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Harding KE, Lewis AK, Dennett A, Hughes K, Clarke M, Taylor NF. An evidence-based demand management strategy using a hub and spoke training model reduces waiting time for children's therapy services: An implementation trial. Child Care Health Dev 2024; 50:e13154. [PMID: 37487607 DOI: 10.1111/cch.13154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 05/21/2023] [Accepted: 06/28/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Waiting lists for community-based paediatric therapy services are common and lead to poorer health outcomes, anxiety and missed opportunities for treatment during crucial developmental stages. The Specific Timely Appointments for Triage (STAT) model has been shown to reduce waiting lists in a range of health settings. AIMS To determine whether providing training and support in the STAT model to champions within five community health centres using a remote 'hub and spoke' approach could reduce waiting time from referral to first appointment. METHODS Representatives from five community health centres providing paediatric therapy services (speech therapy, occupational therapy and other allied health services) participated in five online workshops over 6 months. They were guided sequentially through the steps of the STAT model: understanding supply and demand, reducing backlogs, preserving space for new patients based on demand and redesigning models of care to maintain flow. Waiting time was measured in three consecutive years (pre, during and post intervention) and compared using the Kruskal-Wallis test. Employee satisfaction and perception of the model were explored using surveys. RESULTS Data from 2564 children (mean age 3.2 years, 66% male) showed a 33% reduction in waiting time from the pre-intervention (median 57 days) to the post-intervention period (median 38 days, p < 0.01). The total number of children waiting was observed to reduce from 335 immediately prior to the intervention (mean per centre 67, SD 25.1) to 112 (mean 22, SD 13.6) after implementation (t[8] = 3.56, p < 0.01). There was no impact on employee satisfaction or other aspects of service delivery. CONCLUSION Waiting lists are a major challenge across the health system. STAT provides a practical, low-cost, data-driven approach to tackling waiting times. This study demonstrates its effectiveness in paediatric therapy services and provides evidence for a 'hub and spoke' approach to facilitate implementation that could be provided at scale.
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Affiliation(s)
- Katherine E Harding
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
- Eastern Health Allied Health Clinical Research Office, Box Hill, Australia
| | - Annie K Lewis
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
- Eastern Health Allied Health Clinical Research Office, Box Hill, Australia
| | - Amy Dennett
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
- Eastern Health Allied Health Clinical Research Office, Box Hill, Australia
| | - Kylie Hughes
- Department of Families, Fairness and Housing, Government of Victoria, Melbourne, Australia
| | - Michelle Clarke
- Department of Health, Government of Victoria, Melbourne, Australia
| | - Nicholas F Taylor
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
- Eastern Health Allied Health Clinical Research Office, Box Hill, Australia
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Harding KE, Lewis AK, Taylor NF. 'I just need a plan': Consumer perceptions of waiting for healthcare. J Eval Clin Pract 2023; 29:976-983. [PMID: 36861145 DOI: 10.1111/jep.13821] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/05/2023] [Accepted: 02/07/2023] [Indexed: 03/03/2023]
Abstract
RATIONALE Wait lists are common in the provision of publicly funded services in outpatient and community settings. AIMS AND OBJECTIVES We aimed to explore the experiences of consumers on wait lists across a broad range of services and to understand the impact of delays in access to services on people's lives. METHODS Consumers with experience of being on a wait list for an outpatient or community-based health service participated in one of three focus groups. Data were transcribed and analysed inductively using a thematic approach. RESULTS Waiting for healthcare has detrimental impacts on health and well-being. Consumers on wait lists want their health needs addressed, but they also want the ability to plan, clear communication and to feel like someone cares. Instead, they feel forgotten by impersonal and inflexible systems with very little communication, with emergency departments and general practitioners often left to fill in the gaps. CONCLUSIONS More consumer-centred approaches are needed for access systems for outpatient and community services, featuring honesty about what services can realistically be provided, early access to initial assessment and information and clear lines of communication.
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Affiliation(s)
- Katherine E Harding
- Eastern Health, Allied Health Clinical Research Office, Box Hill, Victoria, Australia
- School of Allied Health, Health Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Annie K Lewis
- Eastern Health, Allied Health Clinical Research Office, Box Hill, Victoria, Australia
- School of Allied Health, Health Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Nicholas F Taylor
- Eastern Health, Allied Health Clinical Research Office, Box Hill, Victoria, Australia
- School of Allied Health, Health Services and Sport, La Trobe University, Bundoora, Victoria, Australia
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Harding KE, Camden C, Lewis AK, Perreault K, Taylor NF. Service redesign interventions to reduce waiting time for paediatric rehabilitation and therapy services: A systematic review of the literature. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:2057-2070. [PMID: 35716009 PMCID: PMC10084082 DOI: 10.1111/hsc.13866] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 04/06/2022] [Accepted: 05/28/2022] [Indexed: 06/15/2023]
Abstract
Despite well-documented benefits of rehabilitation and therapy services for children with disabilities, long waiting lists to access these services are common. There is a growing body of evidence, primarily from mixed or adult services, demonstrating that waiting times can be reduced through strategies that target wasteful processes and support services to keep up with demand. However, providers of rehabilitation and therapy services for children face additional complexities related to the long-term nature of many developmental conditions and the need to consider timing of interventions with developmental milestones and education transition points. This review aimed to synthesise available evidence on service redesign strategies in reducing waiting time for paediatric therapy services. We conducted a systematic review of studies conducted in outpatient paediatric rehabilitation or therapy settings, including physical and mental health services, evaluating a service redesign intervention and presenting comparative data on time to access care. Two reviewers independently applied inclusion criteria, assessed risk of bias and extracted data. Findings were analysed descriptively and the certainty of evidence was synthesised according to criteria for health service research. From 1934 studies identified, 33 met the criteria for inclusion. Interventions were categorised as rapid response strategies, process efficiency interventions or substitution strategies (using alternative providers in place of medical specialists). Reductions in waiting time were reported in 30 studies. Evidence is limited by study designs with high risk of bias, but this is mitigated by consistency of findings and large effect sizes. There is moderate-certainty evidence that service redesign strategies similar to those used in adult populations can be applied in paediatric rehabilitation and therapy settings to reduce waiting time.
