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Canning ML, McDougall R, Yerkovich S, Barras M, Coombes I, Sullivan C, Whitfield K. Measuring the impact of pharmaceutical care bundle delivery on patient outcomes: an observational study. Int J Clin Pharm 2024; 46:1172-1180. [PMID: 38805086 DOI: 10.1007/s11096-024-01750-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 05/06/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Clinical pharmacists perform activities to optimise medicines use and prevent patient harm. Historically, clinical pharmacy quality indicators have measured individual activities not linked to patient outcomes. AIM To determine the proportion of patients who receive a pharmaceutical care bundle (PCB) (consisting of a medication history, medication review, discharge medication list and medicines information on the discharge summary) as well as investigate the relationship between delivery of this PCB and patient outcomes. METHOD Pharmaceutical care bundle activities were defined within state-wide (Queensland, Australia) clinical information systems and datasets were linked. An observational study using routinely recorded data was performed at ten participating sites for adult patients who had a non-same day hospital stay. The association between extent of PCB delivery and three patient outcomes were investigated: length of stay (LOS), unplanned readmission, and mortality. RESULTS In total 283,813 patient hospital stays were evaluated. The delivery of the PCB occurred in 26.9% of patients at the ten participating hospital sites, ranging from 0.6 to 61.2% across sites. Patients with a longer LOS were more likely to receive delivery of the complete PCB (P < 0.001). There was no correlation between PCB and hospital standardised mortality ratio (r = 0.03, p = 0.93). Higher rates of delivery of the PCB were associated with lower rates of unplanned readmission within 30 days (r = - 0.993, p < 0.001). CONCLUSION A complete PCB was delivered to 26.9% of patients and was associated with a significantly lower rate of unplanned readmission within 30 days.
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Affiliation(s)
- Martin Luke Canning
- Pharmacy Department, The Prince Charles Hospital, Rode Rd, Chermside, Qld, 4032, Australia.
- Metro North Clinical Governance, Metro North Health, Herston, Australia.
| | - Ross McDougall
- Pharmacy Department, The Prince Charles Hospital, Rode Rd, Chermside, Qld, 4032, Australia
| | - Stephanie Yerkovich
- Menzies School of Health Research, Casuarina, Australia
- Queensland University of Technology, Brisbane, Australia
| | - Michael Barras
- Princess Alexandra Hospital, Woolloongabba, Australia
- The University of Queensland, Woolloongabba, Australia
| | - Ian Coombes
- The University of Queensland, Woolloongabba, Australia
- Royal Brisbane & Women's Hospital, Herston, Australia
| | - Clair Sullivan
- The University of Queensland, Woolloongabba, Australia
- Digital Metro North, Herston, Australia
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Elgebli A, Hall J, Phipps DL. Protocols versus practice: unravelling clinical checking variations in community pharmacies in England-a multi-method study. Int J Clin Pharm 2024; 46:1114-1123. [PMID: 38822964 PMCID: PMC11399187 DOI: 10.1007/s11096-024-01743-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 04/18/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND Standardisation, a widely accepted concept for risk management, entails designing and implementing task-specific operating procedures. In community pharmacies, Standardised Operating Procedures (SOPs) are a mandatory requirement and are recognised as essential for upholding safety and quality. AIM This study aimed to investigate community pharmacists' (CPs) compliance with SOPs when checking prescriptions, and the reasons for variations between standardised protocols and practice. METHOD Eight sets of SOPs underwent hierarchical task analysis (HTA) to generate a normative description of clinical checking execution as per protocols. Subsequently, twelve CPs were engaged in a simulated clinical checking exercise, verbalising their thoughts while checking virtual prescriptions. Transcribed data underwent content analysis, aligned with a descriptive model to uncover engagement patterns, and disparities between SOPs and CPs' practices. Finally, a focus group discussion took place to contextualise the observed variations. RESULTS HTA aided in constructing a clinical checking model with six primary subtasks and 28 lower subtasks. CPs often omitted subtasks during checks, diverging from prescribed protocols. These deviations, observed in controlled environment, reveal an ingrained aspect within the professional culture of pharmacists, where there may be a tendency not to strictly adhere to protocols, despite variations in work conditions. Contributing factors to this culture include the exercise of professional judgment, reliance on others, and prioritisation of patient preferences. CONCLUSION This study highlights ongoing deviations from SOPs during clinical prescription checks in community pharmacies, suggesting a cultural tendency. Future research should delve into risk management strategies for these deviations and address the delicate balance between flexibility and stringent compliance.
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Affiliation(s)
- Ali Elgebli
- Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, The University of Manchester, Room 1.132, Stopford Building, Oxford Road, Manchester, M13 9PL, UK.
| | - Jason Hall
- Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, The University of Manchester, Room 1.183, Stopford Building, Oxford Road, Manchester, M13 9PT, UK
| | - Denham L Phipps
- Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, The University of Manchester, Room 1.34, Stopford Building, Oxford Road, Manchester, M13 9PT, UK
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Benzies KM, Zanoni P, McNeil DA. Mobilizing strategic inflection points for sustainment of an effective intervention in an integrated learning health system: an interpretive description. Implement Sci Commun 2024; 5:106. [PMID: 39350292 PMCID: PMC11441001 DOI: 10.1186/s43058-024-00644-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 09/16/2024] [Indexed: 10/04/2024] Open
Abstract
BACKGROUND Innovative models of care have the potential to improve the sustainability of health systems by improving patient and provider experiences and population outcomes while simultaneously reducing costs. Yet, it is challenging to recognize the distinctive points during research and quality improvement processes that contribute to sustainment of effective interventions. The business concept of an inflection point-the position on the curve of a trajectory where the progress in implementation of an intervention is accelerated or decelerated-may be useful to understand implementation and improve sustainability and ultimately sustainment of effective interventions. The purpose of this study was to retrospectively identify and describe strategic inflection points that accelerated the sustainability process and led to the sustainment of Alberta Family Integrated Care. METHODS This qualitative study was conducted in Alberta, Canada and employed an interpretive description design. Purposively sampled documents (proposals, project management plans, reports to funders and sponsors, meeting minutes, and fidelity audit and feedback checklists) from the Alberta Family Integrated Care cluster randomized controlled trial and quality improvement project constituted data for this study. RESULTS To accelerate sustainability in the research context, we identified (1) alignment with strategic priorities, (2) iterative, user-centered co-design, and (3) contextualization of implementation as strategic inflection points. To accelerate sustainability in the health system context, we identified (1) the learning health system, (2) enduring partnerships, (3) responsivity to societal and system change, (4) embedded governance, and (5) intentional integration into the health system as strategic inflection points. Capitalizing on these strategic inflection points led to sustainment of Alberta Family Integrated Care in the provincial health system. CONCLUSIONS We identified key inflection points in the research and health system contexts that led to sustainment of Alberta Family Integrated Care. By anticipating, recognizing, and leveraging inflection points in the sustainability process, researchers may be able to accelerate implementation and achieve sustainment of multi-component interventions in complex systems. TRIAL REGISTRATION ClinicalTrials.gov: NCT02879799. Registration date: May 27, 2016. Protocol version: June 9, 2016; version 2. Protocol publication: https://doi.org/10.1186/s13063-017-2181-3 .
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Affiliation(s)
- Karen M Benzies
- Faculty of Nursing, Departments of Pediatrics and Community Health Sciences, Cumming School of Medicine, Social Innovation Initiative, PF3280C Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada.
| | - Pilar Zanoni
- PF4240-A2, Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary AB, T2N 1N4, Canada
| | - Deborah A McNeil
- Maternal Newborn Child and Youth Strategic Clinical NetworkTM, Provincial Clinical Excellence, Alberta Health Services, 10301 Southport Lane SW, Calgary, AB, T2W 1S7, Canada
- Faculty of Nursing and Department of Community Health Sciences, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
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Kirmayer LJ. The place of the social in psychiatry: from structural determinants to the ecology of mind. Soc Psychiatry Psychiatr Epidemiol 2024:10.1007/s00127-024-02772-5. [PMID: 39340545 DOI: 10.1007/s00127-024-02772-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 09/20/2024] [Indexed: 09/30/2024]
Abstract
PURPOSE Social psychiatry considers the ways in which mental disorders are shaped by particular social environments. This paper outlines a cultural-ecosocial approach that emphasizes the ways in which cultural meaning and practices mediate the effects of the social determinants of mental health on the mechanisms of illness, disorder, and disease. METHODS Selective review of literature and conceptual synthesis. RESULTS "The social" in psychiatry stands for the structures and dynamics of groups of people interacting on multiple scales from the intimate sphere of couple and family to neighbourhoods, communities, societies, nations, and transnational or global networks. These interactions create social contexts, niches, forms of belonging, identities, institutions, and larger systems that influence the causes, expression, course, and outcome of mental disorders. Characterizing these systems requires theory that considers the ways in which social systems constitute dynamical systems that configure material, energetic, and informational flows that give rise to human experience. Unpacking the health consequences of these local and extended systems requires an interdisciplinary approach that considers: (1) the social psychological, psychophysiological, and sociophysiological processes that mediate the impact of the environment on body, mind, and person; (2) the interactional dynamics of social systems that give rise to structural adversity and inequity as well as resilience; and (3) the recursive effects of self-understanding, agency and subjectivity. CONCLUSIONS In the cultural-ecosocial view, "the social" is shorthand for interactional processes that constitute material and symbolic structures that provide cultural affordances, constraints, and challenges as well as resources for healing, recovery, and adaptation.
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Affiliation(s)
- Laurence J Kirmayer
- McGill University, Montreal, QC, Canada.
- Lady Davis Institute, Montreal, QC, Canada.
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Salam Z, Carranza M, Newbold B, Wahoush O, Joseph A. Racialized Immigrants' Encounters of Barriers and Facilitators in Seeking Mental Healthcare Services in Ontario, Canada. Community Ment Health J 2024:10.1007/s10597-024-01362-8. [PMID: 39316360 DOI: 10.1007/s10597-024-01362-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2024] [Accepted: 09/07/2024] [Indexed: 09/25/2024]
Abstract
Racialized immigrants have low rates of accessing mental healthcare services. However, there are notable differences among immigrant groups (e.g., refugees, international students, dependants). The aim of this study is to understand racialized immigrants' experiences of accessing mental healthcare services at both systemic and individual levels. Through a qualitative descriptive methodology, interviews were conducted in English with 16 racialized immigrants to understand barriers and facilitators encountered. Additionally, focusing on how cultural and social conceptualizations ideas shape mental healthcare services. Interviews were analyzed through Braun & Clarke's six-step method to reflexive thematic analysis in identifying factors. Three major themes were identified: structural constraints, individual influences, and appraisal of services. With the first, racialized immigrants signaled to issues related to the systemic level that included affordability, wait times, and trust in the system. Individual influences highlighted factors of mental health literacy, social supports, stigma, severity of the issues, and awareness of services themselves. Lastly, extending on the previous theme, appraisal of services was reflective of how social and cultural ideals shaped attitudes towards the appropriateness of the provider or services themselves. The findings from this paper emphasize that racialized immigrants are not homogenous in their experiences and attitudes towards mental healthcare services. While there were similarities across different groups in the individual and systemic factors identified, there were key distinctions driven by appraisal of services themselves and if they were congruent based on their needs, more specifically, what was contributing to their negative mental health status.
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Affiliation(s)
- Zoha Salam
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
| | - Mirna Carranza
- School of Social Work, McMaster University, Hamilton, ON, Canada
| | - Bruce Newbold
- School of Earth, Environment & Society, McMaster University, Hamilton, ON, Canada
| | - Olive Wahoush
- School of Nursing, McMaster University, Hamilton, ON, Canada
| | - Ameil Joseph
- School of Social Work, McMaster University, Hamilton, ON, Canada
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Ajjan RA, Doble E, Holt RIG, Marrero D. Patient related outcome measures (PROMs) in long term conditions-is it time to bring them into routine clinical practice? BMJ 2024; 386:q1921. [PMID: 39242110 DOI: 10.1136/bmj.q1921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/09/2024]
Affiliation(s)
- Ramzi A Ajjan
- Clinical Population and Sciences Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, UK
- Diabetes Centre, St James's University Hospital, Leeds Teaching Hospitals Trust, Leeds, UK
| | | | - Richard I G Holt
- Human Development and Health, Faculty of Medicine, University of Southampton, UK
- Southampton National Institute for Health Research Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - David Marrero
- Indiana University School of Public Health, Bloomington, Indiana, USA
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Pataky RE, Weymann D, Bosdet I, Yip S, Bryan S, Sadatsafavi M, Peacock S, Regier DA. Real-world cost-effectiveness of panel-based genomic testing to inform therapeutic decisions for metastatic colorectal cancer. J Cancer Policy 2024; 41:100496. [PMID: 39032558 DOI: 10.1016/j.jcpo.2024.100496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 06/26/2024] [Accepted: 07/12/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND Mutations in KRAS and NRAS are associated with a lack of response to cetuximab and panitumumab, two biologics used for third-line therapy of metastatic colorectal cancer (mCRC). In British Columbia, Canada, eligibility for cetuximab or panitumumab was first based on single-gene KRAS testing. OncoPanel, a multi-gene next-generation sequencing panel with both KRAS and NRAS, was introduced in 2016. Our objective was to estimate the real-world cost-effectiveness of OncoPanel versus to single-gene KRAS testing to inform eligibility for cetuximab or panitumumab in mCRC. METHODS Using population-based administrative health data, we identified a cohort of mCRC patients who had received a KRAS or OncoPanel test, and completed prior chemotherapy in 2010-2019. We matched KRAS- and OncoPanel-tested patients (1:1) using genetic matching to balance baseline covariates. Mean and incremental 3-year costs, survival, and quality-adjusted survival were estimated using inverse-probability-of-censoring weighting and bootstrapping. We conducted scenario-based sensitivity analysis for key costs and assumptions. FINDINGS All OncoPanel-tested cases (n=371) were matched to a KRAS-tested comparator. In the KRAS and OncoPanel groups, respectively, 55·8 % and 41·2 % of patients were potentially eligible for cetuximab or panitumumab based on mutation status. Incremental cost and effectiveness of OncoPanel were $72 (95 % CI: -6387, 6107), -0·004 life-years (95 % CI: -0·119, 0·113), and -0·011 quality-adjusted life-years (95 % CI: -0·094, 0·075). Reductions in systemic therapy costs were offset by increased costs in other resources. Results were moderately sensitive to time horizon and changes in testing or treatment cost. INTERPRETATION The use of OncoPanel resulted in more precise targeting of cetuximab and panitumumab, but there was no change in incremental cost or quality-adjusted survival. Understanding the balance of costs achieved in practice can provide insight into the effect of future changes in testing policy, test cost, treatment eligibility, or drug prices in this setting.
