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Islam MK, Kellett P. Provincial variations in not having a regular medical doctor and having unmet healthcare needs among Canadians. Int J Health Plann Manage 2022; 37:2090-2105. [PMID: 35246875 DOI: 10.1002/hpm.3451] [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: 11/12/2020] [Revised: 01/10/2022] [Accepted: 02/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite spending 11.0% of the total gross domestic product, the quality of healthcare services in Canada has received mixed reviews. We first separately examined provincial variations in not having a regular medical doctor and having unmet healthcare needs among Canadians. Second, we evaluated provincial variations in the impact of not having a regular medical doctor on having unmet healthcare needs among Canadians. METHODS We applied logistic regressions using data from the 2014 and 2017-2018 Canadian Community Health Surveys (CCHS). The total sample size for this study was 120,345 individuals aged 12 years and older: 61,240 from the 2014 CCHS and 59,105 from the 2017-2018 CCHS. RESULTS We found significant provincial variations in not having a regular medical doctor and having unmet healthcare needs among Canadians. People in Quebec and the Territories were more likely not to have a regular medical doctor than their peers in Alberta. People in Quebec and the Territories were also more likely to have unmet healthcare needs than their counterparts in Alberta. Not having a regular medical doctor impacted whether Canadians reported having unmet healthcare needs to varying degrees across provinces. CONCLUSION Findings from this study may contribute to designing province-specific policy interventions and inform efforts that seek to address barriers to having a regular medical doctor and reducing unmet healthcare needs among Canadians.
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Affiliation(s)
- Md Kamrul Islam
- The Prentice Institute for Global Population and Economy, University of Lethbridge, Lethbridge, Alberta, Canada
| | - Peter Kellett
- Faculty of Health Sciences, University of Lethbridge, Lethbridge, Alberta, Canada
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Hayes KN, Brown KA, Cheung AM, Kim SA, Juurlink DN, Cadarette SM. Comparative Fracture Risk During Osteoporosis Drug Holidays After Long-Term Risedronate Versus Alendronate Therapy : A Propensity Score-Matched Cohort Study. Ann Intern Med 2022; 175:335-343. [PMID: 35007149 DOI: 10.7326/m21-2512] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND An osteoporosis drug holiday is recommended for most patients after 3 to 5 years of therapy. Risedronate has a shorter half-life than alendronate, and thus the residual length of fracture protection may be shorter. OBJECTIVE To examine the comparative risks of drug holidays after long-term (≥3 years) risedronate versus alendronate therapy. DESIGN Population-based, matched, cohort study. SETTING Province-wide health care administrative databases providing comprehensive coverage to Ontario residents aged 65 years or older between November 2000 and March 2020. PATIENTS Persons aged 66 years or older who had long-term risedronate therapy and a drug holiday were matched 1:1 on propensity score to those who had long-term alendronate therapy and a drug holiday. MEASUREMENTS The primary outcome was hip fracture within 3 years after a 120-day ascertainment period. Secondary analyses included shorter follow-up and sex-specific estimates. Cox proportional hazards models were used to estimate hazard ratios (HRs) for fracture risk between groups. RESULTS A total of 25 077 propensity score-matched pairs were eligible (mean age, 81 years; 81% women). Hip fracture rates were higher among risedronate than alendronate drug holidays (12.4 and 10.6 events, respectively, per 1000 patient-years; HR, 1.18 [95% CI, 1.04 to 1.34]; 915 total hip fractures). The association was attenuated when any fracture was included as the outcome (HR, 1.07 [CI, 1.00 to 1.16]) and with shorter drug holidays (1 year: HR, 1.03 [CI, 0.85 to 1.24]; 2 years: HR, 1.14 [CI, 0.96 to 1.32]). LIMITATION Analyses were limited to health care administrative data (potential unmeasured confounding), and some secondary analyses contained few events. CONCLUSION Drug holidays after long-term therapy with risedronate were associated with a small increase in risk for hip fracture compared with alendronate drug holidays. Future research should examine how best to mitigate this risk. PRIMARY FUNDING SOURCE Canadian Institutes of Health Research.
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Affiliation(s)
- Kaleen N Hayes
- Brown University School of Public Health, Providence, Rhode Island, and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada (K.N.H.)
| | - Kevin A Brown
- Dalla Lana School of Public Health, University of Toronto, ICES, and Public Health Ontario, Toronto, Ontario, Canada (K.A.B.)
| | - Angela M Cheung
- Dalla Lana School of Public Health and Department of Medicine, University of Toronto, and University Health Network, Toronto, Ontario, Canada (A.M.C.)
| | - Sandra A Kim
- Department of Medicine, University of Toronto, and Centre for Osteoporosis & Bone Health, Women's College Hospital, Toronto, Ontario, Canada (S.A.K.)
| | - David N Juurlink
- Dalla Lana School of Public Health, University of Toronto, ICES, and Sunnybrook Research Institute, Toronto, Ontario, Canada (D.N.J.)
| | - Suzanne M Cadarette
- Dalla Lana School of Public Health and Leslie Dan Faculty of Pharmacy at the University of Toronto and ICES, Toronto, Ontario, Canada, and Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina (S.M.C.)
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103
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Eissa A, Rowe R, Pinto A, Okoli GN, Campbell KM, Washington JC, Rodríguez JE. Implementing High-Quality Primary Care Through a Health Equity Lens. Ann Fam Med 2022; 20:164-169. [PMID: 35165087 PMCID: PMC8959728 DOI: 10.1370/afm.2785] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 11/13/2021] [Accepted: 12/01/2021] [Indexed: 11/09/2022] Open
Abstract
The COVID-19 pandemic highlighted the importance of centering health equity in future health system and primary care reforms. Strengthening primary care will be needed to correct the longstanding history of mistreatment of First Nations/Indigenous and racialized people, exclusion of health care workers of color, and health care access and outcome inequities further magnified by the COVID-19 pandemic. The National Academies of Sciences, Engineering, and Medicine (NASEM) released a report on Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care, that provided a framework for defining high-quality primary care and proposed 5 recommendations for implementing that definition. Using the report's framework, we identified health equity challenges and opportunities with examples from primary care systems in the United States and Canada. We are poised to reinvigorate primary care because the recent pandemic and the attention to continued racialized police violence sparked renewed conversations and collaborations around equity, diversity, inclusion, and health equity that have been long overdue. The time to transition those conversations to actionable items to improve the health of patients, families, and communities is now.Appeared as Annals "Online First" article.
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Affiliation(s)
- Azza Eissa
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health, Toronto, Ontario, Canada
| | - Robyn Rowe
- ICES Central, Strategic Partnerships & Digital Services, Indigenous Data Team, Kingston, Ontario, Canada.,Health Data Research Network Canada, Indigenous Data Team, Vancouver, British Columbia, Canada
| | - Andrew Pinto
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health, Toronto, Ontario, Canada
| | - George N Okoli
- George and Fay Yee Centre for Healthcare Innovation, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kendall M Campbell
- Department of Family Medicine, University of Texas Medical Branch, Galveston, Texas
| | - Judy C Washington
- Atlantic Medical Group, Overlook Family Medicine Residency Program, Summit, New Jersey
| | - José E Rodríguez
- Department of Family and Preventive Medicine, University of Utah Health, Salt Lake City, Utah .,Office of Health Equity, Diversity & Inclusion, University of Utah Health, Salt Lake City, Utah
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104
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Lin S. COVID-19 Pandemic and Im/migrants' Elevated Health Concerns in Canada: Vaccine Hesitancy, Anticipated Stigma, and Risk Perception of Accessing Care. J Immigr Minor Health 2022; 24:896-908. [PMID: 35212825 PMCID: PMC8874751 DOI: 10.1007/s10903-022-01337-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2022] [Indexed: 01/10/2023]
Abstract
Vaccine hesitancy has taken a toll on COVID-19 immunization globally. This study aims to characterize three COVID-19-related health concerns (i.e., vaccine hesitancy, anticipated stigma, and risk perception) in Canada and how they differ based on im/migration status and other social determinants. Data were obtained from a nationwide probability sample of the Canadian Perspective Survey Series 3 (June 15 to 21, 2020). Multivariable binary logistic regression analysis was performed to investigate the association between each COVID-19 concern and nativity status, while controlling for socio-demographics. Of 3522 participants aged ≥ 25 years, the estimated overall prevalence of vaccine hesitancy was 16.9%, with im/migrants being greater than non-immigrants (21.5% vs. 15.5%, p < 0.001). After controlling for all covariates, im/migrants had around two-fold greater odds of all three health concerns, including risk perception of accessing care (aOR 2.44, 95% CI 1.89–3.15), anticipated stigma of being targeted (aOR 2.24, 95% CI 1.81, 2.78) and COVID-19 vaccine hesitancy (aOR 1.99, 95% CI 1.57–2.52), compared to their Canadian-born peers. Among vaccine-hesitant individuals (n = 596), im/migrants reported higher concerns, than non-immigrants, on vaccine safety (71.3% vs. 49.5%), side effects (66.4% vs 47.3%) and mistrust in vaccinations (12.5% vs 6.6%) as possible reasons of vaccine refusal. For migrant justice, health authorities should ensure equitable access to COVID-19 vaccines and other health-enhancing resources for im/migrants to mitigate their heightened fear, stigma, and mistrust of new vaccines amidst turbulent times.
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Affiliation(s)
- Shen Lin
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Toronto, ON, M5S 1V4, Canada.
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105
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Kuluski K, Cadel L, Marcinow M, Sandercock J, Guilcher SJT. Expanding our understanding of factors impacting delayed hospital discharge: Insights from patients, caregivers, providers and organizational leaders in Ontario, Canada. Health Policy 2022; 126:310-317. [DOI: 10.1016/j.healthpol.2022.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 02/01/2022] [Accepted: 02/07/2022] [Indexed: 11/24/2022]
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106
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Wong WWL, Wong J, Bremner KE, Saeed Y, Mason K, Phoon A, Feng Z, Feld JJ, Mitsakakis N, Powis J, Krahn M. Time Costs and Out-of-Pocket Costs in Patients With Chronic Hepatitis C in a Publicly Funded Health System. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:247-256. [PMID: 35094798 DOI: 10.1016/j.jval.2021.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/28/2021] [Accepted: 08/18/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Chronic hepatitis C (CHC) infection affects more than 70 million people worldwide and imposes considerable health and economic burdens on patients and society. This study estimated 2 understudied components of the economic burden, patient out-of-pocket (OOP) costs and time costs, in patients with CHC in a tertiary hospital clinic setting and a community clinic setting. METHODS This was a multicenter, cross-sectional study with hospital-based (n = 174) and community-based (n = 101) cohorts. We used a standardized instrument to collect healthcare resource use, time, and OOP costs. OOP costs included patient-borne costs for medical services, nonprescription drugs, and nonmedical expenses related to healthcare visits. Patient and caregiver time costs were estimated using an hourly wage value derived from patient-reported employment income and, where missing, derived from the Canadian census. Sensitivity analysis explored alternative methods of valuing time. Costs were reported in 2020 Canadian dollars. RESULTS The mean 3-month OOP cost was $55 (95% confidence interval [CI] $21-$89) and $299 (95% CI $170-$427) for the community and hospital cohorts, respectively. The mean 3-month patient time cost was $743 (95% CI $485-$1002) (community) and $465 (95% CI $248-$682) (hospital). The mean 3-month caregiver time cost was $31 (95% CI $0-$63) (community) and $277 (95% CI $174-$380) (hospital). Patients with decompensated cirrhosis bore the highest costs. CONCLUSIONS OOP costs and patient and caregiver time costs represent a considerable economic burden to patient with CHC, equivalent to 14% and 21% of the reported total 3-month income for the hospital-based and community-based cohorts, respectively.
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Affiliation(s)
- William W L Wong
- School of Pharmacy, University of Waterloo, Kitchener, Ontario, Canada; Toronto Health Economics and Technology Assessment Collaborative, University Health Network, Toronto, Ontario, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.
| | - Josephine Wong
- Toronto Health Economics and Technology Assessment Collaborative, University Health Network, Toronto, Ontario, Canada
| | - Karen E Bremner
- Toronto Health Economics and Technology Assessment Collaborative, University Health Network, Toronto, Ontario, Canada
| | - Yasmin Saeed
- Toronto Health Economics and Technology Assessment Collaborative, University Health Network, Toronto, Ontario, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Kate Mason
- Toronto Community Hepatitis C Program, Toronto, Ontario, Canada
| | - Arcturus Phoon
- Toronto Health Economics and Technology Assessment Collaborative, University Health Network, Toronto, Ontario, Canada
| | - Zeny Feng
- Department of Mathematics and Statistics, University of Guelph, Guelph, Ontario, Canada
| | - Jordan J Feld
- Toronto Centre for Liver Disease, University Health Network, Toronto, Ontario, Canada
| | - Nicholas Mitsakakis
- Toronto Health Economics and Technology Assessment Collaborative, University Health Network, Toronto, Ontario, Canada
| | - Jeff Powis
- Michael Garron Hospital, Toronto, Ontario, Canada
| | - Murray Krahn
- Toronto Health Economics and Technology Assessment Collaborative, University Health Network, Toronto, Ontario, Canada
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107
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St-Louis J, Chowdary P, Dolan G, Goodyear D, Strike K, Pollard D, Teitel J. Multidisciplinary Team Care of Patients with Hemophilic Arthropathy: A Qualitative Assessment of Contemporary Practice in the UK and Canada. Clin Appl Thromb Hemost 2022; 28:10760296211070002. [PMID: 35060765 PMCID: PMC8796082 DOI: 10.1177/10760296211070002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
We used a structured interview to explore approaches to comprehensive hemophilia and arthropathy care among 24 healthcare professionals (HCPs) from multidisciplinary teams (MDTs) in Canada and the UK. Represented MDTs typically comprise a hematologist, nurse, physiotherapist, and sometimes an orthopedic surgeon; pediatric (and some adult) MDTs also include a social worker/psychologist. HCPs emphasized the centrality of a team approach, facilitated through MDT meetings and involvement of all MDT members in patient care. In both countries, nurses and physiotherapists play critical, multifaceted roles. Respondents agreed that MDTs are crucial for successful transitioning, which can be facilitated by close collaboration between pediatric and adult MDTs, even when they are not co-located. Physiotherapists are instrumental in providing non-pharmacological pain relief. Hematologists or physiotherapists typically make orthopedic referrals, with the nurse, physiotherapist and hematologist working together in patient preparation for (and follow-up after) surgery. MDT best practices include a non-hierarchical team approach, ensuring that all MDT members know all patients, and regular MDT meetings. Together, these real-life insights from the MDT perspective emphasize the value of the MDT approach in comprehensive hemophilia care.