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Affiliation(s)
- Katherine E. Harding
- La Trobe University, School of Allied HealthHuman Services and SportMelbourneVictoriaAustralia
- Eastern Health Allied Health Clinical Research OfficeBox HillVictoriaAustralia
| | - Chantal Camden
- Sherbrooke University, School of RehabilitationSherbrookeQuébecCanada
| | - Annie K. Lewis
- La Trobe University, School of Allied HealthHuman Services and SportMelbourneVictoriaAustralia
- Eastern Health Allied Health Clinical Research OfficeBox HillVictoriaAustralia
| | - Kadija Perreault
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale‐NationaleQuébec CityQuébecCanada
- Department of Rehabilitation, Faculty of MedicineUniversité LavalQuébec CityQuébecCanada
| | - Nicholas F. Taylor
- La Trobe University, School of Allied HealthHuman Services and SportMelbourneVictoriaAustralia
- Eastern Health Allied Health Clinical Research OfficeBox HillVictoriaAustralia
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Hurtubise K, Gaboury I, Berbari J, Battista MC, Schuster T, Phoenix M, Rosenbaum P, Kraus De Camargo O, Lovo S, Pritchard-Wiart L, Zwicker JG, Beaudoin AJ, Morin M, Poder T, Gagnon MP, Roch G, Levac D, Tousignant M, Colquhoun H, Miller K, Churchill J, Robeson P, Ruegg A, Nault M, Camden C. Training Intervention and Program of Support (TIPS) for fostering adoption of family-centred telehealth in pediatric rehabilitation: Protocol for a multi-method, prospective hybrid type 3 implementation-effectiveness study (Preprint). JMIR Res Protoc 2022; 11:e40218. [PMID: 36306158 PMCID: PMC9652740 DOI: 10.2196/40218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 07/28/2022] [Accepted: 08/04/2022] [Indexed: 11/23/2022] Open
Abstract
Background Children with disability face long wait times for rehabilitation services. Before the COVID-19 pandemic, telehealth adoption was low across pediatric rehabilitation. Owing to the COVID-19 pandemic restrictions, pediatric therapists were asked to rapidly shift to telehealth, often with minimal training. To facilitate the behavior changes necessary for telehealth adoption, provision of appropriate evidence-based training and support is required. However, evidence to support the effective implementation of such training is lacking. The successful real-world implementation of a training intervention and program of support (TIPS) targeting pediatric therapists to enhance the adoption of family-centered telerehabilitation (FCT) requires the evaluation of both implementation and effectiveness. Objective This study aimed to evaluate TIPS implementation in different pediatric rehabilitation settings and assess TIPS effectiveness, as it relates to therapists’ adoption, service wait times, families’ perception of service quality, and costs. Methods This 4-year, pan-Canadian study involves managers, pediatric occupational therapists, physiotherapists, speech-language pathologists, and families from 20 sites in 8 provincial jurisdictions. It will use a multimethod, prospective, hybrid type 3 implementation-effectiveness design. An interrupted time series will assess TIPS implementation. TIPS will comprise a 1-month training intervention with self-paced learning modules and a webinar, followed by an 11-month support program, including monthly site meetings and access to a virtual community of practice. Longitudinal mixed modeling will be used to analyze indicators of therapists’ adoption of and fidelity to FCT collected at 10 time points. To identify barriers and facilitators to adoption and fidelity, qualitative data will be collected during implementation and analyzed using a deductive-inductive thematic approach. To evaluate effectiveness, a quasi-experimental pretest-posttest design will use questionnaires to evaluate TIPS effectiveness at service, therapist, and family levels. Generalized linear mixed effects models will be used in data analysis. Manager, therapist, and family interviews will be conducted after implementation and analyzed using reflective thematic analysis. Finally, cost data will be gathered to calculate public system and societal costs. Results Ethics approval has been obtained from 2 jurisdictions (February 2022 and July 2022); approval is pending in the others. In total, 20 sites have been recruited, and data collection is anticipated to start in September 2022 and is projected to be completed by September 2024. Data analysis will occur concurrently with data collection, with results disseminated throughout the study period. Conclusions This study will generate knowledge about the effectiveness of TIPS targeting pediatric therapists to enhance FCT adoption in pediatric rehabilitation settings, identify facilitators for and barriers to adoption, and document the impact of telehealth adoption on therapists, services, and families. The study knowledge gained will refine the training intervention, enhance intervention uptake, and support the integration of telehealth as a consistent pediatric rehabilitation service option for families of children with disabilities. Trial Registration ClinicalTrials.gov NCT05312827; https://clinicaltrials.gov/ct2/show/NCT05312827 International Registered Report Identifier (IRRID) PRR1-10.2196/40218
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Affiliation(s)
- Karen Hurtubise
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster Univeristy, Hamilton, ON, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, QC, Canada
- CanChild Centre for Childhood Disability Research, School of Rehabilitation Sciences, McMaster University, Hamilton, ON, Canada
| | - Isabelle Gaboury
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, QC, Canada
| | - Jade Berbari
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Marie-Claude Battista
