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Buhmeida A, Assidi M, Budowle B. Current Healthcare Systems in Light of Hyperendemic NCDs and the COVID-19 Pandemic: Time to Change. Healthcare (Basel) 2023; 11:1382. [PMID: 37239667 PMCID: PMC10218054 DOI: 10.3390/healthcare11101382] [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: 02/06/2023] [Revised: 05/01/2023] [Accepted: 05/06/2023] [Indexed: 05/28/2023] Open
Abstract
Despite the significant achievements of current healthcare systems (CHCSs) in curing or treating several acute conditions, there has been far less success coping with noncommunicable diseases (NCDs), which have complex roots and nonconventional transmission vectors. Owing to the impact of the invisible hyperendemic NCDs and the COVID-19 pandemic, the limitations of CHCSs have been exposed. In contrast, the advent of omics-based technologies and big data science has raised global hope of curing or treating NCDs and improving overall healthcare outcomes. However, challenges related to their use and effectiveness must be addressed. Additionally, while such advancements intend to improve quality of life, they can also contribute the ever-increasing health disparity among vulnerable populations, such as low/middle-income populations, poorly educated people, gender-based violence victims, and minority and indigenous peoples, to name a few. Among five health determinants, the contribution of medical care to individual health does not exceed 11%. Therefore, it is time to implement a new well-being-oriented system complementary or parallel to CHCSs that incorporates all five health determinants to tackle NCDs and unforeseen diseases of the future, as well as to promote cost-effective, accessible, and sustainable healthy lifestyle choices that can reduce the current level of healthcare inequity.
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Affiliation(s)
- Abdelbaset Buhmeida
- Center of Excellence in Genomic Medicine Research, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Mourad Assidi
- Center of Excellence in Genomic Medicine Research, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Bruce Budowle
- Department of Forensic Medicine, University of Helsinki, Universitetsgatan 2, 00100 Helsinki, Finland
- Forensic Science Institute, Radford University, Radford, 24142 VA, USA
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Desveaux L, Budhwani S, Stamenova V, Bhattacharyya O, Shaw J, Bhatia RS. Closing the Virtual Gap in Health Care: A Series of Case Studies Illustrating the Impact of Embedding Evaluation Alongside System Initiatives. J Med Internet Res 2021; 23:e25797. [PMID: 34477560 PMCID: PMC8449303 DOI: 10.2196/25797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 05/20/2021] [Accepted: 07/29/2021] [Indexed: 11/13/2022] Open
Abstract
Early decisions relating to the implementation of virtual care relied on necessity and clinical judgement, but there is a growing need for the generation of evidence to inform policy and practice designs. The need for stronger partnerships between researchers and decision-makers is well recognized, but how these partnerships can be structured and how research can be embedded alongside existing virtual care initiatives remain unclear. We present a series of case studies that illustrate how embedded research can inform policy decisions related to the implementation of virtual care, where decisions are either to (1) discontinue (red light), (2) redesign (yellow light), or (3) scale up existing initiatives (green light). Data were collected through document review and informal interviews with key study personnel. Case 1 involved an evaluation of a mobile diabetes platform that demonstrated a mismatch between the setting and the technology (decision outcome: discontinue). Case 2 involved an evaluation of a mental health support platform that suggested evidence-based modifications to the delivery model (decision outcome: redesign). Case 3 involved an evaluation of video visits that generated evidence to inform the ideal model of implementation at scale (decision outcome: scale up). In this paper, we highlight the characteristics of the partnership and the process that enabled success and use the cases to illustrate how these characteristics were operationalized. Structured communication included monthly check-ins and iterative report development. We also outline key characteristics of the partnership (ie, trust and shared purpose) and the process (ie, timeliness, tailored reporting, and adaptability) that drove the uptake of evidence in decision-making. Across each case, the evaluation was designed to address policy questions articulated by our partners. Furthermore, structured communication provided opportunities for knowledge mobilization. Structured communication was operationalized through monthly meetings as well as the delivery of interim and final reports. These case studies demonstrate the importance of partnering with health system decision-makers to generate and mobilize scientific evidence. Embedded research partnerships founded on a shared purpose of system service provided an effective strategy to bridge the oft-cited gap between science and policy. Structured communication provided a mechanism for collaborative problem-solving and real-time feedback, and it helped contextualize emerging insights.
