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Scruton S, Warner G, Kendell C, Pfaff K, Stajduhar K, Patrick L, Dujela C, Fauteux F, Urquhart R. Navigation programs to support community-dwelling individuals with life-limiting illness: determinants of implementation. BMC Health Serv Res 2024; 24:39. [PMID: 38184522 PMCID: PMC10770879 DOI: 10.1186/s12913-024-10541-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 01/01/2024] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND As the Canadian population ages and the prevalence of chronic illnesses increases, delivering high-quality care to individuals with advanced life limiting illnesses becomes more challenging. Community-based navigation programs are a promising approach to address these challenges, but little is known about how these programs are successfully implemented to meet the needs of this population. This study sought to identify the key determinants that contribute to the successful implementation of these programs within Canada. METHODS A qualitative study was undertaken to understand the implementation of eleven innovative, community-based navigation programs that aim to address the needs of individuals with life-limiting illnesses as they approach the end of life. The Consolidated Framework for Implementation Research (CFIR) guided the study design. Key informants (n = 23) within these programs took part in semi-structured interviews where they were asked to discuss how these programs are implemented. Data were analyzed using techniques employed in qualitative description. RESULTS We identified key determinants of successful implementation within each CFIR domain. In the outer setting domain, participants emphasized the importance of filling gaps in care to meet client needs, developing strong relationships with clients and community-based organizations, and navigating relationships with healthcare providers. At the inner setting level, leadership support, staff compatibility, and available resources were identified as important factors. In terms of intervention characteristics, the ability to adapt was cited as a facilitator, whereas costs were identified as a barrier. For the characteristics of individuals, participants described the importance of having staff whose values align with the program, and who have the experience and skills necessary to work with complex clients. Finally, having strong champions and evaluation processes were highlighted as important process-oriented determinants of successful implementation. CONCLUSION This study provides valuable insights into the determinants of successful implementation of community-based navigation programs in Canada. Understanding these determinants can guide the future development and integration of navigation programs to successfully meet the needs of those with life-limiting illnesses.
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Affiliation(s)
- Sarah Scruton
- Department of Community Health and Epidemiology, Centre for Clinical Research, Dalhousie University, Room 413, 5790 University Avenue, Halifax, NS, B3H 1V7, Canada
| | - Grace Warner
- School of Occupational Therapy, Dalhousie University, Halifax, NS, Canada
| | - Cynthia Kendell
- Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Kathryn Pfaff
- Faculty of Nursing, University of Windsor, Windsor, ON, Canada
| | - Kelli Stajduhar
- School of Nursing, University of Victoria, Victoria, BC, Canada
| | - Linda Patrick
- Faculty of Nursing, University of Windsor, Windsor, ON, Canada
| | - Carren Dujela
- School of Nursing, University of Victoria, Victoria, BC, Canada
| | - Faith Fauteux
- Faculty of Nursing, University of Windsor, Windsor, ON, Canada
| | - Robin Urquhart
- Department of Community Health and Epidemiology, Centre for Clinical Research, Dalhousie University, Room 413, 5790 University Avenue, Halifax, NS, B3H 1V7, Canada.