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Affiliation(s)
| | | | - Gerry Dolan
- Guy's and St Thomas’ NHS Foundation Trust, London, UK
| | | | - Karen Strike
- Hamilton Niagara Regional Hemophilia Treatment Centre, McMaster Children's Hospital, McMaster University, Hamilton, Canada
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108
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Iyer SN, Malla A, Pope M, Mustafa S, Mohan G, Rangaswamy T, Schmitz N, Joober R, Shah J, Margolese HC, Ramachandran P. Whose responsibility? Part 2 of 2: views of patients, families, and clinicians about responsibilities for addressing the needs of persons with mental health problems in Chennai, India and Montreal, Canada. Int J Ment Health Syst 2022; 16:2. [PMID: 35000588 PMCID: PMC8744303 DOI: 10.1186/s13033-021-00511-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 12/09/2021] [Indexed: 11/15/2022] Open
Abstract
Background Individuals with mental health problems have many insufficiently met support needs. Across sociocultural contexts, various parties (e.g., governments, families, persons with mental health problems) assume responsibility for meeting these needs. However, key stakeholders' opinions of the relative responsibilities of these parties for meeting support needs remain largely unexplored. This is a critical knowledge gap, as these perceptions may influence policy and caregiving decisions. Methods Patients with first-episode psychosis (n = 250), their family members (n = 228), and clinicians (n = 50) at two early intervention services in Chennai, India and Montreal, Canada were asked how much responsibility they thought the government versus persons with mental health problems; the government versus families; and families versus persons with mental health problems should bear for meeting seven support needs of persons with mental health problems (e.g., housing; help covering costs of substance use treatment; etc.). Two-way analyses of variance were conducted to examine differences in ratings of responsibility between sites (Chennai, Montreal); raters (patients, families, clinicians); and support needs. Results Across sites and raters, governments were held most responsible for meeting each support need and all needs together. Montreal raters assigned more responsibility to the government than did Chennai raters. Compared to those in Montreal, Chennai raters assigned more responsibility to families versus persons with mental health problems, except for the costs of substance use treatment. Family raters across sites assigned more responsibility to governments than did patient raters, and more responsibility to families versus persons with mental health problems than did patient and clinician raters. At both sites, governments were assigned less responsibility for addressing housing- and school/work reintegration-related needs compared to other needs. In Chennai, the government was seen as most responsible for stigma reduction and least for covering substance use services. Conclusions All stakeholders thought that governments should have substantial responsibility for meeting the needs of individuals with mental health problems, reinforcing calls for greater government investment in mental healthcare across contexts. The greater perceived responsibility of the government in Montreal and of families in Chennai may both reflect and influence differences in cultural norms and healthcare systems in India and Canada. Supplementary Information The online version contains supplementary material available at 10.1186/s13033-021-00511-w.
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Affiliation(s)
- Srividya N Iyer
- Department of Psychiatry, McGill University, Montreal, Canada. .,Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Canada.
| | - Ashok Malla
- Department of Psychiatry, McGill University, Montreal, Canada.,Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Canada
| | - Megan Pope
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Canada
| | - Sally Mustafa
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Canada
| | - Greeshma Mohan
- Schizophrenia Research Foundation (SCARF), Chennai, India
| | | | - Norbert Schmitz
- Department of Psychiatry, McGill University, Montreal, Canada.,Department of Population-Based Medicine, Institute of Health Sciences, University Hospital Tuebingen, Tuebingen, Germany
| | - Ridha Joober
- Department of Psychiatry, McGill University, Montreal, Canada.,Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Canada
| | - Jai Shah
- Department of Psychiatry, McGill University, Montreal, Canada.,Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Canada
| | - Howard C Margolese
- Department of Psychiatry, McGill University, Montreal, Canada.,Prevention and Early Intervention Program for Psychosis, McGill University Health Centre (PEPP-MUHC), Montreal, Canada
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Rey-Aldana D, Mazón-Ramos P, Portela-Romero M, Cinza-Sanjurjo S, Alvarez-Alvarez B, Agra-Bermejo R, Rigueiro-Veloso P, Espasandín-Domínguez J, Gude-Sampedro F, González-Juanatey JR. Longer-Term Results of a Universal Electronic Consultation Program at the Cardiology Department of a Galician Healthcare Area. Circ Cardiovasc Qual Outcomes 2022; 15:e008130. [PMID: 35041483 DOI: 10.1161/circoutcomes.121.008130] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Telemedicine models play a key role in organizing the growing demand for care and healthcare accessibility, but there are no described longer-term results in health care. Our objective is to assess the longer-term results (delay time in care, accessibility, and hospital admissions) of an electronic consultation (e-consultation) outpatient care program. METHODS Epidemiological and clinical data were obtained from the 41 258 patients referred by primary care to the cardiology department from January 1, 2010, to December 31, 2019. Until 2012, all patients were attended in an in-person consultation (2010-2012). In 2013, we instituted an e-consultation program (2013-2019) for all primary care referrals to cardiologists that preceded patients' in-person consultations when considered. We used an interrupted time series regression approach to investigate the impact of the e-consultation on (1) delay time (days) in care and (2) hospital admissions. We also analyzed (3) total number and referral rate (population-adjusted referred rate) in both periods (in-person consultation and e-consultation), and (4) the accessibility was measured as number of consultations and variation according to distance from municipality and reference hospital. RESULTS During the e-consultation, the demand increased (7.2±2.4% versus 10.1±4.8% per 1000 inhabitants, P<0.001), and referrals from different areas were equalized. The reduction in delay to consultation during the in-person consultation (-0.96 [95% CI, -0.951 to -0.966], P<0.001) was maintained with e-consultations (-0.064 [95% CI, 0.043-0.085], P<0.001). After the implementation of e-consultation, we observed that the increasing of hospital admission observed in the in-person consultation (incidence rate ratio, 1.011 [95% CI, 1.003-1.018]), was stabilized (incidence rate ratio, 1.000 [95% CI, 0.985-1.015]; P=0.874). CONCLUSIONS Implementing e-consultations in the outpatient management model may improve accessibility of care for patients furthest from the referral hospital. After e-consultations were implemented, the upward trend of hospital admissions observed during the in-person consultation period was stabilized with a slight downward trend.
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Affiliation(s)
- Daniel Rey-Aldana
- CS A Estrada, Área Sanitaria Integrada Santiago de Compostela, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Spain (D.R.-A.)
| | - Pilar Mazón-Ramos
- Servicio de Cardiología, Complejo Hospitalario Universitario de Santiago de Compostela (IDIS), CIBERCV, Spain (P.M.-R., B.A.-A., R.A.-B., P.R.-V, J.R.G.-J.)
| | - Manuel Portela-Romero
- CS Concepción Arenal, Área Sanitaria de Santiago de Compostela, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), CIBERCV, Spain (M.P.-R.)
| | - Sergio Cinza-Sanjurjo
- CS Porto do Son, Área Sanitaria Integrada Santiago de Compostela (IDIS), CIBERCV, Spain (S.C.-S.)
| | - Belen Alvarez-Alvarez
- Servicio de Cardiología, Complejo Hospitalario Universitario de Santiago de Compostela (IDIS), CIBERCV, Spain (P.M.-R., B.A.-A., R.A.-B., P.R.-V, J.R.G.-J.)
| | - Rosa Agra-Bermejo
- Servicio de Cardiología, Complejo Hospitalario Universitario de Santiago de Compostela (IDIS), CIBERCV, Spain (P.M.-R., B.A.-A., R.A.-B., P.R.-V, J.R.G.-J.)
| | - Pedro Rigueiro-Veloso
- Servicio de Cardiología, Complejo Hospitalario Universitario de Santiago de Compostela (IDIS), CIBERCV, Spain (P.M.-R., B.A.-A., R.A.-B., P.R.-V, J.R.G.-J.)
| | - Jenifer Espasandín-Domínguez
- Unidad de Epidemiología Clínica, Complejo Hospitalario Universitario de Santiago de Compostela, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Spain (J.E.-D.)
| | - Francisco Gude-Sampedro
- Unidad de Epidemiología Clínica. Complejo Hospitalario Universitario de Santiago de Compostela, IDIS, redIAPP, Spain (F.G.-S.)
| | - José R González-Juanatey
- Servicio de Cardiología, Complejo Hospitalario Universitario de Santiago de Compostela (IDIS), CIBERCV, Spain (P.M.-R., B.A.-A., R.A.-B., P.R.-V, J.R.G.-J.)
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Sullivan-Taylor P, Suter E, Laxton S, Oelke ND, Park E. Integrated People-Centred Care in Canada - Policies, Standards, and Implementation Tools to Improve Outcomes. Int J Integr Care 2022; 22:8. [PMID: 35136389 PMCID: PMC8815438 DOI: 10.5334/ijic.5943] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 01/27/2022] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Despite the national and international policy commitment to implement integrated health systems, there is an absence of national standards that support evidence-based design, implementation, and monitoring for improvement. Health Standards Organization (HSO)'s CAN/HSO 76000:2021 - Integrated People-Centred Health Systems (IPCHS) National Standard of Canada (NSC) has been developed to help close this gap. This manuscript outlines the policy context and the process taken to develop the IPCHS standard. DESCRIPTION The IPCHS standard is built around 10 design principles with detailed, action-oriented criteria and guidance for policy makers and health system partners. The IPCHS standard was co-designed with a technical committee that included balanced representation of policy makers, health system decision-makers, Indigenous leaders, providers, patients, caregivers, and academics. Additional feedback was received from a diverse audience during two public review periods and targeted consultation via interviews. This qualitative feedback, combined with the evidence reviews completed by the technical committee, informed the final content of the IPCHS standard. DISCUSSION The IPCHS standard was developed through a co-design process and complements existing frameworks by providing 66 detailed, action-oriented criteria, with specific guidance. The co-design process and consultations resulted in increased awareness and capacity among policy makers and health system partners. Supplementary tools are also in development to facilitate implementation and monitoring of progress and outcomes. This manuscript was developed in collaboration with technical committee members and HSO staff who led the targeted consultation and adoption of the IPCHS standard in six integrated care networks. CONCLUSION Implementing integration strategies requires that we create and sustain a culture of continuous improvement and learning. Key lessons from the development process focused on the importance of co-design, embedding people-centred practices throughout the standard, formal yet iterative methodology inclusive of broad consultation, clear accountability for both policy makers and system partners, tools that support action and can be adapted to local context and level of integrated system maturity.
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Affiliation(s)
| | - Esther Suter
- Faculty of Social Work, University of Calgary, Canada
| | | | - Nelly D. Oelke
- School of Nursing, University of British Columbia, and Scientific Director, Rural Coordination Centre of British Columbia, Adjunct Faculty, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Canada
| | - Emma Park
- Health Standards Organization (HSO), Canada
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111
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Oberoi S, Lambert P, Gupta AA, Deyell RJ, Sung L, Cuvelier GDE. Diagnostic and treatment intervals are not associated with survival in rhabdomyosarcoma: A Cancer in Young People in Canada study. Pediatr Blood Cancer 2022; 69:e29306. [PMID: 34455698 DOI: 10.1002/pbc.29306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 07/21/2021] [Accepted: 08/05/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Delay in diagnosis and treatment initiation can be associated with adverse outcomes in children with cancer. Diagnostic interval (DI) is defined as the time between the date of first health care contact for symptoms related to cancer to the date of cancer diagnosis, and treatment interval (TI) is defined as interval between the definitive cancer diagnosis and cancer treatment initiation. We aimed to determine the predictors of DI and TI in children with rhabdomyosarcoma (RMS) and their association with event-free survival (EFS) and overall survival (OS). METHODS Using the Cancer in Young People in Canada (CYP-C) national population-based database, we conducted a retrospective cohort study of children (0-14.99 years) newly diagnosed with RMS between 2001 and 2015 in Canada. Quantile regression was used to assess the predictors of DI and TI, and Cox regression was used to determine if these intervals were associated with EFS and OS. RESULTS Median DI and TI were 16.5 days (interquartile range [IQR] 6.0-38.0) and 5 days (IQR 0-12), respectively. DI and TI were not significantly associated with age at diagnosis, sex, race, tumor site, stage or histology, treatment region, distance from treatment center, income quintile or diagnosis year (all p > .05). DI and TI were not associated with EFS (DI: hazard ratio [HR] 1.00, 95% CI 0.96-1.05, p = .871; TI: HR 1.03, 95% CI 1.00-1.05, p = .053) or OS (DI: HR 0.99, 95% CI 0.94-1.05, p = .797; TI: HR 1.02, 95% CI 0.99-1.05, p = .155). CONCLUSIONS In the publicly funded Canadian health care system, DI and TI did not affect the survival of children with RMS.
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Affiliation(s)
- Sapna Oberoi
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Pediatric Hematology/Oncology/BMT, CancerCare Manitoba, Winnipeg, Manitoba, Canada.,CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Pascal Lambert
- CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, Manitoba, Canada.,Department of Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Abha A Gupta
- Division of Hematology/Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Rebecca J Deyell
- Division of Hematology/Oncology/BMT, British Columbia Children's Hospital and Research Institute, Vancouver, British Columbia, Canada.,Department of Pediatrics, British Columbia Children's Hospital, Vancouver, British Columbia, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lillian Sung
- Division of Hematology/Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Geoffrey D E Cuvelier
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Pediatric Hematology/Oncology/BMT, CancerCare Manitoba, Winnipeg, Manitoba, Canada.,CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, Manitoba, Canada
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112
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Salunkhe G, Böge K, Wilker T, Zieger A, Jena S, Mungee A, Ta TMT, Bajbouj M, Schomerus G, Hahn E. Perceived Course of Illness on the Desire for Social Distance From People Suffering From Symptoms of Schizophrenia in India. Front Psychiatry 2022; 13:891409. [PMID: 35722581 PMCID: PMC9204028 DOI: 10.3389/fpsyt.2022.891409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/03/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Stigmatization of people with schizophrenia remains a highly relevant topic worldwide, particularly in low- and middle-income countries like India. It is crucial to identify the determinants of the desire for social distance as a proxy for discriminatory behavior in a socio-cultural context to indicate ways to reduce stigma. This study aims to explore whether the public perception of the perceived course of an illness concerning people with symptoms of schizophrenia has an impact on the desire for social distance. SUBJECTS AND METHODS Data collection took place in five cities in India. The sample (N = 447) was stratified for gender, age, and religion. Desire for social distance was sampled based on a self-reported questionnaire using unlabelled vignettes for schizophrenia. First, factor analysis was conducted to identify the main factors underlying the perception of the perceived course of the illness. Subsequently, a regression analysis was conducted to examine the impact of the perception of those prognostic factors on the desire for social distance. RESULTS Factor analysis revealed two independent factors of the perceived course of an illness: (1) life-long dependency on others and loss of social integration and functioning and (2) positive expectations toward treatment outcome. This second factor was significantly associated with a less desire for social distance toward persons with schizophrenia. CONCLUSION The desire for social distance toward people with schizophrenia reduces with the expectation of positive treatment outcomes which underlines the need to raise public mental health awareness and provide psychoeducation for affected people and their family members in India. Help-seeking behaviors can be promoted by directing those needing treatment toward locally available, affordable and credible community-based services rather than facility-based care. Strikingly, lifelong dependency and the inability to socially integrate do not increase the desire for social distance, reflecting the Indian nation's socio-relational values and insufficiency of public mental health services. This indicates the suitability of systemic therapy approaches in public mental healthcare services to support the family's involvement and family-based interventions in caregiving for mentally ill people across the lifespan.
