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Hynes DM, Govier DJ, Niederhausen M, Tuepker A, Laliberte AZ, McCready H, Hickok A, Rowneki M, Waller D, Cordasco KM, Singer SJ, McDonald KM, Slatore CG, Thomas KC, Maciejewski M, Battaglia C, Perla L. Understanding care coordination for Veterans with complex care needs: protocol of a multiple-methods study to build evidence for an effectiveness and implementation study. FRONTIERS IN HEALTH SERVICES 2023; 3:1211577. [PMID: 37654810 PMCID: PMC10465329 DOI: 10.3389/frhs.2023.1211577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 08/01/2023] [Indexed: 09/02/2023]
Abstract
Background For patients with complex health and social needs, care coordination is crucial for improving their access to care, clinical outcomes, care experiences, and controlling their healthcare costs. However, evidence is inconsistent regarding the core elements of care coordination interventions, and lack of standardized processes for assessing patients' needs has made it challenging for providers to optimize care coordination based on patient needs and preferences. Further, ensuring providers have reliable and timely means of communicating about care plans, patients' full spectrum of needs, and transitions in care is important for overcoming potential care fragmentation. In the Veterans Health Administration (VA), several initiatives are underway to implement care coordination processes and services. In this paper, we describe our study underway in the VA aimed at building evidence for designing and implementing care coordination practices that enhance care integration and improve health and care outcomes for Veterans with complex care needs. Methods In a prospective observational multiple methods study, for Aim 1 we will use existing data to identify Veterans with complex care needs who have and have not received care coordination services. We will examine the relationship between receipt of care coordination services and their health outcomes. In Aim 2, we will adapt the Patient Perceptions of Integrated Veteran Care questionnaire to survey a sample of Veterans about their experiences regarding coordination, integration, and the extent to which their care needs are being met. For Aim 3, we will interview providers and care teams about their perceptions of the innovation attributes of current care coordination needs assessment tools and processes, including their improvement over other approaches (relative advantage), fit with current practices (compatibility and innovation fit), complexity, and ability to visualize how the steps proceed to impact the right care at the right time (observability). The provider interviews will inform design and deployment of a widescale provider survey. Discussion Taken together, our study will inform development of an enhanced care coordination intervention that seeks to improve care and outcomes for Veterans with complex care needs.
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Affiliation(s)
- Denise M. Hynes
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, United States
- School of Nursing, Oregon Health & Science University, Portland, OR, United States
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, United States
| | - Diana J. Govier
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, United States
- School of Public Health, Oregon Health & Science University & Portland State University, Portland, OR, United States
| | - Meike Niederhausen
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, United States
- School of Public Health, Oregon Health & Science University & Portland State University, Portland, OR, United States
| | - Anaïs Tuepker
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, United States
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, United States
| | - Avery Z. Laliberte
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, United States
| | - Holly McCready
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, United States
| | - Alex Hickok
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, United States
| | - Mazhgan Rowneki
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, United States
| | - Dylan Waller
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, United States
| | - Kristina M. Cordasco
- Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States
- Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, CA, United States
| | - Sara J. Singer
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Kathryn M. McDonald
- Center for Diagnostic Excellence, Armstrong Institute for Patient Safety and Quality, Johns Hopkins School of Nursing, Baltimore, MD, United States
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Christopher G. Slatore
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, United States
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, Oregon Health & Science University, Portland, OR, United States
- Section of Pulmonary & Critical Care Medicine, VA Portland Health Care System, Portland, OR, United States
| | - Kathleen C. Thomas
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Matthew Maciejewski
