Jun 2, 2020

Primary Care Providers Get New Tool for Social Risk Factors During COVID-19

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COVID-19 Social Care Guidance Tool

Alicia Fung

COVID-19 Social Care Guidance Tool
A care guidance tool developed by physicians at the University of Toronto, the Upstream Lab and the Centre for Effective Practice will give primary care providers a way to screen for and address social factors that affect health during the COVID-19 pandemic. 

The new tool provides a set of questions and considerations to guide family doctors, nurses and other primary care providers in support of people exposed to social risks that impact health, also known as social determinants of health.  

Dr. John Ihnat"As a new family doctor, I see the huge impact of things like income and living conditions on my patients' ability to manage risk during the pandemic, but time management is a constant pressure,” said Dr. John Ihnat, a lecturer in the Department of Family and Community Medicine (DFCM) at U of T and a family physician at Health Access Thorncliffe Park who worked on the project. “This is the kind of tool that can help me explore such important issues both quickly and in a way that genuinely helps my patients." 

The social care tool is the result of collaborative work among physicians and staff at DFCM, the Centre for Effective Practice and the Upstream Lab at the MAP Centre for Urban Health Solutions in St. Michael’s Hospital, Unity Health Toronto. 

Primary care providers have long known that social and economic factors impact health, but it is not yet commonplace to screen patients for these risk factors. However, COVID-19 has made it increasingly important that we acknowledge the impacts of these social determinants of health, as it has become apparent that certain populations are disproportionately affected by the pandemic. 

Professor Katherine Rouleau“The understanding that these factors impact our patients’ health predates COVID, but the current context has put a lot of primary care providers in new and unfamiliar environments caring for patients who they don’t know,” said Professor Katherine Rouleau, vice-chair of global health and social accountability at DFCM who is a family physician at St. Michael’s Hospital. 

“On top of that, with the hustle and bustle of busy practices, we don’t always think to ask about these things and identify patients who are at risk,” Rouleau said. 

The current pandemic has also made it more challenging to address the social determinants of health, according to Drs. Kelsey Lawson and Nothando Swan, two family medicine enhanced skills residents in global health & vulnerable populations at U of T, who are part of the initiative. 

“We collaborated on this tool to ensure that all practitioners had support in asking these crucial questions,” Lawson and Swan wrote in an email. “These are high-yield questions and resources that will positively impact people’s lives.”  

The tool will help primary care providers open a conversation with their patients about social risk factors, and identify essential resources and appropriate supports in the context of COVID-19. 

The ultimate goal is to condition primary care providers to become accustomed to taking these factors into consideration and asking their patients questions about social determinants of health even after the pandemic. 

“Many of us see this as a door for something beyond COVID-19,” said Rouleau. “Our hope within this group is that by creating the habit of asking these questions during COVID-19, people will continue to ask them even after the pandemic.” 



Acknowledgements: This tool was developed collaboratively between the DFCM, CEP and Upstream Lab. The contributions from the DFCM were led by the PGY3 students Drs. Kelsey Lawson and Nothando Swan. The principal team consisted of Drs. Gary Bloch, Ritika Goel, Archna Gupta, John Ihnat, Vanessa Redditt, Katherine Rouleau, Andrew Lam, Andrew Pinto (also lead for Upstream Lab), and Megan Parry.