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Implementation of targeted screening for poverty in a large primary care team in Toronto, Canada: a feasibility study

Authors
  • Wintemute, Kimberly1, 2, 3
  • Noor, Meh2
  • Bhatt, Aashka2
  • Bloch, Gary2, 4
  • Arackal, Suja3
  • Kalia, Sumeet2
  • Aliarzadeh, Babak2
  • La Tona, Sabrina3
  • Lo, Joyce3
  • Pinto, Andrew D.2, 4, 5
  • Greiver, Michelle1, 2, 3
  • 1 North York General Hospital,
  • 2 University of Toronto Practice-Based Research Network, Temerty Faculty of Medicine, University of Toronto,
  • 3 North York Family Health Team, 240 Duncan Mill road, M3B 3S6 Toronto, Ontario Canada
  • 4 St Michael’s Hospital,
  • 5 St. Michael’s Hospital,
Type
Published Article
Journal
BMC Family Practice
Publisher
BioMed Central
Publication Date
Sep 30, 2021
Volume
22
Identifiers
DOI: 10.1186/s12875-021-01514-9
PMID: 34592935
PMCID: PMC8483428
Source
PubMed Central
Keywords
Disciplines
  • Research Article
License
Unknown

Abstract

Background Poverty has a significant influence on health. Efforts to optimize income and reduce poverty could make a difference to the lives of patients and their families. Routine screening for poverty in primary care is an important first step but rarely occurs in Canada. We aimed to implement a targeted screening and referral process in a large, distributed primary care team in Toronto, Ontario, Canada. The main outcome was the proportion of targeted patients screened. Methods This implementation evaluation was conducted with a large community-based primary care team in north Toronto. The primary care team serves relatively wealthy neighborhoods with pockets of poverty. Physicians were invited to participate. We implemented targeted screening by combining census information on neighborhood-level deprivation with postal codes in patient records. For physicians agreeing to participate, we added prompts to screen for poverty to the charts of adult patients living in the most deprived areas. Standardized electronic medical record templates recommended a referral to a team case worker for income optimization, for those patients screening positive. We recorded the number and percentages of participants at each stage, from screening to receiving advice on income optimization. Results 128 targeted patients with at least one visit (25%) were screened. The primary care team included 86 physicians distributed across 19 clinical locations. Thirty-four physicians (39%) participated. Their practices provided care for 27,290 patients aged 18 or older; 852 patients (3%) were found to be living in the most deprived neighborhoods. 509 (60%) had at least one office visit over the 6 months of follow up. 25 patients (20%) screened positive for poverty, and 13 (52%) were referred. Eight patients (62% of those referred) were ultimately seen by a caseworker for income optimization. Conclusions We implemented a targeted poverty screening program combined with resources to optimize income for patients in a large, distributed community-based primary care team. Screening was feasible; however, only a small number of patients were linked to the intervention Further efforts to scale and spread screening and mitigation of poverty are warranted; these should include broadening the targeted population beyond those living in the most deprived areas. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01514-9.

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