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Affiliation(s)
- Laura Desveaux
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Suman Budhwani
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Vess Stamenova
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Onil Bhattacharyya
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - James Shaw
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Joint Centre for Bioethics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - R Sacha Bhatia
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
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Brousselle A, Contandriopoulos D, Haggerty J, Breton M, Rivard M, Beaulieu MD, Champagne G, Perroux M. Stakeholder Views on Solutions to Improve Health System Performance. Healthc Policy 2018; 14:71-85. [PMID: 30129436 PMCID: PMC6147368 DOI: 10.12927/hcpol.2018.25547] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Context Significant reforms are needed to improve healthcare system performance in Quebec. Even though the characteristics of high-performing healthcare systems are well-known, Quebec's reforms have not succeeded in implementing many critical elements. Converging evidence from political science models suggests stakeholders' preferences are central in determining policy content, adoption, and implementation. Objective To analyze whether doctors', nurses', pharmacists' and health administrators' preferences could explain the observed inability to implement known characteristics of high-performing healthcare systems. Design A questionnaire on various propositions identified in the scientific literature was sent to 2,491 potential respondents. Results Overall response rate was 37%. There was considerable consensus on identified solutions to improve the healthcare system. Resistance was observed in two major areas: information systems and changes directly affecting doctors' practice. The groups' positions cannot explain the inability to implement important characteristics of high-performing systems. The findings raise new questions on the actual sources of resistance.
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Affiliation(s)
- Astrid Brousselle
- Professor, School of Public Administration, University of Victoria, Victoria BC; Researcher, Charles LeMoyne Hospital Research Center, Longueuil, QC
| | | | - Jeannie Haggerty
- Professor, Department of Family Medicine, McGill University; Researcher, St. Mary's Hospital Research Center, Montreal, QC
| | - Mylaine Breton
- Professor, Department of Community Health Sciences, Université de Sherbrooke; Researcher, Charles LeMoyne Hospital Research Center, Longueuil, QC
| | - Michèle Rivard
- Professor, University of Montreal School of Public Health; Researcher, University of Montreal Public Health Research Institute (IRSPUM), Montreal, QC
| | - Marie-Dominique Beaulieu
- Professor, Department of Family and Emergency Medicine, University of Montreal; Researcher, University of Montreal Hospital Research Center (CRCHUM), Montreal, QC
| | | | - Mélanie Perroux
- Coordinator, University of Montreal Public Health Research Institute (IRSPUM), Montreal, QC
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Contandriopoulos D, Brousselle A, Larouche C, Breton M, Rivard M, Beaulieu MD, Haggerty J, Champagne G, Perroux M. Healthcare reforms, inertia polarization and group influence. Health Policy 2018; 122:1018-1027. [PMID: 30031554 DOI: 10.1016/j.healthpol.2018.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 06/28/2018] [Accepted: 07/09/2018] [Indexed: 11/17/2022]
Abstract
Healthcare systems performance is the focus of intense policy and media attention in most countries. Quebec (Canada) is no exception, where successive governments have struggled for decades with apparently intractable problems in care accessibility overall, poor performance, and rising costs. This article explores the underlying causes of the disconnection between the high salience of healthcare system dysfunctions in both media and policy debates and the lack of policy change likely to remedy those dysfunctions. Academically, public policies' evolution is usually conceptualized as the product of complex, long-term interactions among diverse groups with specific power sources and preferences. In this context, we wanted to examine empirically whether divergences in stakeholders' views concerning various healthcare reform options could explain why certain policy changes are not implemented despite consensus on their programmatic coherence. The research design was an exploratory sequential design. Data were analyzed narratively as well as graphically using a method derived from social network analysis and graph theory. Results showed striking intergroup convergence around a programmatically sound policy package centred on the general objective of strengthening primary care delivery capacities. Those results, interpreted in light of political science elitist perspectives on the policy process, suggest that the incapacity to reform the system might be explained by one or two groups' having a de facto veto in policy-making.
