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Meulman I, Uiters E, Cloin M, Polder J, Stadhouders N. Systematic review of individual-level, community-level, and healthcare system-level factors contributing to socioeconomic differences in healthcare utilisation in OECD countries with universal health coverage. BMJ Open 2024; 14:e080559. [PMID: 38503421 PMCID: PMC10952876 DOI: 10.1136/bmjopen-2023-080559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 02/20/2024] [Indexed: 03/21/2024] Open
Abstract
OBJECTIVES Countries with universal health coverage (UHC) strive for equal access for equal needs without users getting into financial distress. However, differences in healthcare utilisation (HCU) between socioeconomic groups have been reported in countries with UHC. This systematic review provides an overview individual-level, community-level, and system-level factors contributing to socioeconomic status-related differences in HCU (SES differences in HCU). DESIGN Systematic review following the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) guidelines. The review protocol was published in advance. DATA SOURCES Embase, PubMed, Web of Science, Scopus, Econlit, and PsycInfo were searched on 9 March 2021 and 9 November 2022. ELIGIBILITY CRITERIA Studies that quantified the contribution of one or more factors to SES difference in HCU in OECD countries with UHC. DATA EXTRACTION AND SYNTHESIS Studies were screened for eligibility by two independent reviewers. Data were extracted using a predeveloped data-extraction form. Risk of bias (ROB) was assessed using a tailored version of Hoy's ROB-tool. Findings were categorised according to level and a framework describing the pathway of HCU. RESULTS Of the 7172 articles screened, 314 were included in the review. 64% of the studies adjusted for differences in health needs between socioeconomic groups. The contribution of sex (53%), age (48%), financial situation (25%), and education (22%) to SES differences in HCU were studied most frequently. For most factors, mixed results were found regarding the direction of the contribution to SES differences in HCU. CONCLUSIONS SES differences in HCU extensively correlated to factors besides health needs, suggesting that equal access for equal needs is not consistently accomplished. The contribution of factors seemed highly context dependent as no unequivocal patterns were found of how they contributed to SES differences in HCU. Most studies examined the contribution of individual-level factors to SES differences in HCU, leaving the influence of healthcare system-level characteristics relatively unexplored.
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Affiliation(s)
- Iris Meulman
- School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
- Center for Public Health, Health Services and Society, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Ellen Uiters
- Center for Prevention, Lifestyle and Health, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Mariëlle Cloin
- School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - Johan Polder
- School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
- Center for Public Health, Health Services and Society, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Niek Stadhouders
- Scientific Center for Quality of Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
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Haggerty J, Minotti SC, Bouharaoui F. Development of an individual index of social vulnerability that predicts negative healthcare events: a proposed tool to address healthcare equity in primary care research and practice. Int J Equity Health 2023; 22:157. [PMID: 37596614 PMCID: PMC10436429 DOI: 10.1186/s12939-023-01965-9] [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: 01/18/2023] [Accepted: 07/14/2023] [Indexed: 08/20/2023] Open
Abstract
PURPOSE Socially disadvantaged patients may lack self-efficacy to navigate a complex health system making them vulnerable to healthcare inequity. We aimed to develop an Index of social vulnerability that predicts increased risk of negative healthcare events (e.g. emergency hospitalization), independent of chronic disease burden. The analysis illustrates the conceptual and practical steps leading to the development of a pragmatic Index of social vulnerability to limited healthcare self-efficacy. METHODS Using data from a 3-year cohort of 2507 adult primary care patients in Québec (Canada), we applied two complementary structural equation modelling approaches-Partial Least Squares Path Modelling (PLS-PM) and Multiple indicators and Multiple Causes (MIMIC) modelling-to identify a minimal set of social characteristics that could be summed into an Index related to limited healthcare self-efficacy. We then used logistic regression to determine if the Index predicted: hospital emergency department use; hospital admissions; unmet need for care, and others. We privileged parsimony over explanatory capacity in our analytic decisions to make the Index pragmatic for epidemiologic and clinical use. RESULTS The Individual Social Vulnerability Index is the weighted sum of five indicators: two indicators of social support; educational achievement; financial status; limited language proficiency. The Index predicts increased likelihood of all negative healthcare outcomes except unmet need, with a clear threshold at Index ≥ 2. The effect is independent of chronic disease burden. CONCLUSION When social deficits outweigh social assets by two or more (Index ≥ 2), there is an increased risk of negative healthcare events beyond the risk attributable to poor health. The Index is a pragmatic tool to identify a minority of patients who will require additional support to receive equitable healthcare.