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Urquhart R, Kendell C, Pfaff K, Stajduhar K, Patrick L, Dujela C, Scruton S, Fauteux F, Warner G. How do navigation programs address the needs of those living in the community with advanced, life-limiting Illness? A realist evaluation of programs in Canada. BMC Palliat Care 2023; 22:179. [PMID: 37964238 PMCID: PMC10647106 DOI: 10.1186/s12904-023-01304-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 11/06/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND We sought to identify innovative navigation programs across Canadian jurisdictions that target their services to individuals affected by life-limiting illness and their families, and articulate the principal components of these programs that enable them to address the needs of their clients who are living in the community. METHODS This realist evaluation used a two-phased approach. First, we conducted a horizon scan of innovative community-based navigation programs across Canadian jurisdictions to identify innovative community-based navigation programs that aim to address the needs of community-dwelling individuals affected by life-limiting illness. Second, we conducted semi-structured interviews with key informants from each of the selected programs. Informants included individuals responsible for managing and delivering the program and decision-makers with responsibility and/or oversight of the program. Analyses proceeded in an iterative manner, consistent with realist evaluation methods. This included iteratively developing and refining Context-Mechanism-Outcome (CMO) configurations, and developing the final program theory. RESULTS Twenty-seven navigation programs were identified from the horizon scan. Using specific eligibility criteria, 11 programs were selected for subsequent interviews and in-depth examination. Twenty-three participants were interviewed from these programs, which operated in five Canadian provinces. The programs represented a mixture of community (non-profit or volunteer), research-initiated, and health system programs. The final program theory was articulated as: navigation programs can improve client outcomes if they have supported and empowered staff who have the time and flexibility to personalize care to the needs of their clients. CONCLUSIONS The findings highlight key principles (contexts and mechanisms) that enable navigation programs to develop client relationships, personalize care to client needs, and improve client outcomes. These principles include staff (or volunteer) knowledge and experience to coordinate health and social services, having a point of contact after hours, and providing staff (and volunteers) time and flexibility to develop relationships and respond to individualized client needs. These findings may be used by healthcare organizations - outside of navigation programs - to work towards more person-centred care.
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Affiliation(s)
- Robin Urquhart
- Department of Community Health and Epidemiology, Dalhousie University, Room 413, Halifax, NS, Canada.
| | - Cynthia Kendell
- Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Kathryn Pfaff
- Faculty of Nursing, University of Windsor, Windsor, ON, Canada
| | - Kelli Stajduhar
- School of Nursing, University of Victoria, Victoria, BC, Canada
| | - Linda Patrick
- Faculty of Nursing, University of Windsor, Windsor, ON, Canada
| | - Carren Dujela
- School of Nursing, University of Victoria, Victoria, BC, Canada
| | - Sarah Scruton
- Department of Community Health and Epidemiology, Dalhousie University, Room 413, Halifax, NS, Canada
| | - Faith Fauteux
- Faculty of Nursing, University of Windsor, Windsor, ON, Canada
| | - Grace Warner
- School of Occupational Therapy, Dalhousie University, Halifax, NS, Canada
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Beaubien-Souligny W, Leclerc S, Verdin N, Ramzanali R, Fox DE. Bridging Gaps in Diabetic Nephropathy Care: A Narrative Review Guided by the Lived Experiences of Patient Partners. Can J Kidney Health Dis 2022; 9:20543581221127940. [PMID: 36246342 PMCID: PMC9558862 DOI: 10.1177/20543581221127940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 08/08/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose of review Diabetes affects almost a 10th of the Canadian population, and diabetic nephropathy is one of its main complications. It remains a leading cause of kidney failure despite the availability of effective treatments. Sources of information The sources of information are iterative discussions between health care professionals and patient partners and literature collected through the search of multiple databases. Methods Major pitfalls related to optimal diabetic nephropathy care were identified through discussions between patient partners and clinician researchers. We identified underlying factors that were common between pitfalls. We then conducted a narrative review of strategies to overcome them, with a focus on Canadian initiatives. Key findings We identified 5 pitfalls along the diabetic nephropathy trajectory, including a delay in diabetes diagnosis, suboptimal glycemic control, delay in the detection of kidney involvement, suboptimal kidney protection, and deficient management of advanced chronic kidney disease. Several innovative care models and approaches have been proposed to address these pitfalls; however, they are not consistently applied. To improve diabetic nephropathy care in Canada, we recommend focusing initiatives on improving awareness of diabetic nephropathy, improving access to timely evidence-based care, fostering inclusive patient-centered care environment, and generating new evidence that supports complex disease management. It is imperative that patients and their families are included at the center of these initiatives. Limitations This review was limited to research published in peer-reviewed journals. We did not perform a systematic review of the literature; we included articles that were relevant to the major pitfalls identified by our patient partners. Study quality was also not formally assessed. The combination of these factors limits the scope of our conclusions.