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Affiliation(s)
- Damien Contandriopoulos
- School of Nursing, University of Victoria, PO Box 1700, STN CSC, Victoria, BC V8W 2Y2, Canada.
| | - Astrid Brousselle
- School of public administration, University of Victoria, PO Box 1700, STN CSC, Victoria, BC V8W 2Y2, Canada.
| | - Catherine Larouche
- School of Public Health, University of Montréal, 7101, avenue du Parc, Montreal, QC H3C 3J7, Canada.
| | - Mylaine Breton
- Department of Community Health Sciences, University of Sherbrooke, 200-150, place Charles-LeMoyne, Longueuil, QC J4K 0A8, Canada; Charles LeMoyne Hospital Research Center, 200-150, place Charles-LeMoyne, Longueuil, QC J4K 0A8, Canada.
| | - Michèle Rivard
- Centre for Modern Indian Studies, University of Göttingen, Göttingen, Waldweg, 26 37073 Göttingen, Germany.
| | - Marie-Dominique Beaulieu
- Department of Family and Emergency Medicine, University of Montréal, 2900, boulevard Édouard-Montpetit, Montreal, QC H3T 1J4, Canada; Researcher at the CHUM Research Center, 900, rue Saint-Denis, Montreal, QC H2X 0A9, Canada.
| | - Jeannie Haggerty
- Department of Family Medecine, McGill University, 5858, chemin de la Côte-des-Neiges, Montreal, QC H3S 1Z1, Canada; St. Mary's Hospital Research Center, 3830, avenue Lacombe, Montreal, QC H3T 1M5, Canada.
| | - Geneviève Champagne
- Charles LeMoyne Hospital Research Center, 200-150, place Charles-LeMoyne, Longueuil, QC J4K 0A8, Canada.
| | - Mélanie Perroux
- Regroupement des aidants naturels du Québec (RANQ) 1855 rue Dézéry, Montréal, H1W 2S1, Canada.
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5
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Horodnic AV, Williams CC. Informal payments by patients for health services: prevalence and determinants. SERVICE INDUSTRIES JOURNAL 2018. [DOI: 10.1080/02642069.2018.1450870] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Adrian V. Horodnic
- Faculty of Medicine, ‘Grigore T. Popa’ University of Medicine and Pharmacy, Iasi, Romania
| | - Colin C. Williams
- Sheffield University Management School (SUMS), University of Sheffield, Sheffield, UK
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Beaulieu M, Breton M, Brousselle A. Conceptualizing 20 years of engaged scholarship: A scoping review. PLoS One 2018; 13:e0193201. [PMID: 29489870 PMCID: PMC5831004 DOI: 10.1371/journal.pone.0193201] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 02/06/2018] [Indexed: 11/18/2022] Open
Abstract
Engaged scholarship, a movement that has been growing steadily since 1995, offers a new way of bridging gaps between the university and civil society. Numerous papers and reports have been published since Boyer's foundational discourse in 1996. Yet, beyond a growing interest in orienting universities' missions, we observed a lack a formal definition and conceptualization of this movement. Based on a scoping review of the literature over the past 20 years, the objective of this article is to propose a conceptualization of engaged scholarship. More specifically, we define its values, principles, and processes. We conclude with a discussion of the implications of this new posture for faculty and students, as well as for the university as an institution.