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Affiliation(s)
- Jeannie Haggerty
- McGill University, Department of Family Medicine, Montréal, Québec, H3S 1Z1, Canada.
- St. Mary's Hospital Research Center, Hayes Pavilion - S.4720, 3830 Lacombe Ave., Montréal, Québec, H3T 1M5, Canada.
| | - Simona C Minotti
- St. Mary's Hospital Research Center, Hayes Pavilion - S.4720, 3830 Lacombe Ave., Montréal, Québec, H3T 1M5, Canada
- Institute for Better Health, Trillium Health Partners, 100 Queensway W, Mississauga, ON, L58 1B8, Canada
- Department of Statistics and Quantitative Methods, University of Milano-Bococca, Milano, Italy
| | - Fatima Bouharaoui
- St. Mary's Hospital Research Center, Hayes Pavilion - S.4720, 3830 Lacombe Ave., Montréal, Québec, H3T 1M5, Canada
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Bobbette N, Lysaght R, Ouellette-Kuntz H, Tranmer J, Donnelly C. Organizational attributes of interprofessional primary care for adults with intellectual and developmental disabilities in ontario, Canada: a multiple case study. BMC FAMILY PRACTICE 2021; 22:157. [PMID: 34294044 PMCID: PMC8299637 DOI: 10.1186/s12875-021-01502-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 06/28/2021] [Indexed: 11/24/2022]
Abstract
Background Access to high-quality primary care has been identified as a pressing need for adults with intellectual and developmental disabilities (IDD). Adults with IDD live with complex physical and mental health conditions, use health services differently than the general population and continue to face challenges when accessing health services. Interprofessional primary care teams offer comprehensive and coordinated approaches to primary care delivery and are well-positioned to address the needs of adults with IDD and other vulnerable populations. Although interprofessional primary care teams are recommended, there is currently limited understanding of how interprofessional care is delivered and how access to a team of providers improves the health of this population. The aim of this paper is to describe the organizational attributes of interprofessional primary care for adults with IDD within and across models of team-based care in one local health service context. Methods A multiple case study was conducted with five interprofessional primary care teams in Ontario, Canada. Multiple methods were used to generate data including: a survey, document review, electronic medical record report and qualitative interviews. Pattern matching was the primary analytic approach for the within and across case analysis. Results Adults with IDD were found to be a small part of the patient population served and this group was poorly identified in three of five teams. Key organizational attributes that support the delivery of interprofessional primary care for adults with IDD were identified. Two examples of targeted programs of care for this group were also found. Despite the presence of interprofessional health providers in all teams, there were limited organizational processes to engage a wide-range of interprofessional services in the care of this group. There was no consistent reporting of outcomes or processes in place to measure the impact of interprofessional services for this population. Conclusions This study provides important insights into the current state of interprofessional primary care for adults with IDD in Ontario and highlight a critical need for further work in the field to develop organizational structures and processes to engage in team-based care and demonstrate the value of the approach for this population. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01502-z.
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Affiliation(s)
- Nicole Bobbette
- School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, Kingston, Canada.
