Médecine familiale // Family Medicine

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Integrated Virtual Care (IVC) - An innovative hybrid model of primary care, combining in-person and virtual care options, in Renfrew County, Ontario.
(2025-05-20) Fitzsimon, Jonathan; Godfrey, Leanda; Cronin, Shawna; St-Amant, Antoine
Background Renfrew County is the largest geographic county in Ontario with a dispersed and diverse population. There are insufficient family physicians and other primary care providers to meet the needs of its residents. IVC aims to address this problem by enrolling unattached individuals to a family physician who works predominantly remotely. This enables family physicians from across Ontario to join the program and work a flexible schedule that aligns with their individual professional and personal circumstances. IVC Structure The IVC family physicians are embedded within existing, local interdisciplinary primary care teams (IPCTs). Patients receive comprehensive, team-based primary care, through a hybrid of in-person, at-home and virtual care options, depending on their individual needs and preferences. Virtual care options include secure messaging, telephone and video encounters from the patient’s home, and enhanced telemedicine options at a local IPCT. Partnership with the existing community paramedicine program allows a range of at-home and remote care monitoring options for vulnerable, home-bound patients. Other physicians, nurse practitioners and interdisciplinary health professionals in each local group, provide additional in-clinic care options. Identifying and enrolling unattached residents The Renfrew County Virtual Triage and Assessment Centre (VTAC) is leveraged to identify unattached patients who are accessing care through VTAC, with the offer of joining the IVC program extended to any additional unattached members of their household. Additional unattached residents are identified through Ontario’s Health Care Connect (HCC) program and offered attachment through IVC. Further potential exists to identify and prioritize specified groups of higher needs, unattached patients. New IVC patients complete an onboarding process that includes digital processes for the collation of their medical history followed by a review of their existing medications by a pharmacist. A medical chart and cumulative patient profile are completed prior to their first encounter with their new family physician. Patients have access to the full suite of services provided by their local IPCT. Additional nurse practitioner time is protected for IVC physicians to request in-person assessment for specific issues as required and on-site group physicians are also available to provide in-person care. Patients book appointments with their family physician by calling the front desk, or through an online appointment booking platform. Evaluation IVC aligns with the principles of Ontario's Digital First for Health strategy. As of March 31, 2025, 6804 previously unattached residents are attached to 19 IVC family physicians embedded in three IPCTs. Formal evaluation of patient, clinician and non-clinical staff, showing impressive levels of satisfaction, have been completed and submitted for publication. IVC has contributed significantly to improving cancer screening rates, smoking cessation referrals and evidence-based diabetes care for previously unattached residents. Conclusion Integrated Virtual Care (IVC) in Renfrew County demonstrates that a hybrid model of in-person and virtual care can deliver a highly effective and widely accepted approach to primary care in underserved communities. Findings from multiple evaluations highlight high levels of patient satisfaction, trust in IVC physicians, and broad acceptance of virtual care as a viable and effective modality. Patients reported feeling well-supported, engaged in their care decisions, and appreciative of the convenience and accessibility provided by virtual visits, complemented by in-person care when necessary. Most experienced minimal barriers to technology use, and many expressed gratitude for the reduced travel burden in accessing care. The clear ability to foster meaningful patient-provider relationships through this model reinforces the program’s efficiency and reach. All clinicians and non-clinical staff recognized and valued the role of IVC in increasing patient attachment and providing more equitable access to primary care in their communities. Physicians noted strong patient relationships and appreciated the flexibility of remote care delivery. Interdisciplinary Health Professional expressed pride in contributing to a community-focused initiative, even as they adapted to expanded roles and responsibilities. While challenges such as increased workload and integration into existing clinical teams were acknowledged, participants emphasized the importance of team-based care, leadership support, and streamlined communication enabled by technology. As IVC continues to evolve, this innovative hybrid care model may offer a scalable and sustainable solution for addressing healthcare gaps and promoting more equitable access to team-based primary care in remote, rural, and underserved communities.
Paramedic Adult Triage at a Clinical Assessment Centre - RC VTAC Guidelines
(2023-09-30) Cruchet, Matt; Theron, Stuart; Fitzsimon, Jonathan
All patients are assessed for LOA, HR, RR, SpO2, BP, Temp, Cap refill - calculate the NEWS2 Score*. The paramedic determines whether the patient continues to be managed by the paramedic, undertakes a video consult for physician management or gets referred immediately to the Emergency Department. The criteria outlined in this guideline determines the patient management pathway.