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Affiliation(s)
- Marianne Beaulieu
- Centre de recherche Charles-Le Moyne—Saguenay–Lac-Saint-Jean sur les innovations en santé, Longueuil, Québec, Canada
- Département des sciences de la santé communautaire, Université de Sherbrooke, Longueuil, Québec, Canada
| | - Mylaine Breton
- Centre de recherche Charles-Le Moyne—Saguenay–Lac-Saint-Jean sur les innovations en santé, Longueuil, Québec, Canada
- Département des sciences de la santé communautaire, Université de Sherbrooke, Longueuil, Québec, Canada
| | - Astrid Brousselle
- Centre de recherche Charles-Le Moyne—Saguenay–Lac-Saint-Jean sur les innovations en santé, Longueuil, Québec, Canada
- Département des sciences de la santé communautaire, Université de Sherbrooke, Longueuil, Québec, Canada
- School of Public Administration, University of Victoria, Victoria, British Columbia, Canada
- * E-mail:
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7
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Williams CC, Horodnic AV. Rethinking informal payments by patients in Europe: An institutional approach. Health Policy 2017; 121:1053-1062. [PMID: 28867153 DOI: 10.1016/j.healthpol.2017.08.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 07/12/2017] [Accepted: 08/18/2017] [Indexed: 10/19/2022]
Abstract
The aim of this paper is to explain informal payments by patients to healthcare professionals for the first time through the lens of institutional theory as arising when there are formal institutional imperfections and asymmetry between norms, values and practices and the codified formal laws and regulations. Reporting a 2013 Eurobarometer survey of the prevalence of informal payments by patients in 28 European countries, a strong association is revealed between the degree to which formal and informal institutions are unaligned and the propensity to make informal payments. The association between informal payments and formal institutional imperfections is then explored to evaluate which structural conditions might reduce this institutional asymmetry, and thus the propensity to make informal payments. The paper concludes by exploring the implications for tackling such informal practices.
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Affiliation(s)
- Colin C Williams
- Sheffield University Management School (SUMS), University of Sheffield, Conduit Road, Sheffield S10 1FL, Room: D038.a, United Kingdom.
| | - Adrian V Horodnic
- Sheffield University Management School (SUMS), University of Sheffield, Conduit Road, Sheffield S10 1FL, Room: D038.a, United Kingdom
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8
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Lalonde C, Gilbert MH. Dramaturgical awareness of consultants through the rhetoric and rituals of cooperation. JOURNAL OF ORGANIZATIONAL CHANGE MANAGEMENT 2016. [DOI: 10.1108/jocm-11-2015-0205] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– The purpose of this paper is to examine how rhetoric of cooperation is expressed and constructed during rituals of consultation and how this rhetoric is integrated into the consultant’s dramaturgical awareness that incorporates both impression management and the expression of self.
Design/methodology/approach
– This paper uses a discursive approach and semi-structured interviews with directors and consultants working in the healthcare sector, a sector that routinely employs consultants to accompany directors in organizational change management. Rhetoric is constructed around four narrative lines that also constitute the four ritualized phases of the consulting process.
Findings
– The mantra of “respect rituals of passage and avoid breaking frames” is an integral part of the consultant’s dramaturgical awareness throughout the process, so as not to infringe upon the order of the interaction established with the directors. Moreover, the development of cooperative relations with other members of the organization is based largely on a rather vast repertoire of action resources that the consultant will have to deploy to face four areas of uncertainty in the rites of interaction; namely, anticipation, interpretation, delegation and adherence. Furthermore, this cooperation is far from definitively acquired and must be reflected upon along the way to maintain control over the definition of the situation. This study expands upon the interrelations between the strategic actor and the reflective practitioner in a consultant’s dramaturgical awareness.
Practical implications
– Practical implications are highlighted using the notion of reflective contract (Schön, 1983) for managers as clients, the transcendental precepts of authenticity put forward by Coghland (2008) for consultants as practitioners, and progressive forms of critical theory performativity as suggested by Spicer et al. (2009) and Wickert and Schaefer (2015) for researchers.