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Affiliation(s)
- Reka E Pataky
- Canadian Centre for Applied Research in Cancer Control, Canada; Cancer Control Research, BC Cancer, Vancouver, BC, Canada.
| | - Deirdre Weymann
- Canadian Centre for Applied Research in Cancer Control, Canada; Cancer Control Research, BC Cancer, Vancouver, BC, Canada
| | - Ian Bosdet
- Department of Pathology & Laboratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; Cancer Genetics & Genomics Laboratory, BC Cancer, Vancouver, BC, Canada
| | - Stephen Yip
- Cancer Genetics & Genomics Laboratory, BC Cancer, Vancouver, BC, Canada; Department of Pathology, BC Cancer, Vancouver, BC, Canada
| | - Stirling Bryan
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada; Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Mohsen Sadatsafavi
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Stuart Peacock
- Canadian Centre for Applied Research in Cancer Control, Canada; Cancer Control Research, BC Cancer, Vancouver, BC, Canada; Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada
| | - Dean A Regier
- Canadian Centre for Applied Research in Cancer Control, Canada; Cancer Control Research, BC Cancer, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
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Manns BJ, Hastings S, Marchildon G, Noseworthy T. Health system structure and its influence on outcomes: The Canadian experience. Healthc Manage Forum 2024; 37:340-350. [PMID: 38739751 PMCID: PMC11348631 DOI: 10.1177/08404704241248559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Healthcare delivery systems in Canada are structured using three models: individual institutions, health regions, and single provincial systems, usually with smaller geographic zones. The comparative ability of these models to improve care, outcomes, and the Quadruple Aim is largely unstudied. We reviewed Canadian studies examining outcomes of provincial healthcare delivery system restructuring. Across models, results were inconsistent, and quality of evidence was low. For all provinces, primary care sits outside healthcare delivery systems, with limited governance and integration. The single provincial model can reduce costs of non-clinical support functions like finance, human resources, and analytics. This model may also be best at reducing variations in care, improving electronic information integration that enables clinical decision support and reporting, and supporting the provincial spread and scale of innovations, but further refinements are required and existing studies have major limitations, limiting definitive conclusions.
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Chukwu OA, Nadigel J, Kasaai B, Boateng R, Glazier RH, McMahon M. Understanding the training, mentorship, and professional development priorities of early career embedded researchers. Int J Health Plann Manage 2024; 39:1277-1297. [PMID: 38527109 DOI: 10.1002/hpm.3800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 02/02/2024] [Accepted: 03/12/2024] [Indexed: 03/27/2024] Open
Abstract
INTRODUCTION Health systems are constantly evolving in response to existing and emerging health challenges and are increasingly adopting the Quintuple Aim to guide transformation and improvement efforts. Addressing health challenges and achieving the Quintuple Aim (enhancing patient experience, improving healthcare provider experience, promoting population health, optimising the value of healthcare services, and advancing health equity) may be enhanced with the use of a Learning Health Systems approach that fosters the real-time use of data and evidence to inform improvement efforts and harnesses embedded researchers to co-produce timely, relevant evidence to address priorities. Training programs have emerged to build embedded research capacity within health system organisations and have focused predominantly on the postdoctoral career stage, with little attention paid to the early career researcher (ECR) stage. The objective of this study was to understand ECR training and mentorship needs in the embedded research context to inform the creation new or adaptation of existing programs to build embedded ECR capacity. METHODS This study used a qualitative approach to garner insight from embedded and applied scholars and health systems leaders in Canada from various professional backgrounds and at various career stages using a combination of focus group discussions, key informant interviews, and an online survey. Thematic content analysis was used to examine the responses of study participants within the interview themes. RESULTS Twenty-six (26) participants were included in the study. Results were organised according to four key themes: (1) key competencies and skills needed by embedded ECRs; (2) additional training and capacity development needs; (3) training delivery approaches; and (4) enablers and challenges faced by embedded ECRs. Results highlight the importance of supporting ECRs to develop their leadership and organisational management capabilities; their knowledge of and ability to use research approaches that are well-suited to real-world, complex, evolving environments; and their opportunities to learn with and from each other and mentors. Results underscore the perceived importance of context, including being embedded in a supportive environment that values research and evidence and of academic incentives that recognise and value real-world research impact. The challenges of responding to shifting organisational and system priorities were identified. Additional insights from health systems leaders were also highlighted. CONCLUSION This study identified the multifaceted needs of embedded ECRs and the challenges they face within healthcare systems. Designing new programs or tailoring existing ones to address these needs would build their capacity, foster career progression, and ensure their impact as leaders of evidence-informed health system improvement which is crucial for achieving the Quintuple Aim.
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Affiliation(s)
- Otuto Amarauche Chukwu
- CIHR Institute of Health Services and Policy Research, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Jessica Nadigel
- CIHR Institute of Health Services and Policy Research, Toronto, Ontario, Canada
| | - Bahar Kasaai
- CIHR Institute of Health Services and Policy Research, Toronto, Ontario, Canada
| | - Rhonda Boateng
- CIHR Institute of Health Services and Policy Research, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Richard H Glazier
- CIHR Institute of Health Services and Policy Research, Toronto, Ontario, Canada
- ICES (Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Meghan McMahon
- CIHR Institute of Health Services and Policy Research, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Barber B, Rainham DG, Tyedmers P, Vandertuin T, Ritcey G, Christie SD. Taking action towards climate-resilient, low-carbon, health systems: Perspectives from Canadian health leaders and healthcare professionals. Healthc Manage Forum 2024; 37:395-400. [PMID: 38739689 PMCID: PMC11348628 DOI: 10.1177/08404704241252032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Climate change poses significant public health and health system challenges including increased demand for health services due to chronic and acute health impacts from vector-borne diseases, heat-related illness, and injury from severe weather. As climate change worsens, so do its effects on health systems such as increasing severity of weather extremes causing damage to healthcare infrastructure and interference with supply chains. Ironically, health sectors globally are significant contributors to climate change, generating an estimated 5% of global emissions. Achieving "net zero" health systems require large-scale change with shared decision-making to coordinate a pan-Canadian approach to creating climate-resilient and low-carbon healthcare. In this article, we discuss healthcare professionals' and health leaders' perceptions of responsibility for practicing and advocating for climate-resilient and low-carbon healthcare in Canada.
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Hoben M, Maxwell CJ, Ubell A, Doupe MB, Goodarzi Z, Allana S, Beleno R, Berta W, Bethell J, Daly T, Ginsburg L, Rahman AS, Nguyen H, Tate K, McGrail K. EXploring Patterns of Use and Effects of Adult Day Programs to Improve Trajectories of Continuing Care (EXPEDITE): Protocol for a Retrospective Cohort Study. JMIR Res Protoc 2024; 13:e60896. [PMID: 39213024 PMCID: PMC11399746 DOI: 10.2196/60896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2024] [Revised: 07/05/2024] [Accepted: 07/29/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Adult day programs provide critical supports to older adults and their family or friend caregivers. High-quality care in the community for as long as possible and minimizing facility-based continuing care are key priorities of older adults, their caregivers, and health care systems. While most older adults in need of care live in the community, about 10% of newly admitted care home residents have relatively low care needs that could be met in the community with the right supports. However, research on the effects of day programs is inconsistent. The methodological quality of studies is poor, and we especially lack robust, longitudinal research. OBJECTIVE Our research objectives are to (1) compare patterns of day program use (including nonuse) by province (Alberta, British Columbia, and Manitoba) and time; (2) compare characteristics of older adults by day program use pattern (including nonuse), province, and time; and (3) assess effects of day programs on attendees, compared with a propensity score-matched cohort of older nonattendees in the community. METHODS In this population-based retrospective cohort study, we will use clinical and health administrative data of older adults (65+ years of age) who received publicly funded continuing care in the community in the Canadian provinces of Alberta, British Columbia, and Manitoba between January 1, 2012, and December 31, 2024. We will compare patterns of day program use between provinces and assess changes over time. We will then compare characteristics of older adults (eg, age, sex, physical or cognitive disability, area-based deprivation indices, and caregiver availability or distress) by pattern of day program use or nonuse, province, and time. Finally, we will create a propensity score-matched comparison group of older adults in the community, who have not attended a day program. Using time-to-event models and general estimating equations, we will assess whether day program attendees compared with nonattendees enter care homes later; use emergency, acute, or primary care less frequently; experience less cognitive and physical decline; and have better mental health. RESULTS This will be a 3-year study (July 1, 2024, to June 30, 2027). We received ethics approvals from the relevant ethics boards. Starting on July 1, 2024, we will work with the 3 provincial health systems on data access and linkage, and we expect data analyses to start in early 2025. CONCLUSIONS This study will generate robust Canadian evidence on the question whether day programs have positive, negative, or no effects on various older adult and caregiver outcomes. This will be a prerequisite to improving the quality of care provided to older adults in day programs, ultimately improving the quality of life of older adults and their caregivers. TRIAL REGISTRATION ClinicalTrials.gov NCT06440447; https://clinicaltrials.gov/study/NCT06440447. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/60896.
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Affiliation(s)
- Matthias Hoben
- School of Health Policy and Management, Faculty of Health, York University, Toronto, ON, Canada
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Colleen J Maxwell
- School of Pharmacy, University of Waterloo, Waterloo, ON, Canada
- ICES, Toronto, ON, Canada
| | - Andrea Ubell
- Alzheimer Society of York Region, Aurora, ON, Canada
- Member of the Advisory Committee, Helen Carswell Chair in Dementia Care, Faculty of Health, York University, Toronto, ON, Canada
| | - Malcolm B Doupe
- Max Rady Faculty of Health Sciences, College of Medicine, University of Manitoba, Winnipeg, MB, Canada
- Manitoba Centre for Health Policy, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Centre for Care Research, Western Norway University of Applied Sciences, Winnipeg, MB, Canada
| | - Zahra Goodarzi
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Saleema Allana
- Arthur Labatt Family School of Nursing, Faculty of Health Sciences, Western University, London, ON, Canada
| | - Ron Beleno
- Member of the Advisory Committee, Helen Carswell Chair in Dementia Care, Faculty of Health, York University, Toronto, ON, Canada
| | - Whitney Berta
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Jennifer Bethell
- ICES, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Tamara Daly
- School of Health Policy and Management, Faculty of Health, York University, Toronto, ON, Canada
- Member of the Advisory Committee, Helen Carswell Chair in Dementia Care, Faculty of Health, York University, Toronto, ON, Canada
| | - Liane Ginsburg
- School of Health Policy and Management, Faculty of Health, York University, Toronto, ON, Canada
| | - Atiqur Sm- Rahman
- School of Health Policy and Management, Faculty of Health, York University, Toronto, ON, Canada
| | - Hung Nguyen
- School of Health Policy and Management, Faculty of Health, York University, Toronto, ON, Canada
| | - Kaitlyn Tate
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Kimberlyn McGrail
- Centre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, BC, Canada
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Boateng R, Karim F, Bielecki J, Batt AM, Gajaria A, Munce S, Rac VE. Development and implementation determinants of competency frameworks for mental health clinicians and service providers working with youth: a scoping review protocol. BMJ Open 2024; 14:e087437. [PMID: 39209487 PMCID: PMC11367302 DOI: 10.1136/bmjopen-2024-087437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 07/23/2024] [Indexed: 09/04/2024] Open
Abstract
INTRODUCTION Despite high prevalence, access to mental healthcare for Canadian youth is limited, with less than 20% receiving adequate treatment. Marginalised and at-risk youth face particular challenges, including cultural misunderstandings, long wait times and negative care experiences. A competency framework for mental health clinicians working with youth can be a tool to increase the capacity of the health workforce to deliver culturally responsive care. This scoping review aims to comprehensively summarise the existing literature on competency frameworks for mental health clinicians and youth service providers, assessing how these frameworks align with culturally responsive care and examining their development, evaluation and implementation methods. METHODS AND ANALYSIS This review protocol is guided by the Joanna Briggs Institute and Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines and registered with the Open Science Framework (https://doi.org/10.17605/OSF.IO/EY7NF). The search strategy, developed with an Information Specialist, comprises a three-step process: preliminary searches in two databases, expansion of the search across Medline, CINAHL, EMBASE, PsycInfo, CENTRAL and dissertations and theses databases and examination of reference lists and hand-searching for additional sources. The search strategy was reviewed using the Peer Review of Electronic Search Strategies checklist. Eligible English language articles will be selected through title and abstract screening (level 1) and full-text review (level 2). The search dates are 18 July and 21 August 2023, as well as 19 January 2024. Data from eligible articles will be extracted in duplicate and independently using a data extraction form. The data will then be summarised descriptively and qualitatively using content analysis mapped to the four evidence-based conceptual frameworks and presented in a table. ETHICS AND DISSEMINATION As the scoping review involves gathering and describing existing literature, it is exempt from ethical approval requirements. The findings of this scoping review will be presented at relevant local and international conferences and published in a peer-reviewed journal. The findings will also be disseminated and shared with professional organisations to enhance healthcare workforce capacity and drive systemic change. Furthermore, the findings will be used to inform doctoral work and future mental health and health education research related to underserved youth.
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Affiliation(s)
- Rhonda Boateng
- Program for Health System and Technology Evaluation, Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Fairuz Karim
- Program for Health System and Technology Evaluation, Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
- Translational Research Program, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Joanna Bielecki
- Program for Health System and Technology Evaluation, Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Alan M Batt
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Paramedicine, Monash University, Melbourne, Victoria, Australia
- School of Nursing, Queen’s University, Kingston, Ontario, Canada
| | - Amy Gajaria
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Margaret and Wallace McCain Centre for Child, Youth, & Family Mental Health, Center for Addiction & Mental Health, Toronto, Ontario, Canada
| | - Sarah Munce
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Valeria E Rac
- Program for Health System and Technology Evaluation, Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Ted Rogers Centre for Heart Research at Peter Munk Cardiac Centre, Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
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Arundell LL, Saunders R, Barnett P, Leibowitz J, Buckman JE, Pilling S. Exploring perspectives on how to improve psychological treatment for women from minoritised ethnic communities: A qualitative study with service users. Int J Soc Psychiatry 2024:207640241270800. [PMID: 39175172 DOI: 10.1177/00207640241270800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/24/2024]
Abstract
BACKGROUND Women are disproportionately impacted by depression and anxiety disorders and in particular, women from minoritised ethnic communities experience inequalities in access to outcomes of psychological treatment for these disorders. Better understanding from the views of service users about the factors that impact their access to, and experiences of care could help to optimise treatment for these groups. METHOD This study explored experiences of treatment and gathered suggestions about treatment improvement, from the perspectives of women currently using psychological therapy services. Semi-structured interviews were conducted with 12 female NHS Talking Therapies for anxiety and depression (NHSTTad) service users from minoritised ethnic communities. Data were analysed using thematic analysis. RESULTS Four high-order themes were identified: (1) cultural identity and experiences of mental health and treatment, (2) challenges associated with treatment, (3) facilitators of good treatment experiences and outcomes and (4) improvements for women from minoritised ethnic communities. CONCLUSIONS Findings showed that cultural sensitivity and awareness are important to minoritised ethnic women receiving therapy. Challenges included access difficulties and limitations of treatment options offered, alongside personal challenges of engaging in therapy. Facilitators of good treatment experiences and outcomes included flexibility on the part of the service, as well as therapist-related factors such as identity characteristics (age, gender and culture of therapist), a good therapeutic relationship and the therapist's ability to deliver person-centred care. Improvements included ensuring care is culturally sensitive, reducing waiting times or providing better support for people on waiting lists, providing a flexible service that takes individual needs into account, increasing workforce diversity and reaching out to underserved communities. Many of the suggested improvements are generalisable to underserved minoritised ethnic groups, regardless of gender and could be applied to other psychological therapies services other than NHSTTad.