| | - Rosemary Lysaght
- School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, Kingston, Canada
| | - Hélène Ouellette-Kuntz
- Department of Public Health Sciences & Psychiatry (Division of Developmental Disabilities), Faculty of Health Sciences, Queen's University, Kingston, Canada
| | - Joan Tranmer
- School of Nursing, Faculty of Health Sciences & Institute for Clinical Evaluative Sciences, Queen's University, Kingston, Canada
| | - Catherine Donnelly
- School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, Kingston, Canada
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Eye Examination Recency among African American Older Adults with Chronic Medical Conditions. Healthcare (Basel) 2020; 8:healthcare8020094. [PMID: 32290596 PMCID: PMC7348871 DOI: 10.3390/healthcare8020094] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/01/2020] [Accepted: 04/08/2020] [Indexed: 11/17/2022] Open
Abstract
Background: Pervasive racial and economic inequalities have a disproportionate impact on health care utilization among African Americans. One area where we see such disparities is in the recency of eye examinations among the economically disadvantaged. However, our current understanding of the barriers and facilitators of eye examinations in underserved African-American older adults is limited. Aims: Building on Andersen’s model of health service use and using an exploratory approach; we tested various demographic, social, and health factors that were associated with eye examination among underserved middle-aged and older adults in South Los Angeles. We examined predisposing characteristics, enabling factors, and need-for-care characteristics. Methods: With a cross-sectional design, we conducted this survey on a convenience sample of (n = 740) non-institutionalized African-American older adults who were 55+ years old and residing in South Los Angeles, CA, USA. Data were collected on demographic factors, continuity of care, access to care, self-rated health, chronic medical conditions, and depressive symptoms. The outcome was recency of eye examination. Multivariate regression was used for data analysis. Results: 59% of the participants had received at least one eye examination during the last 12 months. A total of 17% had an eye examination within the last two years. Notably, 26% of diabetic participants did not have an eye examination within the last two years. One out of four participants indicated that, within the last two years, no provider ever recommended that they receive an eye examination. Age, education, continuity of medical care, accessibility of medical care, satisfaction with medical care, providers’ recommendation for eye examination, self-rated health, and a diagnosis of hypertension and diabetes mellitus were predictors of eye examination recency. Overall, our analysis indicates that these enabling factors accounted for most of the variance in the recency of eye examinations. Conclusion: A large proportion of underserved African-American middle-aged and older adults in South Los Angeles do not comply with the recommended annual eye examination. This is, in part, because about one-third of them have not received an eye exam recommendation from their health care providers. However, a wide range of factors such as age, education, continuity of care, satisfaction with access, self-rated health, and a diagnosis of hypertension and diabetes mellitus, also influence whether or not African-American middle-aged and older adults receive an eye examination. Programs should address a wide range of multi-level factors to tackle this health inequality.
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Dahrouge S, Gauthier A, Chiocchio F, Presseau J, Kendall C, Lemonde M, Chomienne MH, Perna A, Toal-Sullivan D, Devlin RA, Timony P, Prud'homme D. Access to Resources in the Community Through Navigation: Protocol for a Mixed-Methods Feasibility Study. JMIR Res Protoc 2019; 8:e11022. [PMID: 30679151 PMCID: PMC6365876 DOI: 10.2196/11022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 09/07/2018] [Accepted: 10/10/2018] [Indexed: 12/15/2022] Open
Abstract
Background Community-based health and social resources can help individuals with complex health and social needs achieve their health goals. However, there is often inadequate access to these resources due to a lack of physician and patient awareness of available resources and the presence of social barriers that limit an individual’s ability to reach these services. Navigation services, where a person is tasked with helping connect patients to community resources, embedded within primary care may facilitate access and strengthen the continuity of care for patients. Objective This study aims to describe the protocol to assess whether the implementation of the Access to Resources in the Community (ARC) navigation model (an innovative approach to navigation services) is feasible, including its potential to achieve its intended outcomes, and to assess the viability of the evaluation approach. Methods The study consists of a single-arm, prospective, explanatory, mixed-methods, pre-post design feasibility study focusing on primary care practice settings with vulnerable populations. Participants include primary care providers and patients. Results Enrollment is closed with 82 patients. Navigation services have ended for 69 patients. Conclusions The study of an innovative complex intervention requires an adequate assessment of the feasibility of the intended approach during which the potential challenges of the planned intervention and need for its adaptation may be uncovered. Undertaking a feasibility study of the ARC navigation model from a conceptually clear and methodologically solid protocol will inform on the practicality and acceptability of the approach, demand for the services, ease of implementation, quality of integration of the new services within primary care, and practicality and potential for efficacy prior to initiating a randomized controlled trial. Trial Registration ClinicalTrials.gov NCT03105635; https://clinicaltrials.gov/ct2/show/NCT03105635 (Archived by WebCite at hhttp://www.webcitation.org/75FrwXORl) International Registered Report Identifier (IRRID) RR1-10.2196/11022