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Affiliation(s)
- Gayatri Salunkhe
- Centre of Medicine and Society, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Kerem Böge
- Department of Psychiatry and Neurosciences, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Tanja Wilker
- Department of Psychiatry and Neurosciences, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Aron Zieger
- Department of Psychiatry and Neurosciences, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Sunita Jena
- Public Health Department, Asian Institute of Public Health, Utkal University, Bhubhaneshwar, India
| | - Aditya Mungee
- Department of Psychiatry and Neurosciences, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Thi Minh Tam Ta
- Department of Psychiatry and Neurosciences, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Malek Bajbouj
- Department of Psychiatry and Neurosciences, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Georg Schomerus
- Department of Psychiatry, Universitätsklinikum Leipzig, University of Leipzig, Leipzig, Germany
| | - Eric Hahn
- Department of Psychiatry and Neurosciences, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
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113
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Odhiambo AJ, Forman L, Nelson LE, O'Campo P, Grace D. Unmasking legislative constraints: An institutional ethnography of linkage and engagement in HIV healthcare for African, Caribbean, and Black people in Ontario, Canada. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000714. [PMID: 36962554 PMCID: PMC10021522 DOI: 10.1371/journal.pgph.0000714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 07/26/2022] [Indexed: 11/19/2022]
Abstract
The Human Immunodeficiency Virus (HIV) epidemic significantly impacts African, Caribbean, and Black (ACB) immigrants in Canada. Health scholarship has revealed striking injustices within Canada's public healthcare system that restrict access to healthcare and violate the human rights of ACB immigrants living with HIV who are marginalized. We conducted an institutional ethnography to comprehensively understand how HIV healthcare in Ontario is organized and experienced by ACB immigrants, focusing on unjust and discriminatory legislative frameworks and institutional practices regulating access to publicly funded healthcare resources and services. We interviewed 20 ACB immigrants and 15 healthcare workers, including specialists, primary care providers, immigration physicians, and social workers. We found a disjuncture between the organization of HIV healthcare in Ontario and how ACB immigrants experienced access to care. We uncovered how immigration, public health and healthcare laws and related institutional practices intersect to produce structural violence which create barriers and missed opportunities to timely linkage and engagement in HIV healthcare. Black immigrants' accounts revealed that they underwent mandatory HIV under the Immigration Medical Examination policy (IME) without providing informed consent and receiving pre and post-test counselling. Furthermore, Black immigrants did not receive referrals and were not adequately linked to care following HIV diagnosis. Troubling encounters with immigration and public health state agents and healthcare legislative barriers including difficulty finding a physician, the 3-month waiting period under the Ontario Health Insurance Plan (OHIP), long wait times, lack of drug coverage, and stigma, discrimination, and anti-Black racism shaped and affected Black people's linkage and engagement in HIV care. We elucidate how the legislative and structural organization of healthcare regulated and constrained health service access for ACB immigrants living with HIV, including their ability to "achieve" HIV undetectability.
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Affiliation(s)
- Apondi J Odhiambo
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Lisa Forman
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - LaRon E Nelson
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Yale School of Nursing, New Haven, Connecticut, United States of America
- St, Michael's Hospital, Li Ka Shing Knowledge Institute, Toronto, Canada
| | - Patricia O'Campo
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- St, Michael's Hospital, Li Ka Shing Knowledge Institute, Toronto, Canada
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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114
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Kiran T, Moineddin R, Kopp A, Glazier RH. Impact of Team-Based Care on Emergency Department Use. Ann Fam Med 2022; 20:24-31. [PMID: 35074764 PMCID: PMC8786428 DOI: 10.1370/afm.2728] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 05/17/2021] [Accepted: 05/26/2021] [Indexed: 11/09/2022] Open
Abstract
PURPOSE We sought to assess the impact of team-based care on emergency department (ED) use in the context of physicians transitioning from fee-for-service payment to capitation payment in Ontario, Canada. METHODS We conducted an interrupted time series analysis to assess annual ED visit rates before and after transition from an enhanced fee-for-service model to either a team capitation model or a nonteam capitation model. We included Ontario residents aged 19 years and older who had at least 3 years of outcome data both pretransition and post-transition (N = 2,524,124). We adjusted for age, sex, income quintile, immigration status, comorbidity, and morbidity, and we stratified by rurality. A sensitivity analysis compared outcomes for team vs nonteam patients matched on year of transition, age, sex, rurality, and health region. RESULTS We compared 387,607 team and 1,399,103 nonteam patients in big cities, 213,394 team and 380,009 nonteam patients in small towns, and 65,289 team and 78,722 nonteam patients in rural areas. In big cities, after adjustment, the ED visit rate increased by 2.4% (95% CI, 2.2% to 2.6%) per year for team patients and 5.2% (95% CI, 5.1% to 5.3%) per year for nonteam patients in the years after transition (P <.001). Similarly, there was a slower increase in ED visits for team relative to nonteam patients in small towns (0.9% [95% CI, 0.7% to 1.1%] vs 2.9% [95% CI, 2.8% to 3.1%], P <.001) and rural areas (‒0.5% [95% CI, -0.8% to 0.2%] vs 1.3% [95% CI, 1.0% to 1.6%], P <.001). Results were much the same in the matched analysis. CONCLUSIONS Adoption of team-based primary care may reduce ED use. Further research is needed to understand optimal team composition and roles.
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Affiliation(s)
- Tara Kiran
- Department of Family and Community Medicine and the MAP Centre for Urban Health Solutions, St Michael's Hospital, Toronto, Ontario, Canada.,Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Rahim Moineddin
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | | | - Richard H Glazier
- Department of Family and Community Medicine and the MAP Centre for Urban Health Solutions, St Michael's Hospital, Toronto, Ontario, Canada.,Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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115
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Gaudet K, Couture M, Ducharme F, Saïas T. Caregiver Emotions When Choosing A Living Environment for A Person with Dementia: A Qualitative Study on Social Workers' Perspectives. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2022; 65:78-96. [PMID: 34080529 DOI: 10.1080/01634372.2021.1936330] [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: 10/01/2020] [Revised: 05/25/2021] [Accepted: 05/25/2021] [Indexed: 06/12/2023]
Abstract
Social workers often address the emotional needs of family caregivers, which are particularly salient during the decision-making process regarding the choice of a living environment for a relative with dementia. In most home care settings, an assessment of caregivers' needs is not part of routine practices. This study aims to describe the intervention strategies adopted by social workers in relation to caregivers' emotions during their decision-making process. A qualitative research design was adopted. Seven social workers were recruited from three health and community service facilities in Montreal, Canada. One group and three individual semi-structured interviews were conducted. Data was analyzed using Miles, Huberman and Saldaña's method (2013). Seven intervention strategies were identified: investigating emotions, acknowledging emotions, encouraging caregivers to carry on their role, focusing on the rational aspects of the decision, mitigating prejudices against nursing homes, mediating family dynamics and acting upon families' needs. Some of these strategies are aimed at social workers meeting the demands of their jobs whilst others are centered around soothing caregiver emotions. These results can inform support services and future interventions by grounding them in the realities of service providers.
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Affiliation(s)
- K Gaudet
- Department of Psychology, Université De Montréal, Montréal, Canada
| | - M Couture
- Department of Psychology, Université De Sherbrooke, Sherbrooke, Canada
- Integrated Health and Social Services University Network for West-Central Montreal, Centre for Research and Expertise in Social Gerontology (CREGÉS), Montréal, Canada
| | - F Ducharme
- Faculty of Nursing, Université De Montréal, Montréal, Canada
- Montreal Geriatrics University Institute Research Center, Montréal, Canada
| | - T Saïas
- Department of Psychology,Université du Québec à Montréal, Canada
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116
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Petrie S, Carson D, Peters P, Hurtig AK, LeBlanc M, Simpson H, Barnabe J, Young M, Ostafichuk M, Hodge H, Gladman J, Smale M, Gonzalez Garcia M. What a Pandemic Has Taught Us About the Potential for Innovation in Rural Health: Commencing an Ethnography in Canada, the United States, Sweden, and Australia. Front Public Health 2021; 9:768624. [PMID: 34950628 PMCID: PMC8688687 DOI: 10.3389/fpubh.2021.768624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/28/2021] [Indexed: 12/03/2022] Open
Abstract
The COVID-19 pandemic coincided with a multi-national federally funded research project examining the potential for health and care services in small rural areas to identify and implement innovations in service delivery. The project has a strong focus on electronic health (eHealth) but covers other areas of innovation as well. The project has been designed as an ethnography to prelude a realist evaluation, asking the question under what conditions can local health and care services take responsibility for designing and implementing new service models that meet local needs? The project had already engaged with several health care practitioners and research students based in Canada, Sweden, Australia, and the United States. Our attention is particularly on rural communities with fewer than 5,000 residents and which are relatively isolated from larger service centres. Between March and September 2020, the project team undertook ethnographic and auto-ethnographic research in their own communities to investigate what the service model responses to the pandemic were, and the extent to which local service managers were able to customize their responses to suit the needs of their communities. An initial program theory drawn from the extant literature suggested that “successful” response to the pandemic would depend on a level of local autonomy, “absorptive capacity,*” strong service-community connections, an “anti-fragile†” approach to implementing change, and a realistic recognition of the historical barriers to implementing eHealth and other innovations in these types of rural communities. The field research in 2020 has refined the theory by focusing even more attention on absorptive capacity and community connections, and by suggesting that some level of ignorance of the barriers to innovation may be beneficial. The research also emphasized the role and power of external actors to the community which had not been well-explored in the literature. This paper will summarize both what the field research revealed about the capacity to respond well to the COVID-19 challenge and highlight the gaps in innovative strategies at a managerial level required for rapid response to system stress. *Absorptive Capacity is defined as the ability of an organization (community, clinic, hospital) to adapt to change. Organizations with flexible capacity can incorporate change in a productive fashion, while those with rigid capacity take longer to adapt, and may do so inappropriately. †Antifragility is defined as an entities' ability to gain stability through stress. Biological examples include building muscle through consistent use, and bones becoming stronger through subtle stress. Antifragility has been used as a guiding principle in programme implementation in the past.
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Affiliation(s)
- Samuel Petrie
- Spatial Determinants of Health Laboratory, Department of Health Sciences, Carleton University, Ottawa, ON, Canada
| | - Dean Carson
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Paul Peters
- Spatial Determinants of Health Laboratory, Department of Health Sciences, Carleton University, Ottawa, ON, Canada
| | - Anna-Karin Hurtig
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Michele LeBlanc
- Spatial Determinants of Health Laboratory, Department of Health Sciences, Carleton University, Ottawa, ON, Canada
| | - Holly Simpson
- Spatial Determinants of Health Laboratory, Department of Health Sciences, Carleton University, Ottawa, ON, Canada
| | - Jaymie Barnabe
- Spatial Determinants of Health Laboratory, Department of Health Sciences, Carleton University, Ottawa, ON, Canada
| | - Mikayla Young
- Spatial Determinants of Health Laboratory, Department of Health Sciences, Carleton University, Ottawa, ON, Canada
| | - Mara Ostafichuk
- Spatial Determinants of Health Laboratory, Department of Health Sciences, Carleton University, Ottawa, ON, Canada
| | - Heidi Hodge
- School of Business and Law, Central Queensland University, Rockhampton, QLD, Australia
| | - Justin Gladman
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Matilda Smale
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
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117
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Lee SK, Mahl SK, Rowe BH. The Induced Productivity Decline Hypothesis: More Physicians, Higher Compensation and Fewer Services. Healthc Policy 2021; 17:90-104. [PMID: 34895412 PMCID: PMC8665726 DOI: 10.12927/hcpol.2021.26655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Public outrage regarding physician shortages during the past two decades have led to policies aimed at significantly increasing physician supply, yet access remains elusive. In this paper, we examine this puzzling trend and the causes underlying it by analyzing physician supply, compensation and productivity and the reasons behind productivity decline. We hypothesize that excess physician compensation beyond a target income induces productivity decline. In contrast to a wage–productivity gap for the average Canadian worker (where productivity has increased but compensation has not kept pace), physicians are experiencing a “reverse wage–productivity gap” whereby compensation is increasing but productivity is decreasing, resulting in more physicians, higher compensation and fewer services. We conclude by discussing potential policy options to address how best to provide timely access to medical care for Canadians while keeping physician healthcare expenditures at sustainable levels.
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Affiliation(s)
- Shoo K Lee
- Professor of Paediatrics, Obstetrics & Gynecology, and Public Health, University of Toronto; Director, Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, ON
| | - Sukhy K Mahl
- Assistant Director, Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, ON
| | - Brian H Rowe
- Professor, Department of Emergency Medicine and School of Public Health, University of Alberta, Edmonton, AB
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118
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Lal S, Gleeson JF, D'Alfonso S, Etienne G, Joober R, Lepage M, Lee H, Alvarez-Jimenez M. A Digital Health Innovation to Prevent Relapse and Support Recovery in Youth Receiving Specialized Services for First-Episode Psychosis: Protocol for a Pilot Pre-Post, Mixed Methods Study of Horyzons-Canada (Phase 2). JMIR Res Protoc 2021; 10:e28141. [PMID: 34879000 PMCID: PMC8693205 DOI: 10.2196/28141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 08/18/2021] [Accepted: 09/07/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Psychotic disorders are among the most disabling of all mental disorders. The first-episode psychosis (FEP) often occurs during adolescence or young adulthood. Young people experiencing FEP often face multiple barriers in accessing a comprehensive range of psychosocial services, which have predominantly been delivered in person. New models of service delivery that are accessible, sustainable, and engaging are needed to support recovery in youth diagnosed with FEP. OBJECTIVE In this paper, we describe a protocol to implement and evaluate the acceptability, safety, and potential efficacy of an online psychosocial therapeutic intervention designed to sustain recovery and prevent relapses in young adults diagnosed with FEP. This intervention was originally developed and tested in Australia and has been adapted for implementation and evaluation in Canada and is called Horyzons-Canada (HoryzonsCa). METHODS This cohort study is implemented in a single-center and applies a pre-post mixed methods (qualitative-quantitative convergent) design. The study involves recruiting 20 participants from a specialized early intervention program for psychosis located in Montreal, Canada and providing them with access to the HoryzonsCa intervention for 8 weeks. Data collection includes interview-based psychometric measures, self-reports, focus groups, and interviews. RESULTS This study received funding from the Brain and Behavior Research Foundation (United States), the Quebec Health Research Funding Agency (Canada), and the Canada Research Chairs Program. The study was approved by the Research Ethics Board of the Centre intégré universitaire de santé et de services sociaux de l'Ouest-de-l'Île-de-Montréal on April 11, 2018 (#IUSMD 17-54). Data were collected from August 16, 2018, to April 29, 2019, and a final sample of 20 individuals participated in the baseline and follow-up interviews, among which 9 participated in the focus groups. Data analysis and reporting are in process. The results of the study will be submitted for publication in 2021. CONCLUSIONS This study will provide preliminary evidence on the acceptability, safety, and potential efficacy of using a digital health innovation adapted for the Canadian context to deliver specialized mental health services to youth diagnosed with FEP. TRIAL REGISTRATION ISRCTN Registry ISRCTN43182105; https://www.isrctn.com/ISRCTN43182105. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR1-10.2196/28141.
