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Aggarwal M, Hutchison B, Wong ST, Katz A, Slade S, Snelgrove D. What factors are associated with the research productivity of primary care researchers in Canada? A qualitative study. BMC Health Serv Res 2024; 24:263. [PMID: 38429708 PMCID: PMC10908166 DOI: 10.1186/s12913-024-10644-6] [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: 06/28/2023] [Accepted: 01/26/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Research evidence to inform primary care policy and practice is essential for building high-performing primary care systems. Nevertheless, research output relating to primary care remains low worldwide. This study describes the factors associated with the research productivity of primary care researchers. METHODS A qualitative, descriptive key informant study approach was used to conduct semi-structured interviews with twenty-three primary care researchers across Canada. Qualitative data were analyzed using reflexive thematic analysis. RESULTS Twenty-three primary care researchers participated in the study. An interplay of personal (psychological characteristics, gender, race, parenthood, education, spousal occupation, and support), professional (mentorship before appointment, national collaborations, type of research, career length), institutional (leadership, culture, resources, protected time, mentorship, type), and system (funding, systematic bias, environment, international collaborations, research data infrastructure) factors were perceived to be associated with research productivity. Research institutes and mentors facilitated collaborations, and mentors and type of research enabled funding success. Jurisdictions with fewer primary care researchers had more national collaborations but fewer funding opportunities. The combination of institutional, professional, and system factors were barriers to the research productivity of female and/or racialized researchers. CONCLUSIONS This study illuminates the intersecting and multifaceted influences on the research productivity of primary care researchers. By exploring individual, professional, institutional, and systemic factors, we underscore the pivotal role of diverse elements in shaping RP. Understanding these intricate influencers is imperative for tailored, evidence-based interventions and policies at the level of academic institutions and funding agencies to optimize resources, promote fair evaluation metrics, and cultivate inclusive environments conducive to diverse research pursuits within the PC discipline in Canada.
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Affiliation(s)
- Monica Aggarwal
- University of Toronto, Dalla Lana School of Public Health, Toronto, Ontario, Canada.
| | - Brian Hutchison
- McMaster University, Departments of Family Medicine and Health Research Methods, Evidence and Impact and the Centre for Health Economics and Policy Analysis, Hamilton, Ontario, Canada
| | - Sabrina T Wong
- University of British Columbia, School of Nursing, Centre for Health Services and Policy Research, Vancouver, British Columbia, Canada
| | - Alan Katz
- University of Manitoba, Departments of Community Health Sciences and Family Medicine Rady Faculty of Health Sciences, Winnipeg, Manitoba, Canada
| | - Steve Slade
- The College of Family Physicians of Canada, Mississauga, Canada
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Lim S, Athilingam P, Lahiri M, Cheung PPM, He HG, Lopez V. A Web-Based Patient Empowerment to Medication Adherence Program for Patients With Rheumatoid Arthritis: Feasibility Randomized Controlled Trial. JMIR Form Res 2023; 7:e48079. [PMID: 37930758 PMCID: PMC10660247 DOI: 10.2196/48079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 09/30/2023] [Accepted: 10/02/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND Living with a chronic illness such as rheumatoid arthritis (RA) requires medications and therapies, as well as long-term follow-up with multidisciplinary clinical teams. Patient involvement in the shared decision-making process on medication regimens is an important element in promoting medication adherence. Literature review and needs assessment showed the viability of technology-based interventions to equip patients with knowledge about chronic illness and competencies to improve their adherence to medications. Thus, a web-based intervention was developed to empower patients living with RA to adhere to their disease-modifying antirheumatic drugs (DMARDs) medication regimen. OBJECTIVE This study aims to discuss the intervention mapping process in the design of a web-based intervention that supports patient empowerment to medication adherence and to evaluate its feasibility among patients living with RA. METHODS The theory-based Patient Empowerment to Medication Adherence Programme (PE2MAP) for patients with RA was built upon the Zimmerman Psychological Empowerment framework, a web-based program launched through the Udemy website. PE2MAP was developed using a 6-step intervention mapping process: (1) needs assessment, (2) program objectives, (3) conceptual framework to