In the Know: Poverty - A Clinical Tool for Primary Care
Our video on Poverty: A Clinical Tool for Primary Care, featuring Dr. Gary Bloch, with information about how poverty can affect your patients and how primary care providers can use this tool in their practice. Visit: effectivepractice.org/poverty
Sophie's story: How CEP helped connect low-income patients to community resources
A walk through Sophie's story. This video outlines the Centre for Effective Practice's EMR-integrated solution in primary care to screen and provide supports for those living in poverty.
Electronic Medical Record Resources
This tool is available as a custom form on Telus PS Suite EMR and Ocean.
Below is the Poverty Tool as custom form. It is recommended that the tool be used on PS Suite EMR v5.2.702 or later to ensure full functionality of the form. Please note that use of the form on earlier versions of the EMR might result in a loss of certain features and functionality.
About the tool
A powerful body of evidence shows that poverty puts patients at higher risk for cardiovascular diseases, diabetes and depression. Children in low income families are at higher risk of low birth weights, mental health problems, asthma, malnutrition, injuries and hospitalization. Providers should routinely screen patients and intervene for poor diet, lack of exercise, substance abuse and high-risk sexual behaviour. It is clear that poverty is another very important risk factor that requires screening and intervention. However, poverty is not always apparent. In Ontario 20 per cent of families or 1.57 million people live in poverty. Poverty is a high risk factor for new immigrants, women, Indigenous peoples, LGBTQ+ and children.
The first and most important step is to identify those who live in poverty.
Poverty: A Clinical Tool for Primary Care Providers is designed to be used over a series of visits to:
- Screen all patients using a key question identified as a good predictor of poverty.
- Consider that new immigrants, women, Indigenous peoples and LGBTQ+ people are among the highest groups at risk.
- Understand that otherwise low risk patients who live in poverty are at higher risk for certain health conditions.
- Intervene, educate and support patients to access tax and other government benefits, and connect them with resources and services.
Poverty puts patients at higher risk for most chronic diseases, mental illnesses, and even accidents and trauma. A Statistics Canada study shows that income inequality is associated with the premature deaths of 40,000 Canadians per year. People living in poverty:
- Are more likely to report having diabetes than higher-earning individuals.Experience higher rates of lung, oral, and cervical cancer.
- Experience cardiovascular disease at a rate 17% higher than the average Canadian.
- Have 58% higher rates of depression than the Canadian average.
- Experience elevated risk of hypertension, arthritis, COPD, asthma, and multiple chronic conditions.
Children in low-income families are at higher risk of:
- Low birth weight
- Mental health problems
- Micronutrient deficiencies
There is no internationally-accepted definition of poverty and no clear consensus on how it should be measured. In Canada many people use Statistics Canada’s low income cut-off lines as a way of understanding who is living in poverty. By this measure, approximately 15% of Canadians, including 1 in 7 children, live in poverty. New immigrants, women, Indigenous peoples and LGBTQ+ people are among the highest risk groups.
The Centre for Effective Practice (CEP) and the College of Family Physicians of Canada (CFPC) have collaborated on an initiative to expand and disseminate the Ontario poverty tool for primary care providers across the country. The Ontario version of this tool has been modified for participating provinces/territories.
Social accountability and equity of care are important components of the College of Family Physicians of Canada’s strategic plan. Poverty screening plays a significant part in addressing these goals. See below to access these tools by province or territory.
This Tool is one of several clinical tools developed as part of the 2014 to 2017 Knowledge Translation in Primary Care Initiative. This multi-year initiative was a collaboration between the Centre for Effective Practice (CEP), Ontario College of Family Physicians (OCFP), and Nurse Practitioners’ Association of Ontario (NPAO). Funded by the Ministry of Health and Long-Term Care, this initiative supported primary care providers with the development of a series of clinical tools and health information resources. Learn more about the Knowledge Translation in Primary Care Initiative.
As part of this initiative, the CEP conducted a Primary Care Needs Assessment to determine topics of interest to primary care providers. In this survey providers identified the need for more effective resources to help patients who are living in poverty.
The Poverty Tool was developed using the CEP’s integrated knowledge translation development methods. The CEP ensures that health care providers are engaged throughout the tool development process, using a user-centered design methodology to test the usability of tools from a provider perspective.
Gary Bloch is a family physician with St. Michael’s Hospital in Toronto, and co-Chair of the OCFP’s Committee on Poverty and Health. His clinical, education, program development, and research interests focus on the intersection between poverty and health, and specifically on what primary care providers can do to address poverty as a health issue. Dr. Bloch is an Assistant Professor at the University of Toronto and a founding member of the advocacy group Health Providers Against Poverty and of Inner City Health Associates, a group of physicians who work with the homeless across Toronto. He has developed curriculum for medical students, residents and practicing physicians on poverty interventions. He has also been heavily involved in the creation and evaluation of health team interventions into the social factors that impact health. He is frequently asked to speak on these topics, to health provider and public audiences. His work has been featured in the Toronto Star, the Globe and Mail, the CBC, and other media outlets.
Conflict of interest
The clinical lead received compensation for his role.
Focus group and usability participants received a small token of appreciation (e.g. gift certificate).
Thank you to everyone who supported the development of these tools and resources!