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Affiliation(s)
- Shalini Lal
- School of Rehabilitation, Faculty of Medicine, University of Montréal, Montréal, QC, Canada
- Youth Mental Health and Technology Lab, Health Innovation and Evaluation Hub, University of Montréal Hospital Research Centre, Montréal, QC, Canada
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montréal, QC, Canada
- ACCESS Open Minds, Douglas Mental Health University Institute, Montréal, QC, Canada
| | - John F Gleeson
- Healthy Brain and Mind Research Centre and School of Behavioural and Health Sciences, Australian Catholic University, Fitzroy, Australia
| | - Simon D'Alfonso
- School of Computing and Information Systems, University of Melbourne, Parkville, Australia
| | - Geraldine Etienne
- ACCESS Open Minds, Douglas Mental Health University Institute, Montréal, QC, Canada
| | - Ridha Joober
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montréal, QC, Canada
- ACCESS Open Minds, Douglas Mental Health University Institute, Montréal, QC, Canada
- Department of Psychiatry, McGill University, Montréal, QC, Canada
| | - Martin Lepage
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montréal, QC, Canada
- Department of Psychiatry, McGill University, Montréal, QC, Canada
| | - Hajin Lee
- School of Rehabilitation, Faculty of Medicine, University of Montréal, Montréal, QC, Canada
- Youth Mental Health and Technology Lab, Health Innovation and Evaluation Hub, University of Montréal Hospital Research Centre, Montréal, QC, Canada
| | - Mario Alvarez-Jimenez
- Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
- Orygen, Parkville, Australia
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119
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Manalili K, Siad FM, Antonio M, Lashewicz B, Santana MJ. Codesigning person-centred quality indicators with diverse communities: A qualitative patient engagement study. Health Expect 2021; 25:2188-2202. [PMID: 34854190 PMCID: PMC9615079 DOI: 10.1111/hex.13388] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 10/27/2021] [Accepted: 10/31/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Effective engagement of underrepresented communities in health research and policy remains a challenge due to barriers that hinder participation. Our study had two objectives: (1) identify themes of person‐centred care (PCC) from perspectives of diverse patients/caregivers that would inform the development of person‐centred quality indicators (PC‐QIs) for evaluating the quality of PCC and initiatives to improve PCC and (2) explore innovative participatory approaches to engage ethnocultural communities in qualitative research. Methods Drawing on participatory action research methods, we partnered with a community‐based organization to train six ‘Community Brokers’ from the Chinese, Filipino, South Asian, Latino‐Hispanic, East African and Syrian communities, who were engaged throughout the study. We also partnered with the provincial health organization to engage their Patient and Family Advisory, who represented further aspects of diversity. We conducted focus group discussions with patients/caregivers to obtain their perspectives on their values, preferences and needs regarding PCC. We identified themes through our study and engaged provincial stakeholders to prioritize these themes for informing the development of PC‐QIs and codesign initiatives for improving PCC. Results Eight focus groups were conducted with 66 diverse participants. Ethnocultural communities highlighted themes related to access and cost of care, language barriers and culture, while the Patient and Family Advisory emphasized patient and caregiver engagement. Together with provincial stakeholders, initiatives were identified to improve PCC, such as codesigning innovative models of training and evaluation of healthcare providers. Conclusion Incorporating patient and community voices requires addressing issues related to equity and understanding barriers to effective and meaningful engagement. Patient or Public Contribution Patient and public engagement was central to our research study. This included partnership with a community‐based organization, with a broad network of ethnocultural communities, as well as the provincial health service delivery organization, who both facilitated the ongoing engagement of diverse patients/caregiver communities throughout our study including designing the study, recruiting participants, collecting and organizing data, interpreting findings and mobilizing knowledge. Drawing from participatory action research methods, patients and the public were involved in the codesign of the PC‐QIs and initiatives to improve PCC in the province based on the findings from our study.
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Affiliation(s)
- Kimberly Manalili
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Fartoon M Siad
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | | | - Bonnie Lashewicz
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Maria J Santana
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.,Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
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120
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d’Entremont MA, Wee CC, Nguyen M, Couture ÉL, Lemaire-Paquette S, Kouz S, Afilalo M, Rinfret S, Schampaert E, Mansour S, Montigny M, Eisenberg M, Lauzon C, Déry JP, L’Allier P, Tardif JC, Huynh T. Racial Disparities in Acute Coronary Syndrome Management Within a Universal Healthcare Context: Insights From the AMI-OPTIMA Trial. CJC Open 2021; 3:S28-S35. [PMID: 34993431 PMCID: PMC8712605 DOI: 10.1016/j.cjco.2021.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 07/07/2021] [Indexed: 11/30/2022] Open
Abstract
Background Although prior studies have demonstrated racial disparities regarding acute coronary syndrome (ACS) care within private or mixed healthcare systems, few researchers have explored such disparities within universal healthcare systems. We aimed to evaluate the quality and outcomes of in-hospital ACS management for White patients vs patients of colour, within a universal healthcare context. Methods We performed a post hoc analysis of the Acute Myocardial Infarction - Knowledge Translation to Optimize Adherence to Evidence-Based Therapy study, a cluster-randomized trial evaluating a knowledge-translation intervention at 24 hospitals in Quebec, Canada (years: 2009 and 2012). The primary endpoint was coronary catheterization. The secondary endpoints included in-hospital mortality, percutaneous and surgical coronary revascularization, major bleeding, total stroke, and discharge prescription of evidence-based medical therapy. Results Of 3444 included patients, 2738 were White, and 706 were people of colour. The mean age was 68.2 years (33.3% women) among White patients and 69.5 years (36.0% women) among patients of colour. Patients of colour were less likely to undergo in-hospital coronary catheterization than were White patients (74.5% vs 80.3%, P = 0.001). This difference was attenuated after adjusting for patient-level characteristics (odds ratio 0.89; 95% confidence interval 0.73-1.09), and it was eliminated after adjusting for hospital-level characteristics (odds ratio 1.04; 95% confidence interval 0.73-1.49). Conclusions Racial disparity in coronary catheterization for ACS persists within a universal healthcare context. Patients’ comorbidities and hospital-level factors may be partially responsible for this inequality. Future research on cardiovascular healthcare in patients with diverse racial/ethnic backgrounds in universal healthcare systems is needed to remediate racial inequality in ACS management.
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Affiliation(s)
- Marc-André d’Entremont
- Sherbrooke University Hospital Centre (CHUS), Department of Medicine, Division of Cardiology, Sherbrooke, Quebec, Canada
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Christina C. Wee
- Beth Israel Deaconess Medical Centre, Department of Medicine, Division of General Medicine, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Michel Nguyen
- Sherbrooke University Hospital Centre (CHUS), Department of Medicine, Division of Cardiology, Sherbrooke, Quebec, Canada
| | - Étienne L. Couture
- Sherbrooke University Hospital Centre (CHUS), Department of Medicine, Division of Cardiology, Sherbrooke, Quebec, Canada
| | - Samuel Lemaire-Paquette
- Sherbrooke University Hospital Centre (CHUS), Department of Medicine, Division of Cardiology, Sherbrooke, Quebec, Canada
| | - Simon Kouz
- Centre Hospitalier Régional de Lanaudière, Department of Medicine, Saint-Charles-Borromée, Quebec, Canada
| | - Marc Afilalo
- Jewish General Hospital, Department of Emergency Medicine, Montreal, Quebec, Canada
| | - Stéphane Rinfret
- McGill Health University Centre, Department of Medicine, Division of Cardiology, Montreal, Quebec, Canada
| | - Erick Schampaert
- Hôpital du Sacré-Cœur de Montreal, Department of Medicine, Division of Cardiology, Montreal, Quebec, Canada
| | - Samer Mansour
- Montreal University Hospital Centre (CHUM), Department of Medicine, Division of Cardiology, Montreal, Quebec, Canada
| | - Martine Montigny
- Cité-de-la-Santé, Department of Medicine, Division of Cardiology, Laval, Quebec, Canada
| | - Mark Eisenberg
- McGill Health University Centre, Department of Medicine, Division of Cardiology, Montreal, Quebec, Canada
| | - Claude Lauzon
- Centre Hospitalier Régional de l’Amiante, Department of Medicine, Thetford Mines, Quebec, Canada
| | - Jean-Pierre Déry
- Quebec Heart and Lung Institute, Department of Medicine, Division of Cardiology, Quebec City, Quebec, Canada
| | - Philippe L’Allier
- Montreal Heart Institute, Department of Medicine, Division of Cardiology, Montreal, Quebec, Canada
| | - Jean-Claude Tardif
- Montreal Heart Institute, Department of Medicine, Division of Cardiology, Montreal, Quebec, Canada
| | - Thao Huynh
- McGill Health University Centre, Department of Medicine, Division of Cardiology, Montreal, Quebec, Canada
- Corresponding author: Dr Thao Huynh, McGill University Health Centre, 1650 Ave, Cedar, Rm E-5200, Montréal, Quebec H3G 1A4, Canada. Tel.: +1-514-934-8075.
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Frank J, Pagliari C, Donaldson C, Pickett KE, Palmer KS. Why Canada Is in Court to Protect Healthcare for All: Global Implications for Universal Health Coverage. FRONTIERS IN HEALTH SERVICES 2021; 1:744105. [PMID: 36926488 PMCID: PMC10012631 DOI: 10.3389/frhs.2021.744105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 10/15/2021] [Indexed: 06/18/2023]
Abstract
Countries worldwide are currently endeavoring to safeguard the long-term health of their populations through implementing Universal Health Coverage (UHC), in line with the United Nation's 2015-30 Sustainable Development Goals (SDGs). Canada has some of the world's strongest legislation supporting equitable access to care for medically necessary hospital and physician services based on need, not ability to pay. A constitutional challenge to this legislation is underway in British Columbia (BC), led by a corporate plaintiff, Cambie Surgeries Corporation (CSC). This constitutional challenge threatens to undermine the high bar for UHC protection that Canada has set for the world, with potential adverse implications for equitable international development. CSC claims that BC's healthcare law-the Medicare Protection Act (MPA)-infringes patients' rights under Canada's constitution, by essentially preventing physicians who are enrolled in BC's publicly-funded Medicare plan from providing expedited care to patients for a private fee. In September 2020, after a trial that ran for 3.5 years and included testimony by more than 100 witnesses from around the world, the court dismissed the plaintiffs' claim. Having lost their case in the Supreme Court of BC, the plaintiffs' appealed in June 2021. The appellate court's ruling and reasons for judgment are expected sometime in 2021. We consider the evidence before the court from the perspective of social epidemiology and health inequalities, demonstrating that structural features of a modern society that exacerbate inequalities, including inequitable access to healthcare, can be expected to lead to worse overall societal outcomes.
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Affiliation(s)
- John Frank
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Claudia Pagliari
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Cam Donaldson
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Kate E. Pickett
- Department of Health Sciences, Faculty of Science, University of York, York, United Kingdom
| | - Karen S. Palmer
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
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Smekal MD, Bello AK, Donald M, Zaidi D, McBrien K, Nicholson K, Novak E, Hemmelgarn B. Enhancing primary care capacity in chronic kidney disease management: a quality improvement educational initiative. BMJ Open 2021; 11:e046068. [PMID: 34753751 PMCID: PMC8578991 DOI: 10.1136/bmjopen-2020-046068] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Gaps in identification, medical management and appropriate referral for patients with chronic kidney disease (CKD) are evident. OBJECTIVE We designed and implemented an interactive educational intervention (accredited workshop) to improve primary care providers' awareness of tools to support guideline-concordant CKD management. DESIGN We used the Kern method to design the educational intervention and targeted the accredited workshops to primary care team members (physicians, nurses and allied health) in Alberta, Canada. We conducted anonymous pre-workshop and post-workshop surveys to identify practice-specific barriers to care, identify potential solutions, and evaluate provider confidence pre-intervention and post-intervention. We used non-parametric statistics to analyse Likert-type survey data and descriptive content analysis to categorise responses to open-ended survey questions. RESULTS We delivered 12 workshops to 114 providers from September 2017 through March 2019. Significant improvements (p<0.001) in confidence to appropriately identify, manage and refer patients with CKD were observed. Participants identified several patient-level, provider-level, and system-level barriers and potential solutions to care for patients with CKD; the majority of these barriers were addressed in the interactive workshop. CONCLUSIONS The Kern model was an effective methodology to design and implement an educational intervention to improve providers' confidence in managing patients with CKD in primary care. Future research is needed to determine if these perceived knowledge and confidence improvements affect patient outcomes and whether improvements are sustained long term.
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Affiliation(s)
| | - Aminu K Bello
- Medicine, University of Alberta, Edmonton, Alberta, Canada
| | | | - Deenaz Zaidi
- Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Kerry McBrien
- Family Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Ellen Novak
- Alberta Kidney Care, Alberta Health Services, Calgary, Alberta, Canada
| | - Brenda Hemmelgarn
- Medicine, University of Calgary, Calgary, Alberta, Canada
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Sutherland JM. Confronting Barriers to Improving Healthcare Performance in Canada. Healthc Policy 2021; 17:6-18. [PMID: 34895407 PMCID: PMC8665728 DOI: 10.12927/hcpol.2021.26660] [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: 10/19/2022] Open
Abstract
Is substantive transformation of healthcare delivery in canada a fool's paradise? Since this idiom refers to a state of happiness unconnected to underlying truths, it may be an apt descriptor given the many problems with the provinces' and territories' delivery of healthcare. Some of these problems cause harm, such as hospital-acquired infections, while others are simply wasteful, such as unnecessary tests or imaging. Moreover, meaningful transformation of healthcare delivery has been elusive and divisive in provinces and territories for decades (Martin et al. 2018; McIntosh et al. 2010; Ontario Ministry of Finance 2012).
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Kiran T, Rodrigues JJ, Aratangy T, Devotta K, Sava N, O'Campo P. Awareness and Use of Community Services among Primary Care Physicians. ACTA ACUST UNITED AC 2021; 16:58-77. [PMID: 32813640 DOI: 10.12927/hcpol.2020.26290] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Primary care physicians play an important role in care coordination, including initiating referrals to community resources. Yet, it is unclear how awareness and use of community resources vary between physicians practising with and without an extended healthcare team. We conducted a cross-sectional survey of primary care physicians practising in Toronto, Canada, to compare awareness and use of community services between physicians practising in team- and non-team-based practice models. Team-based models included Community Health Centres and Family Health Teams - settings in which the government provides funding for the practice to hire non-physician health professionals, such as social workers, pharmacists, nurse practitioners, registered nurses and others. The survey was mailed to physicians, and reminders were done by phone, fax and e-mail. We used logistic regression to compare awareness between physicians in team-based (N = 89) and non-team-based (N = 138) models after controlling for confounders. We found that fewer than half of the physicians were aware of five of eight centralized intake services (e.g., ConnexOntario, Telehomecare). For most services, team-based physicians had at least twice the odds of being aware of the service compared to non-team-based physicians. Our findings suggest that patients in team-based practices may be doubly advantaged, with access to non-physician health professionals within the practice as well as to physicians who are more aware of community resources.
