Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
Department of Family Medicine, Faculty of Medicine, University of Ottawa, 201-600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada.
BMC Prim Care. 2024 Sep 28;25(1):347. doi: 10.1186/s12875-024-02563-6.
Improving health equity and access to the highest possible standard of health care is a key issue of social accountability. Centretown Community Health Centre in Ottawa, Canada has iteratively developed a program to target and serve marginalized and complex populations since 1999. The program implementation was evaluated using a validated implementation framework.
Quantitative and qualitative data were collected through a health records extraction (n = 570), a client complexity assessment tool (n = 74), semi-structured interviews with clients and key stakeholders (n = 41), and a structured client satisfaction survey (n = 30). Data were analyzed using descriptive statistics and inductive thematic analysis.
Five hundred and seventy unique clients were seen between November 1-30, 2021. A third of clients (34%) did not have a provincial health card for access to universal health care services, and most (68%) were homeless or a resident of rooming houses. Most clients who reported their income (92%) were at or below Canada's official poverty line. The total mean complexity score for clients seen over a one-month period (n = 74) was 16.68 (SD 6.75) where a total score of at least 13 of 33 is perceived to be a threshold for client biopsychosocial complexity. Clients gained the majority of their total score from the Social support assessment component of the tool. Clients (n = 31) and key informants (n = 10) highlighted the importance of building relationships with this population, providing wrap-around care, and providing low-barrier care as major strength to the Urban Health program (UH). Key areas for improvement included the need to: i) increase staff diversity, ii) expand program hours and availability, and iii) improve access to harm reduction services. Clients appeared to be highly satisfied with the program, rating the program an average total score of 18.50 out of 20.
The program appears to serve marginalized and complex clients and seems well-received by the community. Our findings have relevance for other health care organizations seeking to better serve marginalized and medically and socially complex individuals and families in their communities.
提高健康公平性和获得尽可能高的医疗保健标准是社会问责的关键问题。自 1999 年以来，加拿大渥太华的 Centretown 社区健康中心一直在不断开发一项针对边缘化和复杂人群的计划。该计划的实施使用经过验证的实施框架进行了评估。
通过健康记录提取（n=570）、客户复杂性评估工具（n=74）、客户和主要利益相关者的半结构化访谈（n=41）以及客户满意度调查（n=30）收集了定量和定性数据。数据使用描述性统计和归纳主题分析进行分析。
2021 年 11 月 1 日至 30 日期间，共为 570 位独特的患者提供了服务。三分之一的患者（34%）没有省级健康卡来获得全民医疗保健服务，大多数（68%）无家可归或居住在客房内。大多数报告收入的患者（92%）处于或低于加拿大官方贫困线。在一个月期间就诊的患者（n=74）的总平均复杂性评分为 16.68（SD 6.75），其中 33 分中的总分至少为 13 被认为是患者生物心理社会复杂性的阈值。患者的总得分主要来自工具的社会支持评估部分。患者（n=31）和主要利益相关者（n=10）强调与这一人群建立关系、提供全面护理以及提供低障碍护理的重要性，这是城市健康计划（UH）的主要优势。需要改进的主要领域包括：i）增加员工多样性，ii）扩大计划时间和可用性，以及 iii）改善获得减少伤害服务的机会。患者似乎对该计划非常满意，对该计划的平均总评分为 20 分中的 18.50 分。
该计划似乎为边缘化和复杂的患者提供服务，并且似乎受到社区的欢迎。我们的研究结果对其他寻求更好地为社区中边缘化和医疗及社会复杂的个人和家庭提供服务的医疗保健组织具有相关性。
