Health Systems Solutions

epidemiology-public-health-implementation, science-brief

Effective Modalities of Virtual Care to Deliver Mental Health and Addictions Services in Canada

The delivery of virtual mental health care by regulated healthcare professionals has grown substantially since the onset of the COVID-19 pandemic. In the limited research conducted on this modality, virtual mental health care has been found to be efficacious for supporting patients with depression, anxiety, and post-traumatic stress disorder. However, there is limited comparative evidence between in-person and virtual modalities, or for severe mental illnesses such as schizophrenia or bipolar disorder. Thus, despite the surge in the use of virtual care during the pandemic, it is important to recognize that virtual care may not be an adequate substitute for in-person treatment for all populations or conditions. Further, while virtual mental health care has the potential to address barriers to access to care for rural and underserved communities, it may also propagate existing inequities in mental health care for under-resourced populations. Many challenges to the delivery of equitable care through virtual mental health remain. Enhancing technological literacy and access for clinicians and clients, and delivering culturally competent care that aligns with the needs of the local population and community is a largely unaddressed priority for advancing transparency, trust and equity. Deliberate consideration of the specific needs and issues, preferences, culture and values of individual patients and communities is important to deliver culturally-competent virtual mental health models of care for equitable, accessible recovery. This should be done through close engagement and collaborative co-creation with patients, mental health researchers, practitioners and communities.
epidemiology-public-health-implementation, science-brief

The COVID-19 Pandemic's Impact on Long-Term Care Homes: Five Lessons Learned

Older adults living in Ontario’s long-term care (LTC) homes have experienced some of the most devastating impacts of the COVID-19 pandemic, including disproportionate deaths, prolonged isolation from family and essential caregivers and reduced quality of life. In response, national and provincial associations and organizations have launched inquiries, issued expert reports, and offered recommendations. This brief summarizes and consolidates key recommendations from five reports and identifies opportunities to strengthen and integrate these recommendations into the Ontario policy environment. We identified five critical lessons learned: 1) Enhance the entry and retention of LTC home staff through the creation of more full-time positions, adequate staffing levels, and improvement of working conditions, 2) Reduce crowding through the elimination of three and four bed ward rooms and creation of more private rooms with dedicated bathrooms, 3) Maintain the ability for essential caregivers to have in-person access to the resident, 4) Ensure residents have access to timely and high-quality palliative care that promotes both quality and length of life, and 5) Build and maintain infection prevention and control (IPAC) expertise within LTC homes. These five lessons learned offer opportunities for significant improvement for Ontario’s LTC homes and can optimize safety, quality of life and outcomes for residents and improve the LTC home environment for staff and essential caregivers.
epidemiology-public-health-implementation, science-brief

Critical Care Capacity During the COVID-19 Pandemic

From March 20, 2020 to October 31, 2021, 9,096 Ontarians have been admitted to intensive care units (ICUs) with COVID-19 related critical illness. The COVID-19 pandemic has strained Ontario’s critical care system. At the peak of wave 3, the number of patients on ventilators was over 180% of pre-pandemic historical averages. The critical care system was able to accommodate this influx of patients by deferring surgeries and procedures, funding new ICU beds, identifying temporary surge space, team-based care models utilizing redeployed staff, and transferring patients between hospitals. This required effective collaboration and coordination across critical care system. The critical care system does not currently have capacity to accommodate a surge as it did during waves 2 and 3 due to worsening staffing shortages, healthcare worker burnout, and health system recovery efforts. Public health measures to mitigate influxes of critically ill patients are needed.
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