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, United States
- Department of Population Health Sciences & Division of General Internal Medicine, Department of Medicine, Duke University, Durham, NC, United States
| | - Catherine Battaglia
- Department of Veterans Affairs, Eastern Colorado Health Care System, Denver, CO, United States
- Department of Health Systems, Management & Policy, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Lisa Perla
- Rehabilitation Services, Veterans Affairs Central Office, Washington, DC, United States
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Konnyu KJ, Yogasingam S, Lépine J, Sullivan K, Alabousi M, Edwards A, Hillmer M, Karunananthan S, Lavis JN, Linklater S, Manns BJ, Moher D, Mortazhejri S, Nazarali S, Paprica PA, Ramsay T, Ryan PM, Sargious P, Shojania KG, Straus SE, Tonelli M, Tricco A, Vachon B, Yu CH, Zahradnik M, Trikalinos TA, Grimshaw JM, Ivers N. Quality improvement strategies for diabetes care: Effects on outcomes for adults living with diabetes. Cochrane Database Syst Rev 2023; 5:CD014513. [PMID: 37254718 PMCID: PMC10233616 DOI: 10.1002/14651858.cd014513] [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] [Indexed: 06/01/2023]
Abstract
BACKGROUND There is a large body of evidence evaluating quality improvement (QI) programmes to improve care for adults living with diabetes. These programmes are often comprised of multiple QI strategies, which may be implemented in various combinations. Decision-makers planning to implement or evaluate a new QI programme, or both, need reliable evidence on the relative effectiveness of different QI strategies (individually and in combination) for different patient populations. OBJECTIVES To update existing systematic reviews of diabetes QI programmes and apply novel meta-analytical techniques to estimate the effectiveness of QI strategies (individually and in combination) on diabetes quality of care. SEARCH METHODS We searched databases (CENTRAL, MEDLINE, Embase and CINAHL) and trials registers (ClinicalTrials.gov and WHO ICTRP) to 4 June 2019. We conducted a top-up search to 23 September 2021; we screened these search results and 42 studies meeting our eligibility criteria are available in the awaiting classification section. SELECTION CRITERIA We included randomised trials that assessed a QI programme to improve care in outpatient settings for people living with diabetes. QI programmes needed to evaluate at least one system- or provider-targeted QI strategy alone or in combination with a patient-targeted strategy. - System-targeted: case management (CM); team changes (TC); electronic patient registry (EPR); facilitated relay of clinical information (FR); continuous quality improvement (CQI). - Provider-targeted: audit and feedback (AF); clinician education (CE); clinician reminders (CR); financial incentives (FI). - Patient-targeted: patient education (PE); promotion of self-management (PSM); patient reminders (PR). Patient-targeted QI strategies needed to occur with a minimum of one provider or system-targeted strategy. DATA COLLECTION AND ANALYSIS We dual-screened search results and abstracted data on study design, study population and QI strategies. We assessed the impact of the programmes on 13 measures of diabetes care, including: glycaemic control (e.g. mean glycated haemoglobin (HbA1c)); cardiovascular risk factor management (e.g. mean systolic blood pressure (SBP), low-density lipoprotein cholesterol (LDL-C), proportion of people living with diabetes that quit smoking or receiving cardiovascular medications); and screening/prevention of microvascular complications (e.g. proportion of patients receiving retinopathy or foot screening); and harms (e.g. proportion of patients experiencing adverse hypoglycaemia or hyperglycaemia). We modelled the association of each QI strategy with outcomes using a series of hierarchical multivariable meta-regression models in a Bayesian framework. The previous version of this review identified that different strategies were more or less effective depending on baseline levels of outcomes. To explore this further, we extended the main additive model for continuous outcomes (HbA1c, SBP and LDL-C) to include an interaction term between each strategy and average baseline risk for each study (baseline thresholds were based on a data-driven approach; we used the median of all baseline values reported in the trials). Based on model diagnostics, the baseline interaction models for HbA1c, SBP and LDL-C performed better than the main model and are therefore presented as the primary analyses for these outcomes. Based on the model results, we qualitatively ordered each QI strategy within three tiers (Top, Middle, Bottom) based on its magnitude of effect relative to the other QI strategies, where 'Top' indicates that the QI strategy was likely one of the most effective strategies for that specific outcome. Secondary analyses explored the sensitivity of results to choices in model specification and priors. Additional information about the methods and results of the review are available as Appendices in an online repository. This