospitalsthat includesProvidenceHealthcareandSt.Joseph’sHealthCentre.
OurCareissupportedby:
DepartmentofFamily&CommunityMedicine,UniversityofToronto
TheUniversityofToronto’sDepartmentofFamily&CommunityMedicineisthe largestacademicdepartmentintheworldandhometotheWorldHealth OrganizationCollaboratingCentreonFamilyMedicineandPrimaryCare.
St.Michael’sFoundation
Establishedin1992,St.Michael'sFoundationmobilizespeople,businessesand foundationstosupportSt.Michael’sHospital’sworld-leadinghealthteamsin designingthebestcare–when,whereandhowpatientsneedit.Fundssupport state-of-the-artfacilities,equipmentneeds,andresearchandeducation initiatives.BecauseSt.Michael'sFoundationstopsatnothingtodeliverthecare experiencepatientsdeserve.
21
AdvisoryGroups
OurCareisguidedbyseveralnationalandprovincialadvisorygroups comprisingclinicalleaders,representativesfromprofessionalorganizations, researchers,healthsystemadministrators,andpatients.Theadvisorygroups havehelpedshapeeachphaseoftheinitiative.TheOurCareQuebecProvincial AdvisoryGroupprovidedinputintopopulationsoffocusforthetwocommunity roundtablesinQuebecandmembershelpedmakerelatedconnectionstolocal communityorganizations.Afulllistofadvisorygroupmembersisavailableon theOurCarewebsite.
TolearnmoreaboutOurCare,pleasevisitourcare.ca.
OurCareisfundedby
OurCareisbasedat OurCareissupportedby
22
