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General practice / Family practice
Protocol
Implementation and impact of an online tool used in primary care to improve access to financial benefits for patients: a study protocol
  1. Anjana Aery1,
  2. Anne Rucchetto2,
  3. Alexander Singer3,
  4. Gayle Halas3,
  5. Gary Bloch4,5,
  6. Ritika Goel4,6,
  7. Danyaal Raza4,5,
  8. Ross E G Upshur4,7,8,
  9. Jackie Bellaire4,9,
  10. Alan Katz3,10,
  11. Andrew David Pinto2,4,5,8
  1. 1 Wellesley Institute, Toronto, Ontario, Canada
  2. 2 The Upstream Lab, Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
  3. 3 Department of Family Medicine, Rady Faculty of Health Sciences, Winnipeg, Manitoba, Canada
  4. 4 Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
  5. 5 Department of Family and Community Medicine, St Michael’s Hospital, Toronto, Ontario, Canada
  6. 6 Central Toronto Community Health Centre, Toronto, Ontario, Canada
  7. 7 Lunenfeld-Tanenbaum Research Institute, Sinai Health Systems, Toronto, Ontario, Canada
  8. 8 Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
  9. 9 South East Toronto Family Health Team, Toronto, Ontario, Canada
  10. 10 Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada
  1. Correspondence to Dr Andrew David Pinto; andrew.pinto{at}utoronto.ca

Abstract

Objectives Addressing the social determinants of health has been identified as crucial to reducing health inequities. However, few evidence-based interventions exist. This study emerges from an ongoing collaboration between physicians, researchers and a financial literacy organisation. Our study will answer the following: Is an online tool that improves access to financial benefits feasible and acceptable? Can such a tool be integrated into clinical workflow? What are patient perspectives on the tool and what is the short-term impact on access to benefits?

Methods An advisory group made up of patients living on low incomes and representatives from community agencies supports this study. We will recruit three primary care sites in Toronto, Ontario and three in Winnipeg, Manitoba that serve low-income communities. We will introduce clinicians to screening for poverty and how benefits can increase income. Health providers will be encouraged to use the tool with any patient seen. The health provider and patient will complete the online tool together, generating a tailored list of benefits and resources to assist with obtaining these benefits. A brief survey on this experience will be administered to patients after they complete the tool, as well as a request to contact them in 1 month. Those who agree to be contacted will be interviewed on whether the intervention improved access to financial benefits. We will also administer an online survey to providers and conduct focus groups at each site.

Ethics and dissemination Key ethical concerns include that patients may feel discomfort when being asked about their financial situation, may feel obliged to complete the tool and may have their expectations falsely raised about receiving benefits. Providers will be trained to address each of these concerns. We will share our findings with providers and policy-makers interested in addressing the social determinants of health within healthcare settings.

Trial registration number Clinicaltrials.gov: NCT02959866. Registered 7 November 2016. Retrospectively registered. Pre-results.

  • cial determinants of health
  • income
  • poverty
  • primary care
  • health promotion

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjopen-2017-015947

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    Footnotes

    • Twitter @AndrewDPinto @upstreamlab

    • Contributors ADP conceived the study. AS, GH, GB, RG, DR, REGU, JB, AK and ADP provided key inputs into the design of the study and refinements of the protocol. AA, AR and ADP assisted in the writing of the first draft of the manuscript. ADP, AS, GH, GB, RG, REGU and AK assisted with obtaining funding for the study. All authors contributed to critical revisions and editing the manuscript for important intellectual content and approved the final manuscript. ADP had full access to all the information present and takes responsibility for the accuracy of this paper.

    • Funding This study was supported by the Canadian Institutes of Health Research (FRN: 142877), Intuit Foundation, Research Manitoba and the St Michael’s Hospital Foundation. None of the funders played any role in the design of the study, data collection, data analysis, interpretation of data or in writing or editing this manuscript.

    • Competing interests None declared.

    • Ethics approval This study was approved by the St Michael’s Hospital Research Ethics Board (15-353), the Health Research Ethics Board at the University of Manitoba (HS19275:H2016:019) and the Michael Garron Hospital Research Ethics Board (691-1608-Mis-298).

    • Provenance and peer review Not commissioned; externally peer reviewed.