review will be maintained as a living systematic review; we will update our syntheses as more data become available. MAIN RESULTS We identified 553 trials (428 patient-randomised and 125 cluster-randomised trials), including a total of 412,161 participants. Of the included studies, 66% involved people living with type 2 diabetes only. Participants were 50% female and the median age of participants was 58.4 years. The mean duration of follow-up was 12.5 months. HbA1c was the commonest reported outcome; screening outcomes and outcomes related to cardiovascular medications, smoking and harms were reported infrequently. The most frequently evaluated QI strategies across all study arms were PE, PSM and CM, while the least frequently evaluated QI strategies included AF, FI and CQI. Our confidence in the evidence is limited due to a lack of information on how studies were conducted. Four QI strategies (CM, TC, PE, PSM) were consistently identified as 'Top' across the majority of outcomes. All QI strategies were ranked as 'Top' for at least one key outcome. The majority of effects of individual QI strategies were modest, but when used in combination could result in meaningful population-level improvements across the majority of outcomes. The median number of QI strategies in multicomponent QI programmes was three. Combinations of the three most effective QI strategies were estimated to lead to the below effects: - PR + PSM + CE: decrease in HbA1c by 0.41% (credibility interval (CrI) -0.61 to -0.22) when baseline HbA1c < 8.3%; - CM + PE + EPR: decrease in HbA1c by 0.62% (CrI -0.84 to -0.39) when baseline HbA1c > 8.3%; - PE + TC + PSM: reduction in SBP by 2.14 mmHg (CrI -3.80 to -0.52) when baseline SBP < 136 mmHg; - CM + TC + PSM: reduction in SBP by 4.39 mmHg (CrI -6.20 to -2.56) when baseline SBP > 136 mmHg; - TC + PE + CM: LDL-C lowering of 5.73 mg/dL (CrI -7.93 to -3.61) when baseline LDL < 107 mg/dL; - TC + CM + CR: LDL-C lowering by 5.52 mg/dL (CrI -9.24 to -1.89) when baseline LDL > 107 mg/dL. Assuming a baseline screening rate of 50%, the three most effective QI strategies were estimated to lead to an absolute improvement of 33% in retinopathy screening (PE + PR + TC) and 38% absolute increase in foot screening (PE + TC + Other). AUTHORS' CONCLUSIONS There is a significant body of evidence about QI programmes to improve the management of diabetes. Multicomponent QI programmes for diabetes care (comprised of effective QI strategies) may achieve meaningful population-level improvements across the majority of outcomes. For health system decision-makers, the evidence summarised in this review can be used to identify strategies to include in QI programmes. For researchers, this synthesis identifies higher-priority QI strategies to examine in further research regarding how to optimise their evaluation and effects. We will maintain this as a living systematic review.
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Affiliation(s)
- Kristin J Konnyu
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Sharlini Yogasingam
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Johanie Lépine
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Katrina Sullivan
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | | | - Alun Edwards
- Department of Medicine, University of Calgary, Calgary, Canada
| | - Michael Hillmer
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Sathya Karunananthan
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Canada
| | - John N Lavis
- McMaster Health Forum, Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | - Stefanie Linklater
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Braden J Manns
- Department of Medicine and Community Health Sciences, University of Calgary, Calgary, Canada
| | - David Moher
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Sameh Mortazhejri
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Samir Nazarali
- Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, Canada
| | - P Alison Paprica
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Timothy Ramsay
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | | | - Peter Sargious
- Department of Medicine, University of Calgary, Calgary, Canada
| | - Kaveh G Shojania
- University of Toronto Centre for Patient Safety, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Sharon E Straus
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital and University of Toronto, Toronto, Canada
| | - Marcello Tonelli
- Department of Medicine and Community Health Sciences, University of Calgary, Calgary, Canada
| | - Andrea Tricco
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital and University of Toronto, Toronto, Canada
- Epidemiology Division and Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Queen's Collaboration for Health Care Quality: A JBI Centre of Excellence, Queen's University, Kingston, Canada
| | - Brigitte Vachon
- School of Rehabilitation, Occupational Therapy Program, University of Montreal, Montreal, Canada
| | - Catherine Hy Yu
- Department of Medicine, St. Michael's Hospital, Toronto, Canada
| | - Michael Zahradnik