Originality/value
– The concept underlying this study is dramaturgical awareness. It is a concept but sparingly explored in the literature, yet nonetheless present among advocates who promote organizational dramaturgy based on the work of Goffman. This concept is linked to Crozier and Friedberg’s theory of the strategic actor and Schön’s theory of the reflective practitioner.
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Contandriopoulos D, Brousselle A, Breton M, Sangster-Gormley E, Kilpatrick K, Dubois CA, Brault I, Perroux M. Nurse practitioners, canaries in the mine of primary care reform. Health Policy 2016; 120:682-9. [PMID: 27085958 DOI: 10.1016/j.healthpol.2016.03.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 03/14/2016] [Accepted: 03/29/2016] [Indexed: 01/13/2023]
Abstract
A strong and effective primary care capacity has been demonstrated to be crucial for controlling costs, improving outcomes, and ultimately enhancing the performance and sustainability of healthcare systems. However, current challenges are such that the future of primary care is unlikely to be an extension of the current dominant model. Profound environmental challenges are accumulating and are likely to drive significant transformation in the field. In this article we build upon the concept of "disruptive innovations" to analyze data from two separate research projects conducted in Quebec (Canada). Results from both projects suggest that introducing nurse practitioners into primary care teams has the potential to disrupt the status quo. We propose three scenarios for the future of primary care and for nurse practitioners' potential contribution to reforming primary care delivery models. In conclusion, we suggest that, like the canary in the coal mine, nurse practitioners' place in primary care will be an indicator of the extent to which healthcare system reforms have actually occurred.
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Affiliation(s)
- Damien Contandriopoulos
- Faculté des sciences infirmières, Université de Montréal, Canada; Institut de recherche en santé publique de l'Université de Montréal, Canada.
| | - Astrid Brousselle
- Département des sciences de la santé communautaire, Université de Sherbrooke, Canada; Centre de recherche de l'hôpital Charles-LeMoyne, Canada.
| | - Mylaine Breton
- Département des sciences de la santé communautaire, Université de Sherbrooke, Canada; Centre de recherche de l'hôpital Charles-LeMoyne, Canada.
| | | | - Kelley Kilpatrick
- Faculté des sciences infirmières, Université de Montréal, Canada; Maisonneuve-Rosemont Hospital Research Centre, Canada.
| | - Carl-Ardy Dubois
- Faculté des sciences infirmières, Université de Montréal, Canada; Institut de recherche en santé publique de l'Université de Montréal, Canada.
| | - Isabelle Brault
- Faculté des sciences infirmières, Université de Montréal, Canada.
| | - Mélanie Perroux
- Faculté des sciences infirmières, Université de Montréal, Canada.
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10
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Contandriopoulos D, Duhoux A, Roy B, Amar M, Bonin JP, Borges Da Silva R, Brault I, Dallaire C, Dubois CA, Girard F, Jean E, Larue C, Lessard L, Mathieu L, Pépin J, Perroux M, Cockenpot A. Integrated Primary Care Teams (IPCT) pilot project in Quebec: a protocol paper. BMJ Open 2015; 5:e010559. [PMID: 26700294 PMCID: PMC4691711 DOI: 10.1136/bmjopen-2015-010559] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 11/26/2015] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The overall aim of this project is to help develop knowledge about primary care delivery models likely to improve the accessibility, quality and efficiency of care. Operationally, this objective will be achieved through supporting and evaluating 8 primary care team pilot sites that rely on an expanded nursing role within a more intensive team-based, interdisciplinary setting. METHODS AND ANALYSIS The first research component is aimed at supporting the development and implementation of the pilot projects, and is divided into 2 parts. The first part is a logical analysis based on interpreting available scientific data to understand the causal processes by which the objectives of the intervention being studied may be achieved. The second part is a developmental evaluation to support teams in the field in a participatory manner and thereby learn from experience. Operationally, the developmental evaluation phase mainly involves semistructured interviews. The second component of the project design focuses on evaluating pilot project results and assessing their costs. This component is in turn made up of 2 parts. Part 1 is a pre-and-post survey of patients receiving the intervention care to analyse their care experience. In part 2, each patient enrolled in part 1 (around 4000 patients) will be matched with 2 patients followed within a traditional primary care model, so that a comparative analysis of the accessibility, quality and efficiency of the intervention can be performed. The cohorts formed in this way will be followed longitudinally for 4 years. ETHICS AND DISSEMINATION The project, as well as all consent forms and research tools, have been accepted by 2 health sciences research ethics committees. The procedures used will conform to best practices regarding the anonymity of patients.
