1
|
Ruest M, Guay M. [Orientations de facilitation pour soutenir l'application de l'Algo dans les services de soutien à domicile des personnes aînées]. Can J Aging 2024; 43:167-175. [PMID: 37902413 DOI: 10.1017/s0714980823000600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023] Open
Abstract
Comment soutenir le déploiement de connaissances coconstruites par des personnes cliniciennes, gestionnaires ou chercheures? Ce thème est abordé à partir de l'étude de l'application de l'Algo, un algorithme clinique décisionnel conçu pour la sélection des aides techniques visant à faciliter l'hygiène corporelle des personnes aînées vivant à domicile. L'objectif de cette note sur les politiques et les pratiques est de présenter les orientations de facilitation dégagées à la suite d'un devis mixte multiphases (2015-2019) mis en œuvre dans les services de soutien à domicile au Québec (Canada). Les orientations de facilitation centrée sur la tâche et holistique sont présentées en fonction des stades d'utilisation de l'Algo, afin de soutenir les personnes cliniciennes, gestionnaires et chercheures dans la poursuite de son application auprès des personnes aînées. De plus, cette note illustre l'apport des devis mixtes à la conduite et à la compréhension de l'application des connaissances coconstruites.
Collapse
Affiliation(s)
- Mélanie Ruest
- Faculté de médecine et des sciences de la santé de l'Université de Sherbrooke et Centre de recherche sur le vieillissement 3001, 12e Avenue Nord, Sherbrooke (Québec) CanadaJ1H 5N4
| | - Manon Guay
- Faculté de médecine et des sciences de la santé de l'Université de Sherbrooke et Centre de recherche sur le vieillissement 3001, 12e Avenue Nord, Sherbrooke (Québec) CanadaJ1H 5N4
| |
Collapse
|
2
|
Lessons on integrated knowledge translation through algorithm's utilization in homecare services: a multiple case study. JBI Evid Implement 2021; 19:419-436. [PMID: 34074950 DOI: 10.1097/xeb.0000000000000286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AIM Integrated knowledge translation (IKT) is an increasingly recommended collaborative approach to minimize knowledge translation gap. Still, few studies have documented the impact of IKT to optimize knowledge uptake in healthcare settings. An IKT-based clinical algorithm (Algo) was deployed in Quebec (Canada) homecare services to support skill mix for selecting bathing equipment for community-dwelling adults. The objective of this study was to document the characteristics related to Algo's IKT process. METHODS A multiple-case study with a nested concurrent mixed design was conducted in provincial homecare services. Based on Knott and Wildavsky's seven-stage classification and the integrated-Promoting Action on Research Implementation in Health Services model, Innovation, Recipients, and Context, characteristics related to Algo's levels of utilization were documented. Quantitative (electronic questionnaire) and qualitative (semistructured interviews and focus groups) data were collected for each case (i.e., homecare service). Descriptive statistics and thematic analysis were performed to describe each case through a mixed methods matrix, for intra/intercase analyses. RESULTS Knowledge translation characteristics of five Algo's levels of utilization were documented: reception, cognition, reference, effort, and impact. Innovation characteristics (e.g., underlying knowledge) were found to facilitate its dissemination and its use. However, the Recipients (e.g., unclear mechanisms to implement change) and Context (e.g., organizational mandates nonaligned with skill mix) characteristics hampered its application through intermediate and advanced levels of utilization. CONCLUSION The knowledge translation analysis of Algo allowed for documenting the IKT-based benefits in terms of utilization in healthcare settings. Although an IKT approach appears to be a strong facilitator for initiating the implementation process, additional characteristics should be considered for promoting and sustaining its use on local, organizational, and external levels of context. Facilitation strategies should document the administrative benefits related to Algo's utilization and contextualize it according to homecare services' characteristics.