Access to Primary Care and Mental Health Care in Renfrew County
(2021-09-30) Belanger, Christopher; Fitzsimon, Jonathan; Bjerre, Lise M.
This report presents a geostatistical analysis of access to primary care, adult and child/youth mental health care, and broadband internet services in Renfrew County, Ontario. We located and mapped primary-care and mental-health providers within and near Renfrew County, and calculated the average travel burden to access these providers within each of Renfrew County’s 19 census subdivisions. The analysis found strong evidence that Renfrew County’s residents face urban/rural disparities in access to both primary care and mental health care. We found that care providers are largely located in urban areas, and that, on average urban residents have much shorter travel times to access care than rural residents. In some cases, rural residents of Renfrew County can need to travel over twenty times longer than urban residents to access care. The situation was similar for mental health services, both for adults and for children and youth. We also found that much of Renfrew County has good access to wired broadband networks. Coverage tended to be better in regions with better health care access, including urban centres along the Highway 17 corridor, but there was also coverage in some rural areas. Taken together, this suggests that telemedicine services could play an important role in increasing access to health care in Renfrew County. Since telemedicine services are provided over the internet, travel times and physical distance are irrelevant. Residents in parts of Renfrew County with long average travel times and few local providers could therefore benefit greatly from telemedicine, and this analysis suggests that many residents in these regions have at least some broadband access.
Renfrew County Virtual Triage and Assessment Centre, March 2024 - An overview of clinical output.
(2024-03-25) St-Amant, Antoine; Fitzsimon, Jonathan
The Renfrew County Virtual Triage and Assessment Centre (VTAC) was established in March 2020. It provides support from medical receptionists, family physicians, and community paramedics 24 hours a day, 7 days a week. VTAC offers various visit modalities, including virtual care by family physicians, in-person care from family physicians and community paramedics, care at Clinical Assessment Centres (CACs) across Renfrew County, and home care for vulnerable, housebound residents. Appointments through VTAC fall into three categories: in-person, virtual and hybrid (which involves real time collaboration between a paramedic in-person with the patient and a physician working remotely). This report briefly presents some of the key metrics for VTAC up to January 31, 2024. The report provides an overview of VTAC’s output, as well as insight into patient demographics, visit modalities, reasons for visits, and visit outcomes. This report mainly focuses on data since VTAC’s inception, with an additional focus since January 2023, as this is when more granular data became available. Granular visit modality data are presented from June 2023. Key Points • Since 2020, VTAC’s clinical focus has shifted from a significant proportion ofCOVID-19 related tests and assessments, to being almost entirely related to other concerns commonly encountered primary care providers. • Over time, the proportion of unattached VTAC patients has increased, with 73% of clinical assessments in 2023 involving unattached residents. • The demand for VTAC services continues to increase, with 2023 marking the highest number of clinical assessments in any year.
Using an Integrated Knowledge Translation (IKT) Approach to Enable Policy Change
(2018) Liddy, Clare; Moroz, Isabella; Joschko, Justin; Horsley, Tanya; Kuziemsky, Craig; Kovacs Burns, Katharina; Kossey, Sandi; Mitera, Gunita; Keely, Erin
This paper explores our efforts to support the expansion of a regional electronic consultation (eConsult) service on a national level by addressing potential policy barriers. We used an IKT strategy based on five key activities leading to a National eConsult Policy Think Tank meeting: 1) identifying potential policy enablers and barriers, 2) engaging national and provincial/territorial partners, 3) including patient voices, 4) undertaking co-design and planning, and 5) adopting a solution-based approach. We successfully leveraged a diverse set of stakeholders in strategic discussions, culminating in actionable suggestions for next steps, which will serve to inform a national implementation strategy.
Faster Access, Better Care: A Guide to Establishing an eConsult Service
(2016) Liddy, Clare; Keely, Erin; Afkham, Amir
The increasing wait times we are witnessing in North America for access to specialist care is jeopardizing patients’ mental and physical health, as well as impacting patient and provider satisfaction. As a family physician (Clare Liddy) and specialist (Erin Keely) we recognized we could do something about this. In 2008, we, along with an information technology expert (Amir Afkham) embarked on an initiative to improve access to specialist knowledge for patients in our Local Health Integration Network (LHIN). In this eBook, we share our experiences and lessons learned during the development and implementation of the Champlain BASETM eConsult service and outline the key considerations that go into the implementation of a successful eConsult service.
