In the next phase of this study, the researchers will extract de-identified practice data about virtual appointments from participating centres’ EMR systems, including:

This will help the research team understand who is receiving virtual care and which aspects of care are being delivered this way. They will then analyze this data in order to recommend which clients and aspects of care are best suited to virtual appointments.

Thanks to COVID-19, it is clearer than ever that marginalized populations are disproportionately impacted by issues that affect health. This is also true when it comes to tuberculosis (TB) in immigrant and refugee populations in Canada.

According to the Public Health Agency of Canada (PHAC), in 2016, newcomers to Canada, who represent approximately 22% of our population, accounted for 70% of reported cases of active TB in this country. This demonstrates the inequitable burden of TB and highlights the need to properly address the risk of TB in these communities.

With funding from PHAC, Access Alliance Multicultural Health and Community Services undertook a project, Tackling TB Stigma: Developing a cross-sectoral approach to reducing TB stigma and improving TB care for vulnerable newcomer populations in Canada. This project explored the lack of awareness of TB, high levels of stigma attached to it, and ways to increase access to quality resources, support, and care for immigrants and refugees living with or at risk of acquiring TB.

Tackling TB Stigma took a cross-sectoral approach which involved representatives from primary care, settlement and public health, and community members from target populations. recognizing that affected populations are experts of their own experience and best positioned to identify the issues and solutions that are most relevant, the project organizers employed a variety of co-design techniques.

A project of this size requires the whole team to be dedicated to a shared goal. The organization’s quality improvement and strategic plans were updated to include advancing sociodemographic data collection. Holding this work as an organizational priority helped ensure it would be adequately resourced and carefully implemented. Together, the team set a goal of being among the top CHCs for data collection, framing it not as “where would we like to go?” but “where do we need to go?” In practical terms, this meant they had to correct or complete data on between 10,000 and 15,000 people.

Transparent, pro-active communication was needed to ensure staff questions were answered and that everyone understood the project and was prepared for change. The whole reception team from the three reception desks at Vaughan CHC's two sites, as well as students and temporary workers that were hired to help, were brought under the supervision of a single lead, Fatima. This organizational shift ensured consistent training, monitoring, feedback, and coaching.

This project also required clients to understand why they were being asked sensitive questions, and to be motivated to answer. The CHC posted notices on their website and in their facilities and handed out print materials asking clients to “please work with us to gather this information,” with clear explanations of how the data would be used.

Despite having a lofty goal and a short timeline, the team needed to start with “baby steps” and iteratively scale up, adapting their processes as they went. They started by analyzing their existing data, processes, and resources to identify necessary changes, such as standardizing intake procedures and changing the configuration of their EMR system. They developed data-collection processes that would be accessible to both staff and clients, and a plan to get caught up.

The first phase of data collection was with clients who already had appointments scheduled. Alerts were added to their charts to remind staff to ask for missing data on arrival. Clients were given private space and an opportunity to complete the questionnaire on their own. Upon request, a staff member or student would go through the questionnaire with them. As much as possible, materials and personal support were made available in the clients’ preferred language. Clients were also permitted to take the questionnaire home, in case they preferred to get help from a family member.

The following phase involved outreach to clients who did not have appointments. Every client with missing data was called, and questionnaires were administered by phone or sent by mail, as preferred. As Fatima points out, clients need us to give them three things: Space, privacy, and time.

In order to help keep staff engaged and motivated, each staff member was given just a few pages of records to work on at a time, and the team lead participated alongside other staff members. Regular team meetings were held to communicate and celebrate progress. Work was consistently audited and rapid feedback provided to help staff feel connected and confident.

Along the way, there were challenges and course corrections. The data template was adjusted twice, meaning that for some clients, the process had be repeated three times. New staff and students who were brought in to lighten the load required additional training to learn the CHC’s systems, and their work required extra verification.

Within a year, Vaughan CHC met its goal of being among the top CHCs in Ontario for sociodemographic data completeness, and they continue to advance this work. They say the key success is to stay positive, even when the work isn’t always fun, like when processes need to be repeated. There’s no magic, but CHC staff perform highly when they have a shared goal, “because this is who we are.”