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Affiliation(s)
| | - Arnaud Duhoux
- Faculty of Nursing, University of Montreal, Montréal, Québec, Canada
| | - Bernard Roy
- Faculty of Nursing, University of Laval, Québec, Québec, Canada
| | - Maxime Amar
- Faculty of Medicine, University of Laval, Québec, Québec, Canada
| | - Jean-Pierre Bonin
- Faculty of Nursing, University of Montreal, Montréal, Québec, Canada
| | | | - Isabelle Brault
- Faculty of Nursing, University of Montreal, Montréal, Québec, Canada
| | | | - Carl-Ardy Dubois
- Faculty of Nursing, University of Montreal, Montréal, Québec, Canada
| | - Francine Girard
- Faculty of Nursing, University of Montreal, Montréal, Québec, Canada
| | | | - Caroline Larue
- Faculty of Nursing, University of Montreal, Montréal, Québec, Canada
| | - Lily Lessard
- University of Québec in Rimouski, Rimouski, Québec, Canada
| | - Luc Mathieu
- University of Sherbrook, School of Nursing, Sherbrooke, Québec, Canada
| | - Jacinthe Pépin
- Faculty of Nursing, University of Montreal, Montréal, Québec, Canada
| | - Mélanie Perroux
- Faculty of Nursing, University of Montreal, Montréal, Québec, Canada
| | - Aurore Cockenpot
- Faculty of Nursing, University of Montreal, Montréal, Québec, Canada
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11
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Hanusaik N, Contandriopoulos D, Kishchuk N, Maximova K, Paradis G, O'Loughlin JL. Chronicling changes to the chronic disease prevention landscape in Canada's public health system 2004-2010. Public Health 2014; 128:716-24. [PMID: 25132388 PMCID: PMC7111625 DOI: 10.1016/j.puhe.2014.05.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 05/22/2014] [Accepted: 05/28/2014] [Indexed: 11/05/2022]
Abstract
The collective impact of major shifts in public health infrastructure and numerous new chronic disease prevention (CDP) capacity-building initiatives that have taken place in Canada over the last decade is unknown. The objective of this study was to determine if CDP capacity (i.e., skills and resources) and involvement in CDP programming improved in public health organizations in Canada from 2004 to 2010. Data for this repeated cross-sectional study were drawn from two waves of a national census of organizations mandated to carry out primary prevention of chronic disease and/or promotion of healthy eating, physical activity and tobacco control. Medians for continuous variables and frequencies for categorical variables were compared across time. Neither resources nor level of priority for CDP increased over time. There was little difference in the proportion of organizations with high levels of skills and involvement in core CDP practices (i.e., needs assessment, identification of relevant practices, planning, evaluation). Skills and involvement in CDP risk factor programming showed some gains, some steady states and some losses. Specifically, skill and involvement in tobacco control programming declined markedly while the proportion of organizations involved in healthy eating and physical activity programming increased. Skills to address and involvement in programming related to social determinants of health remained low over time as did involvement in programming addressing multiple risk factors concurrently. The lack of marked improvement in CDP capacity between 2004 and 2010 against a backdrop of initiatives favourable to strengthening the preventive health system in Canada suggests that efforts may have fallen short.
