Barriers to primary care responsiveness to poverty as a risk factor for health

BMC Family Practice

Research Article

Broden Giambrone¹  Gary Bloch²  Linda Rozmovits³ 

[1] Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada;Department of Family and Community Medicine, St. Michael's Hospital, 80 Bond St, M5B 1X2, Toronto, Ontario, Canada;Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada;Toronto, Ontario, Canada;

关键词: Primary Care;    Family Physician;    Primary Care Provider;    Social Determinant;    Primary Health Care Provider;   

DOI  :  10.1186/1471-2296-12-62

 received in 2011-03-11, accepted in 2011-06-29,  发布年份 2011

来源: Springer

【 摘 要 】

BackgroundPoverty is widely recognized as a major determinant of poor health, and this link has been extensively studied and verified. Despite the strong evidentiary link, little work has been done to determine what primary care health providers can do to address their patients' income as a risk to their health. This qualitative study explores the barriers to primary care responsiveness to poverty as a health issue in a well-resourced jurisdiction with near-universal health care insurance coverage.MethodsOne to one interviews were conducted with twelve experts on poverty and health in primary care in Ontario, Canada. Participants included family physicians, specialist physicians, nurse practitioners, community workers, advocates, policy experts and researchers. The interviews were analysed for anticipated and emergent themes.ResultsThis study reveals provider- and patient-centred structural, attitudinal, and knowledge-based barriers to addressing poverty as a risk to health. While many of its findings reinforce previous work in this area, this study's findings point to a number of areas front line primary care providers could target to address their patients' poverty. These include a lack of provider understanding of the lived reality of poverty, leading to a failure to collect adequate data about patients' social circumstances, and to the development of inappropriate care plans. Participants also pointed to prejudicial attitudes among providers, a failure of primary care disciplines to incorporate approaches to poverty as a standard of care, and a lack of knowledge of concrete steps providers can take to address patients' poverty.ConclusionsWhile this study reinforces, in a well-resourced jurisdiction such as Ontario, the previously reported existence of significant barriers to addressing income as a health issue within primary care, the findings point to the possibility of front line primary care providers taking direct steps to address the health risks posed by poverty. The consistent direction and replicability of these findings point to a refocusing of the research agenda toward an examination of interventions to decrease the health impacts of poverty.

【 授权许可】

CC BY   
© Bloch et al; licensee BioMed Central Ltd. 2011