Issue 2 | December 16 2020
Monthly Bulletin of the Alliance's Learning Health System
Rapid Learnings from Virtual Care
Tackling TB Stigma @ Access Alliance
Advancing Equity Data @ Vaughan
LHS Milestone: NOD-to-TELUS Migration
Recently Published & Presented
Get Involved: Research & Sharing
Learning Events & Opportunities
New Tools &
Rapid Learning from Virtual Care Research
Last month, we told you about a number of studies currently underway in our Learning Health System about COVID-19 and the primary care response to the pandemic. One of these studies has reached a point where we are able to share early learnings and tips to improve virtual care delivery.

This study looks at how the shift to virtual delivery of primary care has impacted access to care, provider-client relationships, quality of care, and efficiency – one from the providers’ perspective, and one from the clients’ perspective. It also explores the barriers and enablers to effective virtual care delivery, and offers insights into how it can be improved and its benefits can be sustained beyond COVID-19.

Click on the linked images below for detailed descriptions of what we've learned so far from clients (top) and providers (bottom), or read on for a high-level summary.
Benefits of Virtual Care Delivery

  • Easier access for clients with barriers related to transportation, scheduling, or mobility.
  • Has allowed continuity of care despite restrictions related to the pandemic.
  • Fewer no-shows.
  • Easier time management for providers.
  • Appointments more frequently started on time.
  • Clients with anxiety issues felt more comfortable receiving care at home.
Challenges for Virtual Care Delivery

  • Barriers for clients with limited access to devices or data, or who have low digital literacy.
  • Difficulty in establishing relationships with new clients.
  • Reduced social interaction between provider and client.
  • Reduced capacity for physical assessment or observation of body language.

Ways to Improve Virtual Care

  • Offer video appointments when possible, especially for mental health care appointments.
  • If possible, conduct the first appointment in person to develop a trusting relationship.
  • Create plain-language materials to assist clients with technical elements of receiving virtual care.
  • Develop security policies to allow clients to email pictures to their providers. 

What's next?

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

  • Sociodemographic information about the clients.
  • Which providers they saw.
  • What issues were addressed.
  • What services were provided.
  • How many appointments were missed or cancelled.

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.
Tackling TB Stigma at Access Alliance
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.
Critical findings so far

  • There is a higher prevalence of communicable diseases like TB, HIV and Hepatitis C in vulnerable populations, along with an equally high level of stigma associated with those diseases.
  • Economic precarity and stigma often make it necessary for people from marginalized populations, such as immigrants and refugees, to prioritize basics like food, housing, employment, settlement, and legal issues over health and care for illnesses like TB.
  • We need to build clear and coordinated pathways to care and support.
  • Care and support for TB needs to be community-based, interdisciplinary, collaborative, culturally appropriate and delivered in a language of comfort for the affected person and their family/supports.

Strategies identified by participants to address TB and stigma
  • Make ongoing comprehensive primary care the main source for TB information, education and care.
  • Engage trusted figures as partners in raising awareness, sharing TB information, and legitimizing the battle against TB and related stigma.

Three areas of recommendations

  • Enhancing TB-related awareness and knowledge among newcomers
  • Improving service provider competencies and practices
  • Improving access to care and support for marginalized people through structural and policy changes.

The full report will be released early in 2021. It will be a tool Alliance members and like-minded organizations can use to advance transformational change in our healthcare system, creating a ``better normal’’ for all marginalized populations.
Advancing Equity Data Collection at Vaughan CHC
In late 2018, Vaughan CHC realized they had a problem: They only had complete sociodemographic data on just over 2% of their clients. Knowing the importance of sociodemographic data for planning and decision-making, they set about to make a change.

Today they have accurate data on over 80% of the clients they serve in both clinical and social/community programs, and they’re pushing those numbers higher. Here’s how they did it and what they learned along the way, as told to Alliance staff by Fatima Teixeira, Reception Team Lead, and LoAn Ta-Young, Acting Executive Director.
A shared goal

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.

Baby steps

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.”
An LHS Milestone: NOD-to-TELUS Migration Complete
On December 7, 2020, the last Alliance member still using Nightingale on Demand (NOD) completed their migration to TELUS PS Suites EMR!
Having a common Electronic Medical Records (EMR system) for all our Community Health Centres, Aboriginal Health Access Centres, and Nurse PractitionerLed Clinics is a core element of the Alliance's Information Management Strategy (IMS), which in turn is the foundation of our emerging Learning Health System. Thank you and congratulations to the IMS and BIRT teams and our member centres for your relentless dedication to completing this implementation!
Recently Published & Presented
Published: Identifying the Features and Impacts of Community Health Centres by the McMaster University Health Forum. This 30-day rapid synthesis was funded by the British Columbia Ministry of Health. It finds overwhelmingly positive impacts across all four dimensions of the quadruple aim.

Presented: Increasing older adults’ access to care: Lessons learned from the pandemic response by Sara Bhatti & Alvis Choi (Yet Keen Seniors' Day Program). Health Equity Impact Assessment Community of Interest webinar, November 25, 2020.
Get Involved: Research & Sharing Opportunities
Help Canada's government understand the barriers faced by LGBTQ+ people by completing and sharing this 15-minute online survey. It addresses experiences of LGBTQ+ people in Canada related to employment, healthcare, housing, and homelessness. Open until February 28, 2021. Anyone who identifies with marginalized/minoritized sexual orientations or gender identities is encouraged to participate.
Passionate about Climate Justice? Consider joining the climate action working group. This is an initiative of several Alliance members who are taking on a number of projects related to climate change and environmental justice. They'd like to increase the size and diversity of their group. Reach out to Gary Machan for more information.

Do you have practice-based learning or research to share? An innovation or care improvement that's ready for spread? Consider submitting an abstract to Power In Community, the Alliance's June 2021 virtual conference! Deadline to apply is January 8, 2021 - See details here.
Learning Events and Opportunities
Virtual Rounds: Monthly COVID Community Rounds presented by the Women's College Hospital Community Response Team and the Centre for Wise Practices in Indigenous Health. Next session: Friday, December 18, 8:15-9:15 am. Topic: Mobile and Pop-Up Models - What is working? Guest speakers: Harvey Manning (Anishnawbe Health) with Cheryl Prescod & Michelle Westin (Black Creek CHC). Register here. Past topics and materials here.
New Tools & Resources
Quality Standard Placemat: Anxiety Disorders. This quick-reference tool summarizes key information from the latest Standard of Care for People with an Anxiety Disorder. Suitable for providers, clients, and caregivers. English | French.
Funding Available
Funding for harm reduction and STBBI projects: The Public Health Agency of Canada (PHAC) is accepting letters of interest to secure funding for community-based projects that address sexually transmitted and blood-borne infections (STBBIs) or advance harm reduction related to HIV and hepatitis among people who use drugs. Up to $250,000 year for up to 5 years. Apply by January 29.