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Affiliation(s)
- Tara Kiran
- Family Physician, St. Michael's Hospital, Associate Professor, Department of Family and Community Medicine, Faculty of Medicine and the Institute of Health Policy, Management and Evaluation, University of Toronto, Scientist, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON
| | - Jessica J Rodrigues
- Research Coordinator, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON
| | - Tatiana Aratangy
- Manager, Survey Research Unit, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON
| | - Kimberly Devotta
- Research Coordinator, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON
| | - Nathalie Sava
- Senior Planner, Health Analytics and Innovation, Toronto Central Local Health Integration Network, Toronto, ON
| | - Patricia O'Campo
- Scientist, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Professor, Dalla Lana School of Public Health, University of Toronto, Toronto, ON
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Sauro KM, Baker GR, Tomlinson G, Parshuram C. The role of hospital characteristics in patient safety: a protocol for a national cohort study. CMAJ Open 2021; 9:E1041-E1047. [PMID: 34815259 PMCID: PMC8612653 DOI: 10.9778/cmajo.20200266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Substantial expenditures on health care safety programs have been justified by their goal of reducing health care associated-harm (adverse events), but adverse event rates have not changed over the past 4 decades. The objective of this study is to describe hospital-level factors that are relevant to safety in Canadian hospitals and the impact of these factors on hospital adverse events. METHODS This is a protocol for a national cohort study to describe the association between hospital-level factors and adverse events. We will survey at least 90 (35%) Canadian hospitals to describe 4 safety-relevant domains, chosen based on the literature and expert consultation, namely patient safety culture, safety strategies, staffing, and volume and capacity. We will retrospectively identify hospital adverse events from a national data source. We will evaluate organization-level factors using established scales and a survey, codesigned by the study team and hospital leaders. Hospital leaders, clinical unit leaders and front-line staff will complete the surveys once a year for 3 years, with an anticipated start date of winter 2022. We will use national health administrative data to estimate the rate and type of hospital adverse events corresponding to each 1-year survey period. INTERPRETATION Analysis of data from this project will describe hospital organizational factors that are relevant to safety and help identify organizational initiatives that improve hospital patient safety. In addition to biyearly reports to the leaders of the participating hospitals, we have a multifaceted and tailored dissemination strategy that includes integrating the knowledge users into the study team to increase the likelihood that our study will lead to improved hospital patient safety.
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Affiliation(s)
- Khara M Sauro
- Department of Community Health Science and O'Brien Institute for Public Health (Sauro); Department of Oncology and Arnie Charbonneau Cancer Institute (Sauro), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Institute of Health Policy, Management and Evaluation (Baker, Tomlinson, Parshuram), University of Toronto, Toronto, Ont.
| | - G Ross Baker
- Department of Community Health Science and O'Brien Institute for Public Health (Sauro); Department of Oncology and Arnie Charbonneau Cancer Institute (Sauro), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Institute of Health Policy, Management and Evaluation (Baker, Tomlinson, Parshuram), University of Toronto, Toronto, Ont
| | - George Tomlinson
- Department of Community Health Science and O'Brien Institute for Public Health (Sauro); Department of Oncology and Arnie Charbonneau Cancer Institute (Sauro), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Institute of Health Policy, Management and Evaluation (Baker, Tomlinson, Parshuram), University of Toronto, Toronto, Ont
| | - Christopher Parshuram
- Department of Community Health Science and O'Brien Institute for Public Health (Sauro); Department of Oncology and Arnie Charbonneau Cancer Institute (Sauro), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Institute of Health Policy, Management and Evaluation (Baker, Tomlinson, Parshuram), University of Toronto, Toronto, Ont
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Hudson MF. General orders for the embedded researcher: Moorings for a developing profession. Learn Health Syst 2021; 5:e10254. [PMID: 34667876 PMCID: PMC8512733 DOI: 10.1002/lrh2.10254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/23/2020] [Accepted: 11/28/2020] [Indexed: 11/18/2022] Open
Abstract
Learning health systems increasingly welcome embedded researchers as stakeholders poised to inform evidence-based practice. While care systems are potentially familiar with the embedded researcher tools and techniques, care systems may less frequently consider embedded research as a vocation. This insensitivity potentially reduces embedded researchers merely to instruments, as opposed to professional partners in transdisciplinary research. This discussion outlines "general orders" for embedded researchers. The general orders outline embedded researchers' fundamental identity and guide conduct as a means to encourage a shared identity among embedded researchers and clarify embedded researchers' roles in learning health system teams. Students and embedded researchers newly engaging learning health systems may particularly benefit from this rudimentary order list.
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Salmon K, Anoja N, Breiner A, Chum M, Dionne A, Dupré N, Fiander A, Fok D, Ghavanini A, Gosselin S, Izenberg A, Johnston W, Kalra S, Matte G, Melanson M, O'Connell C, Ritsma B, Schellenberg K, Shoesmith C, Tremblay S, Williams H, Genge A. Genetic testing for amyotrophic lateral sclerosis in Canada - an assessment of current practices. Amyotroph Lateral Scler Frontotemporal Degener 2021; 23:305-312. [PMID: 34569363 DOI: 10.1080/21678421.2021.1980890] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objective: To understand current genetic testing practices at Canadian ALS clinics. Methods: An online survey and phone interviews, with clinicians practicing in 27 ALS clinics in Canada, were employed to collect data. Quantitative and qualitative analyses were conducted. Results: Ninety-three percent (25/27) of ALS clinics in Canada are routinely ordering genetic testing for familial ALS, while 33% (9/27) of clinics are routinely ordering genetic testing for sporadic ALS. Barriers to genetic testing include a perceived lack of an impact on treatment plan, difficulty in obtaining approvals, primarily from provincial Ministries of Health, and limited access to genetic counseling. Predictive testing practices were found to be the most variable across the country. The average wait time for a symptomatic patient living with ALS to see a genetic counselor in Canada is 10 months (range 0-36 months). Conclusions: Access to genetic testing, and testing practices, vary greatly across Canadian ALS clinics. There may be patients with a monogenetic etiology to their ALS who are not being identified given that genetic testing for patients diagnosed with ALS is not routinely performed at all clinics. This study highlights potential inequities for patients with ALS that can arise from variability in health care delivery across jurisdictions, in a federally-funded, but provincially-regulated, health care system. Clinical trials for both symptomatic ALS patients and pre-symptomatic ALS gene carriers are ongoing, and ALS clinicians in Canada are motivated to improve access to genetic testing for ALS.
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Affiliation(s)
- Kristiana Salmon
- Montreal Neurological Institute-Hospital, McGill University, Montreal, Canada
| | - Nancy Anoja
- Montreal Neurological Institute-Hospital, McGill University, Montreal, Canada
| | | | - Marvin Chum
- St. Joseph's Healthcare Hamilton - McMaster University, Hamilton, Canada
| | - Annie Dionne
- Neuroscience Axis, CHU de Québec - Université Laval, Quebec City, Canada
| | - Nicolas Dupré
- Neuroscience Axis, CHU de Québec - Université Laval, Quebec City, Canada
| | | | - Daniel Fok
- University of British Columbia - Southern Medical Program, Kelowna, Canada
| | | | - Sylvie Gosselin
- Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Canada
| | | | | | | | - Geneviève Matte
- Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | | | | | - Benjamin Ritsma
- Providence Care Hospital - Queen's University, Kingston, Canada
| | | | | | | | | | - Angela Genge
- Montreal Neurological Institute-Hospital, McGill University, Montreal, Canada
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Salami B, Denga B, Taylor R, Ajayi N, Jackson M, Asefaw M, Salma J. Access to mental health for Black youths in Alberta. HEALTH PROMOTION AND CHRONIC DISEASE PREVENTION IN CANADA-RESEARCH POLICY AND PRACTICE 2021; 41:245-253. [PMID: 34549916 DOI: 10.24095/hpcdp.41.9.01] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The objective of this study was to examine the barriers that influence access to and use of mental health services by Black youths in Alberta. METHODS We used a youth-led participatory action research (PAR) methodology within a youth empowerment model situated within intersectionality theory to understand access to health care for both Canadian-born and immigrant Black youth in Alberta. The research project was co-led by an advisory committee consisting of 10 youths who provided advice and tangible support to the research. Seven members of the advisory committee also collected data, co-facilitated conversation cafés, analyzed data and helped in the dissemination activities. We conducted in-depth individual interviews and held four conversation café-style focus groups with a total of 129 youth. During the conversation cafés, the youths took the lead in identifying issues of concern and in explaining the impact of these issues on their lives. Through rigorous data coding and thematic analysis as well as reflexivity and member checking we ensured our empirical findings were trustworthy. RESULTS Our findings highlight key barriers that can limit access to and utilization of mental health services by Black youth, including a lack of cultural inclusion and safety, a lack of knowledge/information on mental health services, the cost of mental health services, geographical barriers, stigma and judgmentalism, and limits of resilience. CONCLUSION Findings confirm diverse/intersecting barriers that collectively perpetuate disproportional access to and uptake of mental health services by Black youths. The results of this study suggest health policy and practice stakeholders should consider the following recommendations to break down barriers: diversify the mental health service workforce; increase the availability and quality of mental health services in Black-dominated neighbourhoods; and embed anti-racist practices and intercultural competencies in mental health service delivery.
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Affiliation(s)
- Bukola Salami
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Benjamin Denga
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Robyn Taylor
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Nife Ajayi
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Margot Jackson
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Msgana Asefaw
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Jordana Salma
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
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Andrysek J. The Economics of Innovation in the Prosthetic and Orthotics Industry. CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 2021; 4:35203. [PMID: 37614992 PMCID: PMC10443472 DOI: 10.33137/cpoj.v4i2.35203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Innovation is an important part of the prosthetic and orthotics (P&O) industry. Innovation has the potential to improve health care services and outcomes, however, it can also be a burden to the system if misdirected. This paper explores the interaction of innovation and economics within the P&O industry, focusing on its current state and future opportunities. Technological advancement, industry competition and pursuit of better patient outcomes drive innovation, while challenges in ensuring better P&O health care include lagging clinical evidence, limited access to data, and existing funding structures. There exists a greater need for inclusive models and frameworks for rehabilitation care, that focus on the use of appropriate technology as supported by research and evidence of effectiveness and cost-effectiveness. Additionally, innovative business models based on social entrepreneurism could open access to untapped and underserved markets and provide greater access to assistive technology.
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Affiliation(s)
- J. Andrysek
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
- Institute of Biomedical Engineering, Faculty of Applied Science and Engineering, University of Toronto, Toronto, Canada
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Savage RD, Hardacre K, Bashi AM, Bronskill SE, Faulkner C, Grieve J, Gruneir A, McCarthy LM, Chamberlain SA, Lam K, Stall NM, Zhu L, Rochon PA. Perspectives on ageing: a qualitative study of the expectations, priorities, needs and values of older people from two Canadian provinces. Age Ageing 2021; 50:1811-1819. [PMID: 34228777 DOI: 10.1093/ageing/afab136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Understanding the needs and values of older people is vital to build responsive policies, services and research agendas in this time of demographic transition. Older peoples' expectations and priorities for ageing, as well as their beliefs regarding challenges facing ageing societies, are multi-faceted and require regular updates as populations' age. OBJECTIVE To develop an understanding of self-perceptions of ageing and societal ageing among Canadian retirees of the education sector to define a meaningful health research agenda. METHODS We conducted four qualitative focus groups among 27 members of a Canadian retired educators' organisation. Data were analysed using an inductive thematic approach. RESULTS We identified four overarching themes: (1) vulnerability to health challenges despite a healthier generation, (2) maintaining health and social connection for optimal ageing, (3) strengthening person-centred healthcare for ageing societies and (4) mobilising a critical mass to enact change. Participants' preconceptions of ageing differed from their personal experiences. They prioritised maintaining health and social connections and felt that current healthcare practices disempowered them to manage and optimise their health. Although the sheer size of their demographic instilled optimism of their potential to garner positive change, participants felt they lacked mechanisms to contribute to developing solutions to address this transition. CONCLUSION Our findings suggest a need for health research that improves perceptions of ageing and supports health system transformations to deliver person-centred care. Opportunities exist to harness their activism to engage older people as partners in shaping solution-oriented research that can support planning for an ageing society.
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Affiliation(s)
- Rachel D Savage
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Kate Hardacre
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
| | - Aya Mahder Bashi
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Susan E Bronskill
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Colin Faulkner
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
| | | | - Andrea Gruneir
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Lisa M McCarthy
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario
| | | | - Kenneth Lam
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Division of Geriatric Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Nathan M Stall
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lynn Zhu
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
| | - Paula A Rochon
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Rodin D, Dare AJ, Booker R, Booth C, Bryant H, Ginsburg O, Giuliani M, Gospodarowicz M, Gupta S, Hammad N, Rosberger Z, Sutcliffe S, Earle CC. Transforming Canada's role in global cancer control. Lancet Oncol 2021; 22:e400-e409. [PMID: 34478676 DOI: 10.1016/s1470-2045(21)00374-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 06/11/2021] [Accepted: 06/17/2021] [Indexed: 11/28/2022]
Abstract
Cancer has not been an explicit priority of Canada's international health and development agenda, but it is key to realising the country's Sustainable Development Goal commitments. Multiple converging political, health, and social forces could now drive support for a more integrated Canadian approach to global cancer control. Success will depend on the extent to which Canadian leaders and institutions can build consensus as a community and agree to work together. Collaboration should include agreement on the framing and prioritisation of the core issues, building a broad coalition base, aligning with priorities of international partners, and on a governance structure that reflects the principles of equity, diversity, and inclusion. This Series paper will discuss global cancer control within Canada's global health agenda, how Canada can address its history of colonisation and present-day disparities in its global work, and the challenges and opportunities of creating a Canadian global cancer control network.