Collapse
|
3
|
Guay M, Latulippe K, Auger C, Giroux D, Séguin-Tremblay N, Gauthier J, Genest C, Morales E, Vincent C. Self-Selection of Bathroom-Assistive Technology: Development of an Electronic Decision Support System (Hygiene 2.0). J Med Internet Res 2020; 22:e16175. [PMID: 32773380 PMCID: PMC7445614 DOI: 10.2196/16175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 04/28/2020] [Accepted: 06/03/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND A clinical algorithm (Algo) in paper form is used in Quebec, Canada, to allow health care workers other than occupational therapists (OTs) to make bathroom adaptation recommendations for older adults. An integrated knowledge transfer process around Algo suggested an electronic version of this decision support system (electronic decision support system [e-DSS]) to be used by older adults and their caregivers in search of information and solutions for their autonomy and safety in the bathroom. OBJECTIVE This study aims to (1) create an e-DSS for the self-selection of bathroom-assistive technology by community-dwelling older adults and their caregivers and (2) assess usability with lay users and experts to improve the design accordingly. METHODS On the basis of a user-centered design approach, the process started with content identification for the prototype through 7 semistructured interviews with key informants of various backgrounds (health care providers, assistive technology providers, and community services) and 4 focus groups (2 with older adults and 2 with caregivers). A thematic content transcript analysis was carried out and used during the creation of the prototype. The prototype was refined iteratively using think-aloud and observation methods with a clinical expert (n=1), researchers (n=3), OTs (n=3), older adults (n=3), and caregivers (n=3), who provided information on the usability of the e-DSS. RESULTS Overall, 4 themes served as the criteria for the prototype of the electronic Algo (Hygiene 2.0 [H2.0]): focus (safety, confidentiality, well-being, and autonomy), engage, facilitate (simplify, clarify, and illustrate), and access. For example, users first pay attention to the images (engage and illustrate) that can be used to depict safe postures (safety), illustrate questions embedded in the decision support tool (clarify and illustrate), and demonstrate the context of the use of assistive technology (safety and clarify). CONCLUSIONS The user-centered design of H2.0 allowed the cocreation of an e-DSS in the form of a website, in line with the needs of community-dwelling older adults and their caregivers seeking bathroom-assistive technology that enables personal hygiene. Each iteration improved usability and brought more insight into the users' realities, tailoring the e-DSS to the implementation context.
Collapse
Affiliation(s)
- Manon Guay
- School of Rehabilitation, Université de Sherbrooke, Sherbrooke, QC, Canada.,Center for Research on Aging, Sherbrooke, QC, Canada
| | - Karine Latulippe
- Department of Teaching and Learning Studies, Université Laval, Quebec, QC, Canada
| | - Claudine Auger
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, QC, Canada
| | - Dominique Giroux
- Center of Excellence on Aging Quebec, Quebec, QC, Canada.,Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec, QC, Canada.,VITAM - Centre de recherche en santé durable, Quebec, QC, Canada
| | | | - Josée Gauthier
- CIUSSS de la Mauricie-et-du-Centre-du-Québec, Trois-Rivières, QC, Canada
| | | | - Ernesto Morales
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec, QC, Canada.,Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec, QC, Canada
| | - Claude Vincent
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec, QC, Canada.,Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec, QC, Canada
| |
Collapse
|
4
|
Guay M, Ruest M, Contandriopoulos D. Deimplementing Untested Practices in Homecare Services: A Preobservational-Postobservational Design. Occup Ther Int 2019; 2019:5638939. [PMID: 31015826 PMCID: PMC6444257 DOI: 10.1155/2019/5638939] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 10/04/2018] [Accepted: 02/03/2019] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION With community-dwelling elders waiting to adapt their bathroom, Health and Social Services Centers in Quebec (Canada) combined human resources through cross-skilling within interdisciplinary teams. To this end, occupational therapists implemented in-house "tools" to support nonoccupational therapists in selecting bathing equipment. However, unknown psychometric properties of those in-house "tools" cast doubt on the quality of service provided to elders. Little is also known about the best processes to use to support the deimplementation of such nonevidence-based practices. This study presents the effect of a knowledge transfer and exchange intervention designed to deimplement in-house "tools" and replace them with an evidence-based tool (Algo). METHODS Censuses were conducted with the 94 Health and Social Services Centers of Quebec providing homecare services, before and after the knowledge transfer and exchange intervention (2009-2013). In 2013, the deimplementation of in-house "tools" and their replacement by Algo were measured with Knott and Wildavsky's levels of utilization. RESULTS Cross-skilling within interdisciplinary teams increased between censuses (87% to 98%), as did use of in-house "tools" (67% to 81%). Algo's uptake started during the knowledge transfer and exchange process as 25 Health and Social Services Centers achieved the first level of utilization. Nonetheless, no Health and Social Services Center deimplemented the in-house "tools" to use Algo. CONCLUSION The knowledge transfer and exchange process led to the development of a scientifically sound clinical tool (Algo) and challenged the status quo in clinical settings regarding the use of nonevidence-based practices. However, the deimplementation of in-use practices has not yet been observed. This study highlights the need to act proactively on the deimplementation and implementation processes.
