Deborah Barrett
Pathways to Primary Care
Expanding access in critical ways for unattached patients
Dr. Laura Stratton in clinic.
Donors Make the Difference
Deb Barrett’s support of Women’s College Hospital’s Crossroads Refugee Clinic has enhanced our ability to provide primary care to newcomers and refugees, and it also ensures that patients are connected to community networks and health navigation support to address their health concerns. We are grateful for Deb Barrett’s generosity, which is helping families get and stay healthy as they settle into their new lives.
New data shows that the number of Ontarians without a family doctor has reached 2.5 million. By not having access to a doctor, there has been a huge cost to the individual patient and health system alike. This includes an increase in hospitalizations and mortality, fragmented care across providers and a general lack of cohesion in providing the important care needed. These unattached patients are having to find care through alternative measures. Women’s College Hospital (WCH) works to provide equitable access to healthcare – this includes finding ways to expand primary care pathways for patients.
Some of our team members are sharing about the care that they provide and its importance in supporting unattached patients with different pathways to primary care.
Gender Affirming Care
Laura Stratton, Family Practice Health Centre (FPHC)
The 2SLGBTQ+ community is diverse and therefore the barriers to care look a bit different for everyone. However, simply having access to any primary care provider is one of the most common challenges – especially for trans and gender diverse individuals, where primary care clinics can be stigmatizing and unwelcoming. Before even stepping into the exam rooms, patients can encounter intake forms that don’t reflect gender and sexual diversity, be misgendered or deadnamed, with no access to gender inclusive washrooms.
At the healthcare provider level, there can be issues around lack of training and education. It's not infrequent that 2SLGBTQ+ patients will need to self-advocate and provide education or resources to their healthcare providers.
“I’ve been providing comprehensive primary care at WCH since 2020. A large portion of my patient practice falls under the 2SLGBTQ+ umbrella. I strongly believe that everyone should have access to primary care, and that inclusive sexual health and gender affirming care are core aspects of comprehensive primary care,” says Dr. Laura Stratton, family physician at WCH’s Family Practice Health Centre.
Dr. Stratton’s role at WCH FPHC involves education and teaching of medical learners. Ever since her own residency, she’s been teaching academic sessions on 2SLGBTQ+ health to all WCH family medicine residents. Whenever learners are with her in clinic, they try to incorporate as much hands-on clinical learning and exposure as possible on some of the unique health needs in 2SLGBTQ+ patients.
“We have also just started a primary care led Gender Affirming Health Clinic pilot project for patients seeking hormone therapy. A key aspect of the clinic is having medical learners involved to help them gain the clinical skills required to provide this care in their own practices. Our hope is for this to be a step forward in scaling up access to care across our health system,” says Stratton.
When patients have access to gender affirming care integrated into all aspects of their healthcare, their overall health improves. It’s imperative that the healthcare system is building capacity to provide inclusive services for everyone.
Healthcare for Refugees
Vanessa Wright, NP-PHC, DN, & Ellen Tang, social worker, Crossroads Clinic
Coming to a new country as a refugee is challenging and scary. Healthcare is an essential service that many newcomers find significant difficulty accessing because of unfamiliarity with the health system, language barriers and cultural differences. The team at the Crossroads Clinic helps patients navigate these challenges.
Vanessa Wright, a nurse practitioner at Crossroads Clinic, works with newly arrived refugees both inside and outside of WCH. In her role, she splits her time between providing clinical care at the Crossroads Clinic and in community shelters where many refugees live after arriving in Canada. Through these carefully cultivated community partnerships with shelters, the Crossroads team can quickly and smoothly connect refugees with the health system within days or even hours of their arrival to the shelter – a critical time for many patients who may be experiencing trauma or other health issues.
“Our clinic offers a unique model that provides specialized comprehensive primary care, mental health and social supports to refugees during their first two years in Canada,” explains Wright. “After two years, the Crossroads Clinic will assist patients to transition to another healthcare provider for ongoing care.”
It is complex work and requires a team-based approach to create a safe and accessible environment for patients.
