Ontario primary care reform and quality improvement activities: an environmental scan

Environmental Scanning Model in Health System and Implementation Steps: A Scoping Review

Background

Various studies have highlighted the usefulness of environmental scanning in assessing community needs and developing programs and policies. We aimed to find the most practical model of using such scanning in the healthcare literature.

Methods

We conducted a scoping review based on the PRISMA guideline to ensure a comprehensive and systematic approach in 2023. To develop a comprehensive search strategy, we worked with experienced librarians and the research team. We then completed a search of five electronic databases, including Web of Science, PubMed, Scopus, Cochrane, and Embase databases. Two independent reviewers screened titles, abstracts, and full-text articles to select studies that met our inclusion criteria. The data was then analyzed and presented in a tabular format to facilitate easy interpretation and understanding.

Results

We retrieved 7243 articles from various databases and sources. After removing 2755 articles due to duplication, we excluded 4380 more articles during the title and abstract screening phase. In the full-text review process, we ruled out an additional 103 articles. Finally, only 5 articles that were directly relevant to the study were included. The model that Bednar and colleagues have in their article is the latest model. Most studies propose six main steps to conduct an environmental survey in the healthcare system.

Conclusion

Since the most important task of managers and policy makers of the health system is to make decisions, they can use our proposed model to collect, analyze and interpret data, identify important patterns and trends so that they can make evidence-based decisions.

Online resources supporting workers with chronic episodic disabilities: an environmental scan

Purpose

The purpose of this research was to conduct an environmental scan describing publicly available resources focussed on working with an episodic disability and providing information and advice about communication and accommodation to support working people living with episodic disabilities.

Design/methodology/approach

The authors conducted an environmental scan of English language, freely available, online resources relevant to episodic disabilities in the workplace. The authors used Google™ to conduct structured keyword searches. Resources were reviewed and data extracted about episodic health condition(s) addressed, intended audience(s), resource format and content about health, legal rights, workplace issues, and accommodation and communication needs.

Findings

Searches yielded 5,300 links to websites which was supplemented by 101 links identified by partners. Screening for relevance found 210 resources for which data were extracted. Of them, 158 addressed specific episodic disabilities or episodic disabilities generally. Most resources provided useful information addressing communication and accommodation of episodic disability. However, information specific to the episodic nature of disability was not consistently available. The resources generally lacked interactivity which could potentially limit users in applying the information to their personal circumstances.

Practical implications

The findings suggest there are good resources to help workers and managers/supervisors navigate accommodations for episodic disabilities. Research should aim to improve the interactivity of information to personalize resources to worker and workplace needs, as well as formally evaluate resources and their outcomes. Practitioners may wish to recommend resources that specifically address workplace challenges for their clients.

Originality/value

The authors believe this is one of few studies that examined publicly available resources relevant to working with episodic disabilities.

The use of the environmental scan in health services delivery research: a scoping review protocol

INTRODUCTION

The environmental scan has been described as an important tool to inform decision-making on policy, planning and programme development in the healthcare sector. Despite the wide adoption of environmental scans, there is no consensus on a working definition within the health services delivery context and methodological guidance on the design and implementation of this approach is lacking in the literature. The objectives of this study are to map the extent, range and nature of evidence that describe the definitions, characteristics, conceptualisations, theoretical underpinnings, study limitations and other features of the environmental scan in the health services delivery literature and to propose a working definition specific to this context.

METHODS AND ANALYSIS

This protocol describes a scoping review based on the methodology outlined by Khalil and colleagues. A comprehensive search strategy was developed by experienced health science librarians in consultation with the research team. A Peer Review of Electronic Search Strategies (PRESS) was completed. Two reviewers will independently screen titles, abstracts and full-text articles and select studies meeting the inclusion criteria from seven electronic databases: Academic Search Premier, Canadian Business & Current Affairs (CBCA), CINAHL, ERIC, Embase, MEDLINE and PsycINFO. The grey literature and reference lists of included articles will also be searched. The data will be analysed and presented in tabular format, and will include a descriptive numerical summary as well as a qualitative thematic analysis.

ETHICS AND DISSEMINATION

This protocol provides an audit trail for a scoping review that will advance understanding about the environmental scan and its application in the health services delivery context. The review will propose a working definition and will inform future research to explore the development of a conceptual framework in this context. Findings will be disseminated through a peer-reviewed journal and conference presentations. The scoping review does not require ethics approval.

Exploring the sensory screening experiences of nurses working in long-term care homes with residents who have dementia: a qualitative study

BACKGROUND

The prevalence of vision and hearing loss is higher amongst older individuals with dementia, as well as higher in long-term care settings than in the wider community. However, the incidence of sensory impairment is underreported and often goes untreated. In this study, we aimed to understand nurses' current experiences of screening and caring for long-term care residents who have dementia and sensory impairment.

METHODS

As part of a larger study on the sensory screening of long-term care residents with dementia, an environmental scan was conducted with front-line healthcare providers. We report here on the findings from the content analysis of individual, semi-structured interviews with nurses working in two long-term care homes in Southern Ontario, Canada. Twenty regulated nurses, including designated resident assessment coordinators, working full- or part-time with individuals who have dementia, participated across the two sites. All interviews were transcribed, and their contents reviewed and coded for themes by means of inductive thematic analysis.

RESULTS

Following a systematic and recursive approach, three analysts identified several themes relating to: 1) the sensory screening process, 2) communication strategies, and 3) quality of life, sensory loss, and dementia. Participants reported on the strengths and limitations of screening procedures, what improvements should be made, which informal strategies are effective, and the continued professional development that is needed.

