EQUIP Healthcare: An overview of a multi-component intervention to enhance equity-oriented care in primary health care settings. Browne et al. (2015)

Browne, A. J., Varcoe, C., Ford-Gilboe, M., & Wathen, N. on behalf of the EQUIP Research Team (2015). EQUIP Healthcare: An overview of a multi-component intervention to enhance equity-oriented care in primary health care settings. International Journal for Equity in Health, 14(152).

Abstract from authors:

This paper provides an overview of an innovative multi-component, organizational-level intervention designed to enhance the capacity of PHC clinics to provide equity-oriented care, particularly for marginalized populations. The intervention, known as EQUIP, is being implemented in Canada in four diverse PHC clinics serving populations who are impacted by structural inequities. We discuss the evidence and theory that provide the basis for the intervention, describe the intervention components, and discuss the methods used to evaluate the implementation and impact of the intervention in diverse contexts.

Article can be found here.

A theory-based primary health care intervention for women who have left abusive partners. – Ford-Gilboe, M., Merritt-Gray, M., Varcoe, C. M., & Wuest, J. (2011).

Ford-Gilboe, M., Merritt-Gray, M., Varcoe, C. M., & Wuest, J. (2011). A theory-based primary health care intervention for women who have left abusive partners. Advances in Nursing Science, 34(3), 1-17.

Abstract from Authors:

Although intimate partner violence is a significant global health problem, few tested interventions have been designed to improve women’s health and quality of life, particularly beyond the crisis of leaving. The Intervention for Health Enhancement After Leaving is a comprehensive, trauma informed, primary health care intervention, which builds on the grounded theory Strengthening Capacity to Limit Intrusion and other research findings. Delivered by a nurse and a domestic violence advocate working collaboratively with women through 6 components (safeguarding, managing basics, managing symptoms, cautious connecting, renewing self, and regenerating family), this promising intervention is in the early phases of testing.

Article can be found here

Access to primary care from the perspective of Aboriginal patients at an urban emergency department. – Browne, Annette J., Smye, Victoria L., Rodney, Patricia, Tang, Sannie Y., Mussell, Bill, & O’Neil, John D. (2011).

Browne, Annette J., Smye, Victoria L., Rodney, Patricia, Tang, Sannie Y., Mussell, Bill, & O’Neil, John D. (2011). Access to primary care from the perspective of Aboriginal patients at an urban emergency department. Qualitative Health Research, 21(3), 333-348. doi: 10.1177/1049732310385824

Abstract from Authors:

In this article, we discuss findings from an ethnographic study in which we explored experiences of access to primary care services from the perspective of Aboriginal people seeking care at an emergency department (ED) located in a large Canadian city. Data were collected over 20 months of immersion in the ED, and included participant observation and in-depth interviews with 44 patients triaged as stable and nonurgent, most of whom were living in poverty and residing in the inner city. Three themes in the findings are discussed: (a) anticipating providers’ assumptions; (b) seeking help for chronic pain; and (c) use of the ED as a reflection of social suffering. Implications of these findings are discussed in relation to the role of the ED as well as the broader primary care sector in responding to the needs of patients affected by poverty, racialization, and other forms of disadvantage.

Article can be found here.

Enhancing measurement of primary health care indicators using an equity lens: An ethnographic study. – Wong, S. T., Browne, A. J., Varcoe, C. M., Lavoie, J. G., Smye, V. L., Godwin, O., et al. (2011).

Wong, S. T., Browne, A. J., Varcoe, C. M., Lavoie, J. G., Smye, V. L., Godwin, O., et al. (2011). Enhancing measurement of primary health care indicators using an equity lens: An ethnographic study. International Journal for Equity in Health, 10, 38.

Abstract from Authors:

Introduction: One important goal of strengthening and renewal in primary healthcare (PHC) is achieving health equity, particularly for vulnerable populations. There has been a flurry of international activity toward the establishment of indicators relevant to measuring and monitoring PHC. Yet, little attention has been paid to whether current indicators: 1) are sensitive enough to detect inequities in processes or outcomes of care, particularly in relation to the health needs of vulnerable groups or 2) adequately capture the complexity of delivering PHC services across diverse groups. The purpose of this paper is to contribute to the discourse regarding what ought to be considered a PHC indicator and to provide some concrete examples illustrating the need for modification and development of new indicators given the goal of PHC achieving health equity.

Methods: Within the context of a larger study of PHC delivery at two Health Centers serving people facing multiple disadvantages, a mixed methods ethnographic design was used. Three sets of data collected included: (a) participant observation data focused on the processes of PHC delivery, (b) interviews with Health Center staff, and (c) interviews with patients.

Results: Thematic analysis suggests there is a disjuncture between clinical work addressing the complex needs of patients facing multiple vulnerabilities such as extreme levels of poverty, multiple chronic conditions, and lack of housing and extant indicators and how they are measured. Items could better measure and monitor performance at the management level including, what is delivered (e.g., focus on social determinants of health) and how services are delivered to socially disadvantaged populations (e.g., effective use of space, expectation for all staff to have welcoming and mutually respectful interactions). New indicators must be developed to capture inputs (e.g., stability of funding sources) and outputs (e.g., whole person care) in ways that better align with care provided to marginalized populations.

Conclusions: The current emphasis on achieving greater equity through PHC, the continued calls for the renewal and strengthening of PHC, and the use of monitoring and performance indicators highlight the relevance of ensuring that there are more accurate methods to capture the complex work of PHC organizations.

Article can be found here