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Affiliation(s)
- Laura-Louise Arundell
- CORE Data Lab, Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, UK
- National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK
| | - Rob Saunders
- CORE Data Lab, Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Phoebe Barnett
- CORE Data Lab, Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, UK
- National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK
| | - Judy Leibowitz
- iCope - Camden and Islington Psychological Therapies Services, Camden & Islington NHS Foundation Trust, London, UK
| | - Joshua Ej Buckman
- CORE Data Lab, Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, UK
- iCope - Camden and Islington Psychological Therapies Services, Camden & Islington NHS Foundation Trust, London, UK
| | - Stephen Pilling
- CORE Data Lab, Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, UK
- National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK
- iCope - Camden and Islington Psychological Therapies Services, Camden & Islington NHS Foundation Trust, London, UK
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Abebe Boe E, Mekonnen S, Fako T, Aschale Wale M, Tade M, Tsega Chekol A. Professionalism and associated factors among nurses working in Hawassa city public hospital, Sidama, Ethiopia. Front Med (Lausanne) 2024; 11:1352499. [PMID: 39238592 PMCID: PMC11374641 DOI: 10.3389/fmed.2024.1352499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 07/26/2024] [Indexed: 09/07/2024] Open
Abstract
Background The foundation of the global healthcare system is nurses, and professionalism in nursing is a basic idea that helps patients, organizations, and people. Studies that have been published in Ethiopia, though, are limited, out-of-date, and poorly documented, especially when it comes to the study setting. Because of this, this study aimed to close a knowledge gap on the level of professionalism in public hospitals in Sidama, Ethiopia. Objective This study aimed to assess professionalism and associated factors among nurses working in Hawassa city public hospitals, Hawassa, Ethiopia. Methods An institutional-based cross-sectional study was conducted among nurses working in Hawassa city public hospital from June to July 2022. A computer-generated simple random sampling technique was used to select 413 study participants. The level of professionalism was assessed through a self-administered questionnaire, using the guidelines of the Registered Nurses Association of Ontario. All the loaded data using Epi-data version 4.6 were exported to a statistical package for social science. An ordinal logistic regression analysis was used to identify the associations between the outcome and predictor variables. The statistical significance of the factors influencing the outcome variable was declared in multivariate logistic regression analysis using an adjusted odds ratio at a 95% confidence interval with a p-value <0.05. Results A total of 405 nurses participated in the study, with a response rate of 98%. Of the total participants, more than half were females (55.3%). The level of professionalism was found to a moderate level. There was a strong link between completing their degree in a governmental institution, being part of a professional organization, serving for several years, and having a BSc or above qualification with a moderate level of professionalism. Conclusion We found a moderate level of professionalism among nurses working in the study setting. This suggests that the Regional Health Bureau should collaborate with other responsible bodies to develop various opportunities for nursing staff to increase their professionalism. The minister of health should be focused on private college nurses, nurses lacking the association, and the qualification of the profession.
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Affiliation(s)
- Eyerusalem Abebe Boe
- Faculty of Health Sciences, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Shiwangizaw Mekonnen
- Faculty of Health Sciences, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Thomas Fako
- Faculty of Health Sciences, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Mastewal Aschale Wale
- Faculty of Health Sciences, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Meku Tade
- Department of Anesthesia, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Aklile Tsega Chekol
- Faculty of Health Sciences, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
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Pohlman KA, Funabashi M, O’Beirne M, Cassidy JD, Hill MD, Hurwitz EL, Kawchuk G, Mior S, Ibrahim Q, Thiel H, Westaway M, Yager J, Vohra S. What's the harm? Results of an active surveillance adverse event reporting system for chiropractors and physiotherapists. PLoS One 2024; 19:e0309069. [PMID: 39159155 PMCID: PMC11332930 DOI: 10.1371/journal.pone.0309069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 08/03/2024] [Indexed: 08/21/2024] Open
Abstract
This prospective, community-based, active surveillance study aimed to report the incidence of moderate, severe, and serious adverse events (AEs) after chiropractic (n = 100) / physiotherapist (n = 50) visit in offices throughout North America between October-2015 and December-2017. Three content-validated questionnaires were used to collect AE information: two completed by the patient (pre-treatment [T0] and 2-7 days post-treatment [T2]) and one completed by the provider immediately post-treatment [T1]. Any new or worsened symptom was considered an AE and further classified as mild, moderate, severe or serious. From the 42 participating providers (31 chiropractors; 11 physiotherapists), 3819 patient visits had complete T0 and T1 assessments. The patients were on average 50±18 years of age and 62.5% females. Neck/back pain was the most common presenting condition (70.0%) with 24.3% of patients reporting no condition/preventative care. From the patients visits with a complete T2 assessment (n = 2136 patient visits, 55.9%), 21.3% reported an AE, of which: 7.9% were mild, 6.2% moderate, 3.7% severe, 1.5% serious, and 2.0% had missing severity rating. The most common symptoms reported with moderate or higher severity were discomfort/pain, stiffness, difficulty walking and headache. This study provides valuable information for patients and providers regarding incidence and severity of AEs following patient visits in multiple community-based professions. These findings can be used to inform patients of what AEs may occur and future research opportunities can focus on mitigating common AEs.
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Affiliation(s)
| | - Martha Funabashi
- Division of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
- Department of Chiropractic, Universite du Quebec a Trois-Rivieres, Trois-Rivieres, Montreal, Canada
| | - Maeve O’Beirne
- Family Medicine, University of Calgary, Calgary, Alberta, Canada
| | - J. David Cassidy
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Michael D. Hill
- Department of Clinical Neurosciences, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Eric L. Hurwitz
- Office of Public Health Studies, Thompson School of Social Work & Public Health, University of Hawaii at Mānoa Honolulu, Hawaii, United States of America
| | - Gregory Kawchuk
- Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
| | - Silvano Mior
- Division of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
- Department of Research and Innovation, Institute of Disability and Rehabilitation Research, Ontario Tech University Toronto, Ontario, Canada
| | - Quazi Ibrahim
- Department of Health Research Methods, Evidence, and Impact, McMaster University (Hamilton, Ontario, Canada)
| | - Haymo Thiel
- Health Sciences University, Bournemouth, United Kingdom
| | - Michael Westaway
- Department of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Jerome Yager
- Department of Paediatrics, Pediatric Neurosciences, University of Alberta, Edmonton, Alberta, Canada
| | - Sunita Vohra
- Department of Pediatrics and Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
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McKay S, Meza JI. Culturally contextualized suicide prevention for international students: new opportunities for research and practice. Front Psychol 2024; 15:1418185. [PMID: 39165758 PMCID: PMC11333360 DOI: 10.3389/fpsyg.2024.1418185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 07/26/2024] [Indexed: 08/22/2024] Open
Abstract
The rising incidence of suicide-related thoughts and behaviors among international students presents a significant public health challenge and growing concern among college campuses. Current intervention strategies often rely on Western-centric and colonized approaches developed and tested with primarily Western, Educated, Industrialized, Rich and Democratic (WEIRD) samples. Exclusion and historical underrepresentation of ethnoracially minoritized groups in suicide prevention treatment trials create gaps in advancing our science because they often miss the cultural contextualization crucial for effective prevention and intervention in diverse groups from different countries of origin. To address the limitations of these Western-centric strategies, we explored existing prevention recommendations and approaches through the lens of an expanded version of the newly developed Protective Factors Framework, tailored for non-Western cultural perspectives. We propose significant opportunities for enhancing current practices and point to promising future directions. The primary areas for development include: (1) bolstering community empowerment and ownership, (2) refining mechanisms of change to encompass multicultural viewpoints, and (3) focusing on effective implementation and thorough evaluation for ongoing refinement. This methodology not only shows promise for enhancing international student suicide prevention but also offers insights for broader application in suicide prevention among other culturally diverse populations.
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Affiliation(s)
- Samuel McKay
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Jocelyn I. Meza
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
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Nikkhah J, Steinbeck V, Grobe TG, Breitkreuz T, Pross C, Busse R. Evaluating the Population-Based Usage and Benefit of Digitally Collected Patient-Reported Outcomes and Experiences in Patients With Chronic Diseases: The PROMchronic Study Protocol. JMIR Res Protoc 2024; 13:e56487. [PMID: 39102279 PMCID: PMC11333866 DOI: 10.2196/56487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/28/2024] [Accepted: 04/24/2024] [Indexed: 08/06/2024] Open
Abstract
BACKGROUND Chronic diseases are associated with a high disease burden. Under- and overprovision of care as well as quality variation between health care providers persists, while current quality indicators rarely capture the patients' perspective. Capturing patient-reported outcome measures (PROMs) as well as patient-reported experience measures (PREMs) is becoming more and more important to identify gaps in care provision, prioritize services most valuable to patients, and aid patients' self-management. OBJECTIVE This study aims to measure the potential benefits and effectiveness of using electronic patient-reported outcome measures (ePROMs) and electronic patient-reported experience measures in a structured and population-based manner to enhance health care for chronic disease patients in Germany. METHODS This prospective cohort study aims to evaluate the potential benefits of PROM usage in patients with chronic diseases. We evaluate whether (1) digitally collected PROMs and PREMs can be used for health system performance assessment by generating a representative response of chronically diseased individuals with asthma, chronic obstructive pulmonary disease, diabetes, and coronary artery disease across Germany, and (2) based on the PROMs and PREMs, low-value care can be identified. As patient-reported outcomes (PROs) are rarely presented back to patients, (3) this study also examines patients' reactions to their PROM scores in the form of digital PRO feedback. For these purposes, randomly selected patients from a nationwide German insurer are digitally surveyed with generic and disease-specific PROMs and PREMs, as well as additional questions on their health-related behavior, 4 times over 1 year. Individual PRO feedback is presented back to patients longitudinally and compared to a peer group after each survey period. Patient-reported data is linked with health insurance data. Response rates, changes in health and experience outcomes over time, self-reported changes in health behavior, and health care system usage will be analyzed. RESULTS The PROMchronic study explores the usage of PROMs in patients with chronic diseases. Data collection began in October 2023, after the initial invitation letter. All the 200,000 potential patients have been invited to participate in the study. Data have not yet been analyzed. Publication of the interim results is planned for the autumn of 2024, and the results are planned to be published in 2025. CONCLUSIONS We aim to fill the research gap on the population-based usage of PROMs and PREMs in patients with chronic diseases and add to the current understanding of PROM data-sharing with patients. The study's results can thereby inform whether a health care system-wide approach to collecting PROMs and PREMs can be used to identify low-value care, assess quality variation within and across chronic conditions, and determine whether PRO feedback is helpful and associated with any changes in patients' health behaviors. TRIAL REGISTRATION German Clinical Trials Register DRKS00031656; https://drks.de/search/en/trial/DRKS00031656. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/56487.
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Affiliation(s)
- Janis Nikkhah
- Department of Healthcare Management, School of Economics and Management, Technical University Berlin, Berlin, Germany
| | - Viktoria Steinbeck
- Department of Healthcare Management, School of Economics and Management, Technical University Berlin, Berlin, Germany
| | | | | | - Christoph Pross
- Department of Healthcare Management, School of Economics and Management, Technical University Berlin, Berlin, Germany
| | - Reinhard Busse
- Department of Healthcare Management, School of Economics and Management, Technical University Berlin, Berlin, Germany
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Goodman M, Theron L, McPherson H, Seidel S, Raimer-Goodman L, Munene K, Gatwiri C. Multisystemic factors predicting street migration of children in Kenya: A multilevel longitudinal study of families and villages. CHILD ABUSE & NEGLECT 2024; 154:106897. [PMID: 38870709 PMCID: PMC11316653 DOI: 10.1016/j.chiabu.2024.106897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 05/22/2024] [Accepted: 06/04/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Street-migration of children is a global problem with sparse multi-level or longitudinal data. Such data are required to inform robust street-migration prevention efforts. OBJECTIVE This study analyzes longitudinal cohort data to identify factors predicting street-migration of children - at caregiver- and village-levels. PARTICIPANTS AND SETTING Kenyan adult respondents (n = 575; 20 villages) actively participated in a community-based intervention, seeking to improve factors previously identified as contributing to street-migration by children. METHODS At two time points, respondents reported street-migration of children, and variables across economic, social, psychological, mental, parenting, and childhood experience domains. Primary study outcome was newly reported street-migration of children at T2 "incident street-migration", compared to households that reported no street-migration at T1 or T2. For caregiver-level analyses, we assessed bivariate significance between variables (T1) and incident street-migration. Variables with significant bivariate associations were included in a hierarchical logistical regression model. For community-level analyses, we calculated the average values of variables at the village-level, after excluding values from respondents who indicated an incident street-migration case to reduce potential outlier influence. We then compared variables between the 5 villages with the highest incidence to the 15 villages with fewer incident cases. RESULTS In regression analyses, caregiver childhood experiences, psychological factors and parenting behaviors predicted future street-migration. Lower village-aggregated depression and higher village-aggregated collective efficacy and social curiosity appeared significantly protective. CONCLUSIONS While parenting and economic strengthening approaches may be helpful, efforts to prevent street migration by children should also strengthen community-level mental health, collective efficacy, and communal harmony.