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Affiliation(s)
- Danielle Rodin
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada; Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada.
| | - Anna J Dare
- Centre for Global Health Research, St Michael's Hospital, Toronto, ON, Canada
| | - Reanne Booker
- Palliative and End-of-Life Care Services-Calgary Zone, Calgary, AB, Canada
| | | | - Heather Bryant
- Canadian Partnership Against Cancer, Toronto, ON, Canada
| | - Ophira Ginsburg
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Population Health and Perlmutter Cancer Centre, NYU Grossman School of Medicine, New York, NY, USA
| | - Meredith Giuliani
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada; Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Mary Gospodarowicz
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada; Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Sumit Gupta
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Division of Haematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada
| | - Nazik Hammad
- Department of Oncology, Queen's University, Kingston, ON, Canada
| | - Zeev Rosberger
- Lady Davis Institute for Medical Research, McGill University, Montreal, QC, Canada
| | | | - Craig C Earle
- Canadian Partnership Against Cancer, Toronto, ON, Canada
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Hayes KN, Gomes T, Tadrous M. Greater than the Sum: Applying Daily-Dose Equivalents to Antipsychotic Prescription Claims to Study Real-World Effects. Front Pharmacol 2021; 12:709349. [PMID: 34421603 PMCID: PMC8378135 DOI: 10.3389/fphar.2021.709349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 07/26/2021] [Indexed: 11/13/2022] Open
Abstract
Traditional methods to standardize exposures in pharmacoepidemiologic studies, like defined daily-doses, may be inadequate to capture drug class effects when there are many in-class medications, formulations, and administration routes. Antipsychotic medications are one example of a drug class with these complexities. Direct dose conversion methods are pharmacologically-based but often overlooked, potentially for lack of real-world guidance and examples of their implementation. The purpose of this article is to describe a method to implement dose conversion, using an example study that quantifies antipsychotic use among a cohort of older adults with dementia. We identified 45,442 older adults (aged ≥66 years) with dementia initiating antipsychotic therapy between January 1, 2009 and December 31, 2012 in Ontario, Canada using linked administrative healthcare databases. We developed and applied a data cleaning and dose conversion algorithm to quantify antipsychotic exposure in chlorpromazine dose equivalents at initiation, month 6, and month 12 of therapy. Results were stratified by route of administration. At initiation, 14% of patients received multiple antipsychotic prescriptions simultaneously. Patients initiating regular injectable and multiple administration routes received the highest median chlorpromazine equivalent daily-doses. Data cleaning changed 3, 16, 36, and 42% of total equivalent daily-doses in patients initiating oral, regular injectable, long-acting injectable, and multiple administration routes, respectively. Dose conversion of prescription claims data was a feasible method to quantify and present antipsychotic drug exposures. Dose conversion methods can be considered for drug effects studies of antipsychotic therapies and other medication classes with complex use.
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Affiliation(s)
- Kaleen N Hayes
- Dalla Lana School of Public Health, Department of Public Health Sciences, University of Toronto, Toronto, ON, Canada
| | - Tara Gomes
- Dalla Lana School of Public Health, Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada.,ICES, Toronto, ON, Canada.,Li Ka Shing Knowledge Institute, Toronto, ON, Canada.,Leslie Dan Faculty of Pharmacy, Department of Pharmaceutical Sciences, University of Toronto, Toronto, ON, Canada
| | - Mina Tadrous
- ICES, Toronto, ON, Canada.,Li Ka Shing Knowledge Institute, Toronto, ON, Canada.,Leslie Dan Faculty of Pharmacy, Department of Pharmaceutical Sciences, University of Toronto, Toronto, ON, Canada.,Women's College Hospital, Toronto, ON, Canada
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Hamel-Smith Grassby M, Wiedmeyer ML, Lavergne MR, Goldenberg SM. Qualitative evaluation of a mandatory health insurance 'wait period' in a publicly funded health system: understanding health inequities for newcomer im/migrant women. BMJ Open 2021; 11:e047597. [PMID: 34353797 PMCID: PMC8344307 DOI: 10.1136/bmjopen-2020-047597] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To evaluate impacts of a residency-based waiting period for health insurance coverage on lived experiences of health and settlement for im/migrant women in British Columbia, Canada. DESIGN The IRIS study is a mixed-methods, community-based, qualitative evaluation of recently arrived im/migrant women's access to sexual and reproductive care. In-depth, semistructured interviews were conducted by trained multilingual and multicultural interviewers with lived migration experience in the participant's preferred language. SETTING Metro Vancouver, British Columbia, Canada from July 2018 to January 2020. PARTICIPANTS Data collected from community focus groups (four groups, n=29) of both service providers and im/migrant women was used. Following this, qualitative interviews with service providers (n=10) and im/migrant women (n=47) were conducted. Eligible participants self-identified as women; were aged 18-49 and had arrived in Canada from another country. Eligible providers were employed in the health, social or legal sectors working with im/migrant women. RESULTS The wait period resulted in mistrust and internalised stigma for racialised im/migrant women, for whom the policy resulted in feeling 'undeserving' of care. Resulting administrative burden produced delays and unmet need for care, particularly related to sexual and reproductive healthcare and children's health. Unexpected costs meant difficult choices between survival and care. Negative health outcomes included the inability to family plan, difficulties during pregnancy, as well as hardships related not being able to seek help for sick children. Community-based organisations provided support in many areas but could not fill all gaps produced by this policy. CONCLUSIONS Findings highlight severe, yet commonly overlooked, health inequities produced by a mandatory health coverage wait period within a purportedly 'universal' healthcare system. Health system policies such as mandatory 'waiting periods' produce discriminatory and inequitable outcomes for im/migrant women. Policy reforms towards full 'healthcare for all' are urgently needed to affirm the health and human rights of all im/migrants.
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Affiliation(s)
- Maggie Hamel-Smith Grassby
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Centre for Gender & Sexual Health Equity, Vancouver, British Columbia, Canada
| | - Mei-Ling Wiedmeyer
- Centre for Gender & Sexual Health Equity, Vancouver, British Columbia, Canada
- Family Practice, The University of British Columbia, Vancouver, British Columbia, Canada
| | - M Ruth Lavergne
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Centre for Gender & Sexual Health Equity, Vancouver, British Columbia, Canada
- Department of Family Medicine, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Shira M Goldenberg
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Centre for Gender & Sexual Health Equity, Vancouver, British Columbia, Canada
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, California, USA
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134
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Lucente G, Kurzawa J, Danseco E. Moving Towards Racial Equity in the Child and Youth Mental Health Sector in Ontario, Canada. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 49:153-156. [PMID: 34328584 PMCID: PMC8323084 DOI: 10.1007/s10488-021-01153-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2021] [Indexed: 11/25/2022]
Abstract
In the aftermath of high-profile incidents involving Black, Indigenous and People of Color (BIPOC) in North America, there is a growing awareness of the pervasiveness of systemic racism and the role that agencies play in perpetuating racism and racial inequities. In the child and youth mental health sector, the journey to improving racial equity is impeded by a lack of consistent frameworks or guidelines. In this commentary, we explore five domains of organizational practices that are prominent in the literature and support diverse clients, communities and staff, including: (1) organizational leadership and commitment, (2) inter-organizational and multisectoral partnerships, (3) workforce diversity and development, (4) client and community needs and engagement, and (5) continuous improvement. As we highlight these domains, we urge researchers, policy makers, and child and youth mental health service providers to work together to advance racial equity in meaningful ways.
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Affiliation(s)
- Gabrielle Lucente
- Ontario Centre of Excellence for Child & Youth Mental Health, Children's Hospital of Eastern Ontario, 695 Industrial Ave., Ottawa, ON, K1G 0Z1, Canada.
| | - Julia Kurzawa
- Ontario Centre of Excellence for Child & Youth Mental Health, Children's Hospital of Eastern Ontario, 695 Industrial Ave., Ottawa, ON, K1G 0Z1, Canada
| | - Evangeline Danseco
- Ontario Centre of Excellence for Child & Youth Mental Health, Children's Hospital of Eastern Ontario, 695 Industrial Ave., Ottawa, ON, K1G 0Z1, Canada
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135
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Pétrin J, McColl MA, Donnelly C, French S, Finlayson M. Prioritizing the healthcare access concerns of Canadians with MS. Mult Scler J Exp Transl Clin 2021; 7:20552173211029672. [PMID: 34290879 PMCID: PMC8276490 DOI: 10.1177/20552173211029672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 06/10/2021] [Indexed: 11/16/2022] Open
Abstract
Background Canadians with MS are high users of healthcare services, yet they report multiple unmet needs, high disease burden, and low satisfaction with care. Engaging patients in healthcare planning can lead to improvements in access and care. There is currently limited evidence that has harnessed the perspectives of Canadians with MS. Objective To identify and prioritize the healthcare access concerns of Canadians with MS. Methods A cross-sectional online survey informed by the Concerns Report Methodology was used to address the objective. Participants were recruited through multiple methods. Descriptive statistics were used to identify the main barriers to healthcare providers, and concerns report methods were used to calculate needs indexes to prioritize concerns of participants. Results 324 Canadians with MS participated in the study between November 18, 2019 and March 27, 2020. The most pressing healthcare access concerns of Canadians with MS were related to availability of healthcare providers with MS knowledge and affordability of services that aim to improve wellness. Conclusion These findings provide healthcare planners with prioritized access concerns of Canadians with MS, which can be used to guide strategic planning to improve the quality of life of these individuals.
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Affiliation(s)
- Julie Pétrin
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - Mary Ann McColl
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - Catherine Donnelly
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - Simon French
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - Marcia Finlayson
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
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136
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Factors Influencing Nonrenewal of Health Insurance Membership in Ejisu-Juaben Municipality of Ashanti Region, Ghana. ADVANCES IN PUBLIC HEALTH 2021. [DOI: 10.1155/2021/5575822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background. In the quest to prevent households from making catastrophic expenditures at the point of seeking healthcare, the government of Ghana introduced the National Health Insurance in 2003. However, people are reluctant to renew their membership. This study was, therefore, conducted to identify factors influencing the nonrenewal of National Health Insurance membership in the Ejisu-Juaben Municipality. Methods. A cross-sectional study was conducted among 427 respondents in the Ejisu-Juaben Municipality to ascertain factors influencing the nonrenewal of health insurance membership status. Data were entered and analyzed using Stata version 14. Univariate and multivariate analyses were performed to determine sociodemographic factors, household factors, and systemic factors influencing the nonrenewal of health insurance status. Statistical significance for all testing was set as
. Results. Sociodemographic factors such as gender (AOR = 0.531; CI = 0.287–0.985) and educational level (AOR = 5.268; CI = 1.130–24.551)) were associated with the nonrenewal of health insurance membership. Income levels in Ghana Cedis were 500–1000 (AOR = 0.216; CI = 0.075–0.617) and 1001–2000 (AOR = 0.085; CI = 0.019–0.383). Systemic decision on factors such as clients’ satisfaction (AOR = 0.149; CI = 0.035–0.640), making copayment (AOR = 0.152; CI = 0,068–0.344), acquiring all prescribed drugs (AOR = 4.191; CI = 2.027–8.668), and awareness of mobile renewal (AOR = 3.139; CI = 1.462–6.739) was associated with nonrenewal of membership. Conclusions. The nonrenewal of health insurance membership was influenced by sociodemographic, household, and systemic factors. Therefore, the Municipal Health Directorate and the National Health Insurance Authority have to work on these factors to reach the target of 100% active coverage in the municipality.
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137
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Leckie JN, Joel MM, Martens K, King A, King M, Korngut LW, de Koning APJ, Pfeffer G, Schellenberg KL. Highly Elevated Prevalence of Spinobulbar Muscular Atrophy in Indigenous Communities in Canada Due to a Founder Effect. NEUROLOGY-GENETICS 2021; 7:e607. [PMID: 34250227 PMCID: PMC8267784 DOI: 10.1212/nxg.0000000000000607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 06/01/2021] [Indexed: 11/24/2022]
Abstract
Objective Spinobulbar muscular atrophy (SBMA) is an X-linked adult-onset neuromuscular disorder that causes progressive weakness and androgen insensitivity in hemizygous males. This condition is reported to be extremely rare, but has higher prevalence in certain populations due to multiple founder effects. Anecdotal observations of a higher prevalence of SBMA in patients of Indigenous descent in Saskatchewan led us to perform this study, to estimate the disease prevalence, and to attempt to identify a founder effect. Methods For our prevalence estimation, we identified patients with confirmed SBMA diagnosis from the Saskatoon neuromuscular clinic database for comparison with population data available from Statistics Canada. For our haplotype analysis, participants with SBMA were recruited from 2 neuromuscular clinics, as well as 5 control participants. Clinical data were collected, as well as a DNA sample using saliva kits. We performed targeted quantification of DXS1194, DXS1111, DXS135, and DXS1125 microsatellite repeats and the AR GGC repeat to attempt to identify a disease haplotype and compare it with prior studies. Results We estimate the prevalence of SBMA among persons of Indigenous descent in Saskatchewan as 14.7 per 100,000 population. Although we believe that this is an underestimate, this still appears to be the highest population prevalence for SBMA in the world. A total of 21 participants were recruited for the haplotype study, and we identified a unique haplotype that was shared among 13 participants with Indigenous ancestry. A second shared haplotype was identified in 2 participants, which may represent a second founder haplotype, but this would need to be confirmed with future studies. Conclusions We describe a very high prevalence of SBMA in western Canadians of Indigenous descent, which appears to predominantly be due to a founder effect. This necessitates further studies of SBMA in these populations to comprehensively ascertain the disease prevalence and allow appropriate allocation of resources to support individuals living with this chronic disease.