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Affiliation(s)
- Simone Dahrouge
- Bruyere Research Institute, Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Alain Gauthier
- Centre for Rural and Northern Health Research, Laurentian University, Sudbury, ON, Canada
| | | | - Justin Presseau
- Clinical Epidemiology Program, The Ottawa Hospital, Ottawa, ON, Canada
| | - Claire Kendall
- Bruyere Research Institute, Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Manon Lemonde
- University of Ontario Institute of Technology, Oshawa, ON, Canada
| | | | | | | | | | - Patrick Timony
- Centre for Rural and Northern Health Research, Laurentian University, Sudbury, ON, Canada
| | - Denis Prud'homme
- Institut du Savoir Montfort, Ottawa, ON, Canada.,University of Ottawa, Ottawa, ON, Canada
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Haidar OM, Lamarche PA, Levesque JF, Pampalon R. The Influence of Individuals' Vulnerabilities and Their Interactions on the Assessment of a Primary Care Experience. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2018; 48:798-819. [PMID: 29807483 DOI: 10.1177/0020731418768186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study examines the relationship between the vulnerabilities of individuals and their assessments of their primary care experiences in the setting of a universal care system. It focuses on 2 specific objectives: (1) evaluating the influence of each of the 5 vulnerabilities on the assessment of the care experience; (2) evaluating the influence of the interactions between the different types of vulnerabilities on the assessment of the care experience. The study identifies the primary care experience of 9,206 people. The health-related, biological, material, relational, and cultural vulnerabilities are also evaluated. Generally, individuals' vulnerabilities are associated with a positive assessment of the primary care experience except for the cultural vulnerability. Material vulnerability is most frequently associated with a positive assessment of the primary care experience. The interactions between the multiple vulnerabilities present for one individual often modify the effect of vulnerability on the assessment of the experience of care. The positive effect of a vulnerability on the assessment of the care experience often increases in the presence of a second vulnerability, especially the health-related vulnerability. The simultaneous presence of health-related vulnerability cancels the negative influence of cultural vulnerability on the assessment of the primary care experience.
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Affiliation(s)
- Ola M Haidar
- 1 University of Montreal, School of Public Health, Montreal, Canada
| | - Paul A Lamarche
- 2 University of Montreal, School of Public Health, Montreal, Canada
| | - Jean-Frederic Levesque
- 3 Bureau of Health Information and Center for Primary Health Care and Equity, University of New South Wales, New South Wales, Australia
| | - Robert Pampalon
- 4 National Institute of Public Health of Quebec and Department of Social and Preventive Medicine, University of Laval, Quebec, Canada
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Abstract
Background Providing equal access to health care is an important objective in most health care systems. It is especially pertinent in systems like the Swedish primary care market, where private providers are free to establish themselves in any part of the country. To improve equity in access to care, 15 out 21 county councils in Sweden have implemented risk-adjusted capitation based on the Care Need Index, which increases capitation to primary care centers with a large share of patients with unfavorable socioeconomic and demographic characteristics. Our aim is to estimate the effects of using care-need adjusted capitation on the supply of private primary care centers. Method We use a dataset that combines information on all primary care centers in Sweden during 2005–2013, the payment system and other conditions for establishing new primary care centers used in the county councils, and demographic, geographic, and socioeconomic variables for low-level geographic areas. To estimate the effects of care-need adjusted capitation, we use difference-in-differences models, contrasting the development over time between areas with and without risk-adjusted capitation, and with high and low Care Need Index values. Results Risk-adjusted capitation significantly increases the number of private primary care centers in areas with relatively high Care Need Index values. The adjustment results in a changed distribution of private centers within county councils; the total number of private centers does not increase in county councils using care-need adjusted capitation. The effects are furthermore increasing over the first three years after the implementation of such capitation, and concentrated to the lower and middle range of the group of areas with high index values. Conclusions Risk-adjusted capitation based on the Care Need Index increases the supply of private primary care centers in areas with unfavorable socioeconomic and demographic characteristics. More generally, this result indicates that risk-adjusted capitation can significantly affect private providers’ establishment decisions. Electronic supplementary material The online version of this article (10.1186/s12913-018-2983-3) contains supplementary material, which is available to authorized users.
