COVID-19 Health Workforce Research In Progress
Principal Investigators: Josephine Etowa, LaRon Nelson
Program: COVID-19 Rapid Research FO - Clinical Mgmt/Health System Interventions (2020-05)
The ongoing COVID-19 pandemic represents an unprecedented challenge for healthcare systems across the world. African, Caribbean and Black communities (ACB) include some of the most vulnerable populations in terms of their susceptibility to COVID-19 and their access and receipt of necessary and appropriate health care. The goal of this study is to improve the health system's response to COVID-19 by minimizing its spread and consequences in ACB communities. Specific objectives are to: 1) Engage ACB communities and health provider stakeholders in research and decision-making processes 2) Examine the contextual vulnerability and challenges experienced by ACB communities 3) Identify the adequacy and non-intended consequences of current health care practices on ACB communities 4) Increase individual, community and organizational capacity and leadership and generate strategies to address COVID-19 related-health outcomes, and 5) Share new knowledge and support its translation into policy and practice models to mitigate the impact of COVID-19 on ACB communities. The project will take place in four phases in two sites in Ontario (Toronto and Ottawa). A local advisory group will ensure consistent community engagement and capacity building. Our research team is comprised of influential and committed researchers, community leaders, healthcare providers and knowledge users from diverse backgrounds and disciplines across Ontario. The expected impacts of the proposed research that will be felt locally and globally by strengthening ACB community responses to COVID-19, identifying evidence-based interventions to strengthen the health system's capacity to care for ACB members, and generating knowledge to reduce COVID-19-related health inequities in ACB communities.
Principal Investigator: Annalee Yassi, Laszchenov Muzimkhul Zungu
Program: COVID-19 Rapid Research FO - Social Policy and Public Health Responses (2020-05)
This research focuses on measures to protect healthcare workers (HCWs) who are at substantially increased risk because of their direct contact with COVID-19 infected patients - and with considerable variation being experienced internationally in different settings. Although there is general agreement on many aspects of policy to protect HCWs, approaches have varied widely with very limited availability of contextualized evidence to guide local decisions. Often differences have been due to availability of specific personal protective equipment (PPE-e.g. N95 respirators, masks, gloves, gowns); sometimes differences have been due to operational necessities (e.g. whether exposed HCWs can continue to work while wearing PPE); sometimes variations in policies relate to availability of COVID-19 test kits or related reagents (e.g. criteria for testing or whether pre-return-to-work testing is implemented); approaches to exposure monitoring and contact tracing for HCWs also vary widely. It is critically important for policymakers to understand consequences of these variations, as well as scrutinize their scientific and contextual rationales. This proposal asks "What works to protect HCWs, in what contexts, using what mechanism, to achieve what outcome?" By building on a strong track record of interdisciplinary research in exactly this field, with well-established international networks with expertise in infection control and occupational health, and a long-history of relationship-building to facilitate this research, this team is extremely well-positioned to conduct this highly relevant research and provide world leadership in this area. It will be conducted through in-depth case studies conducted in Vancouver, Canada and Gauteng, South Africa as well an international cross-country comparative analysis based on surveys and experiences in protecting healthcare workers and a case-control study of workers with COVID-19 infection versus other workers in their same facilities.
Governance and Regulation
Regulating During Crisis: Examining Nursing Regulatory Responses to the COVID-19 Pandemic
Researcher: Kathleen Leslie
Institution: Athabasca University
Program: National Council of State Boards of Nursing Center for Regulatory Excellence Grant (2020-2022)
The COVID-19 pandemic is placing intense pressure on nursing regulatory bodies. With nurses on the front lines of the public health crisis, nursing regulators are being called on to ensure the public has access to the needed health workforce while still maintaining public safety. Critical issues facing regulators include managing registration for new graduates, adjusting scopes of practice to ensure appropriate skill mix, facilitating interjurisdictional mobility, making decisions about temporary or emergency certificates, and understanding implications of working remotely on matters such as disciplinary hearings. All of these decisions bring into focus the concept of protecting the public interest during an unprecedented public health crisis. Our qualitative comparative case study will capture the regulatory responses of six Canadian and American nursing regulatory bodies during the COVID-19 pandemic in order to analyze and synthesize the similarities, differences, and patterns in these regulators’ responses while also considering the mobility of nurses across the Canadian-American border. By collecting data at different time points, we will identify how early decisions regarding the public interest and the balancing of regulatory principles were made and will also consider how nursing regulation may be impacted long-term by the pandemic. The results of this study will provide critically needed evidence about how nursing regulators conceptualize the public interest during crisis and what factors influence this conceptualization, and about the roles and responsibilities of professional regulators during a public health crisis. This evidence will also provide important insight into planning for future crisis situations.