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Affiliation(s)
- William Beaubien-Souligny
- Division of Nephrology, Centre
Hospitalier de l’Université de Montréal, QC, Canada
- Department of Medicine, University of
Montreal, QC, Canada
| | - Simon Leclerc
- Division of Nephrology, Department of
Medicine, The Research Institute of the McGill University Health Centre, Montreal,
QC, Canada
- Division of Nephrology, Hôpital
Maisonneuve-Rosemont, Montreal, QC, Canada
| | - Nancy Verdin
- The Kidney Foundation of Canada,
London, ON, Canada
| | - Rizwana Ramzanali
- Patient and Community Engagement
Research Program, University of Calgary, AB, Canada
| | - Danielle E. Fox
- Department of Community Health
Sciences, University of Calgary, AB, Canada
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Ghosh A, Mattoo SK, Newbury-Birch D. Editorial: The evidence and practice-gap of screening and brief interventions for substance misuse. Front Psychiatry 2022; 13:1056814. [PMID: 36440414 PMCID: PMC9692069 DOI: 10.3389/fpsyt.2022.1056814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 10/31/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Abhishek Ghosh
- Department of Psychiatry, Drug Deaddiction and Treatment Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Dorothy Newbury-Birch
- Centre for Social Innovation, Alcohol and Public Health Research, Teesside University, Middlesbrough, United Kingdom
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Impfen gegen Influenza – Internationale Bestandsaufnahme und Perspektiven für Deutschland. ZEITSCHRIFT FÜR EVIDENZ, FORTBILDUNG UND QUALITÄT IM GESUNDHEITSWESEN 2021; 161:42-49. [PMID: 33640286 PMCID: PMC7903904 DOI: 10.1016/j.zefq.2021.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 01/21/2021] [Accepted: 01/24/2021] [Indexed: 11/23/2022]
Abstract
Hintergrund Die aktuelle SARS-CoV-2-Pandemie erfordert hohe Durchimpfungsraten von chronisch Kranken gegen Influenza, um das Gesundheitssystem nicht zusätzlich zu belasten. Trotz klarer Evidenz für Sicherheit und Wirksamkeit der Influenza-Impfung sind die Impfquoten in den vergangenen Jahren international auf insuffizientem Niveau verblieben. Der Hausarzt hat eine zentrale Bedeutung für die Versorgung dieser Population. Ziel dieser systematischen Übersichtsarbeit war daher die Evaluation verschiedener Maßnahmen in der Allgemeinmedizin zur Steigerung der saisonalen Influenza-Impfquoten bei chronisch Kranken unter Berücksichtigung verschiedener internationaler Gesundheitssysteme. Methoden Eine systematische Literaturrecherche wurde in MEDLINE, CENTRAL, EMBASE und ERIC sowie manuell in Studienregistern und Literaturlisten durchgeführt. Dabei wurden ausschließlich randomisierte kontrollierte Studien berücksichtigt. Die Methodik wurde im Vorfeld in einem Studienprotokoll festgelegt (PROSPERO CRD42018114163). Ergebnisse Insgesamt wurden 14 Studien im Rahmen eines nationalen Gesundheitsdienstes (Großbritannien), einer staatlichen (Australien) und sozialen (Schweiz) Krankenversicherung und eines privaten Gesundheitssystems (USA) in unsere Übersichtsarbeit eingeschlossen. Analoge Patientenerinnerungen und automatisierte Arzterinnerungen sowie Veränderungen der beruflichen Rollen führten ausschließlich im privaten Gesundheitssystem zu einem deutlichen Anstieg der Influenzaimpfquoten. Im nationalen Gesundheitsdienst konnte keine der analysierten Interventionen einen signifikanten Anstieg der Impfquoten erreichen, wobei im nationalen Gesundheitsdienst Großbritanniens verhältnismäßig gute Basisimpfraten gegen Influenza bereits vor Durchführung der Studien interventionsunabhängig vorlagen. Fortbildungsveranstaltungen für Praxisteams und Erinnerungs-SMS zeigten in den sozialen und staatlichen Krankenversicherungssystemen der Schweiz und in Australien gute Resultate. Schlussfolgerungen In Deutschland könnten vor allem Fortbildungsveranstaltungen für medizinische Teams und sowie zentral organisierte Einladungs- und Monitoringsysteme zur Verbesserung der Impfquoten bei chronisch Kranken geeignet sein. Eine staatliche Kostenübernahme der Impfkosten scheint in verschiedenen Gesundheitssystemen für eine gute Basisimpfquote gegen Influenza bei Indikationspatienten zu sorgen.