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Affiliation(s)
- Jamie N Leckie
- Hotchkiss Brain Institute (J.N.L., M.M.J., K.M., L.W.K., G.P.), Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Alberta; Department of Medicine (A.K.), and Department of Community Health and Epidemiology (M.K.), University of Saskatchewan, Saskatoon; Alberta Child Health Research Institute (A.P.J.d.K., G.P.), Department of Medical Genetics, University of Calgary, Alberta; and Division of Neurology (K.L.S.), Department of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Matthew M Joel
- Hotchkiss Brain Institute (J.N.L., M.M.J., K.M., L.W.K., G.P.), Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Alberta; Department of Medicine (A.K.), and Department of Community Health and Epidemiology (M.K.), University of Saskatchewan, Saskatoon; Alberta Child Health Research Institute (A.P.J.d.K., G.P.), Department of Medical Genetics, University of Calgary, Alberta; and Division of Neurology (K.L.S.), Department of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Kristina Martens
- Hotchkiss Brain Institute (J.N.L., M.M.J., K.M., L.W.K., G.P.), Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Alberta; Department of Medicine (A.K.), and Department of Community Health and Epidemiology (M.K.), University of Saskatchewan, Saskatoon; Alberta Child Health Research Institute (A.P.J.d.K., G.P.), Department of Medical Genetics, University of Calgary, Alberta; and Division of Neurology (K.L.S.), Department of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Alexandra King
- Hotchkiss Brain Institute (J.N.L., M.M.J., K.M., L.W.K., G.P.), Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Alberta; Department of Medicine (A.K.), and Department of Community Health and Epidemiology (M.K.), University of Saskatchewan, Saskatoon; Alberta Child Health Research Institute (A.P.J.d.K., G.P.), Department of Medical Genetics, University of Calgary, Alberta; and Division of Neurology (K.L.S.), Department of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Malcolm King
- Hotchkiss Brain Institute (J.N.L., M.M.J., K.M., L.W.K., G.P.), Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Alberta; Department of Medicine (A.K.), and Department of Community Health and Epidemiology (M.K.), University of Saskatchewan, Saskatoon; Alberta Child Health Research Institute (A.P.J.d.K., G.P.), Department of Medical Genetics, University of Calgary, Alberta; and Division of Neurology (K.L.S.), Department of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Lawrence W Korngut
- Hotchkiss Brain Institute (J.N.L., M.M.J., K.M., L.W.K., G.P.), Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Alberta; Department of Medicine (A.K.), and Department of Community Health and Epidemiology (M.K.), University of Saskatchewan, Saskatoon; Alberta Child Health Research Institute (A.P.J.d.K., G.P.), Department of Medical Genetics, University of Calgary, Alberta; and Division of Neurology (K.L.S.), Department of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - A P Jason de Koning
- Hotchkiss Brain Institute (J.N.L., M.M.J., K.M., L.W.K., G.P.), Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Alberta; Department of Medicine (A.K.), and Department of Community Health and Epidemiology (M.K.), University of Saskatchewan, Saskatoon; Alberta Child Health Research Institute (A.P.J.d.K., G.P.), Department of Medical Genetics, University of Calgary, Alberta; and Division of Neurology (K.L.S.), Department of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Gerald Pfeffer
- Hotchkiss Brain Institute (J.N.L., M.M.J., K.M., L.W.K., G.P.), Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Alberta; Department of Medicine (A.K.), and Department of Community Health and Epidemiology (M.K.), University of Saskatchewan, Saskatoon; Alberta Child Health Research Institute (A.P.J.d.K., G.P.), Department of Medical Genetics, University of Calgary, Alberta; and Division of Neurology (K.L.S.), Department of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Kerri L Schellenberg
- Hotchkiss Brain Institute (J.N.L., M.M.J., K.M., L.W.K., G.P.), Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Alberta; Department of Medicine (A.K.), and Department of Community Health and Epidemiology (M.K.), University of Saskatchewan, Saskatoon; Alberta Child Health Research Institute (A.P.J.d.K., G.P.), Department of Medical Genetics, University of Calgary, Alberta; and Division of Neurology (K.L.S.), Department of Medicine, University of Saskatchewan, Saskatoon, Canada
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Strohschein FJ, Newton L, Puts M, Jin R, Haase K, Plante A, Loucks A, Kenis C, Fitch M. Optimiser les soins des adultes âgés atteints de cancer et l'accompagnement de leurs proches: énoncé de position et contribution des infirmières canadiennes en oncologie. Can Oncol Nurs J 2021; 31:357-362. [PMID: 34395844 PMCID: PMC8320801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023] Open
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139
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Strohschein FJ, Newton L, Puts M, Jin R, Haase K, Plante A, Loucks A, Kenis C, Fitch M. Optimizing the Care of Older Canadians with Cancer and their Families: A Statement Articulating the Position and Contribution of Canadian Oncology Nurses. Can Oncol Nurs J 2021; 31:352-356. [PMID: 34395843 PMCID: PMC8320798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023] Open
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Hayes KN, He N, Brown KA, Cheung AM, Juurlink DN, Cadarette SM. Over half of seniors who start oral bisphosphonate therapy are exposed for 3 or more years: novel rolling window approach and patterns of use. Osteoporos Int 2021; 32:1413-1420. [PMID: 33415374 DOI: 10.1007/s00198-020-05794-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 12/10/2020] [Indexed: 12/17/2022]
Abstract
UNLABELLED Most adherence studies only consider treatment following a first prescription. Using an extended follow-up, we found that 60% of seniors starting oral bisphosphonate therapy were exposed for ≥ 3 years (48% for ≥ 5 years). Studies are needed to examine the benefits and harms of continuing bisphosphonate therapy beyond 3 years. INTRODUCTION The purpose of this study was to identify and describe patterns of long-term oral bisphosphonate use among seniors using a novel methodological approach that considers extended follow-up. METHODS Among Ontarians aged 66 years or older, we identified subjects with a first dispensing of alendronate or risedronate between November 2000 and December 2016. We followed them until death or December 2019 to identify patients with ≥ 3 years of bisphosphonate use, defined as a proportion of days covered ≥ 80%, using 3-year rolling windows. We calculated the proportion of patients with long-term therapy (≥ 3 years of use) using Kaplan-Meier estimates. We described patterns of long-term use and compared patient characteristics between patients with and without long-term therapy. RESULTS We identified 260,784 eligible seniors initiating bisphosphonate therapy. Of these, 60% continued therapy ≥ 3 years (77% women), and 48% continued ≥ 5 years. Characteristics did not meaningfully differ between patients with or without long-term therapy. The median length of long-term therapy was 7.0 (IQR 5.1) years for women and 6.1 (IQR 4.3) years for men. Only 20% experienced a treatment gap before long-term therapy, yet 50% experienced a treatment gap of ≥ 120 days after a median 5.3 years of therapy. Eighty-one percent who returned to therapy following a treatment gap re-initiated an oral bisphosphonate, with 18% switching to denosumab. CONCLUSIONS Among seniors initiating oral bisphosphonates, we found that 60% receive at least 3 years of therapy when using an extended follow-up. Studies are needed to examine the benefits and harms of continuing bisphosphonate therapy beyond 3 years.
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Affiliation(s)
- K N Hayes
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON, M5S 3M2, Canada.
| | - N He
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON, M5S 3M2, Canada
- ICES, Toronto, ON, Canada
| | - K A Brown
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Public Health Ontario, Toronto, ON, Canada
| | - A M Cheung
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University Health Network, University of Toronto, Toronto, ON, Canada
| | - D N Juurlink
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Sunnybrook Research Institute, Toronto, ON, Canada
| | - S M Cadarette
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON, M5S 3M2, Canada
- ICES, Toronto, ON, Canada
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
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141
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Gagnon M, Kunyk D. Beyond technology, drips, and machines: Moral distress in PICU nurses caring for end-of-life patients. Nurs Inq 2021; 29:e12437. [PMID: 34157180 DOI: 10.1111/nin.12437] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 05/31/2021] [Accepted: 06/01/2021] [Indexed: 11/30/2022]
Abstract
Moral distress is an experience of profound moral compromise with deeply impactful and potentially long-term consequences to the individual. Critical care areas are fraught with ethical issues, and end-of-life care has been associated with numerous incidences of moral distress among nurses. One such area where the dichotomy of life and death seems to be at its sharpest is in the pediatric intensive care unit. The purpose of this study was to understand the moral distress experiences of pediatric intensive care nurses when caring for pediatric patients at the end of life. A secondary analysis was undertaken of seven transcripts from registered nurses across six Canadian pediatric intensive care units and produced three themes: under prioritization of child patient dignity, burden of insider knowledge, and environmental constraints on nursing roles and responsibilities. When caring for patients at the end of life, nurses experienced moral distress when a dignified death was not realized. Furthermore, despite interprofessional collaboration efforts in Canada, the concept of silo mentality persists and contributes to moral distress. Organizational involvement is needed to address moral distress in pediatric intensive care nurses both to achieve a dignified death for child patients and in addressing silo mentality.
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Affiliation(s)
- Michelle Gagnon
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Diane Kunyk
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
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142
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Kinitz DJ, Salway T, Kia H, Ferlatte O, Rich AJ, Ross LE. Health of two-spirit, lesbian, gay, bisexual and transgender people experiencing poverty in Canada: a review. Health Promot Int 2021; 37:6306809. [PMID: 34148086 DOI: 10.1093/heapro/daab057] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Two-spirit, lesbian, gay, bisexual and transgender (2SLGBTQ+) people are disproportionately represented among those experiencing poverty. Both 2SLGBTQ+ people and people experiencing poverty face poorer health outcomes and greater difficulty accessing healthcare. Evidence of intersectional impacts of 2SLGBTQ+ status and poverty on health can help to inform economic and health policy. The objective of this review is to determine what is known about the health of 2SLGBTQ+ people in Canada experiencing poverty. Following the PRISMA framework, we searched and summarized Canadian literature on 2SLGBTQ+ poverty indexed in Medline, Sociological Abstracts, PsycInfo and EconList (N = 33). 2SLGBTQ+ poverty-related literature remains sparse but is expanding as illustrated by the fact that most (31/33) studies were published in the past decade. Half the studies analysed poverty as a focal variable and half as a covariate. Intersectionality theory assists in understanding the three health-related themes identified-healthcare access, physical health and mental health and substance use-as these outcomes are shaped by intersecting social structures that result in unique forms of discrimination. Those at the intersection of poverty and 2SLGBTQ+ status face poorer health outcomes than other 2SLGBTQ+ people in Canada. Discrimination was an overarching finding that explained persistent associations between 2SLGBTQ+ status, poverty and health. Research that directly interrogated the experiences of 2SLGBTQ+ populations experiencing poverty was sparse. In particular, there is a need to conduct research on underrepresented 2SLGBTQ+ sub-groups who are disproportionately impacted by poverty, including transgender, bisexual and two-spirit populations.
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Affiliation(s)
- David J Kinitz
- Social and Behavioural Health Sciences Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Travis Salway
- Faculty of Health Science, Simon Fraser University, Burnaby, Canada
| | - Hannah Kia
- School of Social Work, University of British Columbia, Vancouver, Canada
| | - Olivier Ferlatte
- École de santé publique, Université de Montréal and Centre de recherche en santé publique, Université de Montréal et CIUSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada
| | - Ashleigh J Rich
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Lori E Ross
- Social and Behavioural Health Sciences Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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143
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Prognostic Association between Common Laboratory Tests and Overall Survival in Elderly Men with De Novo Metastatic Castration Sensitive Prostate Cancer: A Population-Based Study in Canada. Cancers (Basel) 2021; 13:cancers13112844. [PMID: 34200349 PMCID: PMC8200983 DOI: 10.3390/cancers13112844] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/03/2021] [Accepted: 06/05/2021] [Indexed: 12/16/2022] Open
Abstract
Simple Summary Despite significant advancements in the treatment of metastatic prostate cancer, a validated prognostic tool for patients with de novo metastatic castration-sensitive prostate cancer (mCSPC) is still lacking. Using population-based data from Ontario, Canada, we examined the prognostic association between common laboratory tests and survival for patients with mCSPC. These low-cost commonly available laboratory tests, including neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, albumin, hemoglobin, PSA decrease and PSA nadir, were significantly associated with OS. They can provide important prognostic information and should be utilized more frequently among patients with newly diagnosed mCSPC. Abstract De novo cases of metastatic prostate cancer (mCSPC) are associated with poorer prognosis. To assist in clinical decision-making, we aimed to determine the prognostic utility of commonly available laboratory-based markers with overall survival (OS). In a retrospective population-based study, a cohort of 3556 men aged ≥66 years diagnosed with de novo mCSPC between 2014 and 2019 was identified in Ontario (Canada) administrative database. OS was assessed by using the Kaplan–Meier method. Multivariate Cox regression analysis was performed to evaluate the association between laboratory markers and OS adjusting for patient and disease characteristics. Laboratory markers that were assessed include neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), albumin, hemoglobin, serum testosterone and PSA kinetics. Among the 3556 older men with de novo mCSPC, their median age was 77 years (IQR: 71–83). The median survival was 18 months (IQR: 10–31). In multivariate analysis, a statistically significant association with OS was observed with all the markers (NLR, PLR, albumin, hemoglobin, PSA decrease, reaching PSA nadir and a 50% PSA decline), except for testosterone levels. Our findings support the use of markers of systemic inflammation (NLR, PLR and albumin), hemoglobin and PSA metrics as prognostic indicators for OS in de novo mCSPC.
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144
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Rolnitsky A, Unger SL, Urbach DR, Bell CM. Cost of neonatal intensive care for extremely preterm infants in Canada. Transl Pediatr 2021; 10:1630-1636. [PMID: 34295777 PMCID: PMC8261596 DOI: 10.21037/tp-21-36] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 04/21/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Neonatal intensive care is expensive and prolonged. Extremely preterm infants are routinely supported. The costs for this practice at the age of borderline viability are of interest to clinicians and policymakers. METHODS We analyzed data from the Canadian national administrative database on total cost and length of hospital care from a public payor perspective for 23-28-week premature infants from 2011 to 2015. We also compared total and daily costs for 23-25-week newborns. Each comparison evaluated the total cohort and infants who lived more than 3 days. We used non-parametric tests, correlation tests, and generalized linear models for cost difference analysis, adjusting for survival, length of stay, and year. RESULTS We analyzed 6,932 infants' cost records. For all infants, median length of hospital stay was 41 days (IQR, 1-77 days). For infants who survived the first 3 days, median length of stay was 61 days (IQR, 34-90 days). The median total cost was $66,669 (IQR, $4,920-$125,550). For infants who survived the first 3 days, median total cost was $91,137 (IQR, $56,596-$188,757). For infants who survived the first 3 days, median total costs were $147,835 (IQR, $44,711-$233,847) for 23-week infants, $154,736 (IQR, $61,160-$248,290) for 24-week infants, and $130,317 (IQR, $79,737-$229,058) for 25-week infants. These amounts did not differ (P>0.7). CONCLUSIONS Total and daily costs of neonatal intensive care are high. Total cost was not different between surviving 23-25-week infants. These findings highlight the need for a funding strategy for the routine support of these fragile infants.
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145
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Miller FA. The federal spending power: Building forward after the pandemic. Healthc Manage Forum 2021; 34:260-265. [PMID: 33998310 PMCID: PMC8129691 DOI: 10.1177/08404704211012725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The phrase, “the federal spending power,” identifies the federal government’s ability to spend in areas beyond its constitutional authority to legislate—a power that has supported the development of a national system of universal healthcare coverage in Canada. Even before the COVID-19 pandemic, this power was critical to the expansion of Canada’s narrow but deep basket of universally covered services. The challenges exposed by the pandemic mean that still more federal investment will be required. Yet for traditionalists, the material basis of this power is now constrained: the federal government may possess the constitutional authority to invest, but it lacks the fiscal capacity; some form of belt tightening—even austerity—will be necessary. As debates over public spending intensify, health leaders will need to address these questions. Depending on how they do so, health leaders will either support or detract from a healthy recovery.
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Affiliation(s)
- Fiona A Miller
- Centre for Sustainable Health Systems, Institute of Health Policy, Management and Evaluation, 7938University of Toronto, Toronto, Ontario, Canada
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146
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Jarvis K, Farrell A, Richter S, Lukewich J. Determinants of accessibility to primary sexual reproductive health care among vulnerable women in Canada: a scoping review protocol. JBI Evid Synth 2021; 18:2065-2074. [PMID: 32813414 DOI: 10.11124/jbisrir-d-19-00262] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of the review is to describe, synthesize and document the determinants that impact a vulnerable woman's access to primary sexual reproductive health care in Canada. INTRODUCTION Canada is committed to advancing sexual reproductive health care initiatives. Although both men and women require sexual reproductive health care, the implications for women are far more significant. While Canadian women do generally experience "good health," issues with sexual reproductive health do exist, particularly for vulnerable women for whom questions about accessibility arise. Therefore, there is a need to understand the true extent of a woman's access to sexual reproductive health in Canada. Findings will be used to inform future implementation research and provide recommendations to key stakeholders. INCLUSION CRITERIA Studies on primary access to sexual reproductive health care for vulnerable women (those living in poverty, with risky sexual behaviors, and/or are Indigenous, immigrants or refugees) aged nine to 49 who reside in Canada will be considered. Studies published in French or English from 2008 will be included. Women with a physical and/or mental disability and/or who are part of the lesbian, gay, bisexual, transgender and queer community will be excluded if they do not have one or more of the defining characteristics listed above. METHODS Databases to be searched include PubMed, Embase, CINAHL, PsycINFO, Sociological Abstracts and Women's Studies International. Gray literature searches will also be conducted. Following screening, all identified citations will be collated. Titles and abstracts will be screened by independent reviewers. Potentially relevant studies will be retrieved in full and assessed. Data will be extracted by independent reviewers and presented in diagrammatic or tabular form and accompanied by a narrative summary.