Chronic Care Model Decision Support and Clinical Information Systems Interventions for People Living with HIV: A Systematic Review
(2013-06-07) Pasricha, Anjori; Deinstadt, Roo T. M.; Moher, David; Killoran, Amanda; Rourke, Sean B.; Kendall, Claire E.
BACKGROUND The Chronic Care Model is an effective framework for improving chronic disease management. There is scarce literature describing this model for people living with HIV. Decision Support (DS) and Clinical Information Systems (CIS) are two components of this model that aim to improve care by changing health care provider behavior. OBJECTIVE Our aim was to assess the effectiveness of DS and CIS interventions for individuals with HIV, through a systematic literature review. DESIGN We performed systematic electronic searches from 1996 to February 2011 of the medical (E.g. Medline, EMBASE, CINAHL) and grey literature. Effectiveness was measured by the frequency of statistically significant outcome improvement. Data and key equity indicator extraction and synthesis was completed. PARTICIPANTS AND INTERVENTIONS We included comparative studies of people living with HIV that examined the impact of DS or CIS interventions on outcomes. MAIN MEASURES The following measures were assessed: outcome (immunological/virological, medical, psychosocial, economic measures) and health care process/performance measures. KEY RESULTS Records were screened for relevance (n = 10,169), full-text copies of relevant studies were obtained (n = 123), and 16 studies were included in the review. Overall, 5/9 (55.6%) and 17/41 (41.5%) process measures and 5/12 (41.7%) and 3/9 (33.3%) outcome measures for DS and CIS interventions, respectively, were statistically significantly improved. DS–explicit mention of implementation of guidelines and CIS-reminders showed the most frequent improvement in outcomes. DS-only interventions were more effective than CIS-only interventions in improving both process and outcome measures. Clinical, statistical and methodological heterogeneity among studies precluded meta-analysis. Primary studies were methodologically weak and often included multifaceted interventions that made assessment of effectiveness challenging. CONCLUSIONS Overall, DS and CIS interventions may modestly improve care for people living with HIV, having a greater impact on process measures compared to outcome measures. These interventions should be considered as part of strategies to improve HIV care through changing provider performance.
The patient’s voice: an exploratory study of the impact of a group self-management support program
(2012) Johnston, Sharon; Irving, Hannah; Mill, Karina; Rowan, Margo S; Liddy, Clare
Background Given the potential value of self-management support programs for people with chronic diseases, it is vital to understand how they influence participants’ health attitudes and behaviours. The Stanford Chronic Disease Self-Management Program (CDSMP), the most well-known and widely studied such program, is funded in many provinces and jurisdictions throughout Canada. However, there is little published evidence on its impact in the Canadian health-care system. We studied participants’ reactions and perceived impacts of attending the Stanford program in one Ontario health region so we could assess its value to the health region. The study asked: What are participants’ reactions and perceived impacts of attending the Stanford CDSMP? Methods This mixed methods exploratory study held four focus groups approximately one year after participants attended a Stanford program workshop. At the beginning of each session, participants filled out a survey on the type and frequency of community and health resources used for their self-management. During the sessions, a moderator guided the discussion, asking about such things as long-term impact of the program on their lives and barriers to self-management of their chronic conditions. Results Participants perceived diverse effects of the workshop: from having a profound impact on one area to affecting all aspects of their lives. A change in physical activity patterns was the most prominent behaviour change, noted by over half the participants. Other recurrent effects included an improved sense of social connection and better coping skills. Barriers to self-management were experienced by almost all participants with several dominant themes emerging including problems with the health system and patient-physician interaction. Participants reported a wide variety of resources used in their self-management, and in some cases, an increase in use was noted for some resources. Conclusions Self-management support is, at its core, a complex and patient-centred concept, so a diversity of outcomes to match the diversity of participants should be expected. As these interventions move into different target populations and communities, it is essential that we continue to explore through multiple research methods, the effects, and their meaning to participants, ensuring the optimal investment of resources for the very individuals these interventions aim to serve.