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Li Y, Ragunathan S, Fuentes K, Hsu S, Lindsay S. Exploring the experiences of ableism among Asian children and youth with disabilities and their families: a systematic review of qualitative studies. Disabil Rehabil 2024; 46:3849-3868. [PMID: 37737152 DOI: 10.1080/09638288.2023.2258792] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 09/09/2023] [Accepted: 09/10/2023] [Indexed: 09/23/2023]
Abstract
PURPOSE Asian children and youth with disabilities often experience multiple barriers, stigmas and discrimination within and outside their families; yet less is understood about their lived experiences. This systematic review explored the experiences of ableism among Asian children and youth with disabilities and their families. METHODS We conducted a systematic review of qualitative studies and a qualitative meta-synthesis. We searched six databases including Ovid Medline, Embase, PsychInfo, Healthstar, Web of Science, and Scopus. RESULTS Forty-two articles met our inclusion criteria involving 17 countries and regions over a 22-year period. The findings were synthesized into four themes: (1) individual- and family-level ableism (i.e., stigma, fears, concerns, stress and anxieties, physical abuse, bullying, reduced engagement in community activities); (2) institutional-level ableism (i.e., barriers to accessing and navigating supports, ableist attitudes among service providers, unavailable services); (3) societal-level ableism (i.e., cultural and religious stigma, social rejection, discrimination, environmental and policy barriers); and (4) coping strategies (i.e., self-care activities, supports from family, friends and people with similar conditions, religious beliefs). CONCLUSIONS Our results highlight the ableist experiences that Asian children and youth with disabilities and their caregivers often encounter and the strong need for further supports to address ableism using culturally responsive strategies.
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Affiliation(s)
- Yiyan Li
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Sharmigaa Ragunathan
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Kristina Fuentes
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Shaelynn Hsu
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
- Faculty of Science, York University, Toronto, Canada
| | - Sally Lindsay
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Canada
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Seghieri C, Ferré F, Tortù C, Bertarelli G, Mavrogianni C, Usheva N, Toti F, Moreno L, Agapidaki E, Manios Y. Addressing chronic diseases: a comparative study of policies towards type-2 diabetes and hypertension in selected European countries. Eur J Public Health 2024; 34:781-786. [PMID: 38573190 PMCID: PMC11299210 DOI: 10.1093/eurpub/ckae070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Type-2 diabetes (T2D) and hypertension (HTN) are two of the most prevalent non-communicable diseases (NCDs): they both cause a relevant number of premature deaths worldwide and heavily impact the national health systems. This study illustrates the impact of HTN and T2D in four European countries (Albania, Bulgaria, Greece and Spain) and compares their policies towards the monitoring and management of HTN and T2D and the prevention of NCDs as a whole. This analysis is conducted throughout the DigiCare4You Project (H2020)-which implements an innovative solution involving digital tools for the prevention and management of T2D and HTN. METHODS The analysis is implemented through desk research, and it is enriched with additional information directly provided by the local coordinators in the four countries, by filling specific semi-structured forms. RESULTS The countries exhibit significant differences in the prevalence of HTN and T2D and available policies and programs targeted to these two chronic conditions. Each country has implemented strategies for HTN and T2D, including prevention initiatives, therapeutic guidelines, educational programs and children's growth monitoring programs. However, patient education on proper disease management needs improvement in all countries, registries about patients affected by HTN and T2D are not always available, and not all countries promoted acts to contain the increasing rates of risk factors related to NCDs. CONCLUSIONS While political awareness of the risks associated with HTN, T2D and NCDs in general is growing, there is a collective need for countries to strengthen their policies for preventing and managing these chronic diseases.
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Affiliation(s)
- Chiara Seghieri
- Department L’EMbeDS, Institute of Management, Sant’Anna School for Advanced Studies, Pisa, Italy
| | - Francesca Ferré
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Costanza Tortù
- Department L’EMbeDS, Institute of Management, Sant’Anna School for Advanced Studies, Pisa, Italy
| | - Gaia Bertarelli
- Department of Economics, Ca’ Foscari University of Venice, Venice, Italy
| | - Christina Mavrogianni
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Natalya Usheva
- Department of Social Medicine and Health Care Organization, Medical University of Varna, Varna, Bulgaria
| | - Florian Toti
- Department of Internal Medicine, University of Medicine of Tirana, Tirana, Albania
| | - Luis Moreno
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, Universidad de Zaragoza, Instituto Agroalimentario de Aragón (IA2), Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Fisiopatolo gía de la Oesidad y Nutrición (CIBEROBN), Instituto de salud Carlos III, Madrid, Spain
| | | | - Yannis Manios
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
- Institute of Agri-food and Life Sciences, Hellenic Mediterranean University Research Centre, Heraklion, Greece
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Battersby HS, Evans RJ, Eghobamien IJ, Pamukoff DN. Measurement Position Influences Sex Comparisons of Distal Femoral Cartilage Thickness With Ultrasound Imaging. J Appl Biomech 2024; 40:333-345. [PMID: 39013453 DOI: 10.1123/jab.2024-0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 04/01/2024] [Accepted: 04/30/2024] [Indexed: 07/18/2024]
Abstract
The purpose was to examine (1) the effect of measurement position and sex on femoral cartilage outcomes, and (2) the association between gait biomechanics and cartilage outcomes. Fifty individuals participated (25 males and 25 females; age = 20.62 [1.80] y). Ultrasound measured femoral cartilage thickness and echo-intensity at 90°, 115°, and 140° of knee flexion. Gait outcomes included the external knee adduction and knee flexion moments. Cartilage outcomes were compared using 2 (sex) × 3 (position) repeated-measures analysis of variance. Gait and cartilage associations were assessed using stepwise regression. Medial cartilage was thicker when measured at 90° compared with 115° (P = .02) and 140° (P < .01), and 115° compared with 140°, (P < .01) in males but not in females. Cartilage was thicker at 90° compared with 140° across both sexes within all regions (P < .01). Males had thicker cartilage than females in all positions (P < .01). Echo-intensity was lower at 90° than 115° (P < .01) and 140° (P = .01) in the central and lower at 90° than at 115° (P < .01) and 140° (P = .03) in lateral regions. No association was found between gait and cartilage outcomes. Ultrasound imaging position effects cartilage features more in males compared with females. Imaging position and sex influence cartilage outcomes and should be considered in study designs and clinical evaluation.
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Affiliation(s)
| | - Ryan J Evans
- School of Kinesiology, Western University, London, ON, Canada
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22
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Chiu P, Leslie K, Kung JY. Nursing Regulation Literature in Canada: Protocol for a Scoping Review. JMIR Res Protoc 2024; 13:e56163. [PMID: 39059008 PMCID: PMC11316164 DOI: 10.2196/56163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 07/09/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Significant reforms are occurring in health practitioner regulation across Canada. Within the nursing profession, growing workforce challenges and health system demands have accelerated the pace of changes to nursing regulation policies and practices. There is significant political investment to modernize and harmonize nursing regulation across Canada, and evidence is needed to guide regulatory decision-making. To better understand the current state of scholarship and the gaps that exist, a comprehensive understanding of the available literature informing nursing regulation in Canada is first warranted. OBJECTIVE The objective of this scoping review is to examine the nature, extent, and range of literature focused on nursing regulation in Canada. METHODS The review will be conducted in accordance with the Joanna Briggs Institute guidelines for scoping reviews. We will search electronic databases, including Ovid MEDLINE, Ovid EMBASE, CINAHL, Scopus, and Web of Science Core Collection. We will also search for grey literature using the websites of Canadian nursing regulatory bodies, nursing organizations, and other leading Canadian regulatory organizations. No limitations will be placed on the year of publication. The review will include papers that explore nursing regulation in Canada, including topics such as education program accreditation or approval, licensure, standards of practice and code of conduct/ethics development and enforcement, continuing competence, discipline and conduct, regulatory models, governance, and reform. We will extract data using a predeveloped tool. Data will be analyzed using descriptive statistics and conventional content analysis. RESULTS A preliminary search in Ovid MEDLINE was undertaken on December 7, 2023, and a full search was conducted in 5 academic databases on March 15, 2024. Findings will be presented using evidence tables and a narrative summary. Reporting will follow the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) guidelines. This scoping review is expected to be completed in early 2025. CONCLUSIONS The results will be disseminated through conference presentations and a publication in a peer-reviewed journal. The findings will provide a comprehensive overview of the state of nursing regulation literature across Canada and inform the development of a focused research agenda. TRIAL REGISTRATION Open Science Framework osf.io/3qk8t; https://osf.io/bm7jv. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/56163.
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Affiliation(s)
- Patrick Chiu
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Kathleen Leslie
- Faculty of Health Disciplines, Athabasca University, Athabasca, AB, Canada
| | - Janice Y Kung
- Geoffrey & Robyn Sperber Health Sciences Library, University of Alberta, Edmonton, AB, Canada
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23
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Ferrari A, Bellè N, Giannini A, Simoncini T, Vainieri M. Determinants of women's preferences for surgical versus conservative management for pelvic organ prolapse: a survey-based study from Italy. BMJ Open 2024; 14:e084034. [PMID: 39053952 DOI: 10.1136/bmjopen-2024-084034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND AND OBJECTIVE Pelvic organ prolapse (POP) affects 40% of women, with a 12%-19% lifetime surgical risk. Italy showed high practice variation in POP surgery, possibly impacting equity of access to healthcare services, a central goal of Beveridge-like health systems. According to the literature, unwarranted variation, influenced by physician attitudes or resource allocation, must be reduced. We aimed to identify determinants influencing women's choice when asked whether they prefer surgical or conservative POP management. DESIGN, SETTING AND POPULATION In this nationwide prospective study, we distributed a Qualtrics questionnaire via social media to any Italian women over 18 years old who voluntarily decided to participate in the survey. INTERVENTION A grade 3 POP scenario was presented. Women were asked how likely they would have surgery. Each woman randomly received only 1 question out of 11: 1 question was the reference question ('How likely would you have surgery?') while 10 questions contained a potential determinant influencing woman's choice ('How likely would you have surgery if…?'). OUTCOME The outcome was the chance of choosing surgery expressed as a percentage. We analysed the effect of each factor on the outcome by using adjusted beta regression models. RESULTS Respondents (n=222) opted for surgery with a median probability of 61.5%. Factors significantly increasing the chance of choosing surgery were advice from physicians, the presence of a trusted physician during hospitalisation, surgical approach with low complication rates, uterine-sparing surgery, the absence of postoperative abdominal scars and nearby hospital. CONCLUSIONS Our findings provide health managers and policy-makers with new evidence to better understand women's decision-making and partly capture the determinants of unwarranted variation. These inputs may also be used as attributes for a future discrete choice experiment.
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Affiliation(s)
- Amerigo Ferrari
- Institute of Management, MeS (Management and Health) Laboratory, Scuola Superiore Sant'Anna, Pisa, Italy
- Department of Clinical and Experimental Medicine, Division of Obstetrics and Gynaecology, University of Pisa, Pisa, Italy
| | - Nicola Bellè
- Institute of Management, MeS (Management and Health) Laboratory, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Andrea Giannini
- Department of Clinical and Experimental Medicine, Division of Obstetrics and Gynaecology, University of Pisa, Pisa, Italy
| | - Tommaso Simoncini
- Department of Clinical and Experimental Medicine, Division of Obstetrics and Gynaecology, University of Pisa, Pisa, Italy
| | - Milena Vainieri
- Institute of Management, MeS (Management and Health) Laboratory, Scuola Superiore Sant'Anna, Pisa, Italy
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24
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Schuller S, de Rijk A, Corin L, Bertilsson M. Mental Health Stigma in the Workplace and its Association with Possible Actions of Managers to Prevent Sickness Absence of Employees with Mental Health Problems in the Swedish Private Sector: a Video Vignette Study. JOURNAL OF OCCUPATIONAL REHABILITATION 2024:10.1007/s10926-024-10220-z. [PMID: 38990480 DOI: 10.1007/s10926-024-10220-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/15/2024] [Indexed: 07/12/2024]
Abstract
PURPOSE Mental health problems (MHPs) are subjected to workplace stigma and can deteriorate into common mental disorders (CMDs) and sickness absence (SA). Research has shown that personal stigmatizing attitudes limit managers' efforts towards employees with MHPs, but knowledge is lacking regarding stigma in social contexts (contextual stigma) and different types of possible preventive actions. This study investigates personal stigmatizing attitudes and three contextual stigma layers (employee, collegial, organizational) and different types of possible actions to prevent SA of employees with MHPs. METHOD Survey data of 2769 Swedish managers working in the private sector were analysed. Personal stigmatizing attitudes were measured with the managerial stigma towards employee depression scale and supplemented with four additional items capturing contextual stigma. Managers watched video vignettes and assessed which preventive actions (n = 20) were possible to use in their organization. A sum score was calculated reflecting the 'number of actions'. Principal component analysis revealed three action types: adapt tasks and setting, involve experts, and social support. A score reflecting the 'possibilities to implement actions' was calculated for each type. Multiple linear regression analyses were conducted with the four stigma layers as independent variables for each of the three action variables. RESULTS Personal stigmatizing attitudes and contextual stigma were significantly associated with both 'number of actions' and 'possibilities for implementing actions' relating to all action types. Patterns of associations with contextual stigma were significant but varied between the different action types. CONCLUSION This study substantiated the role of personal stigmatizing attitudes and contextual stigma in relation to possible actions of managers to prevent SA of employees with MHPs. The results emphasize the role of contextual stigma. Implications for practice and research are discussed.
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Affiliation(s)
- Sofie Schuller
- Department of Public Administration and Sociology, School of Social and Behavioural Sciences, Erasmus University, PO Box 1738, 3000 DR Rotterdam, Rotterdam, The Netherlands.
- Department of Social Medicine, Faculty of Health, Medicine and Life Sciences, Primary Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.
| | - Angelique de Rijk
- Department of Social Medicine, Faculty of Health, Medicine and Life Sciences, Primary Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Linda Corin
- Institute of Stress Medicine, Region Västra Götaland, Gothenburg, Sweden
| | - Monica Bertilsson
- School of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Mackie AS, Tulli-Shah M, Chappell A, Kariwo M, Ibrahim S, Salami B. Barriers and facilitators to transition from pediatric to adult healthcare for immigrant youth with chronic health conditions. J Pediatr Nurs 2024; 77:e487-e494. [PMID: 38760303 DOI: 10.1016/j.pedn.2024.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/16/2024] [Accepted: 05/08/2024] [Indexed: 05/19/2024]
Abstract
PURPOSE The objective of this study was to investigate the experience of first- and second- generation immigrant youth living with chronic health conditions in Canada, their parents or caregivers, and healthcare and service providers who care for immigrant youth, regarding the transition from pediatric to adult healthcare. DESIGN AND METHODS We conducted semi-structured individual interviews and focus groups. Youth were 1st or 2nd generation immigrants, aged 16-25, with pediatric-onset chronic health conditions. Parents or caregivers had raised youth children as described. Providers delivered healthcare or other services to immigrant populations. Thematic analysis was conducted of all transcripts. RESULTS Twenty youth, 14 parents/caregivers and five service providers participated. Most participants described healthcare transition as very difficult to navigate. Two major themes emerged across participant narratives: 1. Barriers to transition: lack of family experience in Canada, language, discrimination, financial strain, stigma, and long wait times. Some of these barriers are specific to newcomer families, but others are generalizable to the Canadian population. 2. Facilitators of transition: youth independence, youth acting as cultural bridges within their families, and cross-sector support between healthcare, education, social work and settlement services. CONCLUSIONS Immigrant youth and their families face a broad range of barriers to healthcare transition. The collaborative nature of cross-sector support effectively addressed some of the barriers faced by newcomer families. PRACTICE IMPLICATIONS Clinicians should provide immigrant youth and their families with accessible information about the health condition and how to navigate the adult healthcare system prior to transition, particularly when language barriers exist.
