Kris Aubrey-Bassler

Aim: This study aimed to explore patient perspectives on standardized screening for social needs within the context of primary care in Canada. Background: Social determinants of health significantly influence patient health outcomes. While standardized screening for patient social needs has gained momentum, patient perspectives on the utility of said screening, particularly within the Canadian context, remains underexplored. Methods: Semi-structured interviews were conducted with participants aged 18 and older (n = 195), recruited from a larger multi-site study, using purposive maximum-variation sampling across four Canadian provinces (Ontario, Manitoba, Saskatchewan, and Newfoundland and Labrador). Questions asked during the interviews focused on financial well-being (ability to afford basic needs), housing status, social well-being, transportation, ability to afford utilities, and employment status. These interviews followed another study component where participants were asked to complete a short social needs questionnaire (the SPARK tool). Data was analysed using a thematic content analysis. Five themes were generated, including (1) openness to screening for social needs, (2) value in healthcare providers knowing patients’ social needs, (3) overall scepticism and trust/distrust in the healthcare system and professionals; (4) potential for harm; (5) meaningful engagement and provider training on social needs. Findings: Participants were generally comfortable being asked about their social needs but stressed the importance of privacy, especially regarding financial well-being (ability to afford basic needs and extended health-care related expenses), as well as clear usefulness of the data and building physician-patient trust. Participants were generally open to social needs screening, though discomfort emerged when discussing race, employment, housing, and financial well-being, largely driven by concerns about privacy, trust, and data use. These findings highlight the importance of transparent communication, robust data governance, and explicit informed consent to support acceptable and effective implementation of social needs data collection.

We aimed to evaluate the feasibility and impact of community-based healthy food retailing interventions in two private food retailers in rural Newfoundland and Labrador. We conducted a case study realist evaluation which investigates the complexities, effects, components, and inner workings population health interventions (i.e. healthy food retailing). We conducted qualitative, semi-structured interviews with Ss before (November 2022) and after (February 2024) self-selected healthy food retailing interventions were implemented. Content analysis was used to code interview transcripts and create Context-Mechanisms-Outcome (CMO) statements representing how actions to create healthy food retailing work. Participating stores designed food retailing interventions aimed to increase healthy food availability, accessibility, affordability, and acceptability through new online ordering and delivery services with healthy food recipes (S1) and changes to store equipment and food packaging (S2). CMO statements highlighted determining factors of (i) community mindedness and feedback, (ii) store status in the food system, (iii) bulk buying, (iv) advertising and communication, and (v) level of establishment. Various concepts of smallness influence the ways in which the outcomes of interventions manifest in the store’s operations and its relationship with its customers. Success of healthy food retailing interventions were related to factors beyond the ‘food’ itself. The potential ‘mix’ of contextual and mechanistic factors that will generate the ideal outcome must be adequately appreciated to advance healthy food availability, affordability, and acceptability in rural food stores and communities. These explanatory findings can inform future design, adoption, adaptation, and implementation of healthy retailing interventions in NL and Canada.

Introduction Newfoundland and Labrador (NL) faces persistent difficulty attaching its residents to primary care. We undertook a stock and flow analysis to represent how inflows and outflows of family physicians (FPs) shape effective capacity and to provide a reconciled estimate of FP supply for 2024. This approach clarifies drivers of change, exposes intervention points, and supports timely planning. Methods We assembled a multi-year headcount series and linked it to CIHI's "entering/leaving direct care" flows, harmonizing definitions and time frames across sources. We compared observed year-to-year stock change with net flows to identify timing and classification gaps. Stakeholder consultations informed key parameters (graduates and retention, internationally trained entrants, migration, retirement, and scope shift). Because confirmations are released with a lag, we produced a reconciled 2024 estimate using the CIHI headcount as baseline and these validated inputs. Findings FP headcount changed from 680 (2014) to 666 (2023) (–2.1%) after peaking at 728 (2017); the ratio fell from 129 to 124 per 100,000 population. The workforce became more urban (rural 255→203; urban 424→460) and more Canada-trained (417→466) while foreign trained decreased (261→199). Net interprovincial migration averaged –24/year, with pronounced losses in 2019 (–57) and 2022 (–42). CIHI entry–exit data point to marked volatility in the FP workforce: entries/exits were 110/96 (2019), 62/88 (2020), and 71/117 (2021), with residuals versus stock change indicating definitional/timing differences. The 2024 reconciliation yielded ≈658 FPs (net –8.5 from 2023), ≈507 FTE at 0.77 FTE/head, and ≈122 per 100,000 population. Conclusion Inflows from local graduates and IMGs did not fully offset exits from migration, retirement, and scope/burnout in 2024. Recruitment alone is unlikely to close access gaps; retention-first strategies, scaleup of team-based care with role optimization, targeted rural supports, and routine monitoring of flows are needed to stabilize and grow effective primary care capacity in NL.