Collapse
Affiliation(s)
- Manon Guay
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, J1H 5N4, Canada
- Research Centre on Aging, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke, J1H 4C4, Canada
| | - Mélanie Ruest
- Research Centre on Aging, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke, J1H 4C4, Canada
- Research Programs in Health Sciences, Faculty of Medicine and Health Sciences, Université de Sherbrooke, J1H 5N4, Canada
| | | |
Collapse
|
5
|
Saari M, Xiao S, Rowe A, Patterson E, Killackey T, Raffaghello J, Tourangeau AE. The role of unregulated care providers in home care: A scoping review. J Nurs Manag 2018; 26:782-794. [DOI: 10.1111/jonm.12613] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2017] [Indexed: 01/07/2023]
Affiliation(s)
| | - Sarah Xiao
- Lawrence S. Bloomberg Faculty of Nursing; University of Toronto; Toronto ON Canada
| | - Alissa Rowe
- Southwest Local Health Integration Network; London ON Canada
| | - Erin Patterson
- School of Health & Life Sciences & Community Services; Conestoga College Institute of Technology and Advanced Learning; Kitchener ON Canada
| | - Tieghan Killackey
- Lawrence S. Bloomberg Faculty of Nursing; University of Toronto; Toronto ON Canada
| | - Julia Raffaghello
- Lawrence S. Bloomberg Faculty of Nursing; University of Toronto; Toronto ON Canada
| | - Ann E. Tourangeau
- Lawrence S. Bloomberg Faculty of Nursing; University of Toronto; Toronto ON Canada
| |
Collapse
|
6
|
Jesus TS, Landry MD, Dussault G, Fronteira I. Human resources for health (and rehabilitation): Six Rehab-Workforce Challenges for the century. HUMAN RESOURCES FOR HEALTH 2017; 15:8. [PMID: 28114960 PMCID: PMC5259954 DOI: 10.1186/s12960-017-0182-7] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 01/12/2017] [Indexed: 05/26/2023]
Abstract
BACKGROUND People with disabilities face challenges accessing basic rehabilitation health care. In 2006, the United Nations Convention on the Rights of Persons with Disabilities (CRPD) outlined the global necessity to meet the rehabilitation needs of people with disabilities, but this goal is often challenged by the undersupply and inequitable distribution of rehabilitation workers. While the aggregate study and monitoring of the physical rehabilitation workforce has been mostly ignored by researchers or policy-makers, this paper aims to present the 'challenges and opportunities' for guiding further long-term research and policies on developing the relatively neglected, highly heterogeneous physical rehabilitation workforce. METHODS The challenges were identified through a two-phased investigation. Phase 1: critical review of the rehabilitation workforce literature, organized by the availability, accessibility, acceptability and quality (AAAQ) framework. Phase 2: integrate reviewed data into a SWOT framework to identify the strengths and opportunities to be maximized and the weaknesses and threats to be overcome. RESULTS The critical review and SWOT analysis have identified the following global situation: (i) needs-based shortages and lack of access to rehabilitation workers, particularly in lower income countries and in rural/remote areas; (ii) deficiencies in the data sources and monitoring structures; and (iii) few exemplary innovations, of both national and international scope, that may help reduce supply-side shortages in underserved areas. DISCUSSION Based on the results, we have prioritized the following 'Six Rehab-Workforce Challenges': (1) monitoring supply requirements: accounting for rehabilitation needs and demand; (2) supply data sources: the need for structural improvements; (3) ensuring the study of a whole rehabilitation workforce (i.e. not focused on single professions), including across service levels; (4) staffing underserved locations: the rising of education, attractiveness and tele-service; (5) adapt policy options to different contexts (e.g. rural vs urban), even within a country; and (6) develop international solutions, within an interdependent world. CONCLUSIONS Concrete examples of feasible local, global and research action toward meeting the Six Rehab-Workforce Challenges are provided. Altogether, these may help advance a policy and research agenda for ensuring that an adequate rehabilitation workforce can meet the current and future rehabilitation health needs.