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Affiliation(s)
- Andrew S Mackie
- Department of Pediatrics, University of Alberta, 11405-87 Avenue, Edmonton, Alberta T6G 1C9, Canada.
| | - Mia Tulli-Shah
- Faculty of Nursing, University of Alberta, 11405-87 Avenue, Edmonton, Alberta T6G 1C9, Canada
| | - Alyssa Chappell
- Department of Pediatrics, University of Alberta, 11405-87 Avenue, Edmonton, Alberta T6G 1C9, Canada
| | - Michael Kariwo
- Faculty of Education, University of Alberta, 11210 - 87 Avenue, Edmonton, Alberta T6G 2G5, Canada
| | - Siciida Ibrahim
- Department of Pediatrics, University of Alberta, 11405-87 Avenue, Edmonton, Alberta T6G 1C9, Canada
| | - Bukola Salami
- Faculty of Nursing, University of Alberta, 11405-87 Avenue, Edmonton, Alberta T6G 1C9, Canada
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De Rosis S. Performance measurement and user-centeredness in the healthcare sector: Opening the black box adapting the framework of Donabedian. Int J Health Plann Manage 2024; 39:1172-1182. [PMID: 37947478 DOI: 10.1002/hpm.3732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 12/12/2022] [Accepted: 10/25/2023] [Indexed: 11/12/2023] Open
Abstract
The framework of Donabedian is widely applied to performance assessment at the healthcare system level. Donabedian categorised the care quality measurement around three dimensions, namely structure, process, and outcomes. The first dimension concerns the inputs; the second one, the combinations of factors and inputs; the last one, the effectiveness in terms of patients' health status. Donabedian early included in the last dimension the patient satisfaction. Nevertheless, nowadays, outcomes are generally measured through hard endpoints, such as re-admissions and mortality indicators. Recently, the Patient-Reported Outcome Measures (PROMs) have been included among the outcome measures within the Donabedian framework. How to move the concept of patient-centeredness to a macro level, including the patient point of view in care quality measurement, evaluation, and improvement? This paper integrates the Donabedian structure-process-outcome framework, by incorporating in the proper dimension the patient-indicators, namely the abovementioned PROMs and Patient-Reported Experience Measures (PREMs). While PROMs are clearly measures of outcome, PREMs can be collocated in the process dimension, since they can be useful for mapping processes and care pathways, in a lean perspective, as well as in the outcome dimension, because inherently linked to outcome, and enablers of patient-centeredness.
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Affiliation(s)
- Sabina De Rosis
- Management and Healthcare Laboratory, Institute of Management and Department L'EMbeDS, Sant'Anna School, Pisa, Italy
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27
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Strosher H, Hainstock T, Karsten S, Whyte B, Hauschildt C, McMillan T, Sboto-Frankenstein U, Trytten C. Patient-oriented research: An essential driver of learning health system capacity development. Healthc Manage Forum 2024; 37:283-289. [PMID: 38511346 DOI: 10.1177/08404704241235601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
Canada's health system faces a lag in implementing high-quality evidence and research-driven innovation into service delivery, while demonstrating accountability and benefit to the public. To address these challenges, Patient-Oriented Research (POR) builds teams that engage researchers, healthcare providers, decision-makers, and most importantly, patients (people with lived and living experience) in the process of generating and applying evidence to inform health services and decision-making. A Learning Health System (LHS) systematically integrates external evidence with internal data and experience and puts that knowledge into practice in a continuous cycle. Using a POR/LHS example from a BC health authority, we describe nine enablers required to support LHS capacity development. The LHS case study, Walk With Me, addresses a health system high-priority topic: the toxic drug crisis. Understanding the value of learning health systems, along with the enablers required to support and implement them, will empower health leaders to champion and orchestrate positive change.
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Affiliation(s)
- Heather Strosher
- Island Health Research Department, Victoria, British Columbia, Canada
- BC SUPPORT Unit Island Centre, Victoria, British Columbia, Canada
| | - Taylor Hainstock
- Island Health Research Department, Victoria, British Columbia, Canada
- BC SUPPORT Unit Island Centre, Victoria, British Columbia, Canada
| | - Sharon Karsten
- Vancouver Island University, Nanaimo, British Columbia, Canada
- Walk With Me, Comox, British Columbia, Canada
| | | | | | - Tara McMillan
- Island Health Research Department, Victoria, British Columbia, Canada
- BC SUPPORT Unit Island Centre, Victoria, British Columbia, Canada
| | | | - Cindy Trytten
- Island Health Research Department, Victoria, British Columbia, Canada
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28
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Ma B, Park YJ, Ramien M. Epidemiology and Healthcare Expenditure for Skin Disease in Emergency Departments in Alberta, Canada. J Cutan Med Surg 2024; 28:340-345. [PMID: 38591361 DOI: 10.1177/12034754241239907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
BACKGROUND There are limited data on the epidemiology and costs associated with managing dermatologic conditions in emergency departments (EDs). OBJECTIVE To assess the incidence and mean cost per case of skin diseases in EDs in Alberta. METHODS Alberta Health Services' Interactive Health Data Application was used to determine the epidemiology and costs associated with nonneoplastic dermatologic diseases in EDs in the province of Alberta, Canada, from 2018 to 2022. Skin conditions were identified using the International Classification of Disease 10th edition diagnostic groupings. RESULTS Skin disease represented 3.59% of all ED presentations in Alberta in 2022. The total costs associated with managing dermatologic conditions have remained stable over time at approximately 15 million Canadian Dollars (CAD) annually, but the mean cost per case has risen from 188.88 (SD 15.42) in 2018 to 246.25 CAD (SD 27.47) in 2022 (7.59%/year). Infections of skin and subcutaneous tissue were the most expensive diagnostic grouping. The most common dermatologic diagnostic groupings presenting to the ED were infections of skin and subcutaneous tissue [mean age-standardized incidence rate (ASIR) of 143.67 per 100,000 standard population (SD 241.99)], urticaria and erythema [mean ASIR 33.57 per 100,000 standard population (SD 59.13)], and dermatitis and eczema [mean ASIR 18.59 per 100,000 standard population (SD 23.65)]. Cellulitis was both the most common and the costliest individual diagnosis. The majority of patients were triaged as less urgent or nonurgent. CONCLUSIONS Skin disease represents a substantial public health burden in EDs. Further research into drivers of cost change and areas for cost savings is essential.
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Affiliation(s)
- Bryan Ma
- Division of Dermatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Ye-Jean Park
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Michele Ramien
- Division of Dermatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Division of Community Pediatrics, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Douglass PL, Itchhaporia D, Bozkurt B, Roswell RO, Khandelwal A, Capers Q, Berlacher K, Ogunniyi MO, Bailey AL, Levy PD, Grant AJ, Tocco J, Natcheva A, Asare AG, Bhatt AB, Mieres JH, Disch MF, Echols MR. Achieving Equitable Cardiovascular Care for All: ACC Board of Trustees Health Equity Task Force Action Plan. JACC. ADVANCES 2024; 3:101050. [PMID: 39130032 PMCID: PMC11313050 DOI: 10.1016/j.jacadv.2024.101050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 05/15/2024] [Accepted: 05/17/2024] [Indexed: 08/13/2024]
Abstract
Advancements in cardiovascular (CV) disease management are notable, yet health inequities prevail, associated with increased morbidity and mortality noted among non-Hispanic African Americans in the United States. The 2002 Institute of Medicine Report revealed ongoing racial and ethnic health care disparities, spearheading a deeper understanding of the social determinants of health and systemic racism to develop strategies for CV health equity (HE). This article outlines the strategic HE approach of the American College of Cardiology, comprising 6 strategic equity domains: workforce pathway inclusivity, health care, data, science, and tools; education and training; membership, partnership, and collaboration; advocacy and policy; and clinical trial diversity. The American College of Cardiology's Health Equity Task Force champions the improvement of patients' lived experiences, population health, and clinician well-being while reducing health care costs-the Quadruple Aim of Health Equity. Thus, we examine multifaceted HE interventions and provide evidence for scalable real-world interventions to promote equitable CV care.
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Affiliation(s)
- Paul L. Douglass
- Chair, ACC BOT Health Equity Taskforce, Wellstar Health System, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Dipti Itchhaporia
- Chair of Cardiovascular Health, Hoag Memorial Hospital Presbyterian, Newport Beach, California, USA
| | - Biykem Bozkurt
- Winters Center for Heart Failure, Cardiovascular Research Institute, Baylor College of Medicine, Newport Beach, California, USA
| | - Robert O. Roswell
- Department of Science Education and Cardiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York, USA
| | - Akshay Khandelwal
- System Chair, Department of Cardiovascular Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Quinn Capers
- Chair of Medicine, Howard University, Washington, DC, USA
| | - Kathryn Berlacher
- University of Pittsburgh Medical Center, Heart and Vascular Institute
| | - Modele O. Ogunniyi
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Division of Cardiology, Department Medicine, Grady Health System, Atlanta, Georgia, USA
| | - Alison L. Bailey
- Center for Heart, Lung and Vascular Health at Parkridge, Parkridge Health System, Chattanooga, Tennessee, USA
| | - Phillip D. Levy
- Department of Emergency Medicine, Wayne State University, Detroit, Michigan, USA
| | - Aubrey J. Grant
- Division of Cardiology, Department Medicine, Medstar Heart and Vascular Institute, Washington, DC, USA
| | - Jack Tocco
- Department of Community and Population Health, Northwell Health, Brooklyn, New York, USA
| | - Angela Natcheva
- Division of Diversity Equity and Inclusion, American College of Cardiology, Washington, DC, USA
| | - Akua G. Asare
- Division of Diversity Equity and Inclusion, American College of Cardiology, Washington, DC, USA
| | - Ami B. Bhatt
- American College of Cardiology, Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer H. Mieres
- Department of Cardiology, Zucker School of Medicine at Hofstra/Northwell, Brooklyn, New York, USA
| | - Maghee F. Disch
- Division of Diversity Equity and Inclusion, American College of Cardiology, Washington, DC, USA
| | - Melvin R. Echols
- Chief Diversity, Equity and Inclusion Officer at American College of Cardiology, Morehouse School of Medicine, Atlanta, Georgia, USA
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Li J, Chen Y, Tang M, Wang S. Do Negative Self-Evaluative Emotions Enhance Healthier Food Choices? Exploring the Moderating Role of Self-Affirmation. Behav Sci (Basel) 2024; 14:538. [PMID: 39062361 PMCID: PMC11274215 DOI: 10.3390/bs14070538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 06/13/2024] [Accepted: 06/17/2024] [Indexed: 07/28/2024] Open
Abstract
Negative self-evaluative emotions arise when an individual engages in behavior that is perceived as inadequate or inconsistent with personal or societal norms and values, leading to feelings of inadequacy, shame, and dissatisfaction with oneself. These emotions are a central motivating force for changing unhealthy behaviors. However, negative evaluative emotions may also direct individuals towards defensive reactions such as reactance and avoidance. This can cause negative self-evaluative emotions to be less effective in reducing unhealthy behavior. More importantly, empirical evidence is needed to explore strategies for enhancing the effectiveness of interventions. In this study, we used an online experiment with 100 student participants to examine if increasing self-affirmation can increase the effectiveness of negative self-evaluative emotions in reducing unhealthy food consumption. We found that negative self-evaluative emotions can significantly increase healthy food consumption. However, our analysis did not reveal a significant moderating impact of self-affirmation on the effectiveness of negative self-evaluative emotions in reducing unhealthy consumption. This is the first study to explore the moderating impact of self-affirmation on the effectiveness of negative self-evaluative emotions on health behavioral change, which opens new avenues for studying how to apply the combination of stimulating negative self-evaluative emotions and increasing self-affirmation to induce behavioral change regarding healthy diets and even a broader range of fields.
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Affiliation(s)
- Jingwen Li
- Faculty of Behavioural and Social Sciences, University of Groningen, 9712 TS Groningen, The Netherlands;
| | - Yu Chen
- Faculty of Economics and Business, University of Groningen, 9747 AT Groningen, The Netherlands;
| | - Mingcong Tang
- Department of Psychological and Brain Sciences, Boston University, Boston, MA 02215, USA;
| | - Shuangmiao Wang
- Institute of Health Promotion and Medical Communication Science, Guangdong Medical University, Zhanjiang 524023, China
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Parker G, Hunter S, Born K, Miller FA. Mapping the Environmental Co-Benefits of Reducing Low-Value Care: A Scoping Review and Bibliometric Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:818. [PMID: 39063397 PMCID: PMC11276457 DOI: 10.3390/ijerph21070818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 06/07/2024] [Accepted: 06/18/2024] [Indexed: 07/28/2024]
Abstract
Reducing low-value care (LVC) and improving healthcare's climate readiness are critical factors for improving the sustainability of health systems. Care practices that have been deemed low or no-value generate carbon emissions, waste and pollution without improving patient or population health. There is nascent, but growing, research and evaluation to inform practice change focused on the environmental co-benefits of reducing LVC. The objective of this study was to develop foundational knowledge of this field through a scoping review and bibliometric analysis. We searched four databases, Medline, Embase, Scopus and CINAHL, and followed established scoping review and bibliometric analysis methodology to collect and analyze the data. A total of 145 publications met the inclusion criteria and were published between 2013 and July 2023, with over 80% published since 2020. Empirical studies comprised 21%, while commentary or opinions comprised 51% of publications. The majority focused on healthcare generally (27%), laboratory testing (14%), and medications (14%). Empirical publications covered a broad range of environmental issues with general and practice-specific 'Greenhouse gas (GHG) emissions', 'waste management' and 'resource use' as most common topics. Reducing practice-specific 'GHG emissions' was the most commonly reported environmental outcome. The bibliometric analysis revealed nine international collaboration networks producing work on eight key healthcare areas. The nineteen 'top' authors were primarily from the US, Australia and Canada.