“I think the Crossroads team is very good at seeing ourselves as a bridge. We actively work to facilitate linkages between our patients and various members of our team and to services that our patients need from external providers within their communities,” shares Ellen Tang, social worker at Crossroads Clinic.
As a team, they are attuned to the impact of social determinants of health in the lives of newcomer patients. Factors such as income, immigration status, housing, language ability, and more, influence patients' access to health and mental health care in very tangible ways. It is not enough for patients to receive a prescription or a referral for therapy.
At the Crossroads Clinic, the team considers: How are patients going to be able to pay for it? Do they have transportation to get to appointments? Will they be able to receive care in a language they understand? Are the care recommendations culturally appropriate? Are there competing psychosocial needs that pose a barrier to receiving care?
This type of holistic work requires connecting with other parts of our healthcare system and many other social services that newcomers are disconnected from.
When a patient family is ready to transition to a primary care provider in their community, the Crossroads Clinic administrative staff take care in connecting them to an appropriate provider – considering factors such as OHIP eligibility, distance, language, and complexity of care needs. The team also follows up with patients after they have seen their new primary care provider to ensure a smooth transition.
Approximately 50 patients are transitioned each month from the Crossroads Clinic to providers across the city and around the province. This model of care allows for a continual intake of new refugee patients.
“Right now, there is not enough capacity across the primary care system and even less within refugee-specific primary care services in Toronto. This means many refugees on arrival are unattached to primary care, and they may be receiving episodic care at walk in clinics and emergency departments,” says Tang. “This situation erodes opportunities for refugee newcomers to build trust in our healthcare system, which I believe is key to our ability as a system to have a positive impact on refugee health outcomes.”
Scaling up refugee-specific primary care services using a holistic model can relieve pressure from other parts of the health system and provide expertise in coordinating care for those with complex needs.
“Healthcare is a human right. As refugee care providers, we are continuously on the brink of agile response planning and primary care modelling,” says Wright. “In turn, we can serve as an example of what connecting patients to primary care may look like, built on the needs of populations and communities.”
Sexual Health
Sarah McCarthy, RN, Team Lead, Bay Centre
Sexual health can be sensitive and complex, making it important for patients to have timely access to a provider with training and expertise.
“Fear of judgement or lack of confidentiality are some of the reasons patients prefer to seek care for their sexual health with a team who specializes in this area. As well, patients often turn to our clinic as they may lack access to primary care services,” shares Sarah McCarthy, registered nurse and team lead at Bay Centre.
To help navigate these barriers, Bay Centre’s services do not require a referral, which means that anyone can call to book an appointment. The centre streamlines access and bypasses the need for a referral for STI testing and treatment, cervical cancer screening, IUD insertion and removal, implant insertion and removal, abortion care, contraception counseling, HPV vaccination, or emergency contraception.
“The clinic is staffed by providers who are experts in the field of sexual health. Due to the large volume of visits, such as IUD insertions and implant removals, our teams excel at providing this care,” says McCarthy. “Scaling the specific care provided through our clinic would be extremely beneficial to the broader health system by presenting more avenues to access sexual health primary care.”
Bay Centre is increasing access to some of its services across the province through initiatives like its virtual medical abortion program. Many patients living in rural areas do not have a primary care provider who provides medical termination and would need to travel hours to reach the nearest abortion clinic. Bay Centre offers no-touch virtual medical abortion services to assist patients who face geographical or other barriers to visiting a clinic in person.
Bay Centre also mentors primary care providers in the community who want more information on how to prescribe the medical abortion medication, Mifegymiso, or who are trying to troubleshoot a challenging medical abortion case, ensuring that patients have access to the same services and expertise regardless of where they live.
Access to primary care is essential to a well-functioning health system and healthy communities. These programs are just a few examples of how innovative care models can increase capacity and expand access to care across our city and our province.
Donors Make the Difference
Deborah Barrett
Deb Barrett’s support of Women’s College Hospital’s Crossroads Refugee Clinic has enhanced our ability to provide primary care to newcomers and refugees, and it also ensures that patients are connected to community networks and health navigation support to address their health concerns. We are grateful for Deb Barrett’s generosity, which is helping families get and stay healthy as they settle into their new lives.