- Department of Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Tibor Schuster
- Department of Family Medicine, McGill Univeristy, Montreal, QC, Canada
| | - Michelle Phoenix
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster Univeristy, Hamilton, ON, Canada
- CanChild Centre for Childhood Disability Research, School of Rehabilitation Sciences, McMaster University, Hamilton, ON, Canada
| | - Peter Rosenbaum
- CanChild Centre for Childhood Disability Research, School of Rehabilitation Sciences, McMaster University, Hamilton, ON, Canada
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Olaf Kraus De Camargo
- CanChild Centre for Childhood Disability Research, School of Rehabilitation Sciences, McMaster University, Hamilton, ON, Canada
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Stacey Lovo
- School of Rehabilitation Sciences, University of Saskatchewan, Saskatoon, SK, Canada
| | | | - Jill G Zwicker
- CanChild Centre for Childhood Disability Research, School of Rehabilitation Sciences, McMaster University, Hamilton, ON, Canada
- Department of Occupational Sciences and Occupational Therapy, University of British Columbia, Vancouver, BC, Canada
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Audrée Jeanne Beaudoin
- Institut Universitaire de Première Ligne en Santé et Services Sociaux, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie - Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
- École de Réadaptation, Faculté de Médecine et Sciences de la Santé, Univeristé de Sherbrooke, Sherbrooke, QC, Canada
| | - Mélanie Morin
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
- École de Réadaptation, Faculté de Médecine et Sciences de la Santé, Univeristé de Sherbrooke, Sherbrooke, QC, Canada
| | - Thomas Poder
- School of Public Health, Université de Montréal, Montréal, QC, Canada
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Est de l'Île de Montréal, Montréal, QC, Canada
| | - Marie-Pierre Gagnon
- Population Health and Optimal Health Practices Research Unit, Centre Hospitalier de Québec-Univeristé Laval Research Centre, Québec, QC, Canada
- Faculty of Nursing, Univeristé Laval, Québec, QC, Canada
| | - Geneviève Roch
- Population Health and Optimal Health Practices Research Unit, Centre Hospitalier de Québec-Univeristé Laval Research Centre, Québec, QC, Canada
- Faculty of Nursing, Univeristé Laval, Québec, QC, Canada
| | - Danielle Levac
- CanChild Centre for Childhood Disability Research, School of Rehabilitation Sciences, McMaster University, Hamilton, ON, Canada
- Faculty of Medicine, Univeristé de Montréal, Montréal, QC, Canada
| | - Michel Tousignant
- École de Réadaptation, Faculté de Médecine et Sciences de la Santé, Univeristé de Sherbrooke, Sherbrooke, QC, Canada
| | - Heather Colquhoun
- Occupational Science and Occupational Therapy Department, University of Toronto, Toronto, ON, Canada
| | - Kimberly Miller
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
- Department of Physical Therapy, Univeristy of British Columbia, Vancouver, BC, Canada
| | | | | | - Andréa Ruegg
- Training Intervention and Program of Support Study Team, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Martine Nault
- Training Intervention and Program of Support Study Team, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Chantal Camden
- CanChild Centre for Childhood Disability Research, School of Rehabilitation Sciences, McMaster University, Hamilton, ON, Canada
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
- École de Réadaptation, Faculté de Médecine et Sciences de la Santé, Univeristé de Sherbrooke, Sherbrooke, QC, Canada
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Harding KE, Lewis AK, Snowdon DA, Kent B, Taylor NF. A Multi-Faceted Strategy for Evidence Translation Reduces Healthcare Waiting Time: A Mixed Methods Study Using the RE-AIM Framework. FRONTIERS IN REHABILITATION SCIENCES 2021; 2:638602. [PMID: 36188815 PMCID: PMC9397794 DOI: 10.3389/fresc.2021.638602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/01/2021] [Indexed: 11/13/2022]
Abstract
Background: Waiting lists are often thought to be inevitable in healthcare, but strategies that address patient flow by reducing complexity, combining triage with initial management, and/or actively managing the relationship between supply and demand can work. One such model, Specific Timely Appointments for Triage (STAT), brings these elements together and has been found in multiple trials to reduce waiting times by 30–40%. The next challenge is to translate this knowledge into practice. Method: A multi-faceted knowledge translation strategy, including workshops, resources, dissemination of research findings and a community of practice (CoP) was implemented. A mixed methods evaluation of the strategy was conducted based on the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework, drawing on an internal database and a survey of workshop and CoP participants. Results: Demonstrating reach, at July 2020 an internal database held details of 342 clinicians and managers from 64 health services who had participated in the workshop program (n = 308) and/or elected to join an online CoP (n = 227). 40 of 69 (58%) respondents to a survey of this population reported they had adopted the model, with some providing data demonstrating that the STAT model had been efficacious in reducing waiting time. Perceived barriers to implementation included an overwhelming existing waiting list, an imbalance between supply and demand and lack of resources. Conclusion: There is high quality evidence from trials that STAT reduces waiting time. Using the RE-AIM framework, this evaluation of a translation strategy demonstrates uptake of evidence to reduce waiting time in health services.