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Sanftenberg L, Brombacher F, Schelling J, J. Klug S, Gensichen J. Increasing Influenza Vaccination Rates in People With Chronic Illness. DEUTSCHES ARZTEBLATT INTERNATIONAL 2019; 116:645-652. [PMID: 31617479 PMCID: PMC6832108 DOI: 10.3238/arztebl.2019.0645] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 04/02/2019] [Accepted: 06/28/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND The safety and efficacy of influenza vaccination for the chronically ill are clearly supported by the evidence, yet vaccination rates in this vulnerable popu- lation remain low. This leads to many avoidable hospitalizations and deaths in Germany every year. The goal of this systematic review is to identify measures in primary care medicine that can be used to increase influenza vaccination rates among the chronically ill. METHODS This review was carried out as recommended in the PRISMA statement. A systematic literature search was performed. Only randomized, controlled trials were included in the analysis. Details can be found in the study protocol (PROSPERO, CRD42018114163). RESULTS 15 trials were included in the analysis. Training sessions for medical practice teams focusing on a particular disease raised the vaccination rates by as much as 22%. A financial incentive had the greatest effect (relative risk [RR]: 2.79; 95% confidence interval: [1.18; 6.62]). Reminders via text message yielded a maximum 3.8% absolute increase in vaccination rates. Complex interventions were not found to be of any greater benefit than simple ones. CONCLUSION A variety of approaches can be effective. Focusing training sessions for medical practice teams on certain diseases may be of greater benefit than vacci- nation-centered training sessions. Reminder systems for doctors should be more reliably implemented. Simple strategies are perhaps the most suitable ones in the heterogeneous population of chronically ill persons. The limitations of this system- atic review include the heterogeneity of the studies that we examined and the small number of studies in each category.
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Affiliation(s)
- Linda Sanftenberg
- Institute of General Practice and Family Medicine, University Hospital, LMU Munich, Munich
| | - Felix Brombacher
- Institute of General Practice and Family Medicine, University Hospital, LMU Munich, Munich
| | - Jörg Schelling
- Institute of General Practice and Family Medicine, University Hospital, LMU Munich, Munich
| | - Stefanie J. Klug
- Chair of Epidemiology, Faculty for Sport and Health Sciences, Technical University of Munich, Munich
| | - Jochen Gensichen
- Institute of General Practice and Family Medicine, University Hospital, LMU Munich, Munich
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Singh J, Dahrouge S, Green ME. The impact of the adoption of a patient rostering model on primary care access and continuity of care in urban family practices in Ontario, Canada. BMC FAMILY PRACTICE 2019; 20:52. [PMID: 30999868 PMCID: PMC6474046 DOI: 10.1186/s12875-019-0942-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 04/02/2019] [Indexed: 01/07/2024]
Abstract
BACKGROUND Greater continuity and access to primary care results in improved patient health, satisfaction, and reduced healthcare costs. Although patient rostering is considered to be a cornerstone of a high performing primary care system and is believed to improve continuity and access, few studies have examined these relationships. This study examined the impact of the adoption of a patient rostering enhanced fee-for-service model (eFFS) on continuity, coordination of specialized care, and access. METHOD A population-based longitudinal study was conducted using health administrative data from urban family practices in Ontario, Canada. Family physicians that transitioned from traditional FFS (tFFS) to eFFS between 2004 and 2013 were followed overtime. Physicians providing comprehensive primary care that had at least 4 years of pre-transition and 2 years of post-transition data were eligible. Patients were attributed to physicians on an annual basis by determining the provider that billed the largest dollar amount over a 2 year period. Outcomes of interest were the usual provider of care index (UPC), a referral index (RI) (% of total primary care referrals for a physician's roster made by the main provider), and emergency department (ED) visits for family practice sensitive conditions (FPSCs). Mixed-effects segmented linear and logistic regressions were used to examine changes in outcomes while controlling for patient and provider contextual factors. RESULTS Prior to transitioning, UPC was decreasing at a rate of 0.27%/year (95% CI: -0.34 to - 0.21, p < 0.0001). Following the transition, UPC began decreasing by an additional 0.59%/year (95% CI: -0.69 to - 0.49, p < 0.0001) relative to the pre-transition rate. RI decreased by an additional 0.34%/year (95% CI: -0.43 to - 0.24, p < 0.0001) relative to the pre-transition period, where it had been stable. The transition had minimal impact on FPSC ED visits. CONCLUSION Continuity and coordination of specialized care slightly decreased upon transition from tFFS to eFFS. This is likely due to physicians working in groups and sharing patients following the transition to the eFFS model. Adoption of an enrolment model with after-hours care did not decrease non-urgent ED use, which may reflect the small impact that primary care access has on these types of ED visits.