Objectives: To compare primary care for depression among patients detected in the first 21 months of the SARS-CoV-2 pandemic to patients detected pre-pandemic, and examine whether depression care was associated with patient characteristics. Design: Retrospective pre–post study using de-identified data from electronic medical record data from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN). Setting: Primary care clinics enrolled in CPCSSN from 1 January 2018 to 31 December 2021. Population: Patients with a valid CPCSSN case definition of depression detected between 01 January 2018 and 31 December 2021 were included in the cohort and categorised by detection date (pre-pandemic or during Canadian pandemic waves). Outcome measures: Primary care encounters, psychotropic prescriptions and selective serotonin reuptake inhibitor (SSRI) prescriptions were observed at 3 and 12 months post-detection. Multivariable regression evaluated associations between patients’ depression detection timing and depression care, adjusting for age, sex, rurality, neighbourhood deprivation quintile, province, number of observable comorbidities and pre-detection psychotropic use. Results: 91 453 patients with depression were identified, of whom 53% were detected pre-pandemic. Patients detected during the pandemic were younger and less comorbid than those detected pre-pandemic. Proportions of patients with any encounter, psychotropic prescriptions and SSRI prescriptions were higher for patients detected during every pandemic wave compared with patients detected pre-pandemic. The adjusted incidence rate ratios (aIRRs) of number of encounters (aIRR=1.15; 95% CI 1.13 to 1.17), psychotropics (aIRR=1.11, 95% CI 1.09 to 1.13) and SSRIs prescribed (aIRR=1.12; 95% CI 1.10 to 1.15) within 3 months of detection were higher among patients detected during the first pandemic wave compared with those detected pre-pandemic. Socio-demographic characteristics had weaker associations with outcomes compared with timing of detection. Results were similar within 12 months of detection. Conclusion: Overall, primary care for depression was maintained during the pandemic despite challenging circumstances. Increases in paediatric encounter rates and increased prescribing in younger adults warrant further investigation to understand the factors driving these patterns. Trial registration number: ClinicalTrials.gov NCT05813652 .

Objective This study validates the previously tested Screening for Poverty And Related social determinants to improve Knowledge of and access to resources (‘SPARK Tool’) against comparison questions from well-established national surveys (Post Survey Questionnaire (PSQ)) to inform the development of a standardised tool to collect patients’ demographic and social needs data in healthcare. Design Cross-sectional study. Setting Pan-Canadian study of participants from four Canadian provinces (SK, MB, ON and NL). Participants 192 participants were interviewed concurrently, completing both the SPARK tool and PSQ survey. Main outcomes Survey topics included demographics: language, immigration, race, disability, sex, gender identity, sexual orientation; and social needs: education, income, medication access, transportation, housing, social support and employment status. Concurrent validity was performed to assess agreement and correlation between SPARK and comparison questions at an individual level as well as within domain clusters. We report on Cohen’s kappa measure of inter-rater reliability, Pearson correlation coefficient and Cramer’s V to assess overall capture of needs in the SPARK and PSQ as well as within each domain. Agreement between the surveys was described using correct (true positive and true negative) and incorrect (false positive and false negative) classification. Results There was a moderate correlation between SPARK and PSQ (0.44, p60), SPARK correctly classified 90.5% (n=176/191). Conclusions SPARK provides a brief 15 min screening tool for primary care clinics to capture social and access needs. SPARK was able to correctly classify most participants within each domain. Related ongoing research is needed to further validate SPARK in a large representative sample and explore primary care implementation strategies to support integration.