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Affiliation(s)
| | | | | | - Fiona A. Miller
- Collaborative Centre for Climate, Health & Sustainable Care, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
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Hudani A, Schwan K, Labonté R, Yaya S. Bounding systems: A qualitative study exploring healthcare coordination between the emergency youth shelter system and health system in Toronto, Canada. PLoS One 2024; 19:e0303655. [PMID: 38905314 PMCID: PMC11192382 DOI: 10.1371/journal.pone.0303655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 04/26/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND Several youth staying at emergency youth shelters (EYSs) in Toronto experience poorly coordinated care for their health needs, as both the EYS and health systems operate largely in silos when coordinating care for this population. Understanding how each system is structurally and functionally bound in their healthcare coordination roles for youth experiencing homelessness (YEH) is a preliminary step to identify how healthcare coordination can be strengthened using a system thinking lens, particularly through the framework for transformative system change. METHODS Forty-six documents, and twenty-four semi-structured interviews were analyzed to explore how the EYS and health systems are bound in their healthcare coordination roles. We continuously compared data collected from documents and interviews using constant comparative analysis to build a comprehensive understanding of each system's layers, and the niches (i.e., programs and activities), organizations and actors within these layers that contribute to the provision and coordination of healthcare for YEH, within and between these two systems. RESULTS The EYS and health systems are governed by different ministries, have separate mandates, and therefore have distinct layers, niches, and organizations respective to coordinating healthcare for YEH. While neither system takes sole responsibility for this task, several government, research, and community-based efforts exist to strengthen healthcare coordination for this population, with some overlap between systems. Several organizations and actors within each system are collaborating to develop relevant frameworks, policies, and programs to strengthen healthcare coordination for YEH. Findings indicate that EYS staff play a more active role in coordinating care for YEH than health system staff. CONCLUSION A vast network of organizations and actors within each system layer, work both in silos and collaboratively to coordinate health services for YEH. Efforts are being made to bridge the gap between systems to improve healthcare coordination, and thereby youths' health outcomes.
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Affiliation(s)
- Alzahra Hudani
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Kaitlin Schwan
- Women’s National Housing & Homelessness Network, Toronto, Ontario, Canada
| | - Ronald Labonté
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Ontario, Canada
- The George Institute for Global Health, Imperial College London, London, United Kingdom
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Van Bortel T, Wickramasinghe ND, Treacy S, Khan N, Ouali U, Sumathipala A, Svab V, Nader D, Kadri N, Monteiro MF, Knifton L, Quinn N, Van Audenhove C, Lasalvia A, Bonetto C, Thornicroft G, van Weeghel J, Brouwers E. Anticipated and experienced stigma and discrimination in the workplace among individuals with major depressive disorder in 35 countries: qualitative framework analysis of a mixed-method cross-sectional study. BMJ Open 2024; 14:e077528. [PMID: 38904137 PMCID: PMC11191817 DOI: 10.1136/bmjopen-2023-077528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 06/05/2024] [Indexed: 06/22/2024] Open
Abstract
OBJECTIVES Workplace stigmatisation and discrimination are significant barriers to accessing employment opportunities, reintegration and promotion in the workforce for people with mental illnesses in comparison to other disabilities. This paper presents qualitative evidence of anticipated and experienced workplace stigma and discrimination among individuals with major depressive disorder (MDD) in 35 countries, and how these experiences differ across countries based on their Human Development Index (HDI) level. DESIGN Mixed-method cross-sectional survey. PARTICIPANTS, SETTING AND MEASURES The qualitative data were gathered as part of the combined European Union Anti-Stigma Programme European Network and global International Study of Discrimination and Stigma Outcomes for Depression studies examining stigma and discrimination among individuals with MDD across 35 countries. Anticipated and experienced stigma and discrimination were assessed using the Discrimination and Stigma Scale version 12 (DISC-12). This study used responses to the open-ended DISC-12 questions related to employment. Data were analysed using the framework analysis method. RESULTS The framework analysis of qualitative data of 141 participants identified 6 key 'frames' exploring (1) participants reported experiences of workplace stigma and discrimination; (2) impact of experienced workplace stigma and discrimination; (3) anticipated workplace stigma and discrimination; (4) ways of coping; (5) positive work experiences and (6) contextualisation of workplace stigma and discrimination. In general, participants from very high HDI countries reported higher levels of anticipated and experienced discrimination than other HDI groups (eg, less understanding and support, being more avoided/shunned, stopping themselves from looking for work because of expectation and fear of discrimination). Furthermore, participants from medium/low HDI countries were more likely to report positive workplace experiences. CONCLUSIONS This study makes a significant contribution towards workplace stigma and discrimination among individuals with MDD, still an under-researched mental health diagnosis. These findings illuminate important relationships that may exist between countries/contexts and stigma and discrimination, identifying that individuals from very high HDI countries were more likely to report anticipated and experienced workplace discrimination.
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Affiliation(s)
- Tine Van Bortel
- Leicester School of Allied Health Sciences, De Montfort University, Leicester, UK
- Cambridge Public Health, Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Nuwan Darshana Wickramasinghe
- Department of Community Medicine, Rajarata University of Sri Lanka Faculty of Medicine and Allied Sciences, Saliyapura, Sri Lanka
| | | | - Nashi Khan
- Rashid Latif Khan University, Lahore, Pakistan
| | - Uta Ouali
- Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - Athula Sumathipala
- Research Institute for Primary Care & Health Sciences, School of Medicine, Keele University, Keele, UK
- Institute for Global Health, Faculty of Health, Keele University, Staffordshire, UK
| | - Vesna Svab
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Doaa Nader
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Nadia Kadri
- Psychiatric Center, Ibn Rushd University, Casablanca, Morocco
| | | | | | | | | | - Antonio Lasalvia
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Chiara Bonetto
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Graham Thornicroft
- Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jaap van Weeghel
- Tranzo Scientific Center for Care and Welfare, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
- Phrenos Centre of Expertise, Utrecht, Netherlands
| | - Evelien Brouwers
- Tranzo Scientific Center for Care and Welfare, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
- Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
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Sheth MS, Rochon PA, Altaf A, Boblitz A, Bronskill SE, Brown KA, Hahn-Goldberg S, Huynh T, Lewis-Fung SE, Feng P, Savage RD. Factors associated with transition to a nursing home in older adults living in naturally occurring retirement communities. J Am Geriatr Soc 2024. [PMID: 38888381 DOI: 10.1111/jgs.19038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 05/03/2024] [Accepted: 05/09/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND Naturally occurring retirement communities (NORCs) are geographic areas (generally high-rise buildings or neighborhoods) that have a high concentration of individuals 65 years and older. Supportive service programs in NORCs can address resident needs and delay nursing home (NH) admission but understanding what factors are associated with NORC residents requiring NH admission is needed to tailor such programs. Our aim was to examine individual- and neighborhood-level factors associated with NH wait-list status in NORC residents in Ontario. METHODS We conducted a population-based, cross-sectional study of Ontario adults 65 years of age or older living in a NORC building as of January 1, 2020, by linking a provincial registry of NORC high-rise buildings with health administrative data. Older adults were classified as being on the NH wait-list if they had an open application for a NH on the index date. We conducted a multilevel logistic regression analysis using generalized estimating equations to determine individual- and neighborhood-level factors associated with NH wait-list status, including sociodemographic, clinical, healthcare use, and building factors. We explored the role of sex and age through stratification by sex (male, female) and age (65-80 and 80+ years). RESULTS Among 220,864 NORC residents, 4710 individuals (2.1%) were on the NH wait-list. Female sex, older age, immigrant status, dementia diagnosis, receiving homecare, multimorbidity, and polypharmacy (five or more unique drug names) were associated with an increased odds of wait-list status. Several neighborhood-level variables were associated with a significantly increased likelihood of wait-list status, including low income, high dependency, high ethnic diversity, and living in a building with supports. CONCLUSION NORC supportive service programs can be tailored to account for the factors associated with NH wait-list status, allowing NORC residents who are living in the community to age in their desired place and achieve optimal health outcomes.
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Affiliation(s)
- Maya S Sheth
- Women's Age Lab, Women's College Hospital, Toronto, Ontario, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Paula A Rochon
- Women's Age Lab, Women's College Hospital, Toronto, Ontario, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Susan E Bronskill
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Kevin A Brown
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Public Health Ontario, Toronto, Ontario, Canada
| | - Shoshana Hahn-Goldberg
- NORC Innovation Centre, University Health Network, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Tai Huynh
- NORC Innovation Centre, University Health Network, Toronto, Ontario, Canada
| | | | - Patrick Feng
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Rachel D Savage
- Women's Age Lab, Women's College Hospital, Toronto, Ontario, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Forray AI, Oltean O, Hanft-Robert S, Madzamba R, Liem A, Schouten B, Anthonissen C, Swartz L, Cherecheș RM, Higgen S, Hall BJ, Mösko M. Uncovering multi-level mental healthcare barriers for migrants: a qualitative analysis across China, Germany, Netherlands, Romania, and South Africa. BMC Public Health 2024; 24:1593. [PMID: 38877460 PMCID: PMC11177472 DOI: 10.1186/s12889-024-19046-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 06/03/2024] [Indexed: 06/16/2024] Open
Abstract
BACKGROUND Forced displacement is a significant issue globally, and it affected 112 million people in 2022. Many of these people have found refuge in low- and middle-income countries. Migrants and refugees face complex and specialized health challenges, particularly in the area of mental health. This study aims to provide an in-depth qualitative assessment of the multi-level barriers that migrants face in accessing mental health services in Germany, Macao (Special Administrative Region of China), the Netherlands, Romania, and South Africa. The ultimate objective is to inform tailored health policy and management practices for this vulnerable population. METHODS Adhering to a qualitative research paradigm, the study centers on stakeholders' perspectives spanning microsystems, mesosystems, and macrosystems of healthcare. Utilizing a purposive sampling methodology, key informants from the aforementioned geographical locations were engaged in semi-structured interviews. Data underwent thematic content analysis guided by a deductive-inductive approach. RESULTS The study unveiled three pivotal thematic barriers: language and communication obstacles, cultural impediments, and systemic constraints. The unavailability of professional interpreters universally exacerbated language barriers across all countries. Cultural barriers, stigmatization, and discrimination, specifically within the mental health sector, were found to limit access to healthcare further. Systemic barriers encompassed bureaucratic intricacies and a conspicuous lack of resources, including a failure to recognize the urgency of mental healthcare needs for migrants. CONCLUSIONS This research elucidates the multifaceted, systemic challenges hindering equitable mental healthcare provision for migrants. It posits that sweeping policy reforms are imperative, advocating for the implementation of strategies, such as increasing the availability of language services, enhancing healthcare providers' capacity, and legal framework and policy change to be more inclusive. The findings substantially contribute to scholarly discourse by providing an interdisciplinary and international lens on the barriers to mental healthcare access for displaced populations.
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Affiliation(s)
- Alina Ioana Forray
- Faculty of Political, Administrative and Communication Sciences, Center for Health Innovation, Babeș-Bolyai University, Cluj-Napoca, Romania
- Department of Community Medicine, Discipline of Public Health and Management, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ovidiu Oltean
- Faculty of Political, Administrative and Communication Sciences, Center for Health Innovation, Babeș-Bolyai University, Cluj-Napoca, Romania
| | - Saskia Hanft-Robert
- Department of Medical Psychology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Rowan Madzamba
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Andrian Liem
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University, Selangor, Malaysia
| | - Barbara Schouten
- Department of Communication Science, Amsterdam School of Communication Research (ASCoR), University of Amsterdam, Center for Urban Mental Health, Amsterdam, The Netherlands
| | - Christine Anthonissen
- Department of General Linguistics, Stellenbosch University, Stellenbosch, South Africa
| | - Leslie Swartz
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Răzvan Mircea Cherecheș
- Faculty of Political, Administrative and Communication Sciences, Center for Health Innovation, Babeș-Bolyai University, Cluj-Napoca, Romania
- Postgraduate Program for Bio-Behavioral Integrative Medicine (UBBMed), Babeș-Bolyai University, Cluj-Napoca, Romania
| | - Sanna Higgen
- Department of Medical Psychology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Brian J Hall
- Center for Global Health Equity, NYU Shanghai, Shanghai, China
| | - Mike Mösko
- Department of Medical Psychology, University Medical Center Hamburg Eppendorf, Hamburg, Germany.
- Department of Applied Human Sciences, University of Applied Sciences Magdeburg-Stendal, Stendal, Germany.
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Abousifein M, Falbo AT, Luyckx J, Abelson J, Ganann R, Vrkljan B, Carusone SC. Co-designing a participatory evaluation of older adult partner engagement in the mcmaster collaborative for health and aging. RESEARCH INVOLVEMENT AND ENGAGEMENT 2024; 10:58. [PMID: 38863030 PMCID: PMC11165825 DOI: 10.1186/s40900-024-00595-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 06/03/2024] [Indexed: 06/13/2024]
Abstract
Engagement of patients and the public in health research is crucial for ensuring research relevance and alignment with community needs. However, there is a lack of nuanced evaluations and examples that promote collaborative and reflective learning about partnerships with partners. The aim of this paper is to provide a case example of a participatory evaluation of the engagement of older adult partners in an aging-focused research centre. We outline our process of co-planning and implementing an evaluation of the McMaster Collaborative for Health and Aging's engagement strategy through the use of multiple methods, including a standardized tool and qualitative approaches. The team chose to explore and capture the engagement experiences and perspectives of the older adult partners within the Collaborative using a survey (the Public and Patient Engagement Evaluation Tool (PPEET)), an art-based method (photovoice), and a focus group. We present a brief summary of the findings but primarily focus this paper on the experiences of using each methodology and tool, with an emphasis on promoting dialogue on the benefits, limitations, and challenges. We reflect on the process of co-planning and the integration of both standardized tools and qualitative approaches to adopt a holistic approach to evaluating partnership within the Collaborative. Ultimately, this case example aims to provide practical guidance for other research groups navigating the complexities of partnership engagement and evaluation, thereby promoting meaningful partnerships in research.
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Affiliation(s)
- Marfy Abousifein
- McMaster Collaborative for Health and Aging, McMaster University, Hamilton, Canada.
| | - A Tina Falbo
- McMaster Collaborative for Health and Aging, McMaster University, Hamilton, Canada
| | - Joyce Luyckx
- McMaster Collaborative for Health and Aging, McMaster University, Hamilton, Canada
| | - Julia Abelson
- McMaster Collaborative for Health and Aging, McMaster University, Hamilton, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | - Rebecca Ganann
- McMaster Collaborative for Health and Aging, McMaster University, Hamilton, Canada
- School of Nursing, McMaster University, Hamilton, Canada
| | - Brenda Vrkljan
- McMaster Collaborative for Health and Aging, McMaster University, Hamilton, Canada
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Soo Chan Carusone
- McMaster Collaborative for Health and Aging, McMaster University, Hamilton, Canada
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Bourissi H, Mellas S. Government Recognition and Support for Family Caregivers: A Comparative Review of Policies in Northern and Southern Countries With a Focus on Oncology Caregivers. Cureus 2024; 16:e63085. [PMID: 39055450 PMCID: PMC11270140 DOI: 10.7759/cureus.63085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2024] [Indexed: 07/27/2024] Open
Abstract
The recognition of informal caregivers by governments is gradually increasing. Currently, several countries, mainly in the Northern Hemisphere, have officially acknowledged the role of caregivers and offer various forms of support. In contrast, in southern countries, data on informal caregivers, especially those caring for cancer patients, remain sparse. Furthermore, the acknowledgment and support for caregivers' roles are still lacking in many of these regions. Notably, existing policies in northern countries predominantly focus on caregivers for the elderly and disabled, with only a few initiatives directly supporting caregivers of cancer patients. This review aims to shed light on the measures some governments have taken to support caregivers and advocate for further actions and policies to enhance caregiver support. This review is grounded on a thorough examination of articles, governmental reports, and empirical studies related to family caregiver support.