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Affiliation(s)
- N Hanusaik
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada.
| | - D Contandriopoulos
- Université de Montréal, Faculté de sciences infirmières, Montréal, Québec, Canada; Institut de recherche en santé publique de l'Université de Montréal (IRSPUM), Montréal, Québec, Canada
| | - N Kishchuk
- Program Evaluation & Beyond Inc., Montréal, Québec, Canada; Université de Montréal, Département de médecine sociale et préventive, Montréal, Québec, Canada
| | - K Maximova
- University of Alberta, Department of Public Health Sciences, Edmonton, Alberta, Canada
| | - G Paradis
- McGill University, Department of Epidemiology, Biostatistics, and Occupational Health, Montréal, Québec, Canada; Institut national de santé publique du Québec (INSPQ), Montréal, Québec, Canada
| | - J L O'Loughlin
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada; Université de Montréal, Département de médecine sociale et préventive, Montréal, Québec, Canada; Institut national de santé publique du Québec (INSPQ), Montréal, Québec, Canada
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12
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Moat KA, Lavis JN, Abelson J. How contexts and issues influence the use of policy-relevant research syntheses: a critical interpretive synthesis. Milbank Q 2013; 91:604-48. [PMID: 24028700 DOI: 10.1111/1468-0009.12026] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
CONTEXT Evidence briefs have emerged as a promising approach to synthesizing the best available research evidence for health system policymakers and stakeholders. An evidence brief may draw on systematic reviews and many other types of policy-relevant information, including local data and studies, to describe a problem, options for addressing it, and key implementation considerations. We conducted a systematic review to examine the ways in which context- and issue-related factors influence the perceived usefulness of evidence briefs among their intended users. METHODS We used a critical interpretive synthesis approach to review both empirical and nonempirical literature and to develop a model that explains how context and issues influence policymakers' and stakeholders' views of the utility of evidence briefs prepared for priority policy issues. We used a "compass" question to create a detailed search strategy and conducted electronic searches in CINAHL, EMBASE, HealthSTAR, IPSA, MEDLINE, OAIster (gray literature), ProQuest A&I Theses, ProQuest (Sociological Abstracts, Applied Social Sciences Index and Abstracts, Worldwide Political Science Abstracts, International Bibliography of Social Sciences, PAIS, Political Science), PsychInfo, Web of Science, and WilsonWeb (Social Science Abstracts). Finally, we used a grounded and interpretive analytic approach to synthesize the results. FINDINGS Of the 4,461 papers retrieved, 3,908 were excluded and 553 were assessed for "relevance," with 137 included in the initial sample of papers to be analyzed and an additional 23 purposively sampled to fill conceptual gaps. Several themes emerged: (1) many established types of "evidence" are viewed as useful content in an evidence brief, along with several promising formatting features; (2) contextual factors, particularly the institutions, interests, and values of a given context, can influence views of evidence briefs; (3) whether an issue is polarizing and whether it is salient (or not) and familiar (or not) to actors in the policy arena can influence views of evidence briefs prepared for that issue; (4) influential factors can emerge in several ways (as context driven, issue driven, or a result of issue-context resonance); (5) these factors work through two primary pathways, affecting either the users or the producers of briefs; and (6) these factors influence views of evidence briefs through a variety of mechanisms. CONCLUSIONS Those persons funding and preparing evidence briefs need to consider a variety of context- and issue-related factors when deciding how to make them most useful in policymaking.