Introduction: SARS-CoV-2 is now endemic and expected to remain a health threat, with new variants continuing to emerge and the potential for vaccines to become less effective. While effective vaccines and natural immunity have significantly reduced hospitalisations and the need for critical care, outpatient treatment options remain limited, and real-world evidence on their clinical and cost-effectiveness is lacking. In this paper, we present the design of the Canadian Adaptive Platform Trial of Treatments for COVID in Community Settings (CanTreatCOVID). By evaluating multiple treatment options in a pragmatic adaptive platform trial, this study will generate high-quality, generalisable evidence to inform clinical guidelines and healthcare decision-making. Methods and analysis: CanTreatCOVID is an open-label, individually randomised, multicentre, national adaptive platform trial designed to evaluate the clinical and cost-effectiveness of therapeutics for non-hospitalised SARS-CoV-2 patients across Canada. Eligible participants must present with symptomatic SARS-CoV-2 infection, confirmed by PCR or rapid antigen testing (RAT), within 5 days of symptom onset. The trial targets two groups that are expected to be at higher risk of more severe disease: (1) individuals aged 50 years and older and (2) those aged 18–49 years with one or more comorbidities. CanTreatCOVID uses numerous approaches to recruit participants to the study, including a multifaceted public communication strategy and outreach through primary care, outpatient clinics and emergency departments. Participants are randomised to receive either usual care, including supportive and symptom-based management, or an investigational therapeutic selected by the Canadian COVID-19 Outpatient Therapeutics Committee. The first therapeutic arm evaluates nirmatrelvir/ritonavir (Paxlovid), administered two times per day for 5 days. The second therapeutic arm investigates a combination antioxidant therapy (selenium 300 µg, zinc 40 mg, lycopene 45 mg and vitamin C 1.5 g), administered for 10 days. The primary outcome is all-cause hospitalisation or death within 28 days of randomisation. Ethics and dissemination: The CanTreatCOVID master protocol and subprotocols have been approved by Health Canada and local research ethics boards in the participating provinces across Canada. The results of the study will be disseminated to policy-makers, presented at conferences and published in peer-reviewed journals to ensure that findings are accessible to the broader scientific and medical communities. This study was approved by the Unity Health Toronto Research Ethics Board (#22-179) and Clinical Trials Ontario (Project ID 4133). Trial registration number: NCT05614349

Introduction: Primary care nurses (PCNs) are the second largest workforce in primary care and play a critical role in facilitating access to coordinated care and reducing health disparities. There is renewed interest in team-based primary care as a solution for health workforce challenges. Some team models enable PCNs (ie, nurse practitioners, registered nurses, licensed/registered practical nurses) to leverage one another’s expertise to work to optimal scope; the extent to which this happens depends on multiple context-dependent factors. We will conduct an umbrella review to synthesise and compare international knowledge syntheses focused on scope of practice enactment (ie., roles and activities) of PCNs in primary care. Methods and analysis: We will conduct the umbrella review according to the Joanna Briggs Institute methodology, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol (PRISMA-P) guidelines, and using the Nursing Care Organization Framework as guidance. We will search a wide range of scientific electronic databases and grey literature sources, and consider articles published in English and French by the Organization for Economic Cooperation and Development and designated key partner countries for inclusion, with no publication date limits. Two independent reviewers will screen titles, abstracts and full-text articles, and any disagreements will be resolved through discussion or by a third reviewer. We will use the Risk of Bias Assessment Tool for Systematic Reviews to assess the quality and risk of bias in the included systematic and scoping reviews. Ethics and dissemination: Results will be presented in a PRISMA Scoping Review flow diagram. We will synthesise data from included studies in a detailed literature review table and develop visual aids to communicate the shared and unique roles and activities of PCN scope of practice. We will disseminate the results of the review through peer-reviewed publications and conferences related to this field. Ethics approval is not required.

Sleep disturbances are one of the biggest barriers to resuming normal functioning following cancer treatment. Cognitive behavioral therapy for insomnia (CBT-I) has demonstrated efficacy in cancer survivors but few studies have recorded adverse events (AEs) that occur during treatment. The purpose of this study was to report the prevalence, severity, and attribution of AEs during CBT-I with cancer survivors. Cancer survivors from Atlantic Canada with insomnia and comorbid cognitive impairment were recruited to participate in a randomized controlled trial of CBT-I. Participants reported the prevalence, severity, and attribution of AEs at mid-treatment (4 weeks) and post-treatment (8 weeks). The likeliness of AEs being related to treatment was also rated by an independent clinician. Of the 122 cancer survivors who completed treatment (Mage = 60.3, 77.9% women), 72 reported a total of 197 AEs. At mid-treatment, participants reported 113 AEs, but only 11 were rated as being attributed to the intervention. At post-treatment, participants did not report any AEs attributed to the intervention. An independent rater attributed more AEs to the treatment than the participants at both time points (4 weeks: 16 vs. 11, 8 weeks: 1 vs. 0). Gender (p = .014) and pre-treatment anxiety (p < .001) were associated with reporting an AE. CBT-I is a safe treatment that is well-tolerated by cancer survivors. The majority of participants did not experience AEs that could be attributed to the treatment. Clinicians should continue to recommend CBT-I as the first-line treatment for cancer survivors experiencing insomnia symptoms. This study is a secondary analysis of a randomized controlled trial titled ‘Addressing Cancer Treatment-Related Insomnia Online in Atlantic Canada (ACTION) study’ ( https://www.clinicaltrials.gov/search?cond=NCT04026048 identifier: NCT04026048).