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Affiliation(s)
- Jatinderpreet Singh
- Department of Public Health Sciences, Queen's University, 62 Fifth Field Company Lane, Kingston, ON, K7L 3N6, Canada. .,Department of Family Medicine, Queen's University, 220 Bagot St, Kingston, ON, K7L 3G2, Canada.
| | - Simone Dahrouge
- Department of Family Medicine, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada.,Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Michael E Green
- Department of Public Health Sciences, Queen's University, 62 Fifth Field Company Lane, Kingston, ON, K7L 3N6, Canada.,Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.,Department of Family Medicine, Queen's University, 220 Bagot St, Kingston, ON, K7L 3G2, Canada
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Kurpas D, Szwamel K, Lenarcik D, Guzek M, Prusaczyk A, Żuk P, Michalowska J, Grzeda A, Mroczek B. Effectiveness of Healthcare Coordination in Patients with Chronic Respiratory Diseases. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1040:47-62. [PMID: 28801791 DOI: 10.1007/5584_2017_84] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Coordination of healthcare effectively prevents exacerbations and reduces the number of hospitalizations, emergency visits, and the mortality rate in patients with chronic respiratory diseases. The purpose of this study was to determine clinical effectiveness of ambulatory healthcare coordination in chronic respiratory patients and its effect on the level of healthcare services as an indicator of direct medical costs. We conducted a retrospective health record survey, using an online database of 550 patients with chronic respiratory diseases. There were decreases in breathing rate, heart rate, and the number of cigarettes smoked per day, and forced vital capacity (FVC) and forced expired volume in 1 s (FEV1) increased after the implementation of the coordinated healthcare structure. These benefits were accompanied by increases in the number of visits to the pulmonary outpatient clinic (p < 0.001), diagnostic costs (p < 0.001), and referrals to other outpatient clinics (p < 0.003) and hospitals (p < 0.001). The advantageous effects of healthcare coordination on clinical status of respiratory patients above outlined persisted over a 3-year period being reviewed.
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Affiliation(s)
- Donata Kurpas
- Department of Family Medicine, Wroclaw Medical University, 1 Syrokomli St., 51-141, Wroclaw, Poland.
- Opole Medical School, 68 Katowicka Street, 45-060, Opole, Poland.
| | - Katarzyna Szwamel
- Department of Family Medicine, Wroclaw Medical University, 1 Syrokomli St., 51-141, Wroclaw, Poland
- Opole Medical School, 68 Katowicka Street, 45-060, Opole, Poland
| | - Dorota Lenarcik
- Medical and Diagnostic Center, 2 Kleeberg Street, 08-110, Siedlce, Poland
| | - Marika Guzek
- Medical and Diagnostic Center, 2 Kleeberg Street, 08-110, Siedlce, Poland
| | - Artur Prusaczyk
- Medical and Diagnostic Center, 2 Kleeberg Street, 08-110, Siedlce, Poland
| | - Paweł Żuk
- Medical and Diagnostic Center, 2 Kleeberg Street, 08-110, Siedlce, Poland
| | | | - Agnieszka Grzeda
- Medical and Diagnostic Center, 2 Kleeberg Street, 08-110, Siedlce, Poland
| | - Bożena Mroczek
- Department of Humanities in Medicine, Pomeranian Medical University, 11 Generała Chlapowskiego Street, 70-204, Szczecin, Poland
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