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Holen-Rabbersvik E, Eikebrokk TR, Fensli RW, Thygesen E, Slettebø Å. Important challenges for coordination and inter-municipal cooperation in health care services: a Delphi study. BMC Health Serv Res 2013; 13:451. [PMID: 24171839 PMCID: PMC4228434 DOI: 10.1186/1472-6963-13-451] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Accepted: 10/27/2013] [Indexed: 11/28/2022] Open
Abstract
Background Demographical changes have stimulated a coordination reform in the Norwegian health care sector, creating new working practices and extending coordination within and between primary and hospital care, increasing the need for inter-municipal cooperation (IMC). This study aimed to identify challenges to coordination and IMC in the Norwegian health care sector as a basis for further theorizing and managerial advice in this growing area of research and practice. Methods A Delphi study of consensus development was used. Experts in coordination and IMC in health care services were selected by the healthcare manager or the councillor in their respective municipalities. In the first round, an expert panel received open-ended questions addressing possible challenges, and their answers were categorized and consolidated as the basis for further validation in the second round. The expert panel members were then asked to point out important statements in the third round, before the most important statements ranked by a majority of the members were rated again in the fourth round, including the option to explain the ratings. The same procedure was used in round five, with the exception that the expert panel members could view the consolidated results of their previous rankings as the basis for a new and final rating. The statements reaching consensus in round five were abstracted and themed. Results Nineteen experts consented to participate. Nine experts (47%) completed all of the five rounds. Eight statements concerning coordination reached consensus, resulting in four themes covering these challenges: different culture, uneven balance of power, lack of the possibility to communicate electronically, and demanding tasks in relation to resources. Three statements regarding challenges to IMC reached consensus, resulting in following themes: coopetition, complex leadership, and resistance to change. Conclusions This study identified several important challenges for coordination and it supports previous research. IMC in health care services deals with challenges other than coordination, and these must be addressed specifically. Our study contributes to extended knowledge of theoretical and practical implications in the field of coordination and IMC in health care sector.
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Grignon M. A democratic responsiveness approach to real reform: an exploration of health care systems' resilience. JOURNAL OF HEALTH POLITICS, POLICY AND LAW 2012; 37:665-676. [PMID: 22466049 DOI: 10.1215/03616878-1597475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Real reforms attempt to change how health care is financed and how it is rationed. Three main explanations have been offered to explain why such reforms are so difficult: institutional gridlock, path dependency, and societal preferences. The latter posits that choices made regarding the health care system in a given country reflect the broader societal set of values in that country and that as a result public resistance to real reform may more accurately reflect citizens' personal convictions, self-interest, or even active social choices. "Conscientious objectors" may do more to derail reform than previously recognized.
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Abstract
INTRODUCTION The paper highlights key trajectories and outcomes of the recent policy developments toward integrated health care delivery systems in Quebec and Ontario in the primary care sector and in the development of regional networks of health and social services. It particularly explores how policy legacies, interests and cultures may be mitigated to develop and sustain different models of integrated health care that are pertinent to the local contexts. POLICY DEVELOPMENTS In Quebec, three decades of iterative developments in health and social services evolved in 2005 into integrated centres for health and social services at the local levels (CSSSs). Four integrated university-based health care networks provide ultra-specialised services. Family Medicine Groups and network clinics are designed to enhance access and continuity of care. Ontario's Family Health Teams (2004) constitute an innovative public funding for private delivery model that is set up to enhance the capacity of primary care and to facilitate patient-based care. Ontario's Local Health Integration Networks (LHINs) with autonomous boards of provider organisations are intended to coordinate and integrate care. CONCLUSION Integration strategies in Quebec and Ontario yield clinical autonomy and power to physicians while simultaneously making them key partners in change. Contextual factors combined with increased and varied forms of physician remunerations and incentives mitigated some of the challenges from policy legacies, interests and cultures. Virtual partnerships and accountability agreements between providers promise positive but gradual movement toward integrated health service systems.
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Affiliation(s)
- Izzat Jiwani
- Health Policy Researcher and Management Consultant, IMJ Management Inc. Suite 2801-78 Harrison Garden Boulevard, North York, Ontario, M2N 7E2, Canada
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