Background: Data on the social determinants of health could be used to improve care, support quality improvement initiatives, and track progress toward health equity. However, this data collection is not widespread. Artificial intelligence (AI), specifically natural language processing and machine learning, could be used to derive social determinants of health data from electronic medical records. This could reduce the time and resources required to obtain social determinants of health data. Objective: This study aimed to understand perspectives of a diverse sample of Canadians on the use of AI to derive social determinants of health information from electronic medical record data, including benefits and concerns. Methods: Using a qualitative description approach, in-depth interviews were conducted with 195 participants purposefully recruited from Ontario, Newfoundland and Labrador, Manitoba, and Saskatchewan. Transcripts were analyzed using an inductive and deductive content analysis. Results: A total of 4 themes were identified. First, AI was described as the inevitable future, facilitating more efficient, accessible social determinants of health information and use in primary care. Second, participants expressed concerns about potential health care harms and a distrust in AI and public systems. Third, some participants indicated that AI could lead to a loss of the human touch in health care, emphasizing a preference for strong relationships with providers and individualized care. Fourth, participants described the critical importance of consent and the need for strong safeguards to protect patient data and trust. Conclusions: These findings provide important considerations for the use of AI in health care, and particularly when health care administrators and decision makers seek to derive social determinants of health data.

Introduction: While effective vaccines and natural immunity have significantly reduced hospitalizations and the need for critical care, SARS-CoV-2 is now endemic and is expected to continue to pose a threat to health. New variants are expected to continue to emerge, and vaccines may become less effective. Effective and affordable therapeutics for SARS-CoV-2 that can be easily used in community settings are needed to accelerate recovery, reduce hospitalizations and mortality, and mitigate the development of post-acute sequelae of SARS-CoV-2, also known as “long COVID.” In this paper we present the design of the Canadian Adaptive Platform Trial of Treatments for COVID in Community Settings (CanTreatCOVID). Methods and analysis: CanTreatCOVID is an open-label, individually randomized, multi-centre, national adaptive platform trial designed to evaluate the clinical and cost-effectiveness of therapeutics for non-hospitalized SARS-CoV-2 patients across Canada. Eligible participants must present with symptomatic SARS-CoV-2 infection, confirmed by PCR or rapid antigen testing (RAT), within 5 days of symptom onset. The trial targets two groups that are expected to be at higher risk of more severe disease: (1) individuals aged 50 years and older, and (2) those aged 18-49 years with one or more comorbidities. CanTreatCOVID uses numerous approaches to recruit participants to the study, including a multi-faceted public communication strategy and outreach through primary care, out-patient clinics, and emergency departments. Participants are randomized to receive either usual care, including supportive and symptom-based management, or an investigational therapeutic selected by the Canadian COVID-19 Outpatient Therapeutics Committee. The first therapeutic arm evaluates nirmatrelvir/ritonavir (Paxlovid™), administered twice daily for 5 days. The second therapeutic arm investigates a combination antioxidant therapy (selenium 300 µg, zinc 40 mg, lycopene 45 mg, and vitamin C 1.5 g), administered for 10 days. The primary outcome is all-cause hospitalization or death within 28 days of randomization. Ethics and dissemination: The CanTreatCOVID master protocol and sub-protocols have been approved by Health Canada and local research ethics boards in the participating provinces across Canada. The results of the study will be disseminated to policymakers, presented at conferences, and published in peer-reviewed journals to ensure that findings are accessible to the broader scientific and medical communities. Trial registration number: NCT05614349 Strengths and Limitations Box: The CanTreatCOVID community-focused design allows enrollment without in-person visits. The adaptive platform trial structure provides flexibility to add promising therapies and remove ineffective ones, which is critical in a rapidly changing pandemic environment CanTreatCOVID gathers real-world data on outpatient COVID-19 care The open-label design avoids logistical challenges associated with placebo controls in large-scale trials, though it may introduce bias related to subjective outcomes The reliance on self-reported adherence to study medications could lead to variability