Upstream Lab project receives CIHR award to improve primary care access

A $200K grant from the Canadian Institutes of Health Research (CIHR) will enable researchers to study how various approaches can support vulnerable patients in accessing primary care.

Leading this initiative are Dr. Andrew Pinto, Dr. Benita Hosseini and Mr. Alexander Zsager, along with Dr. Danielle Martin, Chair of the Department of Family and Community Medicine at the University of Toronto, and Dr. Michael Green, President of The College of Family Physicians of Canada. Actively collaborating with experts and patient partners across Alberta, British Columbia, Newfoundland and Labrador, Nova Scotia, Ontario, and Quebec, the project will be based at Upstream Lab, MAP Centre for Urban Health Solutions, St. Michael’s Hospital.

The ENGAGE project (Evaluating Novel Approaches that enGage And support vulnerable patient Groups to Equitably access primary care: Building the foundation for a national adaptive platform trial) will assess current practices and resources to engage vulnerable patients in primary care across Canada.

The results of this work will establish a foundation for designing an Adaptive Platform Trial (APT) to evaluate approaches to support vulnerable patients in accessing primary care. Similar to a revolving door, interventions can enter or leave the study without creating an entirely new trial when new information becomes available. Using an APT design allows researchers to quickly respond to changing policies and funding in primary care while ensuring strategies remain effective.

Central to this initiative is building the ENGAGE team and seeking feedback from frontline healthcare providers and vulnerable patients, including low-income individuals, racialized groups, newcomers, and people experiencing homelessness. Patient and community partners have been integral to the project from its inception through the evaluation stage.

By interviewing policymakers and people with lived experience, the project will shed light on factors affecting vulnerable patients’ access to primary care. Data from reports and publicly available information will also contribute to mapping the current strategies and their effectiveness.

With the support of the Office of Health System Partnership at the University of Toronto and Ontario Health, the research team will conduct a pilot trial to determine whether working with a healthcare navigator engages more patients, compared to sharing multilingual posters through community agencies. The trial will be conducted in 16 community health centers, 15 Family Health Teams, and 1 Aboriginal Health Access Centre in Toronto for three months. The results will then inform the design of a future APT throughout Canada.

ENGAGE aims to impact policy and future research on engaging and supporting vulnerable patients in primary care. This work will catalyze a new collaboration among researchers, patient partners, health providers, and system leaders to identify the best approaches to address the crisis in primary care access.