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Affiliation(s)
- Katherine E. Harding
- Allied Health Clinical Research Office, Eastern Health, Melbourne, VIC, Australia
- School of Allied Health, La Trobe University, Melbourne, VIC, Australia
- *Correspondence: Katherine E. Harding
| | - Annie K. Lewis
- Allied Health Clinical Research Office, Eastern Health, Melbourne, VIC, Australia
- School of Allied Health, La Trobe University, Melbourne, VIC, Australia
| | - David A. Snowdon
- Allied Health Clinical Research Office, Eastern Health, Melbourne, VIC, Australia
| | - Bridie Kent
- Faculty of Health, University of Plymouth, Plymouth, United Kingdom
| | - Nicholas F. Taylor
- Allied Health Clinical Research Office, Eastern Health, Melbourne, VIC, Australia
- School of Allied Health, La Trobe University, Melbourne, VIC, Australia
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Quini E, Kaushik R. Is Managed Care Better Care? The Effects of Medicaid Managed Care on Children With Medical Complexity. Hosp Pediatr 2020; 10:709-711. [PMID: 32669284 DOI: 10.1542/hpeds.2020-0046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Emily Quini
- The Children's Hospital of San Antonio, San Antonio, Texas; and Department of General Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Ruchi Kaushik
- The Children's Hospital of San Antonio, San Antonio, Texas; and Department of General Pediatrics, Baylor College of Medicine, Houston, Texas
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Nuri RP, Ghahari S, Aldersey HM, Huque AS. Exploring access to government-led support for children with disabilities in Bangladesh. PLoS One 2020; 15:e0235439. [PMID: 32614867 PMCID: PMC7332059 DOI: 10.1371/journal.pone.0235439] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 06/15/2020] [Indexed: 12/20/2022] Open
Abstract
While access to support for individuals with disabilities has attracted international attention, children with disabilities and their families continue to face a range of barriers that limit their timely access to the needed support, including health service. This is even worse for children with disabilities living in resource poor settings like Bangladesh. The objective of this study was to determine the extent to which families of children with disabilities have knowledge about and access to government support for their children with disabilities in Bangladesh. We employed a cross-sectional study among 393 families of children with disabilities who sought services from the Centre for the Rehabilitation of the Paralysed for their children with disabilities in Bangladesh. We used chi-square test to measure the association between categorical variables and, Mann-Whitney U-test to compare mean across different sub-groups. Overall, family members of children with disabilities have limited knowledge about and access to government support. We found a significant association between knowledge and access to government support (p<0.001). Family members with children with disabilities aged younger than six years had less access to government support (p<0.001). We thus concluded with an urgent call on government agencies and service providers to provide relevant and timely information to families of children with disabilities to enable them to access the needed support.
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Affiliation(s)
- Reshma Parvin Nuri
- School of Rehabilitation Therapy, Queen’s University, Kingston, Ontario, Canada
- * E-mail:
| | - Setareh Ghahari
- School of Rehabilitation Therapy, Queen’s University, Kingston, Ontario, Canada
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The impact of bowel management on the quality of life in children with spina bifida with overactive bladder and detrusor sphincter dyssynergia. J Pediatr Urol 2019; 15:457-466. [PMID: 31202611 DOI: 10.1016/j.jpurol.2019.05.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 05/06/2019] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The aim of the study was to assess the impact of bowel management on the quality of life in children with spina bifida with overactive bladder and detrusor sphincter dyssynergia. MATERIALS AND METHOD The research was carried out over the 2014-2017 period, during which 70 patients with spina bifida with overactive bladder and detrusor sphincter dyssynergia were observed. The first group (group 1) consisted of 35 patients who were administered bowel management combined with anticholinergic medication therapy and CIC. The second group (group 2) consisted of 35 patients who were treated only with anticholinergic medication therapy and CIC. Bowel management included daily enema, laxative application, and a special diet, with a view of treating constipation and fecal incontinence that was estimated on the basis of Roma III criteria, the echosonographically determined transversal rectal diameter, and encopresis frequency. The effects of the administered bowel management on urinary incontinence were estimated on the basis of the average dry interval between two CICs. Regarding the quality of life, a KINDL questionnaire was used for children and parents to determine the overall quality of life, but also the various aspects of the quality of children's life (physical well-being, emotional well-being, self-confidence, family, friends, school, disease). The test score ranges from 0 to 100, where 0 is the lowest and 100 denotes the highest quality of life. The follow-up period of every patient was one year. RESULTS At baseline, there was no significant difference between the groups regarding demographic and clinical features (p > 0.05). After one year, treatment by bowel management demonstrated significant improvement for both fecal constipation/incontinence and urinary incontinence (p < 0.001). The bowel management group showed improved overall quality of life in contrast to the group without bowel management 88.9 ± 7.1 vs. 55.4 ± 11.4 (p < 0.001, assessed by parents) and 84.5 ± 8.9 vs. 53.4 ± 12.5 (p < 0.001, assessed by children), respectively. Moreover, the positive impact of bowel management on quality of life was confirmed for all domains of the quality of life (physical well-being, emotional well-being, self-confidence, family, friends, school, disease), (p < 0.001 for all), both by the parents' and the children's assessment. CONCLUSION Administering bowel management considerably alleviates the symptoms of fecal and urinary incontinence and considerably improves the quality of life. Bowel management should be considered as an integral part of treatment of children with spina bifida.
