Researchers highlight the critical role of Ontario’s primary care providers during the pandemic

Primary care providers have an important role to play in the pandemic, and improving access to that care is key, say researchers from the Ontario Scientific Advisory Board on COVID-19.

This week, researchers published a three-part briefing detailing the work of primary care providers during the first two years of the pandemic.

The widely reported brief describes the challenges affecting primary care in Ontario and offers lessons learned to improve access to primary care.

“The pandemic is not over, and COVID-19 is increasingly becoming a disease that will be fought in the community with the support of family physicians, nurses and primary care teams,” said Danielle Martin, a clinician and faculty member at Women’s College Hospital who chairs the Department of Family and of Public Medicine, Faculty of Medicine, Temerti.

“The Science Table wanted to understand the evidence base regarding the contribution of primary care to the pandemic response so far, as well as the current strengths and challenges that will affect the response to future waves. At this time, it is very important to understand the lessons learned from the last two and a half years.”

The primary authors of the brief, which was conceived by Martin, include primary care experts from across Ontario with a wide range of expertise, including Iman Bayoumi, Azza Eisa, Noah Ivers, Tara Kieran, Dereli Mangin, Sarah Newberry, Andrew Pinto and Camilla Premji . The team analyzed more than 200 articles for the study and consulted extensively with other experts in their work.

The publication of the summaries is the last official act of the Ontario Scientific Advisory Board on COVID-19. An advisory panel comprised of scientific experts and health system leaders evaluated and reported evidence relevant to the pandemic to guide Ontario’s response.

Research shows that health systems with strong primary care have better health outcomes and improved health equity at lower costs, making exploring lessons learned about primary care during the pandemic a fitting conclusion to the Science Table activity.

The three-part report features dozens of researchers and primary care experts from Ontario, Canada and around the world. It outlines evidence of how primary care clinicians – family doctors, nurses, pharmacists, social workers and other allied health professionals – have taken on new roles and worked longer days to support COVID-19 care in addition to their normal clinical work , which includes preventive, chronic and acute care.

Primary care clinicians in Ontario have taken on new responsibilities such as: COVID testing, assessment and isolation; counseling and delivery of vaccines; and prescribing, referral and emergency care after COVID-19. They also helped other areas of the health care system, such as emergency departments, intensive care units, and long-term care, as well as helping people with mental health problems, as well as poverty and food insecurity.

“As misinformation grows around COVID-19, primary care clinicians are highly trusted members of their communities—an invaluable resource for communicating the rapidly changing scientific developments in the prevention and treatment of COVID-19 to the public,” said Fahad Razak, research associate director of the Ontario Scientific Advisory Board on COVID-19, who is a clinician-scientist at St. Michael’s Hospital, Unity Health Toronto, and an associate professor at the Temerti Faculty of Medicine and Dala Lana School of Public Health.

Researchers note that Ontario faces a major challenge to keep up with demand for primary care. About 1.8 million Ontarians do not have a regular family doctor, and new immigrants and people living on low incomes are least likely to have one.

In addition, 1.7 million Ontarians have a family doctor of retirement age. This shortage is compounded by the declining number of medical school graduates choosing to specialize in family medicine. These challenges, along with inequitable access to emergency care, will determine the ability of primary care to respond to future waves of pandemics and support health system recovery.

Based on their findings, the researchers outlined several lessons learned:

• Support provided in formal relationships and through team models provides better support for COVID-19 and non-COVID-19 health problems in the community.
• Without additional resources, the response to COVID-19 leads to compromises and unmet needs in other areas.
• Innovative models and new partnerships support patients in getting the care they need, but infrastructure is needed for sustainability, diffusion and scale.
• The lack of an integrated data system has compromised the response to the pandemic in primary care.
• Primary care can use its longitudinal relationships to achieve public health goals.

Martin says the ultimate goal of the work is to provide evidence to help decision-makers, including governments, professional associations and leading providers, improve current pandemic answer

“We are in a position where we are facing a significant shortage of human resources in health, inequitable access to teams and uncertainty about the future,” Martin said. “I hope the crisis we’ve faced will encourage all system leaders to look for evidence on how we can best improve access to high-quality primary care for all Ontarians.”