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Affiliation(s)
- Hiba Bourissi
- Laboratory of Anatomy, Surgery, and Anesthesiology, Faculty of Medicine, Pharmacy, and Dental Medicine, Fez, MAR
- Health Sciences, Faculty of Science and Technology, Fez, MAR
| | - Soufiane Mellas
- Laboratory of Anatomy, Surgery, and Anesthesiology, Faculty of Medicine, Pharmacy, and Dental Medicine, Fez, MAR
- Urology, Centre Hospitalier Universitaire Hassan II, Fez, MAR
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Manning JC, Carter T, Blake I, Bingham V, Cooper J, Turner A, C Marufu T, Wood D, Coad J. Acute paediatric inpatient care of children and young people admitted with self-harm or eating disorders: A single centre evaluation. J Child Health Care 2024; 28:302-315. [PMID: 35703125 PMCID: PMC11141094 DOI: 10.1177/13674935221107962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In the United Kingdom, the prevalence of children and young people (CYP) accessing acute paediatric inpatient care with mental health problems is increasing, with self-harm and eating disorders particularly prevalent. This study evaluated CYP experiences of being in receipt of acute paediatric inpatient care following either self-harm or crisis stemming from an eating disorder to inform domains for a person-centred outcome measure (PCOM). A series of stakeholder engagement events were conducted between April and July 2015 where creative approaches were used to explore stakeholder experiences of care and to identify outcome domains that were subsequently prioritised using a Nominal Group Technique. Data were analysed using inductive thematic approach, with significance scores calculated for domain statements. Ninety-six stakeholders (15 CYP, eight parents and carers, and 73 professionals) participated. Findings showed five priority PCOM domains: privacy and surveillance; holistic care; making choices, appropriate communication; working together to achieve care goals; and respect and empowerment. This single centre evaluation highlights the need for a PCOM to be developed for this patient group that comprehensively reflects stakeholders' expectations in order to inform improvements to quality of acute paediatric care.
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Affiliation(s)
- Joseph C Manning
- Nottingham Children’s Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
- Centre for Children and Young People Health Research (CYPHR), School of Health Sciences, University of Nottinghan, Nottingham, UK
| | - Tim Carter
- Centre for Children and Young People Health Research (CYPHR), School of Health Sciences, University of Nottinghan, Nottingham, UK
| | - Iszara Blake
- Nottingham Children’s Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Verity Bingham
- Nottingham Children’s Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Joanne Cooper
- Institute of Care Excellence, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Andrew Turner
- Faculty Research Centre for Intelligent Healthcare, Coventry University, UK
| | - Takawira C Marufu
- Nottingham Children’s Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
- Centre for Children and Young People Health Research (CYPHR), School of Health Sciences, University of Nottinghan, Nottingham, UK
| | - Damian Wood
- Nottingham Children’s Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Jane Coad
- Centre for Children and Young People Health Research (CYPHR), School of Health Sciences, University of Nottinghan, Nottingham, UK
- Institute of Care Excellence, Nottingham University Hospitals NHS Trust, Nottingham, UK
- University Hospital Coventry and Warwickshire, NHS Trust, Nottingham, UK
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Cash B, Lawless M, Robson K, Fealy S, Corboy D. Understanding the enablers to implementing sustainable health and well-being programs for older adults in rural Australia: A scoping review. Aust J Rural Health 2024; 32:419-432. [PMID: 38506524 DOI: 10.1111/ajr.13111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 03/06/2024] [Accepted: 03/10/2024] [Indexed: 03/21/2024] Open
Abstract
INTRODUCTION Supporting the health and well-being of older Australians necessitates the implementation of effective and sustainable community-based interventions. Rural settings, however, pose unique challenges to intervention implementation and sustainability, with limited research exploring strategies employed to overcome these complexities. OBJECTIVE To identify enabling strategies that support the sustainable implementation of community-based health and well-being interventions for older adults in rural Australia. DESIGN A scoping review, following methods by Arksey and O'Malley and enhanced by elements of the Joanna Briggs Institute methodology for scoping reviews and Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR), was conducted. An electronic search of seven databases was completed in April 2023. A thematic analysis was applied to provide a comprehensive and contextualised understanding of the phenomenon of interest. FINDINGS Of 1277 records screened, 15 studies were identified and included for review. Five themes identified key enablers for rural implementation: (1) Co-designing for the local context; (2) Embedding local champions; (3) Leveraging existing local resources; (4) Maintaining impact beyond the end of the funded period and (5) Flexibility in funding models. DISCUSSION The sustainable implementation of interventions requires active community involvement and consultation through all stages of program design and delivery to effectively meet the health and well-being needs of older rural-dwelling Australians. CONCLUSION Our findings advocate for clear implementation guidelines to support the design, delivery and adaptation of community-based programs that appropriately reflect the unique contextual needs and strengths of rural communities.
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Affiliation(s)
- Belinda Cash
- Manna Institute, Ageing Well in Rural and Regional Australia Research Group, School of Social Work and Arts, Charles Sturt University, Albury, New South Wales, Australia
| | - Michael Lawless
- College of Nursing and Health Sciences, Caring Futures Institute, Flinders University, Bedford Park, South Australia, Australia
| | - Kristy Robson
- Three Rivers Department of Rural Health, Charles Sturt University, Albury, New South Wales, Australia
| | - Shanna Fealy
- Ageing Well in Rural and Regional Australia Research Group, Charles Sturt University, Albury, New South Wales, Australia
| | - Denise Corboy
- Blue Sky Mind Research Consultancy, Ballarat, Victoria, Australia
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Iaconi A, Hoben M, Berta, PhD W, Duan Y, Norton PG, Song Y, Chamberlain SA, Beeber A, Anderson RA, Lanham HJ, Perez J, Wang J, Choroschun K, Shrestha S, Cummings G, Estabrooks CA. The Association of Nursing Homes' Organizational Context With Care Aide Empowerment: A Cross-Sectional Study. THE GERONTOLOGIST 2024; 64:gnae033. [PMID: 38695153 PMCID: PMC11129593 DOI: 10.1093/geront/gnae033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Indexed: 05/28/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Organizational context is thought to influence whether care aides feel empowered, but we lack empirical evidence in the nursing home sector. Our objective was to examine the association of features of nursing homes' unit organizational context with care aides' psychological empowerment. RESEARCH DESIGN AND METHODS This cross-sectional study analyzed survey data from 3765 care aides in 91 Western Canadian nursing homes. Random-intercept mixed-effects regressions were used to examine the associations between nursing home unit organizational context and care aides' psychological empowerment, controlling for care aide, care unit, and nursing home covariates. RESULTS Organizational (IVs) culture, social capital, and care aides' perceptions of sufficient time to do their work were positively associated with all four components of psychological empowerment (DVs): competence (0.17 [0.13, 0.21] for culture, 0.18 [0.14, 0.21] for social capital, 0.03 [0.01, 0.05] for time), meaning (0.21 [0.18, 0.25] for culture, 0.19 [0.16, 0.23] for social capital, 0.03 [0.01, 0.05 for time), self-determination (0.38 [0.33, 0.44] for culture, 0.17 [0.12, 0.21] for social capital, 0.08 [0.05, 0.11] for time), and impact (0.26 [0.21, 0.31] for culture, 0.23 [0.19, 0.28] for social capital, 0.04 [0.01, 0.07] for time). DISCUSSION AND IMPLICATIONS In this study, modifiable elements of organizational context (i.e., culture, social capital, and time) were positively associated with care aides' psychological empowerment. Future interventions might usefully target these modifiable elements of unit level context in the interest of assessing their effects on staff work attitudes and outcomes, including the quality of resident care.
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Affiliation(s)
- Alba Iaconi
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Matthias Hoben
- Faculty of Health, School of Health Policy and Management, York University, Toronto, Ontario, Canada
| | - Whitney Berta, PhD
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Yinfei Duan
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Peter G Norton
- Family Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Yuting Song
- Faculty of Nursing, Qingdao University, Qingdao, Shandong, China
| | - Stephanie A Chamberlain
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Anna Beeber
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ruth A Anderson
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Holly J Lanham
- Joe R. & Teresa Lozano Long School of Medicine, The University of Texas Health San Antonio, San Antonio, Texas, USA
| | - Janelle Perez
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jing Wang
- Nursing Department, College of Health and Human Services, University of New Hampshire, Durham, New Hampshire, USA
| | | | - Shovana Shrestha
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Greta Cummings
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Carole A Estabrooks
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
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McCallum AM, Vandenberg HER, Penz KL. Help Wanted, Experience Preferred, Stamina a Must: A Narrative Review of the Contextual Factors Influencing Nursing Recruitment and Retention in Rural and Remote Western Canada from the Early Twentieth Century to 2023. Can J Nurs Res 2024; 56:134-150. [PMID: 37802101 PMCID: PMC11032004 DOI: 10.1177/08445621231204962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/08/2023] Open
Abstract
Rural and remote communities of Western Canada have struggled to recruit and retain nursing professionals since the turn of the twentieth century. Existing literature has identified the unique challenges of rural nursing due to the shifting context of rural and remote nursing practice. The objective of this narrative review is to explore the history of rural and remote nursing to better understand the contextual influences shaping rural nursing shortages in Western Canada. This narrative review compared 27 sources of scholarly and historical evidence on the nature of rural nursing practices and recruitment and retention methods following the First World War until 2023. The findings suggest that the complex nature of rural nursing practice is a consistent challenge that has intersected with the long-standing power inequities that are inherent in rural marginalization, political influences, the nursing profession, social structures, and organizational design, to perpetuate rural nursing shortages throughout the past century. Integration and collaboration are needed to reduce systemic marginalization and develop effective and sustainable solutions to reduce nursing shortages in rural and remote areas of Western Canada.
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Affiliation(s)
| | | | - Kelly L. Penz
- University of Saskatchewan College of Nursing, Saskatoon, SK, Canada
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Al-Ghetaa RK, Alabousi M, You JJ, Emary PC, Riva JJ, Dufton J, Kagoma YK, Rampersaud R, Goytan MJ, Feasby TE, Reed M, Busse JW. Temporal Trends in Spinal Imaging in Ontario (2002-2019) and Manitoba (2001-2011), Canada. Cureus 2024; 16:e63267. [PMID: 39070358 PMCID: PMC11282485 DOI: 10.7759/cureus.63267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2024] [Indexed: 07/30/2024] Open
Abstract
Background Several studies have reported the overuse of spinal imaging, which, in Canada, led to several provincial pathways aimed at optimizing the use of imaging. We assessed temporal trends in spine imaging in two Canadian provinces. Methods We explored the use of X-ray, computed tomography (CT), and magnetic resonance imaging (MRI) examinations of the cervical, thoracic, and lumbar spine regions among adults in Ontario (April 1, 2002, to March 31, 2019) and in Manitoba, Canada (April 1, 2001, to March 31, 2011) using linked Ontario Health Insurance Plan administrative databases and data from Manitoba Health. We calculated the age- and sex-adjusted rates of spinal X-ray, CT, and MRI examinations by dividing the number of imaging studies by the population of each province for each year and estimated the use of each imaging modality per 100,000 persons. Results The total cost of spine imaging in Ontario increased from $45.8 million in 2002/03 to $70.3 million in 2018/19 (a 54% increase), and in Manitoba from $2.2 million in 2001/02 to $5 million in 2010/11 (a 127% increase). In Ontario, rates of spine X-rays decreased by 12% and spine CT scans decreased by 28% over this time period, while in Manitoba, rates of spine X-rays and CT scans remained constant. Age- and sex-adjusted utilization of spinal MRI scans per 100,000 persons markedly increased over time in both Ontario (277%) and Manitoba (350%). Conclusion Despite efforts to reduce the use of inappropriate spinal imaging, both Ontario and Manitoba have greatly increased utilization of spine MRI in the past two decades.
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Affiliation(s)
- Rayeh K Al-Ghetaa
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, CAN
| | | | - John J You
- Medicine, Trillium Health Partners, Mississauga, CAN
| | | | - John J Riva
- Family Medicine, McMaster University, Hamilton, CAN
| | - John Dufton
- Imaging, University Hospital of Northern British Columbia, Prince George, CAN
| | | | | | | | | | - Martin Reed
- Radiology, University of Manitoba, Winnipeg, CAN
| | - Jason W Busse
- Health Research Methodology, McMaster University, Hamilton, CAN
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Hajdini J, Hajdini U, Cankja K. Putting the pieces together: towards an integrative framework for healthcare performance. J Health Organ Manag 2024; ahead-of-print:447-466. [PMID: 38785038 DOI: 10.1108/jhom-09-2023-0280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
PURPOSE In the past few decades, performance measuring systems have become important managerial tools for healthcare organizations. Healthcare performance metrics are a useful tool in understanding how healthcare organizations achieve their goals while satisfying the needs of their patients and conforming to national and international standards. Various efforts have been made to assess healthcare performance. Most of these measures are focused on a single perspective or developed by a single source to meet management and strategic objectives on time. DESIGN/METHODOLOGY/APPROACH We develop a review of the literature to shed light on the measures used to assess performance in the healthcare sector at various points in time, as well as to establish a thorough understanding of healthcare performance measurement. FINDINGS Developing real-time digital traceability of metrics and an integrative perspective that increases the actionability of information acquired is an attractive potential made possible by the introduction of new technologies and the digitization of data. ORIGINALITY/VALUE We conclude that a proper measurement system should be one to combine patient, physician, non-medical staff and system perspective, which will further facilitate the assessment of healthcare performance and the comparative function.