Facilitators and barriers to accessing reproductive health care for migrant beer promoters in Cambodia, Laos, Thailand and Vietnam: A mixed methods study
(2012) Webber, Gail; Spitzer, Denise; Somrongthong, Ratana; Dat, Truong Cong; Kounnavongsa, Somphone
Background The purpose of the research was to assess access to sexual and reproductive health services for migrant women who work as beer promoters. This mixed methods research was conducted in Phnom Penh, Cambodia, Bangkok, Thailand, Vientiane, Laos, and Hanoi, Vietnam during 2010 to 2011. Methods Focus groups were held with beer promoters and separate focus groups or interviews with key informants to explore the factors affecting beer promoters’ access to health care institutions for reproductive health care. The findings of the focus groups were used to develop a survey for beer promoters. This survey was conducted in popular health institutions for these women in each of the four Asian cities. Results Several common themes were evident. Work demands prevented beer promoters from accessing health care. Institutional factors affecting care included cost, location, environmental factors (e.g. waiting times, cleanliness and confidentiality) and service factors (e.g. staff attitudes, clinic hours, and availability of medications). Personal factors affecting access were shyness and fear, lack of knowledge, and support from family and friends. The survey of the beer promoters confirmed that cost, location and both environmental and service factors impact on access to health care services for beer promoters. Many beer promoters are sexually active, and a significant proportion of those surveyed rely on sex work to supplement their income. Many also drink with their clients. Despite a few differences amongst the surveyed population, the findings were remarkably similar across the four research sites. Conclusions Recommendations from the research include the provision of evening and weekend clinic hours to facilitate access, free or low cost clinics, and health insurance through employer or government plans which are easy to access for migrants. Other improvements that would facilitate the access of beer promoters to these services include increased funding to hire more staff (reducing waiting times) and to stock more needed medications, mobile clinics to come to the workplace or free transportation for beer promoters to the clinics, improved training to reduce health care provider stigma against beer promoters, and public education about the importance of reproductive health care, including preventative services.
How many patients should a family physician have? Factors to consider in answering a deceptively simple question
(2012-06-28) Muldoon, Laura; Dahrouge, Simone; Russell, Grant; Hogg, William; Ward, Natalie
The ratio of patients to physicians has long been used as a tool for measuring and planning healthcare resources in Canada. Some current changes in primary care, such as enrolment of patients with physicians, make this ratio easier to calculate, while others, such as changing practice structure, make it more complex to interpret. Based on information gleaned from a review of the literature, we argue that before panel size can be used as an accountability measure for individual physicians or practices in primary care, we must understand its relationship to quality and outcomes at individual and population levels, as well as the contextual factors that affect it.
A cost-consequences analysis of a primary care librarian question and answering service
(2012-06-28) McGowan, Jessie; Hogg, William; Zhong, Jianwei; Zhao, Xue
Background - Cost consequences analysis was completed from randomized controlled trial (RCT) data for the Just-in-time (JIT) librarian consultation service in primary care that ran from October 2005 to April 2006. The service was aimed at providing answers to clinical questions arising during the clinical encounter while the patient waits. Cost saving and cost avoidance were also analyzed. The data comes from eighty-eight primary care providers in the Ottawa area working in Family Health Networks (FHNs) and Family Health Groups (FHGs). // Methods - We conducted a cost consequences analysis based on data from the JIT project. We also estimated the potential economic benefit of JIT librarian consultation service to the health care system. // Results - The results show that the cost per question for the JIT service was $38.20. The cost could be as low as $5.70 per question for a regular service. Nationally, if this service was implemented and if family physicians saw additional patients when the JIT service saved them time, up to 61,100 extra patients could be seen annually. A conservative estimate of the cost savings and cost avoidance per question for JIT was $11.55. // Conclusions - The cost per question, if the librarian service was used at full capacity, is quite low. Financial savings to the health care system might exceed the cost of the service. Saving physician's time during their day could potentially lead to better access to family physicians by patients. Implementing a librarian consultation service can happen quickly as the time required to train professional librarians to do this service is short.
Developing a National Newborn Screening Strategy for Canada
(2010) Wilson, Kumanan; Kennedy, Shelley J.; Potter, Beth K.; Geraghty, Michael T.; Chakraborty, Pranesh
Attitudes About Wife Beating: A Comparison of Medical Students and Arts Students
(1994) McCall, Marnie A.; Webber, Gail
An inventory of beliefs about wife beating was used to compare the attitudes of medical students and arts students to woman abuse. Data were collected from 66 first year medical students, 56 third year medical students, and 66 arts students. All groups showed similar relatively sympathetic attitudes overall toward battered women, and there was no significant difference in the three groups. Age, education, marital status, and personal or close experience with abuse did not affect attitudes. Female respondents were shown to be statistically more sympathetic to battered women than men in two of the three subscales, but the scores were so close that this may not translate into a clinically significant finding.