Collapse
Affiliation(s)
- Tiago S. Jesus
- Portuguese Ministry of Education, Aggregation of Schools of Escariz, 4540-320 Escariz, Portugal
| | - Michel D. Landry
- Doctor of Physical Therapy Division, Duke University Medical Center, Duke University, Box 104002, 27710 Durham, NC United States of America
- Duke Global Health Institute, Duke University, Durham, NC United States of America
| | - Gilles Dussault
- Global Health and Tropical Medicine (GHTM) & WHO Collaborating Center on Health Workforce Policy and Planning, Institute of Hygiene and Tropical Medicine-NOVA University of Lisbon (IHMT-UNL), Rua da Junqueira 100, 1349-008 Lisbon, Portugal
| | - Inês Fronteira
- Global Health and Tropical Medicine (GHTM) & WHO Collaborating Center on Health Workforce Policy and Planning, Institute of Hygiene and Tropical Medicine-NOVA University of Lisbon (IHMT-UNL), Rua da Junqueira 100, 1349-008 Lisbon, Portugal
| |
Collapse
|
7
|
Ruest M, Bourget A, Delli-Colli N, Guay M. Algo Used by Homecare Nonoccupational Therapists Selecting Bathing Assistive Technology: Enhancing Standardization by Exploring Clinical Reasoning. Occup Ther Health Care 2017; 31:20-33. [PMID: 28094591 DOI: 10.1080/07380577.2016.1270481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Algo is a clinical decision algorithm developed to support nonoccupational therapists in establishing assistive technology recommendations to enable physically disabled adults to perform their hygiene at home. This study aimed to explore the in-depth clinical reasoning of nonoccupational therapists using Algo to pinpoint the items leading to disagreements regarding recommendations. A multiple-case study was conducted with eight nonoccupational therapists trained to use Algo and filmed while using it with six standardized clients. Explicitation interviews were conducted for the conflicting recommendations. Identifying the key reasoning skills to develop in Algo users has led to three recommendations to enhance standardization with seniors.
Collapse
Affiliation(s)
- Mélanie Ruest
- a Health Sciences Research Programs, Faculty of Medicine And Health Sciences , Université de Sherbrooke , Sherbrooke, Quebec , Canada.,b Research Centre on Aging , Health and Social Services Centre - University Institute of Geriatrics of Sherbrooke , Sherbrooke, Quebec , Canada
| | - Annick Bourget
- c School of Rehabilitation , Faculty of Medicine and Health Sciences, Université de Sherbrooke , Sherbrooke, Quebec , Canada
| | - Nathalie Delli-Colli
- d School of Social Work , Faculty of Arts, Humanities and Social Sciences, Université de Sherbrooke , Sherbrooke, Quebec , Canada
| | - Manon Guay
- b Research Centre on Aging , Health and Social Services Centre - University Institute of Geriatrics of Sherbrooke , Sherbrooke, Quebec , Canada.,c School of Rehabilitation , Faculty of Medicine and Health Sciences, Université de Sherbrooke , Sherbrooke, Quebec , Canada
| |
Collapse
|
8
|
Guay M, Gagnon M, Ruest M, Bourget A. Interrater reliability of Algo used by non-occupational therapist members of homecare interdisciplinary teams. Disabil Rehabil 2016; 39:883-888. [PMID: 27111712 DOI: 10.3109/09638288.2016.1168488] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To determine if non-occupational therapists (non-OTs) with different job titles using Algo, a clinical algorithm for recommending bathroom modifications (e.g., bath seat) for community-dwelling elders in "straightforward" situations, will make clinically equivalent recommendations for standardized clients. METHOD Eight non-OTs (three social workers, two physical rehabilitation therapists, two homecare aides and one auxiliary nurse) were trained on Algo and used it with six standardized clients. Bathroom adaptations recommended (one of nine options) by non-OTs were compared to assess interrater agreement using Fleiss adapted kappa. RESULTS Estimated kappa was 0.43 [0.36; 0.49] qualified as a moderate agreement, according to Landis and Koch's arbitrary divisions, among the recommendations of non-OTs. However, clinical equivalence is reached, since safety and client needs were met when raters selected two different options (e.g., with or without a seat back). CONCLUSIONS Non-OTs using Algo in the same simulated clinical scenarios recommend clinically equivalent bathroom adaptations, increasing the confidence regarding the interrater reliability of Algo used by non-OT members of homecare interdisciplinary teams Implications for Rehabilitation In homecare services, non-occupational therapists from different health care disciplines (e.g., homecare aides, social workers, physical rehabilitation therapists) may be asked to select assistive devices for the hygiene care of clients living at home. Algo was designed to guide non-occupational therapists in the selection of assistive devices when performed with clients in straightforward cases. This study indicates that non-occupational therapists using Algo recommend similar and acceptable bathroom adaptations to enhance client safety.
