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Background: Through medicare, residents in Canada are entitled to medically necessary physician services without paying out of pocket, but still many people struggle to access primary care. We conducted a survey to explore people's experience with and priorities for primary care. Methods: We conducted an online, bilingual survey of adults in Canada in fall 2022. We distributed an anonymous link through diverse channels and a closed link to 122 053 people via a national public opinion firm. We weighted completed responses to mirror Canada's population and adjusted for sociodemographic characteristics using regression models. Results: We analyzed 9279 completed surveys (5.9% response rate via closed link). More than one-fifth of respondents (21.8%) reported having no primary care clinician, and among those who did, 34.5% reported getting a same or next-day appointment for urgent issues. Of respondents, 89.4% expressed comfort seeing another team member if their doctor recommended it, but only 35.9%, 9.5%, and 12.4% reported that their practice had a nurse, social worker, or pharmacist, respectively. The primary care attribute that mattered most was having a clinician who 'knows me as a person and considers all the factors that affect my health.' After we adjusted for respondent characteristics, people in Quebec, the Atlantic region, and British Columbia had lower odds of reporting a primary care clinician than people in Ontario (adjusted odds ratio 0.30, 0.33, and 0.39, respectively; p < 0.001). We also observed large provincial variations in timely access, interprofessional care, and walk-in clinic use. Interpretation: More than 1 in 5 respondents did not have access to primary care, with large variation by province. Reforms should strive to expand access to relationship-based, longitudinal care in a team setting., Research over decades has shown that health systems with strong primary care have better health outcomes, better equity in outcomes, and lower costs. (1,2) Yet, worldwide, countries have struggled with [...]

The term syncretism has had a metamorphic history in terms of its meaning, starting as positive with Plutarch, to being positive and negative during the Reformation, and then becoming neutral and negative after the Reformation to becoming decidedly negative from the 1920s onward. Despite advances in interpreting syncretism in more neutral or positive ways, the word's meaning and function remain imprecise. Central to the fog surrounding the word is its implicit meaning of some type of mixture, whether negative, neutral, or positive. The question then becomes, 'Is mixture a valid central meaning of the word?' More importantly, can the suspicious lens of decolonialism offer insight into redefining it and also give direction as to how it could function? This article studies the development of the term, examines current scholarship within the World Coundl of Churches, and situates syncretism within the larger context of the decolonial discussion in trying to redefine it in light of its original meaning. Keywords syncretism, decolonialism, being, non-being, liminality, ontology, cosmology, epistemohgy, For most of the 20th century, syncretism has been a problem for the church. In some respects, this is partially due to misunderstandings of indigenous cultural practices. In others, this [...]

Background: Variations in primary care practices may explain some differences in health outcomes during the COVID-19 pandemic. We sought to evaluate the characteristics of primary care practices by the proportion of patients unvaccinated against SARS-CoV-2. Methods: We conducted a population-based, cross-sectional cohort study using linked administrative data sets in Ontario, Canada. We calculated the percentage of patients unvaccinated against SARS-CoV-2 enrolled with each comprehensive-care family physician, ranked physicians according to the proportion of patients unvaccinated, and identified physicians in the top 10% (v. the other 90%). We compared characteristics of family physicians and their patients in these 2 groups using standardized differences. Results: We analyzed 9060 family physicians with 10 837 909 enrolled patients. Family physicians with the largest proportion (top 10%) of unvaccinated patients (n = 906) were more likely to be male, to have trained outside of Canada, to be older, and to work in an enhanced fee-for-service model than those in the remaining 90%. Vaccine coverage ([greater than or equal to] 2 doses of SARS-CoV-2 vaccine) was 74% among patients of physicians with the largest proportion of unvaccinated patients, compared with 87% in the remaining patient population. Patients in the top 10% group tended to be younger and live in areas with higher levels of ethnic diversity and immigration and lower incomes. Interpretation: Primary care practices with the largest proportion of patients unvaccinated against SARS-CoV-2 served marginalized communities and were less likely to use team-based care models. These findings can guide resource planning and help tailor interventions to integrate public health priorities within primary care practices., Among people in Canada, concerns about risks and adverse effects are the top reasons for non-intent to receive a SARS-CoV-2 vaccine. (1) These trends are most commonly observed among communities [...]