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Non-attendance of vulnerable populations within epilepsy outpatient services in Ireland. Ir J Med Sci 2017; 187:525-528. [PMID: 29032416 DOI: 10.1007/s11845-017-1697-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 10/05/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Outpatient non-attendance is a prevalent issue that contributes to significant wasted clinical resources and can be influenced by a number of complex factors. AIMS The aim of this study is to characterize "did not attend" (DNA) rates in three identified subpopulations of epilepsy patients to determine if current care provision models suffice. METHODS In this study, we identified all patients residing in social housing, in residential care, and those incarcerated who have been offered appointments by our service. We calculated the total number of appointments issued to each group over their entire interaction with our service and their subsequent non-attendance rate as a group. Additionally, we calculated the baseline DNA rate for our epilepsy clinic as a whole for comparison. RESULTS We found that the baseline DNA rate for the clinic as a whole was 18.9%. Those in social housing, in residential care, and incarcerated had significantly higher DNA rates of 24, 20.2, and 54.3%, respectively. CONCLUSIONS This study provided evidence that in certain groups of patients, clinicians may need to explore other care delivery models due to high DNA rates.
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Brandon AD, Costanian C, El Sayed MF, Tamim H. Factors associated with difficulty accessing health care for infants in Canada: mothers' reports from the cross-sectional Maternity Experiences Survey. BMC Pediatr 2016; 16:192. [PMID: 27887580 PMCID: PMC5124240 DOI: 10.1186/s12887-016-0733-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 11/16/2016] [Indexed: 11/10/2022] Open
Abstract
Background Approximately 13% of Canadian mothers report difficulty accessing health care for their infants, yet little is known about the factors associated with difficulty. Therefore, we examined factors associated with difficulty accessing non-routine health care for Canadian infants, from birth to 14 months of age, as reported by their mothers. Methods Data was drawn from the Maternity Experiences Survey (MES), a cross-sectional, nationally representative survey of mothers who gave birth between November 2005 and May 2006, aged 15 years or older, and lived with their infants at the time of survey administration. A multivariable logistic regression analysis was conducted to determine factors associated with reporting difficulty, with difficulty defined as a mother reporting it being somewhat or very difficult to access a health care provider. Results Analysis of 2832 mothers who reported needing to access a health care provider for their infant for a non-routine visit found that 13% reported difficulty accessing a provider. Factors associated with reporting difficulty were: residing in Quebec (aOR 1.89, 95% CI: 1.31–2.73), being an immigrant (aOR 1.58, 95% CI: 1.10–2.27), mistimed pregnancy (aOR 1.44, 95% CI: 1.05–1.98), low level of social support (aOR 1.69, 95% CI: 1.05–2.73), good health (aOR 1.88, 95% CI: 1.43–2.47), postpartum depression symptoms (aOR 1.55, 95% CI: 1.02–2.37) and a self-reported ‘too-short’ postpartum hospital stay (aOR 1.69, 95% CI: 1.21–2.35). Additionally, accessing care for an infant with a birth weight of 2500 g or more (aOR 2.43, 95% CI: 1.02–5.82), was associated with reporting difficulty. Household income, mothers’ level of education, marital status, Aboriginal ethnicity, and size of community of residence were not associated with difficulty accessing care. Conclusions Ease of health care access for Canadian infants is not equal, suggesting that efforts to improve access should be tailored to groups facing increased difficulties.