Principal Investigators: Ivy Bourgeault, Mary Bartram
Program: Op. Grant: COVID-19 MS & Substance Use - Matching Access to Service with Needs
The people who provide mental health and substance use services play acritical role in the response to COVID-19.The pandemic has brought about big changes for this workforce, such as the sudden shift to online approaches, adjusting to wearing masks, and responding to increasing levels of anxiety, trauma and grief in the population. We know from previous disasters and epidemics that the mental health and substance use impacts are likely to be complex and long-lasting, and may not fully emerge until after the worst of the crisis. PURPOSE: This study will provide better information about the availability of mental health professionals like psychologists, social workers and addictions counsellors to respond to the mental health and substance use needs of people in response to COVID-19. GOALS: The specific goals are to address gaps in information about how COVID-19 has changed the kinds of mental and substance use services that people need and that can be offered, and to provide the people who make decisions about mental health and substances use services with the information they need to improve these services. APPROACH: We will summarize information that has been previously published and we will gather new information from surveys, interviews with experts and mental health and substance use service providers and their organizations. We will examine not only those working in the public system, but also in the private system including employee assistance programs, private practitioners and those in private treatment centres. Once all of this information is gathered, we will engage with leaders and decision makers to build a shared action plan for next steps.
Principal Investigators: Cary Kogan, Geoffrey Reed
Program: COVID-19 Rapid Research - Clinical Management & Health System Interventions (2020-05)
Due to the COVID-19 pandemic, health care workers face highly stressful and rapidly changing work environments, often caring for those with COVID-19 without adequate protective equipment while coping with their own fears of getting sick or infecting others. Studies from other pandemics tell us that health care workers often experience impairing psychological symptoms such anxiety, sadness, insomnia and general distress, which can be long lasting and lead to reduced quality of care and safety or to leaving their jobs. Mental health concerns in the population have increased because of the pandemic (e.g., isolation, anxiety, substance use), but accessing services is more difficult. Psychiatrists and other mental health professionals face increased demands and substantial stress; it is critical to understand their experiences to ensure the availability of high-quality services, including those using telehealth technologies like videoconferencing. This study uses detailed online surveys in 6 languages to assess the impact of the COVID-19 pandemic on clinical practice and well-being of global mental health professionals. The survey will be implemented at three time points to look at changes over time. Participants will be members of the World Health Organization's Global Clinical Practice Network, including 15500 mental health clinicians from 159 countries. The study assesses: 1) Effects of COVID-19 on work circumstances and services; 2) Work-related stress and distress; 3) Use of telehealth services and related concerns; and 4) Expectations, resource needs, and recommendations. The study responds to the CIHR call by providing evidence to inform clinical and health system management and public health response. Findings will inform CIHI (co-applicant knowledge user), the Government of Canada, WHO, professional associations and health systems as they work to ensure continuity of care for people with mental illness and to protect and retain the mental healthcare workforce.
Principal Investigators: Maria Mathews, Lindsay Hedden, Julia Lukewich, Emily Marshall
Family physicians (FP) play an important role in pandemic response and recovery. However, existing pandemic plans do not adequately incorporate FP. What are the roles of FP during a pandemic? What facilitates and hinders FP from fulfilling these roles? The goal of the project is to inform the development of pandemic plans for FP by examining experiences in four regions in Canada: Newfoundland and Labrador, Nova Scotia, Ontario, and British Columbia. The project is a multiple case study of regions in four provinces. Each case consists of a two-part mixed-methods design consisting of: 1) chronology of FP roles in the COVID19 pandemic response and 2) qualitative interviews with FP. In each province, we will create the chronology through a document review (supplemented, as needed, by key informant interviews) to describe key milestones in COVID19 pandemic and FP roles and responsibilities at each stage of the pandemic. Using the chronology as common frame of reference, we will conduct semi-structured qualitative interviews with FP who work in each region. In the interview, for each pandemic stage, we will ask FP to describe the facilitators and barriers to performing the proposed, actual and potential roles FP, and the influence of their gender on roles, facilitators and barriers. Results will provide government ministries, public health units, other health organizations, and FP evidence and tools (such as checklists) with which to respond to a second COVID19 wave and plan for future pandemics.
Home, Community and Long Term Care
Long-Term Care in Crisis: The Reality of COVID-19
Researcher: Andrea Baumann (lead)
Institution: McMaster University
Program: CIHR COVID-19 Rapid Research FO - Clinical Mgmt/Health System Interventions (2020-06)
Long-term care (LTC) in Canada is in crisis due to the COVID-19 pandemic. To date, 82% of all recorded COVID-19 deaths nationwide are connected to LTC and retirement homes. This research will accelerate the availability of high-quality and real-time evidence to support Canada's rapid response to the global pandemic in order to better manage COVID-19 and position Canada to meet future health threats with particular reference to LTC. The goal of this research is to conduct a thorough examination of the LTC system. The limited capacity of LTC homes in Canada to manage COVID-19 has been emphasized in the media. The challenge facing governments is to understand what went wrong and to create policies that ensure improvements across the LTC sector. The transdisciplinary research team comprises experts in health services, political science, organization and management, finance, health law and health economics, sociology and labour studies. The research findings will provide comprehensive information on critical factors necessary for decision making in LTC. The evidence will provide tangible solutions for multiple stakeholders, including governments, service providers and healthcare workers.