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Deslauriers S, Raymond MH, Laliberté M, Lavoie A, Desmeules F, Feldman DE, Perreault K. Variations in demand and provision for publicly funded outpatient musculoskeletal physiotherapy services across Quebec, Canada. J Eval Clin Pract 2017; 23:1489-1497. [PMID: 29063716 DOI: 10.1111/jep.12838] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 09/12/2017] [Accepted: 09/26/2017] [Indexed: 01/02/2023]
Abstract
RATIONALE The prevalence of musculoskeletal disorders is high and expected to increase in the next decade. Persons suffering from musculoskeletal disorders benefit from early physiotherapy services. However, access to publicly funded physiotherapy services has been shown to be compromised by long waiting times and limited availability of resources in many countries around the world. Decisions on resource allocation may create geographic disparities in provision and access to services, which may result in inequity in access. AIMS AND OBJECTIVES This study aimed to assess variations in demand and provision of publicly funded outpatient physiotherapy services across the province of Quebec, Canada, as well as to assess the demand to provision relationship. METHODS We conducted a secondary analysis of data retrieved from the 2008 Quebec Health Survey and data obtained from a survey of hospitals in the province of Quebec in 2015. We used geographic information systems analyses and descriptive analyses to assess geographic variations and the relationship between demand and provision. RESULTS Our results indicate substantial variations in the provision and demand for physiotherapy services in the province of Quebec. The variations in service provision did not follow the variations in demand. Long waiting times and insufficient provision of services were found in many regions. CONCLUSIONS The variations in provision of physiotherapy services between regions reported in our study did not correspond to the variations in demand. Such geographic variations and demand to provision mismatches may create inequity in access to services, especially for those unable to afford private services.
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Affiliation(s)
- Simon Deslauriers
- Faculty of Medicine, Université Laval; Centre for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Quebec City, Canada
| | - Marie-Hélène Raymond
- School of Rehabilitation, Faculty of Medicine, Université de Montréal; Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montréal, Canada
| | - Maude Laliberté
- School of Rehabilitation, Faculty of Medicine, Université de Montréal; Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montréal, Canada
| | - Amélie Lavoie
- Faculty of Medicine, Université Laval; Centre for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Quebec City, Canada
| | - François Desmeules
- School of Rehabilitation, Faculty of Medicine, Université de Montréal; Maisonneuve-Rosemont Hospital Research Centre, Montréal, Canada
| | - Debbie E Feldman
- School of Rehabilitation, Faculty of Medicine, Université de Montréal; Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montréal, Canada
| | - Kadija Perreault
- Department of Rehabilitation, Faculty of Medicine, Université Laval; CIRRIS, Quebec City, Canada
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McAnuff J, Boyes C, Kolehmainen N. Family-clinician interactions in children's health services: a secondary analysis of occupational therapists' practice descriptions. Health Expect 2015; 18:2236-51. [PMID: 24766653 PMCID: PMC5810711 DOI: 10.1111/hex.12194] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2014] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Effective family-clinician interactions are important for good health outcomes. Two types of interactions are consistently recommended: relational (e.g. listening, empathy, and respect) and participatory (e.g. shared decision-making, planning and problem-solving), but there is little specific guidance on how to implement these interactions in practice. OBJECTIVE To identify specific, practice-based examples of relational and participatory family-clinician interactions in children's occupational therapy. DESIGN A qualitative secondary analysis was used. The data consisted of a list of occupational therapists' self-reported practice actions (n = 217) and direct quotes describing their content and context. The practice actions were categorized into a range of relational and participatory family-centred interactions using a modified framework analysis. RESULTS Of the 217 practice actions, the majority [121 (55.76%)] did not describe examples of therapists implementing family-clinician interactions. Of the remaining practice actions, 19 (8.76%) described 'relational' interactions (e.g. 'Listen to carer', 'Gather perspectives from others'); 47 (21.66%) described 'participatory' interactions (e.g. 'Identify the family's goals and priorities', 'Allow the family to choose'); 2 (0.92%) described both ('Take guidance from carers'); and 28 (12.9%) were excluded from the analysis. DISCUSSION AND CONCLUSIONS A range of relational and participatory interactions were identified. Descriptions of participatory interactions were more frequent than descriptions of relational interactions, and overall the therapists described their family-clinician interactions less frequently than their other practice actions. The specific, real-life examples of different types of interactions identified in the study can be used as a basis for reflection on practice and developing more specific guidance.
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Affiliation(s)
- Jennifer McAnuff
- Children's Occupational Therapy ServiceLeeds Community Healthcare NHS TrustLeedsUK
| | - Chris Boyes
- Faculty of Health and Life SciencesYork St. John UniversityYorkUK
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Bisaro DL, Bidonde J, Kane KJ, Bergsma S, Musselman KE. Past and current use of walking measures for children with spina bifida: a systematic review. Arch Phys Med Rehabil 2015; 96:1533-1543.e31. [PMID: 25944500 DOI: 10.1016/j.apmr.2015.04.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 04/16/2015] [Accepted: 04/21/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To describe walking measurement in children with spina bifida and to identify patterns in the use of walking measures in this population. DATA SOURCES Seven medical databases-Medline, PubMed, Embase, Scopus, Web of Science, CINAHL, and AMED-were searched from the earliest known record until March 11, 2014. Search terms encompassed 3 themes: (1) children; (2) spina bifida; and (3) walking. STUDY SELECTION Articles were included if participants were children with spina bifida aged 1 to 17 years and if walking was measured. Articles were excluded if the assessment was restricted to kinematic, kinetic, or electromyographic analysis of walking. A total of 1751 abstracts were screened by 2 authors independently, and 109 articles were included in this review. DATA EXTRACTION Data were extracted using standardized forms. Extracted data included study and participant characteristics and details about the walking measures used, including psychometric properties. Two authors evaluated the methodological quality of articles using a previously published framework that considers sampling method, study design, and psychometric properties of the measures used. DATA SYNTHESIS Nineteen walking measures were identified. Ordinal-level rating scales (eg, Hoffer Functional Ambulation Scale) were most commonly used (57% of articles), followed by ratio-level, spatiotemporal measures, such as walking speed (18% of articles). Walking was measured for various reasons relevant to multiple health care disciplines. A machine learning analysis was used to identify patterns in the use of walking measures. The learned classifier predicted whether a spatiotemporal measure was used with 77.1% accuracy. A trend to use spatiotemporal measures in older children and those with lumbar and sacral spinal lesions was identified. Most articles were prospective studies that used samples of convenience and unblinded assessors. Few articles evaluated or considered the psychometric properties of the walking measures used. CONCLUSIONS Despite a demonstrated need to measure walking in children with spina bifida, few valid, reliable, and responsive measures have been established for this population.