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Affiliation(s)
- Johana Hajdini
- Università degli Studi Gabriele d'Annunzio Chieti Pescara, Pescara, Italy
| | - Ursina Hajdini
- University Hospital Center 'Mother Teresa', Tirana, Albania
| | - Klejdi Cankja
- University Hospital Center 'Mother Teresa', Tirana, Albania
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Pasat Z, Sinn CLJ, Rahman B, Gayowsky A, Lokker C, Tarride JE, Alarakhia M, Costa AP. The relationship between patient experience and real-world digital health access in primary care: A population-based cross-sectional study. PLoS One 2024; 19:e0299005. [PMID: 38713719 PMCID: PMC11075820 DOI: 10.1371/journal.pone.0299005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 02/04/2024] [Indexed: 05/09/2024] Open
Abstract
Implementing digital health technologies in primary care is anticipated to improve patient experience. We examined the relationships between patient experience and digital health access in primary care settings in Ontario, Canada. We conducted a retrospective cross-sectional study using patient responses to the Health Care Experience Survey linked to health and administrative data between April 2019-February 2020. We measured patient experience by summarizing HCES questions. We used multivariable logistic regression stratified by the number of primary care visits to investigate associations between patient experience with digital health access and moderating variables. Our cohort included 2,692 Ontario adults, of which 63.0% accessed telehealth, 2.6% viewed medical records online, and 3.6% booked appointments online. Although patients reported overwhelmingly positive experiences, we found no consistent relationship with digital health access. Online appointment booking access was associated with lower odds of poor experience for patients with three or more primary care visits in the past 12 months (adjusted odds ratio 0.16, 95% CI 0.02-0.56). Younger age, tight financial circumstances, English as a second language, and knowing their primary care provider for fewer years had greater odds of poor patient experience. In 2019/2020, we found limited uptake of digital health in primary care and no clear association between real-world digital health adoption and patient experience in Ontario. Our findings provide an essential context for ensuing rapid shifts in digital health adoption during the COVID-19 pandemic, serving as a baseline to reexamine subsequent improvements in patient experience.
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Affiliation(s)
- Zain Pasat
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Centre for Integrated Care, St. Joseph’s Health System, Hamilton, Ontario, Canada
| | - Chi-Ling Joanna Sinn
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Centre for Integrated Care, St. Joseph’s Health System, Hamilton, Ontario, Canada
| | - Bahram Rahman
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Anastasia Gayowsky
- ICES McMaster, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Cynthia Lokker
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Jean-Eric Tarride
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Programs for Assessment of Technology in Health (PATH), The Research Institute of St. Joe’s Hamilton, St. Joseph’s Healthcare, Hamilton, Ontario, Canada
| | - Mohamed Alarakhia
- Michael G. DeGroote School of Medicine, McMaster University, Waterloo Regional Campus, Kitchener, Ontario, Canada
- eHealth Centre of Excellence, Kitchener, Ontario, Canada
| | - Andrew P. Costa
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Centre for Integrated Care, St. Joseph’s Health System, Hamilton, Ontario, Canada
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Shih GY, Fan SC, Lin CH, Hung CH. The Text-Picture Integration Scale for Perspectives on Mental Illness: Development and Validation. Am J Occup Ther 2024; 78:7803205190. [PMID: 38625144 DOI: 10.5014/ajot.2024.050531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024] Open
Abstract
IMPORTANCE Understanding the root cause of mental illness stigma is necessary to adopt effective management strategies. OBJECTIVE To establish a stable and effective text-picture integration rating scale to predict public perspectives on mental illness and to examine its reliability and validity. DESIGN Descriptive cross-sectional study using internet survey data. SETTING Online. PARTICIPANTS Two hundred volunteers. RESULTS The 10-item the Text-Picture Integration Scale for Perspectives on Mental Illness was developed. The authors conducted data analysis using SPSS to evaluate the reliability and criterion-related validity of the Mental Health Literacy Scale (MHLS). The Text-Picture Integration Scale's item-level content validity index ranged from 0.83 to 1.00, and the scale-level content validity index was 0.97. The scale demonstrated acceptable reliability (Cronbach's α = .80). The mean value of individual items ranged from 3.18 to 4.48, and the mean total score was 39.44 (SD = 8.47). The Text-Picture Integration Scale exhibited satisfactory criterion-related validity with the MHLS (r = .76, p < .001). CONCLUSIONS AND RELEVANCE Preliminary analyses support that the Text-Picture Integration Scale is a stable and effective rating scale to determine public perspectives on mental illness and is appropriate for evaluating destigmatization efforts. Plain-Language Summary: The study findings support the use of the Text-Picture Integration Scale as a stable and effective rating scale to determine public perspectives on mental illness. The scale is also appropriate for evaluating ways to address the stigmas that people associate with mental illness, which pose challenges for people in recovery. Occupational therapists can leverage their understanding of public perspectives on mental illness when choosing interventions to support the overall well-being of their clients with mental illness.
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Affiliation(s)
- Guan-Yu Shih
- Guan-Yu Shih, BS, is Occupational Therapy Student, Department of Occupational Therapy, College of Medical Science and Technology, Chung Shan Medical University, Taichung City, Taiwan
| | - Shih-Chen Fan
- Shih-Chen Fan, PhD, is Associate Professor, Department of Occupational Therapy, College of Medical Science and Technology, Chung Shan Medical University, and Occupational Therapy Room, Chung Shan Medical University Hospital, Taichung City, Taiwan
| | - Chung-Hui Lin
- Chung-Hui Lin, MS, is Lecturer, Department of Occupational Therapy, College of Medical Science and Technology, Chung Shan Medical University, and Occupational Therapy Room, Chung Shan Medical University Hospital, Taichung City, Taiwan
| | - Chia-Hui Hung
- Chia-Hui Hung, PhD, is Associate Professor, Department of Occupational Therapy, College of Medical Science and Technology, Chung Shan Medical University, and Occupational Therapy Room, Chung Shan Medical University Hospital, Taichung City, Taiwan Taichung City, Taiwan;
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Frid S, Amat-Fernández C, Fuentes-Expósito MÁ, Muñoz-Mateu M, Valachis A, Sisó-Almirall A, Grau-Corral I. Mapping the Evidence on the Impact of mHealth Interventions on Patient-Reported Outcomes in Patients With Breast Cancer: A Systematic Review. JCO Clin Cancer Inform 2024; 8:e2400014. [PMID: 38710001 PMCID: PMC11161246 DOI: 10.1200/cci.24.00014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 03/01/2024] [Accepted: 03/13/2024] [Indexed: 05/08/2024] Open
Abstract
PURPOSE To comprehensively synthesize the existing evidence concerning mHealth interventions for patients with breast cancer (BC). DESIGN On July 30, 2023, we searched PubMed, PsycINFO, and Google Scholar for articles using the following inclusion criteria: evaluation of mHealth interventions in patients with cancer, at least 30 participants with BC, randomized control trials or prospective pre-post studies, determinants of health (patient-reported outcomes [PROs] and quality of life [QoL]) as primary outcomes, interventions lasting at least 8 weeks, publication after January 2015. Publications were excluded if they evaluated telehealth or used web-based software for desktop devices only. The quality of the included studies was analyzed with the Cochrane Collaboration Risk of Bias Tool and the Methodological Index for Non-Randomized Studies. RESULTS We included 30 studies (20 focused on BC), encompassing 5,691 patients with cancer (median 113, IQR, 135.5). Among these, 3,606 had BC (median 99, IQR, 75). All studies contained multiple interventions, including physical activity, tailored information for self-management of the disease, and symptom tracker. Interventions showed better results on self-efficacy (3/3), QoL (10/14), and physical activity (5/7). Lifestyle programs (3/3), expert consulting (4/4), and tailored information (10/11) yielded the best results. Apps with interactive support had a higher rate of positive findings, while interventions targeted to survivors showed worse results. mHealth tools were not available to the public in most of the studies (17/30). CONCLUSION mHealth interventions yielded heterogeneous results on different outcomes. Identifying lack of evidence on clinical scenarios (eg, patients undergoing systemic therapy other than chemotherapy) could aid in refining strategic planning for forthcoming research endeavors within this field.
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Affiliation(s)
- Santiago Frid
- Clinical Informatics Service, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Clara Amat-Fernández
- Health Services Research Group, Hospital del Mar Research Institute, Barcelona, Spain
| | | | | | - Antonis Valachis
- Department of Oncology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | | | - Immaculada Grau-Corral
- Fundación iSYS, Barcelona, Spain
- mHealth and digital Health Observatory, Hospital Clínic de Barcelona, Barcelona, Spain
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Cameron CD, Mounir NA, Abdulkareem ST, Gallant NL. Designing a virtual course for essential care partners (ECPs) in long-term care (LTC): a pre-implementation study. Aging Ment Health 2024; 28:771-790. [PMID: 38147407 DOI: 10.1080/13607863.2023.2297069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 12/11/2023] [Indexed: 12/28/2023]
Abstract
Objectives: We describe our co-design process aimed at supporting the reintegration of essential care partners into long-term care homes during the COVID-19 pandemic. Methods: More specifically, using a co-design process, we describe the pre-design, generative, and evaluative phases of developing a virtual infection prevention and control course for essential care partners at our partnering long-term care home. For the evaluative phase, we also provide an overview of our findings from interviews conducted with essential care partners on the expected barriers and facilitators associated with this virtual course. Results: Results from these interviews indicated that the virtual course was viewed as comprehensive, detailed, engaging, refreshing, and reliable, and that its successful implementation would require appropriate resources and support to ensure its sustainability and sustainment. Findings from this study provide guidance for the post-design phase of our co-design process. Conclusion: Our careful documentation of our co-design process also facilitates its replication for other technological interventions and in different healthcare settings. Limitations of the present study and implications for co-designing in the context of emergent public health emergencies are explored in the discussion.
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Affiliation(s)
| | - Nadine A Mounir
- Department of Psychology, University of Regina, Regina, Canada
| | | | - Natasha L Gallant
- Department of Psychology, University of Regina, Regina, Canada
- Centre on Aging and Health, University of Regina, Regina, Canada
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Petrie S, Cheng I, McMahon M, Lavis JN. Future leaders in a learning health system: Exploring the Health System Impact Fellowship. Healthc Manage Forum 2024; 37:151-155. [PMID: 38016119 PMCID: PMC11044521 DOI: 10.1177/08404704231216951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
The Canadian health system is reeling following the COVID-19 pandemic. Strains have become growing cracks, with long emergency department wait times, shortage of human health resources, and growing dissatisfaction from both clinicians and patients. To address long-needed health system reform in Canada, a modernization of training is required for the next generation health leaders. The Canadian Institutes of Health Research Health System Impact Fellowship (HSIF) is an example of a well-funded and connected training program which prioritizes embedded research and embedding technically trained scholars with health system partners. The program has been successful in the scope and impact of its training outcomes as well as providing health system partners with a pool of connected and capable scholars. Looking forward, integrating aspects of evidence synthesis from both domestic and international sources and adapting a general contractor approach to implementation within the HSIF could help catalyze learning health system reform in Canada.
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Affiliation(s)
- Samuel Petrie
- University Health Network, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Ivy Cheng
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Meghan McMahon
- University of Toronto, Toronto, Ontario, Canada
- CIHR Institute of Health Services and Policy Research, Ottawa, Ontario, Canada
| | - John N. Lavis
- McMaster University, Hamilton, Ontario, Canada
- McMaster Health Forum, Hamilton, Ontario, Canada
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Rickert M. [The concept of the Excellence Academy of the Convention of University Professorships for Orthopaedics and Trauma Surgery]. ORTHOPADIE (HEIDELBERG, GERMANY) 2024; 53:324-326. [PMID: 38573373 DOI: 10.1007/s00132-024-04494-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/06/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND The departure of young habilitated colleagues from their university careers reflects, on the one hand, a move away from university medicine per se and, on the other, an unwillingness to take on university management positions. In addition to the question of "How do I qualify for these positions?", the question of "Why should I aspire to such a position?" is increasingly taking centre stage when less expensive alternatives are available. In addition, there is uncertainty about the extent to which one's own achievements and qualities are sufficient to distinguish oneself clinically and scientifically in the course of one's career and thereby recommend oneself for management positions. AIMS This is where the KUOU's Excellence Academy comes in, with the aim of identifying young colleagues with high potential for university leadership positions at an early stage, encouraging them to get to know each other, and focusing the attention and visibility of the university locations and the associated appreciation on the members of the Academy. The focus here is on ensuring that excellent colleagues benefit from the many years of experience of the members of the KUOU, receive feedback on their clinical and scientific achievements and are supported in their university career in the form of mentoring. CONCLUSION The large number of 22 very good applications, of which 12 candidates were accepted, confirms our belief that there are excellently qualified colleagues at our sites, who are ready to take on responsibility in the future in the triad of research, teaching and patient care.
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Affiliation(s)
- Markus Rickert
- Klinik für Orthopädie und Orthopädische Chirurgie, Klinikstraße 33, 35392, Gießen, Deutschland.
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50
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Rathod S, Skórniewska Z, Engelthaler T, Fell B, Sajid S, Phiri P. Treatment resistant depression: A comparative study of access, pathways, and outcomes between Caucasian and ethnic minority individuals. J Affect Disord 2024; 352:357-365. [PMID: 38342322 DOI: 10.1016/j.jad.2024.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 02/13/2024]
Abstract
BACKGROUND Treatment resistant depression (TRD) is considered when an individual fails to respond to two or more different antidepressants in adequate doses, duration and with adequate adherence within the same major depressive episode. AIM To examine the clinical profiles of TRD patients through data from electronic healthcare records and compare characteristics and treatment pathways of ethnic minority and non-minority patients in UK. METHODS A retrospective, longitudinal, observational cohort study of patients with TRD was carried out in 10 Mental Health NHS Foundation Trusts in the Akrivia Health/UK Clinical Record Interactive Search (CRIS) system network. The CRIS system was used as a means of analysing de-identified data across 3.2 million anonymised patients' records. RESULTS 10,048 patient records were deemed eligible for this study, of which 20.2 % of patients identified as BAME, and 79.8 % patients identified as White. Overall, around half of the patients were likely to be prescribed an antidepressant within 2 months of the MDD diagnosis. White patients were prescribed more antidepressants than the BAME group (p < 0.001), with a significant effect size for comorbidities. LIMITATIONS The nature of the data source limited the ability to filter for short treatment durations as clinicians did not often record concrete medication end-dates in clinical note fields. CONCLUSION There are significant differences in care pathways between ethnic groups in relation to TRD patients. It is vital to understand factors causing these potential clinical biases and increase awareness and education to deliver the most effective treatments for TRD in ethnic minority patients.
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Affiliation(s)
- Shanaya Rathod
- Research and Innovation Department, Southern Health NHS Foundation Trust, Southampton SO30 3JB, UK.
| | | | - Tomas Engelthaler
- Akrivia Health, Clarendon House, Cornmarket Street, Oxford, OX1 3HJ, UK
| | - Benjamin Fell
- Akrivia Health, Clarendon House, Cornmarket Street, Oxford, OX1 3HJ, UK
| | - Sana Sajid
- Research and Innovation Department, Southern Health NHS Foundation Trust, Southampton SO30 3JB, UK
| | - Peter Phiri
- Research and Innovation Department, Southern Health NHS Foundation Trust, Southampton SO30 3JB, UK; School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, UK
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