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Thomas A Trikalinos
- Departments of Health Services, Policy, and Practice and Biostatistics, Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Noah Ivers
- Department of Family and Community Medicine, Women's College Hospital, Toronto, Canada
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Longhini J, Canzan F, Mezzalira E, Saiani L, Ambrosi E. Organisational models in primary health care to manage chronic conditions: A scoping review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e565-e588. [PMID: 34672051 DOI: 10.1111/hsc.13611] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 10/06/2021] [Accepted: 10/08/2021] [Indexed: 06/13/2023]
Abstract
Chronic diseases are increasing incessantly, and more efforts are needed in order to develop effective organisational models in primary health care, which may address the challenges posed by the consequent multimorbidity. The aim of this study was to assess and map methods, interventions and outcomes investigated over the last decade regarding the effectiveness of chronic care organisational models in primary care settings. We conducted a scoping review including systematic reviews, clinical trials, and observational studies, published from 2010 to 2020, that evaluated the effectiveness of organisational models for chronic conditions in primary care settings, including home care, community, and general practice. We included 67 international studies out of the 6,540 retrieved studies. The prevalent study design was the observational design (25 studies, 37.3%), and 62 studies (92.5%) were conducted on the adult population. Four main models emerged, called complex integrated care models. These included models grounded on the Chronic Care Model framework and similar, case or care management, and models centred on involvement of pharmacists or community health workers. Across the organisational models, self-management support and multidisciplinary teams were the most common components. Clinical outcomes have been investigated the most, while caregiver outcomes have been detected in the minority of cases. Almost one-third of the included studies reported only significant effects in the outcomes. No sufficient data were available to determine the most effective models of care. However, more complex models seem to lead to better outcomes. In conclusion, in the development of more comprehensive organisational models to manage chronic conditions in primary health care, more efforts are needed on the paediatric population, on the inclusion of caregiver outcomes in the effectiveness evaluation of organisational models and on the involvement of social community resources. As regarding the studies investigating organisational models, more detailed descriptions should be provided with regard to interventions, and the training, roles and responsibilities of health and lay figures in delivering care.
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Affiliation(s)
- Jessica Longhini
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| | - Federica Canzan
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Elisabetta Mezzalira
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Luisa Saiani
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Elisa Ambrosi
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
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Madsen N, Joyce C, Vlasses F, Burkhart L. Effectiveness of an interprofessional ambulatory care model on diabetes: evaluating clinical markers in a low-income patient population. J Interprof Care 2021; 36:500-508. [PMID: 34353211 DOI: 10.1080/13561820.2021.1941816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The purpose of this study was to determine whether a new ambulatory care model, interprofessional collaborative care-coordinated team model (interprofessional model), based on the Wagner Care Model improved clinical indicators in a low-income population. This study was a retrospective 12-month pre-post (n = 204) and propensity matched (n = 171) comparative study of the interprofessional model in a primary clinic for patients with type 2 diabetes. Secondary data were collected from June 2014to February 2017 in an academic medical centre in a large Midwestern city. Findings demonstrated statistically and clinically significant improvement in A1C in both the pre/post arm of the study (↓ 0.8%) and the intervention/propensity matched arm (↓ 0.53%). Within the intervention group, there was a significant decrease in weight in the pre/post arm with 55% of cases losing weight, whereas 45% did not lose weight (p = .02). Diastolic blood pressure less than 90 also significantly improved in the pre/post arm of the study (10.1% n = 18, versus 3.9%, n = 7, p = .04). The interprofessional model showed that an ambulatory healthcare redesign incorporating an interprofessional team approach to optimise the health of this type 2 diabetes patient population can be effective. This study demonstrates the importance of using interprofessional collaborative practice teams to guide healthcare and improve patient outcomes.