CONCLUSIONS

Nurses demonstrated insight into the facilitators and barriers to effective screening and care of residents with dementia and sensory impairments, and expressed the need for further education, more suitable screening tools, and formalised accountability within the screening process for vision and hearing loss in these long-term care residents.

Recommendations for successful sensory screening in older adults with dementia in long-term care: a qualitative environmental scan of Canadian specialists

OBJECTIVES

This study aimed to identify screening tools, technologies and strategies that vision and hearing care specialists recommend to front-line healthcare professionals for the screening of older adults in long-term care homes who have dementia.

SETTING

An environmental scan of healthcare professionals took place via telephone interviews between December 2015 and March 2016. All interviews were audio recorded, transcribed, proofed for accuracy, and their contents thematically analysed by two members of the research team.

PARTICIPANTS

A convenience sample of 11 professionals from across Canada specialising in the fields of vision and hearing healthcare and technology for older adults with cognitive impairment were included in the study.

OUTCOME MEASURES

As part of a larger mixed-methods project, this qualitative study used semistructured interviews and their subsequent content analysis.

RESULTS

Following a two-step content analysis of interview data, coded citations were grouped into three main categories: (1) barriers, (2) facilitators and (3) tools and strategies that do or do not work for sensory screening of older adults with dementia. We report on the information offered by participants within each of these themes, along with a summary of tools and strategies that work for screening older adults with dementia.

CONCLUSIONS

Recommendations from sensory specialists to nurses working in long-term care included the need for improved interprofessional communication and collaboration, as well as flexibility, additional time and strategic use of clinical intuition and ingenuity. These suggestions at times contradicted the realities of service provision or the need for standardised and validated measures.

Physicians’ accounts of frontline tensions when implementing pilot projects to improve primary care

Purpose

Canada’s primary care system has been described as “a culture of pilot projects” with little evidence of converting successful initiatives into funded, permanent programs or sharing project outcomes and insights across jurisdictions. Health services pilot projects are advocated as an effective strategy for identifying promising models of care and building integrated care partnerships in local settings. In the qualitative study reported here, the purpose of this paper is to investigate the strengths and challenges of this approach.

Design/methodology/approach

Semi-structured interviews were conducted with 34 primary care physicians who discussed their experiences as pilot project leads. Following thematic analysis methods, broad system issues were captured as well as individual project information.

Findings

While participants often portrayed themselves as advocates for vulnerable patients, mobilizing healthcare organizations and providers to support new models of care was discussed as challenging. Competition between local healthcare providers and initiatives could impact pilot project success. Participants also reported tensions between their clinical, project management and research roles with additional time demands and skill requirements interfering with the work of implementing and evaluating service innovations.

Originality/value

Study findings highlight the complexity of pilot project implementation, which encompasses physician commitment to addressing care for vulnerable populations through to the need for additional skill set requirements and the impact of local project environments. The current pilot project approach could be strengthened by including more multidisciplinary collaboration and providing infrastructure supports to enhance the design, implementation and evaluation of health services improvement initiatives.

Environmental Scanning as a Public Health Tool: Kentucky's Human Papillomavirus Vaccination Project

Borrowing from business, quality improvement programs, and strategic planning principles, environmental scanning is gaining popularity in public health practice and research and is advocated as an assessment and data collection tool by federal funding agencies and other health-related organizations. Applicable to a range of current and emerging health topics, environmental scans — through various methods — assess multiple facets of an issue by engaging stakeholders who can ask or answer research questions, exploring related policy, critiquing published and gray literature, collecting and analyzing qualitative and quantitative data in both primary and secondary forms, disseminating findings to internal and external stakeholders, and informing subsequent planning and decision making. To illustrate the environmental scanning process in a public health setting and showcase its value to practitioners in the field, we describe a federally funded environmental scan for a human papillomavirus vaccination project in Kentucky.

Socioeconomic status and allied health use: Among patients in an academic family health team

OBJECTIVE

To identify whether socioeconomic status is associated with allied health use among patients in a large academic family health team (FHT).

DESIGN

Data were collected through a retrospective chart review using an electronic medical record system.

SETTING

A large academic FHT in Ottawa, Ont.

PARTICIPANTS

Patients with at least 1 in-person clinician encounter between January 1, 2012, and December 31, 2013.

MAIN OUTCOME MEASURES

Descriptive statistics were used to compare patients who accessed allied health services with those who did not. We conducted logistic regression analyses to determine whether income quintile was independently associated with allied health use after adjusting for other patient characteristics.

RESULTS

The inclusion criteria identified 2938 unique patients, of whom 949 (32.3%) saw an allied health provider(AHP) during the study period. While patients in the fourth income quintile had the greatest AHP use per person (41.2% of patients had at least 1 AHP visit), those in the lowest income quintile had the greatest mean number of AHPs seen(mean [SD] = 1.48 [0.80]). After adjustment, the odds of seeing an AHP were significantly increased with older age (odds ratio [OR] = 1.02, 95% CI 1.01 to 1.02) and female sex (OR = 1.81, 95% CI 1.48 to 2.22). Compared with patients in the highest income quintile, patients in the lowest (OR = 1.33, 95% CI 1.02 to 1.72) and fourth (OR = 1.88, 95% CI 1.33 to 2.66) income quintiles had significantly higher odds of seeing AHPs.

CONCLUSION

Within an academic FHT, lower-income patients were more likely to use allied health services, suggesting equitable allocation of resources. We encourage other FHTs to similarly assess their allied health resource allocation as an important outcome for investments in Ontario FHTs.