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Affiliation(s)
- Derek L Bisaro
- School of Physical Therapy, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Julia Bidonde
- School of Physical Therapy, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Kyra J Kane
- School of Physical Therapy, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Shane Bergsma
- Department of Computer Science, College of Arts and Science, University of Saskatchewan, Saskatoon, SK, Canada
| | - Kristin E Musselman
- School of Physical Therapy, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada; Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada; Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
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Jimenez-Gomez A, Standridge SM. A refined approach to evaluating global developmental delay for the international medical community. Pediatr Neurol 2014; 51:198-206. [PMID: 25079568 DOI: 10.1016/j.pediatrneurol.2013.12.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 11/18/2013] [Accepted: 12/21/2013] [Indexed: 12/08/2022]
Abstract
BACKGROUND Global developmental delay is usually defined as significant delay in two or more domains of development. Etiologic diagnosis generally proves difficult and the etiology remains undetermined in up to 62% of these children. Those in whom an etiology is established generally undergo an exhaustive and costly diagnostic evaluation, even though this may not change the medical or therapeutic management of the delay. The history and physical examination may provide up to 40% of etiologic diagnoses if adequately conducted. METHODS We performed a critical review of the literature on global developmental delay via PubMed. RESULTS Five major etiologic categories for global developmental delay were identified and traits of the history and physical examination suggestive for their diagnosis were described. Additionally, current diagnostic tools and their benefits and limitations were appraised. CONCLUSIONS We propose an improved approach to enhance clinical diagnosis in both resource-rich and resource-limited settings favoring early intervention and management.
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Affiliation(s)
- Andres Jimenez-Gomez
- Cincinnati Children's Hospital Medical Center Pediatric Residency Program, Cincinnati, Ohio
| | - Shannon M Standridge
- Department of Child Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
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Majnemer A, Shikako-Thomas K, Lach L, Shevell M, Law M, Schmitz N, Poulin C. Rehabilitation service utilization in children and youth with cerebral palsy. Child Care Health Dev 2014; 40:275-82. [PMID: 23363242 DOI: 10.1111/cch.12026] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/24/2012] [Indexed: 11/29/2022]
Abstract
AIM To describe the pattern of use of rehabilitation services in children and adolescents with cerebral palsy (CP), and to identify factors associated with use. METHODS In this study, parents of 91 school-age children and 167 adolescents with CP completed a questionnaire regarding educational and rehabilitation resources received within the last 6 months. Rehabilitation services included occupational therapy (OT), physical therapy (PT), speech language pathology (SLP), psychology and special education. Demographic characteristics were documented and developmental and functional status was assessed. Relationships between service utilization and sociodemographic factors, functioning and school setting were determined. RESULTS Over half of children (53.2%) and adolescents (57.5%) were in regular schools; however, 41% of these required special education resources. The remainder (42.5-46.8%) was in special schools. The majority of children (84.6%) were receiving at least one rehabilitation service although this decreased (68.1%) in adolescence. PT and OT were most common and services were provided predominantly in the school setting. Services were primarily weekly direct interventions at school age, with weekly interventions or consultations most common for adolescents. Younger age was associated with service receipt at school age only. Children with greater motor limitations, lower IQ and greater activity limitations were more likely to receive OT, PT, SLP or special education. Children in segregated schools were significantly more likely to receive rehabilitation services, when compared with children in regular schools. CONCLUSIONS The majority of children and youth received one or more services. Individuals with greater motor or cognitive challenges were more likely to receive a range of school-based services from rehabilitation specialists. When compared with children of school age, adolescents were less likely to receive services and when provided, services were more likely to be consultative. Services may need to be more optimally organized through childhood to enhance benefits to children with CP across activity limitation profiles.
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Affiliation(s)
- A Majnemer
- School of Physical & Occupational Therapy, Faculty of Medicine, McGill University, Montreal, QC, Canada; Montreal Children's Hospital-MUHC and Centre for Interdisciplinary Research in Rehabilitation (CRIR), Montreal, QC, Canada
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Lee SF, Lee WS. Promoting the quality of hospital service for children with developmental delays. SERVICE INDUSTRIES JOURNAL 2013. [DOI: 10.1080/02642069.2011.635788] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Tétreault S, Beaupré P, Deschênes PM, Rajotte T, Gascon H, Boucher N, Carrière M. Comment mobiliser la communauté grâce au forum communautaire ? ACTA ACUST UNITED AC 2013. [DOI: 10.7202/1019110ar] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Dans le contexte actuel, il est important d’utiliser des méthodologies facilitant la consultation des citoyens concernés par une problématique quelconque. À cet effet, il est proposé d’explorer la méthode du forum communautaire. Celle-ci a été utilisée lors d’une étude québécoise portant sur les stratégies de soutien destinées aux familles ayant un enfant handicapé d’âge mineur. Le forum communautaire sera décrit et différents aspects de son organisation seront expliqués. Les avantages et les limites de cette consultation citoyenne seront également discutés. Le forum communautaire s’avère un outil intéressant pour l’intervenant social, car il remplit une triple fonction. Il permet de recueillir des informations de qualité, de sensibiliser les gens à un problème social ou de santé et de réaliser un processus de réflexion autour d’une question précise. La participation de la communauté étant incontournable dans la recherche de solutions à des préoccupations sociétales, le forum communautaire s’avère un outil de choix.