Developing a Curriculum Framework for Global Health in Family Medicine: Emerging Principles, Competencies, and Educational Approaches
(2011) Redwood-Campbell, Lynda; Pakes, Barry; Rouleau, Katherine; MacDonald, Colla J.; Arya, Neil; Schultz, Karen; Dhatt, Reena; Wilson, Briana; Hadi, Abdullahel; Pottie, Kevin
Background - Recognizing the growing demand from medical students and residents for more comprehensive global health training, and the paucity of explicit curricula on such issues, global health and curriculum experts from the six Ontario Family Medicine Residency Programs worked together to design a framework for global health curricula in family medicine training programs. // Methods - A working group comprised of global health educators from Ontario's six medical schools conducted a scoping review of global health curricula, competencies, and pedagogical approaches. The working group then hosted a full day meeting, inviting experts in education, clinical care, family medicine and public health, and developed a consensus process and draft framework to design global health curricula. Through a series of weekly teleconferences over the next six months, the framework was revised and used to guide the identification of enabling global health competencies (behaviours, skills and attitudes) for Canadian Family Medicine training. // Results - The main outcome was an evidence-informed interactive framework http://globalhealth.ennovativesolution.com/ webcite to provide a shared foundation to guide the design, delivery and evaluation of global health education programs for Ontario's family medicine residency programs. The curriculum framework blended a definition and mission for global health training, core values and principles, global health competencies aligning with the Canadian Medical Education Directives for Specialists (CanMEDS) competencies, and key learning approaches. The framework guided the development of subsequent enabling competencies. // Conclusions - The shared curriculum framework can support the design, delivery and evaluation of global health curriculum in Canada and around the world, lay the foundation for research and development, provide consistency across programmes, and support the creation of learning and evaluation tools to align with the framework. The process used to develop this framework can be applied to other aspects of residency curriculum development.
Sympathetic nervous dysregulation in the absence of systolic left ventricular dysfunction in a rat model of insulin resistance with hyperglycemia
(2011) DaSilva, Jean N; Thackeray, James T; Radziuk, Jerry; Harper, Mary-Ellen; Suuronen, Erik J; Ascah, Kathryn J; Beanlands, Rob S,
Background: Diabetes mellitus is strongly associated with cardiovascular dysfunction, derived in part from impairment of sympathetic nervous system signaling. Glucose, insulin, and non-esterified fatty acids are potent stimulants of sympathetic activity and norepinephrine (NE) release. We hypothesized that sustained hyperglycemia in the high fat diet-fed streptozotocin (STZ) rat model of sustained hyperglycemia with insulin resistance would exhibit progressive sympathetic nervous dysfunction in parallel with deteriorating myocardial systolic and/or diastolic function. Methods: Cardiac sympathetic nervous integrity was investigated in vivo via biodistribution of the positron emission tomography radiotracer and NE analogue [11C]meta-hydroxyephedrine ([11C]HED). Cardiac systolic and diastolic function was evaluated by echocardiography. Plasma and cardiac NE levels and NE reuptake transporter (NET) expression were evaluated as correlative measurements. Results: The animal model displays insulin resistance, sustained hyperglycemia, and progressive hypoinsulinemia. After 8 weeks of persistent hyperglycemia, there was a significant 13-25% reduction in [11C]HED retention in myocardium of STZ-treated hyperglycemic but not euglycemic rats as compared to controls. There was a parallel 17% reduction in immunoblot density for NE reuptake transporter, a 1.2 fold and 2.5 fold elevation of cardiac and plasma NE respectively, and no change in sympathetic nerve density. No change in ejection fraction or fractional area change was detected by echocardiography. Reduced heart rate, prolonged mitral valve deceleration time, and elevated transmitral early to atrial flow velocity ratio measured by pulse-wave Doppler in hyperglycemic rats suggest diastolic impairment of the left ventricle. Conclusions: Taken together, these data suggest that sustained hyperglycemia is associated with elevated myocardial NE content and dysregulation of sympathetic nervous system signaling in the absence of systolic impairment. Keywords: norepinephrine, [11C]meta-hydroxyephedrine (HED), small animal echocardiography, positron emission tomography, diabetes mellitus, cardiovascular disease
Performance Feedback: An Exploratory Study to Examine the Acceptability and Impact for Interdisciplinary Primary Care Teams
(2011-05-25) Johnston, Sharon; Green, Michael; Thille, Patricia; Savage, Colleen; Roberts, Lynn; Russell, Grant; Hogg, William