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Affiliation(s)
- Alisa D Brandon
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada.
| | - Christy Costanian
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada
| | - Manal F El Sayed
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Hala Tamim
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada
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Pineault R, Borgès Da Silva R, Provost S, Breton M, Tousignant P, Fournier M, Prud'homme A, Levesque JF. Impacts of Québec Primary Healthcare Reforms on Patients' Experience of Care, Unmet Needs, and Use of Services. INTERNATIONAL JOURNAL OF FAMILY MEDICINE 2016; 2016:8938420. [PMID: 26977318 PMCID: PMC4764746 DOI: 10.1155/2016/8938420] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 01/11/2016] [Indexed: 06/05/2023]
Abstract
Introduction. Healthcare reforms launched in the early 2000s in Québec, Canada, involved the implementation of new forms of primary healthcare (PHC) organizations: Family Medicine Groups (FMGs) and Network Clinics (NCs). The objective of this paper is to assess how the organizational changes associated with these reforms have impact on patients' experience of care, use of services, and unmet needs. Methods. We conducted population and organization surveys in 2005 and 2010 in two regions of the province of Québec. The design was a before-and-after natural experiment. Changes over time between new models and other practices were assessed using difference-in-differences statistical procedures. Results. Accessibility decreased between 2003 and 2010, but less so in the treatment than in the comparison group. Continuity of care generally improved, but the increase was less for patients in the treatment group. Responsiveness also increased during the period and more so in the treatment group. There was no other significant difference between the two groups. Conclusion. PHC reform in Québec has brought about major organizational changes that have translated into slight improvements in accessibility of care and responsiveness. However, the reform does not seem to have had an impact on continuity, comprehensiveness, perceived care outcomes, use of services, and unmet needs.
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Affiliation(s)
- Raynald Pineault
- Direction de Santé Publique du Centre Intégré Universitaire de Santé et de Services Sociaux du Centre-Est-de-l'Île-de-Montréal, 1301 rue Sherbrooke Est, Montréal, QC, Canada H2L 1M3
- Institut National de Santé Publique du Québec, 190 boulevard Crémazie Est, Montréal, QC, Canada H2P 1E2
- Centre de Recherche du Centre hospitalier de l'Université de Montréal, 900 rue St-Denis, Montréal, QC, Canada H2X 0A9
- Institut de Recherche en Santé Publique de l'Université de Montréal, 7101 avenue du Parc, Montréal, QC, Canada H3N 1X9
| | - Roxane Borgès Da Silva
- Direction de Santé Publique du Centre Intégré Universitaire de Santé et de Services Sociaux du Centre-Est-de-l'Île-de-Montréal, 1301 rue Sherbrooke Est, Montréal, QC, Canada H2L 1M3
- Centre de Recherche du Centre hospitalier de l'Université de Montréal, 900 rue St-Denis, Montréal, QC, Canada H2X 0A9
- Institut de Recherche en Santé Publique de l'Université de Montréal, 7101 avenue du Parc, Montréal, QC, Canada H3N 1X9
- Faculté des Sciences Infirmières de l'Université de Montréal, 2375 chemin de la Côte-Ste-Catherine, Montréal, QC, Canada H3T 1A8
| | - Sylvie Provost
- Direction de Santé Publique du Centre Intégré Universitaire de Santé et de Services Sociaux du Centre-Est-de-l'Île-de-Montréal, 1301 rue Sherbrooke Est, Montréal, QC, Canada H2L 1M3
- Institut National de Santé Publique du Québec, 190 boulevard Crémazie Est, Montréal, QC, Canada H2P 1E2
- Institut de Recherche en Santé Publique de l'Université de Montréal, 7101 avenue du Parc, Montréal, QC, Canada H3N 1X9
| | - Mylaine Breton
- Centre de Recherche de l'Hôpital Charles-Lemoyne, 150 place Charles-Lemoyne, Bureau 200, Longueuil, QC, Canada J5C 2B6
- Département des Sciences de la Santé Communautaire de l'Université de Sherbrooke, 3001 12 avenue Nord, Sherbrooke, QC, Canada J1H 5H3
| | - Pierre Tousignant
- Direction de Santé Publique du Centre Intégré Universitaire de Santé et de Services Sociaux du Centre-Est-de-l'Île-de-Montréal, 1301 rue Sherbrooke Est, Montréal, QC, Canada H2L 1M3
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 avenue des Pins Ouest, Montréal, QC, Canada H3A 1A2
| | - Michel Fournier
- Direction de Santé Publique du Centre Intégré Universitaire de Santé et de Services Sociaux du Centre-Est-de-l'Île-de-Montréal, 1301 rue Sherbrooke Est, Montréal, QC, Canada H2L 1M3