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Affiliation(s)
- Nancy Madsen
- School of Nursing/DeKalb, Northern Illinois University, US
| | - Cara Joyce
- Health Informatics and Data Science Parkinson School of Health Sciences and Public Health Maywood, Illinois, US
| | - Frances Vlasses
- Marcella Niehoff School of Nursing, Loyola University Chicago, Illinois, US
| | - Lisa Burkhart
- Marcella Niehoff School of Nursing, Loyola University Chicago, Illinois, US.,Research Health Scientist, Center of Innovation for Complex Chronic Healthcare, Edward Hines Junior VA Hospital, Hines, IL, US
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Nuffer W, Gilliam E, Trujillo T, Griend JV, Thompson M. A 3-Year Chronic Disease Public Health Intervention Focused on a Network of Rural Pharmacies Supported by Student Pharmacists. J Pharm Pract 2019; 34:535-541. [PMID: 31648590 DOI: 10.1177/0897190019882868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To retrospectively analyze and report various tracked outcomes of a 3-year collaboration offering chronic disease management services in diabetes and cardiovascular disease in pharmacies across 12 rural communities supported year-round by fourth-year student pharmacists. METHODS Individualized medication therapy management services were provided to patients with cardiovascular disease and diabetes in a 6-month series based upon national guidelines standards of care. Objective laboratory measurements, adherence rates, goals set for patients, vaccination rates, and routine maintenance examinations were all tracked as part of the program. Provider acceptance of recommendations from student pharmacists were tracked, and patients completed a 3-question survey regarding satisfaction with services. RESULTS A total of 430 student pharmacists rotated through these pharmacy sites providing care to 779 unique patients across 3 years. Statistically significant improvements in A1C (-0.8%, P < .001) and systolic and diastolic blood pressure (5 mm Hg, 3 mm Hg, respectively, P < .01) were associated with the pharmacy care. Adherence issues were identified and addressed with 44% of these patients. In all, 70% of patients reported successful goal attainment of >50% from baseline. Providers accepted student therapy change recommendations 56% of the time. Patients reported satisfaction with services provided in the pharmacies (average scores of 4.22-4.67 on a 1-5 Likert-type scale). CONCLUSIONS A 3-year pharmacy intervention in 12 rural areas made positive impacts on patients' adherence rates and self-management in diabetes and cardiovascular disease and was associated with statistically significant improvements in A1C and blood pressure while challenging fourth-year student pharmacists to perform at a high level on community pharmacy rotations.
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Affiliation(s)
- Wesley Nuffer
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy & Pharmaceutical Sciences, Aurora, CO, USA
| | - Eric Gilliam
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy & Pharmaceutical Sciences, Aurora, CO, USA
| | - Tara Trujillo
- 2915Colorado Department of Public Health and Environment, Denver, CO, USA
| | - Joseph Vande Griend
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy & Pharmaceutical Sciences, Aurora, CO, USA
| | - Megan Thompson
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy & Pharmaceutical Sciences, Aurora, CO, USA
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Town M, Smoliak O, Brauer P, Forbes L. Prenatal Nutrition in Team-Based Care: Current Practices and Opportunities for Optimization of Care. CAN J DIET PRACT RES 2019; 80:96-103. [PMID: 30724090 DOI: 10.3148/cjdpr-2018-043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Purpose: To describe prenatal nutrition care currently delivered by Family Health Teams (FHTs) and Community Health Centres (CHCs) in Ontario, from the perspectives of health care providers, and to identify opportunities for improving care. Methods: Ten 1-hour, interdisciplinary focus groups were conducted in FHTs and CHCs, involving a total of 73 health care providers. Focus groups ranged in size from 3 to 11 team members, and at least 3 different professions participated in each group. The shared perspectives and experiences on prenatal nutrition care were collected using a semi-structured interview guide and analyzed using thematic analysis. Results: Limited time was spent on prenatal nutrition education and counselling. Two themes emerged describing gaps in care: (i) providing care in "borderline" high-risk pregnancies (i.e., impaired glucose tolerance) and (ii) providing care around gestational weight gain. Providers envisioned improving services offered by increasing preventative care, empowering providers to provide more nutrition care, facilitating patient self-care, and building a 1-stop shop "medical home". Conclusions: This study's findings can guide strategies to mobilize current nutritional knowledge into routine prenatal care, and the shared vision for improvement will inform the routes for new practice that are supported by health care professionals.
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Affiliation(s)
- Martina Town
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON.,Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON
| | - Olga Smoliak
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON.,Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON
| | - Paula Brauer
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON.,Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON
| | - Laura Forbes
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON.,Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON
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