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Affiliation(s)
- Sylvie Tétreault
- Ph.D., Doctorat en service social, Professeure titulaire en ergothérapie, Faculté de médecine, Département de réadaptation, Université Laval
| | - Pauline Beaupré
- Ph.D., Doctorat en psychologie, Professeure titulaire en éducation, UQAR, Campus de Lévis, Département des sciences de l’éducation
| | - Pascale Marier Deschênes
- Baccalauréat en service social, Coordonnatrice de recherche, Centre interdisciplinaire de recherche en réadaptation et en intégration sociale (CIRRIS)
| | - Thomas Rajotte
- Candidat au Doctorat en éducation, UQAR, Campus de Lévis, Département des sciences de l’éducation
| | - Hubert Gascon
- Ph.D., Doctorat en psychologie, professeur titulaire en éducation, UQAR, Campus de Lévis, Département des sciences de l’éducation
| | - Normand Boucher
- Ph.D., Postdoctorat en sociologie, Chercheur régulier, Centre interdisciplinaire de recherche en réadaptation et en intégration sociale (CIRRIS)
| | - Monique Carrière
- Ph.D., Doctorat en sciences de l’administration, Professeure retraitée Université Laval, Faculté de médecine, Département de réadaptation
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Camden C, Swaine B, Tétreault S, Bergeron S, Lambert C. Development, implementation, and evaluation of the Apollo model of pediatric rehabilitation service delivery. Phys Occup Ther Pediatr 2013; 33:213-29. [PMID: 23231584 DOI: 10.3109/01942638.2012.739270] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This article presents the experience of a rehabilitation program that undertook the challenge to reorganize its services to address accessibility issues and improve service quality. The context in which the reorganization process occurred, along with the relevant literature justifying the need for a new service delivery model, and an historical perspective on the planning; implementation; and evaluation phases of the process are described. In the planning phase, the constitution of the working committee, the data collected, and the information found in the literature are presented. Apollo, the new service delivery model, is then described along with each of its components (e.g., community, group, and individual interventions). Actions and lessons learnt during the implementation of each component are presented. We hope by sharing our experiences that we can help others make informed decisions about service reorganization to improve the quality of services provided to children with disabilities, their families, and their communities.
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Affiliation(s)
- Chantal Camden
- School of Rehabilitation, Université de Montréal, Montreal, Quebec, Canada.
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Tuominen-Eriksson AM, Svensson Y, Gunnarsson RK. Children with Disabilities are Often Misdiagnosed Initially and Children with Neuropsychiatric Disorders are Referred to Adequate Resources 30 Months Later Than Children with Other Disabilities. J Autism Dev Disord 2013; 43:579-84. [DOI: 10.1007/s10803-012-1595-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Camden C, Swaine B, Levasseur M. Did waiting times really decrease following a service reorganization? Results from a retrospective study in a pediatric rehabilitation program in Québec. Disabil Rehabil 2012; 35:719-24. [PMID: 22897135 DOI: 10.3109/09638288.2012.705948] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To examine changes in waiting times and types of services received before, during and after a pediatric rehabilitation service reorganization including new admission procedures; To compare waiting time data available in the program's administrative database and children's medical files. METHOD Waiting time was defined as the time elapsed between referral and accessing a service provided by any clinician in the program (program waiting time) or by any clinician within a discipline (discipline-specific waiting time). Services were categorized as individual, group treatment, or other. ANOVAs and χ(2) tests were used to examine changes in waiting times and type of services, respectively. Paired T-tests compared the program waiting times from the two databases. RESULTS Data were collected on 188 children (mean age: 4 years and 1 month). The program and occupational therapy waiting times were shorter following the service reorganization. For two disciplines, the proportion of children receiving individual treatment diminished over time, while group and other types of interventions increased. Program waiting times calculated using the two data sources did not differ significantly but differences in the available data highlighted administrative issues. CONCLUSIONS Service reorganization can decrease waiting times and change the type of services offered over time.
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Affiliation(s)
- Chantal Camden
- Centre de Réadaptation Estrie, Sherbrooke, Québec, Canada.
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Kolehmainen N, MacLennan G, Ternent L, Duncan EAS, Duncan EM, Ryan SB, McKee L, Francis JJ. Using shared goal setting to improve access and equity: a mixed methods study of the Good Goals intervention in children's occupational therapy. Implement Sci 2012; 7:76. [PMID: 22898191 PMCID: PMC3444894 DOI: 10.1186/1748-5908-7-76] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Accepted: 07/27/2012] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Access and equity in children's therapy services may be improved by directing clinicians' use of resources toward specific goals that are important to patients. A practice-change intervention (titled 'Good Goals') was designed to achieve this. This study investigated uptake, adoption, and possible effects of that intervention in children's occupational therapy services. METHODS Mixed methods case studies (n = 3 services, including 46 therapists and 558 children) were conducted. The intervention was delivered over 25 weeks through face-to-face training, team workbooks, and 'tools for change'. Data were collected before, during, and after the intervention on a range of factors using interviews, a focus group, case note analysis, routine data, document analysis, and researchers' observations. RESULTS Factors related to uptake and adoptions were: mode of intervention delivery, competing demands on therapists' time, and leadership by service manager. Service managers and therapists reported that the intervention: helped therapists establish a shared rationale for clinical decisions; increased clarity in service provision; and improved interactions with families and schools. During the study period, therapists' behaviours changed: identifying goals, odds ratio 2.4 (95% CI 1.5 to 3.8); agreeing goals, 3.5 (2.4 to 5.1); evaluating progress, 2.0 (1.1 to 3.5). Children's LoT decreased by two months [95% CI -8 to +4 months] across the services. Cost per therapist trained ranged from £1,003 to £1,277, depending upon service size and therapists' salary bands. CONCLUSIONS Good Goals is a promising quality improvement intervention that can be delivered and adopted in practice and may have benefits. Further research is required to evaluate its: (i) impact on patient outcomes, effectiveness, cost-effectiveness, and (ii) transferability to other clinical contexts.