| | - Alexandre Prud'homme
- Direction de Santé Publique du Centre Intégré Universitaire de Santé et de Services Sociaux du Centre-Est-de-l'Île-de-Montréal, 1301 rue Sherbrooke Est, Montréal, QC, Canada H2L 1M3
| | - Jean-Frédéric Levesque
- Centre for Primary Health Care and Equity, University of New South Wales, Kensington, NSW 2033, Australia
- Bureau of Health Information, 67 Albert Avenue, Chatswood, NSW 2067, Australia
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Abstract
Designing and implementing effective lifestyle modification strategies remains one of the great challenges in diabetes care. Historically, programs have focused on individual behavior change with little or no attempt to integrate change within the broader social framework or community context. However, these contextual factors have been shown to be associated with poor diabetes outcomes, particularly in low-income minority populations. Recent evidence suggests that one way to address these disparities is to match patient needs to existing community resources. Not only does this position patients to more quickly adapt behavior in a practical way, but this also refers patients back to their local communities where a support mechanism is in place to sustain healthy behavior. Technology offers a new and promising platform for connecting patients to meaningful resources (also referred to as "assets"). This paper summarizes several noteworthy innovations that use technology as a practical bridge between healthcare and community-based resources that promote diabetes self-care.
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Affiliation(s)
- Elizabeth L. Tung
- Section of General Internal Medicine, Chicago Center of Diabetes Translation Research, University of Chicago, 5841 South Maryland Avenue, MC 2007, Chicago, IL 60637, USA
| | - Monica E. Peek
- Section of General Internal Medicine, Chicago Center of Diabetes Translation Research, University of Chicago, 5841 South Maryland Avenue, MC 2007, Chicago, IL 60637, USA
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Dahrouge S. Roles of nurse practitioners and family physicians in community health centres. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2014; 60:1020-1027. [PMID: 25551130 PMCID: PMC4229163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To describe the models of practice used by nurse practitioners (NPs) and FPs in community health centres (CHCs), and to examine the roles of NPs and FPs in these models. DESIGN Cross-sectional study using an organizational survey completed by managers of the CHC sites, as well as administrative data on patient sociodemographic characteristics and encounter activities. SETTING A total of 21 CHCs (13 main sites and 8 satellite sites) operating in eastern Ontario during the period from December 1, 2006, to November 30, 2008. PARTICIPANTS A total of 44 849 patients, 53 full-time equivalent FPs, and 41 full-time equivalent NPs. MAIN OUTCOME MEASURES Family physicians' and NPs' models of practice, the sociodemographic characteristics and medical profiles of patients who were treated in each model of practice, and FPs' and NPs' use of time. RESULTS Patients were attributed to 1 of 3 models of practice in CHCs based on the proportion of visits to FPs and NPs: FP care (53% of patients), NP care (29%), and shared care (18%). Patients who received care in the NP model of practice were younger and more likely to be female, be homeless, and not have postsecondary education.Patients who received care in the FP model of practice had more complex medical conditions (cardiovascular disease, mental illness, lung disease, and diabetes) and more annual visits. Patients who received care in the shared care model had intermediate profiles. Nurse practitioners performed more off-site care and walk-in visits. Family physicians and NPs spent a similar proportion of time performing various duties such as direct clinical care and administration tasks. CONCLUSION Although NPs mainly cared for their own patient panels (in the NP care model), they did share some patients with FPs and provide some care to patients under the FP model of practice. Patients who were cared for by FPs and NPs had quite different characteristics.
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Affiliation(s)
- Simone Dahrouge
- Correspondence: Dr Simone Dahrouge, C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, 43 Bruyère St, Annex E, Ottawa, ON K1R 7G5; e-mail
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