Background - This mixed methods study was designed to explore the acceptability and impact of feedback of team performance data to primary care interdisciplinary teams. // Methods - Seven interdisciplinary teams were offered a one-hour, facilitated performance feedback session presenting data from a comprehensive, previously-conducted evaluation, selecting highlights such as performance on chronic disease management, access, patient satisfaction and team function. // Results - Several recurrent themes emerged from participants' surveys and two rounds of interviews within three months of the feedback session. Team performance measurement and feedback was welcomed across teams and disciplines. This feedback could build the team, the culture, and the capacity for quality improvement. However, existing performance indicators do not equally reflect the role of different disciplines within an interdisciplinary team. Finally, the effect of team performance feedback on intentions to improve performance was hindered by a poor understanding of how the team could use the data. // Conclusions - The findings further our understanding of how performance feedback may engage interdisciplinary team members in improving the quality of primary care and the unique challenges specific to these settings. There is a need to develop a shared sense of responsibility and agenda for quality improvement. Therefore, more efforts to develop flexible and interactive performance-reporting structures (that better reflect contributions from all team members) in which teams could specify the information and audience may assist in promoting quality improvement.
Barriers and facilitators to recruitment of physicians and practices for primary care health services research at one centre
(2010) Gyorfi-Dyke, Elizabeth; Russell, Grant; Donskov, Melissa; Hogg, William; Liddy, Clare; Johnston, Sharon
Background - While some research has been conducted examining recruitment methods to engage physicians and practices in primary care research, further research is needed on recruitment methodology as it remains a recurrent challenge and plays a crucial role in primary care research. This paper reviews recruitment strategies, common challenges, and innovative practices from five recent primary care health services research studies in Ontario, Canada. // Methods - We used mixed qualitative and quantitative methods to gather data from investigators and/or project staff from five research teams. Team members were interviewed and asked to fill out a brief survey on recruitment methods, results, and challenges encountered during a recent or ongoing project involving primary care practices or physicians. Data analysis included qualitative analysis of interview notes and descriptive statistics generated for each study. // Results - Recruitment rates varied markedly across the projects despite similar initial strategies. Common challenges and creative solutions were reported by many of the research teams, including building a sampling frame, developing front-office rapport, adapting recruitment strategies, promoting buy-in and interest in the research question, and training a staff recruiter. // Conclusions - Investigators must continue to find effective ways of reaching and involving diverse and representative samples of primary care providers and practices by building personal connections with, and buy-in from, potential participants. Flexible recruitment strategies and an understanding of the needs and interests of potential participants may also facilitate recruitment.
Life in the big city: The multiple vulnerabilities of migrant Cambodian garment factory workers to HIV
(2010-11-25T18:51:35Z) Webber, Gail C.; Edwards, Nancy; Graham, Ian D.; Amaratunga, Carol; Keane, Vincent; Socheat, Ros
Cambodia has one of the highest prevalence rates of HIV in Asia; an increasing number of HIV positive Cambodians are women. The purpose of this qualitative study was to assess the context of HIV prevention for rural-to-urban migrant Cambodian female garment factory workers. Interviews with migrant garment factory workers and key informants, and focus group with health care providers confirmed that poverty was the primary motivator for migration. Women and key informants reported awareness that some migrants had sexual relationships with local men or engaged in sex work to supplement their income. Factory restrictions limited women's ability to access health care services and health education programs. Key themes of the research were economic, social and occupational vulnerabilities of these migrant workers placed them in a context of increased risk of acquiring HIV. Interventions to reduce the risk of HIV infection for migrant Cambodian garment factory workers should address these themes.
Mother-to-child transmission of HIV in Canada: A population health risk management perspective
(2003) Webber, Gail C.
Childbirth in the Canadian North: A qualitative study in the Moose Factory zone
(1993) Webber, Gail C.; Wilson, C. Ruth
Cree women from the Moose Factory zone were asked about their views on evacuation for childbirth. Significant concerns cited were separation from children, loneliness, boredom, and the hospital accommodations. Shopping, the medical staff and equipment, and the opportunity to visit relatives were considered positive factors. Suggested improvements were to bring along family members, to provide alternative accommodation, and to have activities to occupy the time.

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