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Affiliation(s)
- Niina Kolehmainen
- Health Services Research Unit, University of Aberdeen, 3rd floor, HSB, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Graeme MacLennan
- Health Services Research Unit, University of Aberdeen, 3rd floor, HSB, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Laura Ternent
- Health Services Research Unit and Health Economics Research Unit, University of Aberdeen, 3rd floor, HSB, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Edward AS Duncan
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, FK9 4LA, UK
| | - Eilidh M Duncan
- Health Services Research Unit and Aberdeen Health Psychology Group, University of Aberdeen, 2nd floor, HSB, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Stephen B Ryan
- Health Services Research Unit, University of Aberdeen, 3rd floor, HSB, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Lorna McKee
- Health Services Research Unit, University of Aberdeen, 3rd floor, HSB, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Jill J Francis
- Health Services Research Unit and Aberdeen Health Psychology Group, University of Aberdeen, 2nd floor, HSB, Foresterhill, Aberdeen, AB25 2ZD, UK
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Camden C, Swaine B, Tétreault S, Carrière M. Going beyond the identification of change facilitators to effectively implement a new model of services: lessons learned from a case example in paediatric rehabilitation. Dev Neurorehabil 2011; 14:247-60. [PMID: 21732809 DOI: 10.3109/17518423.2011.577049] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To identify facilitators and barriers to service reorganization, how they evolved and interacted to influence change during the implementation of a new service delivery model of paediatric rehabilitation. METHODS Over 3 years, different stakeholders responded to SWOT questionnaires (n = 139) and participated in focus groups (n = 19) and telephone interviews (n = 13). A framework based on socio constructivist theories made sense of the data. RESULTS Facilitators related to the programme's structure (e.g. funding), the actors (e.g. willingness to test the new service model) and the change management process (e.g. participative approach). Some initial facilitators became barriers (e.g. leadership lacked at the end), while other barriers emerged (e.g. lack of tools). Understanding factor interactions requires examining the multiple actors' intentions, actions and consequences and their relations with structural elements. CONCLUSIONS Analysing facilitators and barriers helped better understand the change processes, but this must be followed by concrete actions to successfully implement new paediatric rehabilitation models.
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Affiliation(s)
- Chantal Camden
- École de Réadaptation, Université de Montréal, Québec, Canada.
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Kolehmainen N, MacLennan G, Francis JJ, Duncan EAS. Clinicians' caseload management behaviours as explanatory factors in patients' length of time on caseloads: a predictive multilevel study in paediatric community occupational therapy. BMC Health Serv Res 2010; 10:249. [PMID: 20731865 PMCID: PMC2936379 DOI: 10.1186/1472-6963-10-249] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Accepted: 08/23/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Long waiting times and large caseloads are a challenge to children's therapy services internationally. Research in hospital-based healthcare indicates that waiting times are a function of throughput, and that length of care episode is related to clinicians' caseload management behaviour (i.e. actions at assessment, treatment, post-treatment, and discharge). There have been few attempts to study this in community health services. The present study investigated whether community occupational therapists' behaviour predicts children's length of time (LoT) on caseloads. METHODS Retrospective survey of case notes of children recently discharged from occupational therapy services. Using cluster random sampling, case notes were drawn from therapy records in six NHSScotland Health Boards. Data about therapists' behaviours of assessing, treating, reviewing and discharging, together with child characteristics, were used to construct regression models of factors related to LoT. RESULTS Twenty-six therapists [median(IQR) time in paediatrics 8(6-13) years] and 154 of their cases [mean(SD) age 7(3) years; median(IQR) LoT 10(3-21)] were included. A multi-level model, adjusting for clustering, for therapists' actions of communicating assessment outcomes to parents, providing treatment, and placing the child on review, and for a diagnosis of cerebral palsy, explained 44% of variation in LoT. CONCLUSIONS Occupational therapists' caseload management behaviours are associated with children's LoT on caseloads. Further research is required to investigate the direction of relationships between therapists' behaviours and LoT; and the relationships between contextual factors, therapists' caseload management behaviours and LoT. Further exploration of therapists' beliefs about caseload management could also be useful in identifying possible factors contributing to variation between therapists.
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Affiliation(s)
- Niina Kolehmainen
- Health Services Research Unit, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen, UK
- Aberdeen Health Psychology Group, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen, UK
| | - Graeme MacLennan
- Health Services Research Unit, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen, UK
| | - Jillian J Francis
- Health Services Research Unit, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen, UK
- Aberdeen Health Psychology Group, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen, UK
| | - Edward AS Duncan
- Nursing, Midwifery and Allied Health Professions Research Unit, Iris Murdoch Building, University of Stirling, Stirling, UK
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Sawin KJ, Bellin MH. Quality of life in individuals with spina bifida: A research update. ACTA ACUST UNITED AC 2010; 16:47-59. [DOI: 10.1002/ddrr.96] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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