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Affiliation(s)
- Kimberly Jarvis
- Faculty of Nursing, Memorial University of Newfoundland, Newfoundland, Canada.,Faculty of Nursing, University of Alberta, Edmonton, Canada.,Memorial University Faculty of Nursing Collaboration for Evidence-Based Nursing and Primary Health Care: A JBI Affiliated Group
| | - Alison Farrell
- Faculty of Nursing, Memorial University of Newfoundland, Newfoundland, Canada.,Memorial University Faculty of Nursing Collaboration for Evidence-Based Nursing and Primary Health Care: A JBI Affiliated Group
| | - Solina Richter
- Faculty of Nursing, University of Alberta, Edmonton, Canada
| | - Julia Lukewich
- Faculty of Nursing, Memorial University of Newfoundland, Newfoundland, Canada.,Memorial University Faculty of Nursing Collaboration for Evidence-Based Nursing and Primary Health Care: A JBI Affiliated Group
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147
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Fleury MJ, Grenier G, Gentil L, Roberge P. Deployment of the consultation-liaison model in adult and child-adolescent psychiatry and its impact on improving mental health treatment. BMC FAMILY PRACTICE 2021; 22:82. [PMID: 33926390 PMCID: PMC8086343 DOI: 10.1186/s12875-021-01437-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 04/06/2021] [Indexed: 11/21/2022]
Abstract
Background Little information exists on the perceptions of psychiatrists regarding the implementation and various impacts of the consultation-liaison model. This model has been used in Quebec (Canada) through the function of specialist respondent-psychiatrists (SRP) since 2009. This study assessed the main activities, barriers or facilitators, and impact of SRP in adult and child-adolescent psychiatry on the capacity of service providers in primary care and youth centers to treat patients with mental health disorders (MHD). Methods Data included 126 self-administered questionnaires from SRP and semi-structured interviews from 48 SRP managers. Mixed methods were used, with qualitative findings from managers complementing the SRP survey. Comparative analyses of SRP responses in adult versus child-adolescent psychiatry were also conducted. Results Psychiatrists dedicated a median 24.12 h/month to the SRP function, mainly involving case discussions with primary care teams or youth centers. They were confident about the level of support they provided and satisfied with their influence in clinical decision-making, but less satisfied with the support provided by their organizations. SRP evaluated their impacts on clinical practice as moderate, particularly among general practitioners (GP). SRP working in child-adolescent psychiatry were more comfortable, motivated, and positive about their overall performance and impact than in adult psychiatry. Organizational barriers (e.g. team instability) were most prevalent, followed by system-level factors (e.g. network size and complexity, lack of resources, model inflexibility) and individual factors (e.g. GP reluctance to treat patients with MHD). Organizational facilitators included support from family medicine group directors, collaboration with university family medicine groups and coordination by liaison nurses; at the system level, pre-existing relationships and working in the same institution; while individual-level facilitators included SRP personality and strong organizational support. Conclusion Quebec SRP were implemented sparingly in family medicine groups and youth centers, while SRP viewed their overall impact as moderate. Results were more positive in child-adolescent psychiatry than in adult psychiatry. Increased support for the SRP function, adapting the model to GP in need of more direct support, and resolving key system issues may improve SRP effectiveness in terms of team stability, coordination among providers, access to MH services and readiness to implement innovations. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01437-5.
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Affiliation(s)
- M-J Fleury
- Department of Psychiatry, McGill University, Montreal, QC, Canada. .,Douglas Mental Health University Institute Research Center, Montréal, QC, Canada.
| | - G Grenier
- Douglas Mental Health University Institute Research Center, Montréal, QC, Canada
| | - L Gentil
- Douglas Mental Health University Institute Research Center, Montréal, QC, Canada
| | - P Roberge
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, Sherbrooke, QC, Canada
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148
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Ramos KJ, Sykes J, Stanojevic S, Ma X, Ostrenga JS, Fink A, Quon BS, Marshall BC, Faro A, Petren K, Elbert A, Goss CH, Stephenson AL. Survival and Lung Transplant Outcomes for Individuals With Advanced Cystic Fibrosis Lung Disease Living in the United States and Canada: An Analysis of National Registries. Chest 2021; 160:843-853. [PMID: 33878343 DOI: 10.1016/j.chest.2021.04.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 04/02/2021] [Accepted: 04/02/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Understanding how health outcomes differ for patients with advanced cystic fibrosis (CF) lung disease living in the United States compared with Canada has health policy implications. RESEARCH QUESTION What are rates of lung transplant (LTx) and rates of death without LTx in the United States and Canada among individuals with FEV1 < 40% predicted? STUDY DESIGN AND METHODS This was a retrospective population-based cohort study, 2005 to 2016, using the US CF Foundation, United Network for Organ Sharing, and Canadian CF registries. Individuals with CF and at least two FEV1 measurements < 40% predicted within a 5-year period, age ≥ 6 years, without prior LTx were included. Multivariable competing risk regression for time to death without LTx (LTx as a competing risk) and time to LTx (death as a competing risk) was performed. RESULTS There were 5,899 patients (53% male) and 905 patients (54% male) with CF with FEV1 < 40% predicted living in the United States and Canada, respectively. Multivariable competing risk regression models identified an increased risk of death without LTx (hazard ratio [HR], 1.79; 95% CI, 1.52-2.1) and decreased LTx (HR, 0.66; 95% CI, 0.58-0.74) among individuals in the United States compared with Canada. More pronounced differences were seen in the patients in the United States with Medicaid/Medicare insurance compared with Canadians (multivariable HR for death without LTx, 2.24 [95% CI, 1.89-2.64]; multivariable HR for LTx, 0.54 [95% CI, 0.47-0.61]). Patients of nonwhite race were also disadvantaged (multivariable HR for death without LTx, 1.56 [95% CI, 1.32-1.84]; multivariable HR for LTx, 0.47 [95% CI, 0.36-0.62]). INTERPRETATION There are lower rates of LTx and an increased risk of death without LTx for US patients with CF with FEV1 < 40% predicted compared with Canadian patients. Findings are more striking among US patients with CF with Medicaid/Medicare health insurance, and nonwhite patients in both countries, raising concerns about underuse of LTx among vulnerable populations.
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Affiliation(s)
- Kathleen J Ramos
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA.
| | - Jenna Sykes
- Division of Respirology, St. Michael's Hospital, Toronto, ON, Canada
| | - Sanja Stanojevic
- Translational Medicine, Hospital for Sick Children, Toronto, ON, Canada
| | - Xiayi Ma
- Division of Respirology, St. Michael's Hospital, Toronto, ON, Canada
| | | | - Aliza Fink
- Cystic Fibrosis Foundation, Bethesda, MD
| | - Bradley S Quon
- Division of Respirology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | | | | | | | - Christopher H Goss
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA; Division of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Washington, Seattle, WA
| | - Anne L Stephenson
- Division of Respirology, St. Michael's Hospital, Toronto, ON, Canada; Keenan Research Centre, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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149
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Pang HYM, Chalmers K, Landon B, Elshaug AG, Matelski J, Ling V, Krzyzanowska MK, Kulkarni G, Erickson BA, Cram P. Utilization Rates of Pancreatectomy, Radical Prostatectomy, and Nephrectomy in New York, Ontario, and New South Wales, 2011 to 2018. JAMA Netw Open 2021; 4:e215477. [PMID: 33871618 PMCID: PMC8056282 DOI: 10.1001/jamanetworkopen.2021.5477] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 02/20/2021] [Indexed: 12/13/2022] Open
Abstract
Importance Few studies have compared surgical utilization between countries or how rates may differ according to patients' socioeconomic status. Objective To compare population-level utilization of 3 common nonemergent surgical procedures in New York State (US), Ontario (Canada), and New South Wales (Australia) and how utilization differs for residents of lower- and higher-income neighborhoods. Design, Setting, and Participants This cohort study included all adults aged 18 years and older who were hospitalized for pancreatectomy, radical prostatectomy, or nephrectomy between 2011 and 2016 in New York, between 2011 and 2018 in Ontario, and between 2013 and 2018 in New South Wales. Each patient's address of residence was linked to 2016 census data to ascertain neighborhood income. Data were analyzed from August 2019 to November 2020. Main Outcomes and Measures Primary outcomes were (1) each jurisdiction's per capita age- and sex-standardized utilization rates (procedures per 100 000 residents per year) for each surgery and (2) utilization rates among residents of lower- and higher-income neighborhoods. Results This study included 115 428 surgical patients (25 780 [22.3%] women); 5717, 21 752, and 24 617 patients in New York were hospitalized for pancreatectomy, radical prostatectomy, and nephrectomy, respectively; 4929, 19 125, and 16 916 patients in Ontario, respectively; and 2069, 13 499, and 6804 patients in New South Wales, respectively. Patients in New South Wales were older for all procedures (eg, radical prostatectomy, mean [SD] age in New South Wales, 64.8 [7.3] years; in New York, 62.7 [8.4] years; in Ontario, 62.8 [6.7] years; P < .001); patients in New York were more likely than those in other locations to be women for pancreatectomy (New York: 2926 [51.2%]; Ontario: 2372 [48.1%]; New South Wales, 1003 [48.5%]; P = .004) and nephrectomy (New York: 10 645 [43.2%]; Ontario: 6529 [38.6%]; 2605 [38.3%]; P < .001). With the exception of nephrectomy in Ontario, there was a higher annual utilization rate for all procedures in all jurisdictions among patients residing in affluent neighborhoods (quintile 5) compared with poorer neighborhoods (quintile 1). This difference was largest in New South Wales for pancreatectomy (4.65 additional procedures per 100 000 residents [SE, 0.28]; P < .001) and radical prostatectomy (73.46 additional procedures per 100 000 residents [SE, 1.20]; P < .001); largest in New York for nephrectomy (8.43 additional procedures per 100 000 residents [SE, 0.85]; P < .001) and smallest in New York for radical prostatectomy (19.70 additional procedures per 100 000 residents [SE, 2.63]; P < .001); and smallest in Ontario for pancreatectomy (1.15 additional procedures per 100 000 residents [SE, 0.28]; P < .001) and nephrectomy (-1.10 additional procedures per 100 000 residents [SE, 0.52]; P < .001). New York had the highest utilization of nephrectomy (28.93 procedures per 100 000 residents per year [SE, 0.18]) and New South Wales for had the highest utilization of pancreatectomy and radical prostatectomy (6.94 procedures per 100 000 residents per year [SE, 0.15] and 94.37 procedures per 100 000 residents per year [SE, 0.81], respectively; all P < .001). Utilization was lowest in Ontario for all procedures (pancreatectomy, 6.18 procedures per 100 000 residents per year [SE, 0.09]; radical prostatectomy, 49.24 procedures per 100 000 residents per year [SE, 0.36]; nephrectomy, 21.40 procedures per 100 000 residents per year [SE, 0.16]; all P < .001). Conclusions and Relevance In this study, New York and New South Wales had higher per capita surgical utilization and larger neighborhood income-utilization gradients than Ontario. These findings suggest that income-based disparities are larger in the United States and Australia and smaller in Canada and highlight trade-offs inherent in the health care systems of different countries.
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Affiliation(s)
- Hilary Y. M. Pang
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Kelsey Chalmers
- Menzies Centre for Health Policy, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
- Lown Institute, Brookline, Massachusetts
| | - Bruce Landon
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Adam G. Elshaug
- Centre for Health Policy, Melbourne School of Population and Global Health and the Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
- USC–Brookings Schaeffer Initiative for Health Policy, The Brookings Institution, Washington, DC
| | - John Matelski
- Biostatistics Research Unit, Toronto General Hospital, Toronto, Ontario, Canada
| | | | - Monika K. Krzyzanowska
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Medical Oncology and Haematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Girish Kulkarni
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES Sciences, Toronto, Ontario, Canada
- Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | | | - Peter Cram
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES Sciences, Toronto, Ontario, Canada
- Department of General Internal Medicine, University Health Network and Sinai Health Systems, Toronto, Ontario, Canada
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Blanchette V, Patry J, Brousseau-Foley M. Adequacy Between Canadian Clinical Guidelines and Recommendations Compared With International Guidelines for the Management of Diabetic Foot Ulcers. Can J Diabetes 2021; 45:761-767.e12. [PMID: 34052133 DOI: 10.1016/j.jcjd.2021.03.004] [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: 10/15/2020] [Revised: 01/21/2021] [Accepted: 03/19/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Although quality of care in the prevention and management of diabetic foot ulceration (DFU) has improved with the use of comprehensive evidence-based clinical practice guidelines, disparities between national and international guidelines have been demonstrated in one study conducted in Western Pacific regions. Although there are challenges of systematic implementation of evidence-based care in some clinical settings, their applications have demonstrated positive outcomes on DFU-associated burdens in many countries. The aim of this study was to review and evaluate 3 Canadian clinical practice guidelines and recommendations (CPGRs) in comparison with the 2019 International Working Group on the Diabetic Foot (IWGDF) guidelines. METHODS Extraction of all 85 recommendations from the IWGDF guidelines was performed and 3 independent investigators used a rating recommendations adequacy method with descriptive statistics. The Appraisal of Guidelines REsearch & Evaluation (AGREE) II instrument was used for quality appraisal and reliability scores were noted using intraclass correlation coefficients. RESULTS The Wounds Canada CPGR had the higher adequacy with the IWGDF guidelines. However, its development method was poor to fair. The Registered Nurses' Association of Ontario CPGR was superior for its development and implementation strategies, but major gaps were found in all chapters. The Diabetes Canada CPGR obtained a good quality appraisal evaluation, but was not dedicated exclusively to DFU and some important recommendations were absent. Reliability scores of AGREE II were good between investigators (p<0.0001). Some disparities were noted between Canadian and international recommendations. CONCLUSIONS Some disparities were noted, future orientations for development should include various health-care professionals involved in the team approach, patient-oriented research, recommendations published along with their level of evidence and strength of recommendations (such as with the Grading of Recommendations, Assessment, Development and Evaluations system) and implementation strategies to enhance evidence-based practice in Canada.
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Affiliation(s)
- Virginie Blanchette
- Department of Physical Activity Sciences and Podiatric Medicine, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada; Centre de recherche du Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec, Canada.
| | - Jérôme Patry
- Department of Physical Activity Sciences and Podiatric Medicine, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada; Centre de recherche du Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec, Canada; Faculty of Medicine, Family Medicine and Emergency Medicine Department, Université Laval, Québec, Canada
| | - Magali Brousseau-Foley
- Department of Physical Activity Sciences and Podiatric Medicine, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada; Faculty of Medicine, Centre intégré universitaire de santé et de services sociaux de la Mauricie et du Centre-du-Québec affiliated with Université de Montréal, Trois-Rivières Family Medicine University Clinic, Trois-Rivières, Québec, Canada
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