Collapse
Affiliation(s)
- Manon Guay
- a Faculty of Medicine and Health Sciences , School of Rehabilitation, Université de Sherbrooke , Sherbrooke , Quebec , Canada.,b Research Center on Aging , Sherbrooke , Quebec , Canada
| | - Marilyn Gagnon
- c Centre intégré universitaires de santé et de services sociaux de l'Estrie - Centre hospitalier universitaire de Sherbrooke , Sherbrooke , Quebec , Canada
| | - Mélanie Ruest
- b Research Center on Aging , Sherbrooke , Quebec , Canada
| | - Annick Bourget
- a Faculty of Medicine and Health Sciences , School of Rehabilitation, Université de Sherbrooke , Sherbrooke , Quebec , Canada
| |
Collapse
|
9
|
Raymond MH, Demers L, Feldman DE. Waiting list management practices for home-care occupational therapy in the province of Quebec, Canada. HEALTH & SOCIAL CARE IN THE COMMUNITY 2016; 24:154-164. [PMID: 25684435 DOI: 10.1111/hsc.12195] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/07/2014] [Indexed: 06/04/2023]
Abstract
Referral prioritisation is commonly used in home-based occupational therapy to minimise the negative impacts of waiting, but this practice is not standardised. This may lead to inequities in access to care, especially for clients considered as low priority, who tend to bear the brunt of lengthy waiting lists. This cross-sectional study aimed to describe waiting list management practices targeting low-priority clients in home-based occupational therapy in the province of Quebec, Canada, and to investigate the association between these practices and the length of the waiting list. A structured telephone interview was conducted in 2012-2013 with the person who manages the occupational therapy waiting list in 55 home care programmes across Quebec. Questions pertained to strategies aimed at servicing low-priority clients, the date of the oldest referral and the number of clients waiting. Results were analysed using descriptive statistics and non-parametric tests. The median wait time for the oldest referral was 18 months (range: 2-108 months). A variety of strategies were used to service low-priority clients. Programmes that used no strategies to service low-priority clients (n = 16) had longer wait times (P < 0.0001) and a greater number of people on the waiting list (P = 0.006) compared with programmes that applied a maximum wait time target (n = 12). In conclusion, diverse strategies exist to allocate services to low-priority clients in home-based occupational therapy programmes. However, in programmes where none of these strategies are used, low-priority clients may be denied access to services indefinitely.
Collapse
Affiliation(s)
| | - Louise Demers
- School of Rehabilitation, Université de Montréal, Montreal, Quebec, Canada
- Research Center, Institut Universitaire de gératrie de Montréal, Montreal, Quebec, Canada
| | - Debbie E Feldman
- School of Rehabilitation, Université de Montréal, Montreal, Quebec, Canada
- Direction of Public Health of Montreal, Health Services and Population Health Team, Montreal, Quebec, Canada
- Greater Montreal Interdisciplinary Rehabilitation Research Centre (CRIR), Montreal, Quebec, Canada
| |
Collapse
|
10
|
Guay M, Dubois MF, Robitaille J, Desrosiers J. Development of Algo, a clinical algorithm for non–occupational therapists selecting bathing equipment. The Canadian Journal of Occupational Therapy 2014; 81:237-246. [DOI: 10.1177/0008417414539643] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. In Quebec, occupational therapy guidelines allow non–occupational therapists, such as home health aides, to select bathing equipment for “straightforward” cases of clients living at home as long as the aides use a decision-making tool. Purpose. Our aim was to develop a tool that met the common needs of Quebec’s health and social services centres (HSSCs), which involve home health aides in selecting bathing equipment for home-dwelling clients. Method. We followed an ongoing iterative process involving a literature review as well as (a) a synthesis of 40 in-house tools, (b) feedback from 10 occupational therapists (two questionnaires and one focus group), (c) pretests, and (d) translation. Findings. Algo is a clinical algorithm constituting a visual map of the logical steps to follow when selecting bathing equipment for straightforward cases. Algo is a series of yes/no questions dealing with occupation, person, and environment. Implications. Algo, rooted in evidence and regulatory board guidelines, is available to HSSCs involving non-occupational therapists in selecting bathing equipment.
Collapse
|