guide the intervention, (4) program plan, (5) adoption, and (6) evaluation involving multidisciplinary health care professionals (HCPs) and a multimedia team. PE2MAP is designed as a 4-week web-based intervention program with a complementary RA handbook. A feasibility randomized controlled trial was completed on 30 participants from the intervention group who are actively taking DMARD medication for RA to test the acceptability and feasibility of the PE2MAP. RESULTS The mean age and disease duration of the 30 participants were 52.63 and 8.50 years, respectively. The feasibility data showed 87% (n=26) completed the 4-week web-based PE2MAP intervention, 57% (n=17) completed all 100% of the contents, and 27% (n=8) completed 96% to 74% of the contents, indicating the overall feasibility of the intervention. As a whole, 96% (n=24) of the participants found the information on managing the side effects of medications, keeping fit, managing flare-ups, and monitoring joint swelling/pain/stiffness as the most useful contents of the intervention. In addition, 88% (n=23) and 92% (n=24) agreed that the intervention improved their adherence to medications and management of their side effects, including confidence in communicating with their health care team, respectively. The dos and do nots of traditional Chinese medicine were found by 96% (n=25) to be useful. Goal setting was rated as the least useful skill by 6 (23.1%) of the participants. CONCLUSIONS The web-based PE2MAP intervention was found to be acceptable, feasible, and effective as a web-based tool to empower patients with RA to manage and adhere to their DMARD medications. Further well-designed randomized controlled trials are warranted to explore the effectiveness of this intervention in the management of patients with RA.
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Affiliation(s)
- Siriwan Lim
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Manjari Lahiri
- Division of Rheumatology, Department of Medicine, National University Hospital, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Peter Pak Moon Cheung
- Division of Rheumatology, Department of Medicine, National University Hospital, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Hong-Gu He
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Violeta Lopez
- School of Nursing, Midwifery and Social Sciences, Central Queensland University, Rockhampton, Queensland, Australia
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Litchfield I, Calvert MJ, Kinsella F, Sungum N, Aiyegbusi OL. "I just wanted to speak to someone- and there was no one…": using Burden of Treatment Theory to understand the impact of a novel ATMP on early recipients. Orphanet J Rare Dis 2023; 18:86. [PMID: 37069697 PMCID: PMC10111696 DOI: 10.1186/s13023-023-02680-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 04/02/2023] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND Advanced therapy medicinal products such as Chimeric antigen receptor T-cell therapy offer ground-breaking opportunities for the treatment of various cancers, inherited diseases, and chronic conditions. With development of these novel therapies continuing to increase it's important to learn from the experiences of patients who were among the first recipients of ATMPs. In this way we can improve the clinical and psychosocial support offered to early patient recipients in the future to support the successful completion of treatments and trials. STUDY DESIGN We conducted a qualitative investigation informed by the principles of the key informant technique to capture the experience of some of the first patients to experience CAR-T therapy in the UK. A directed content analysis was used to populate a theoretical framework informed by Burden of Treatment Theory to determine the lessons that can be learnt in supporting their care, support, and ongoing self-management. RESULTS A total of five key informants were interviewed. Their experiences were described within the three domains of the burden of treatment framework; (1) The health care tasks delegated to patients, Participants described the frequency of follow-up and the resources involved, the esoteric nature of the information provided by clinicians; (2) Exacerbating factors of the treatment, which notably included the lack of understanding of the clinical impacts of the treatment in the broader health service, and the lack of a peer network to support patient understanding; (3) Consequences of the treatment, in which they described the anxiety induced by the process surrounding their selection for treatment, and the feeling of loneliness and isolation at being amongst the very first recipients. CONCLUSIONS If ATMPs are to be successfully introduced at the rates forecast, then it is important that the burden placed on early recipients is minimised. We have discovered how they can feel emotionally isolated, clinically vulnerable, and structurally unsupported by a disparate and pressured health service. We recommend that where possible, structured peer support be put in place alongside signposting to additional information that includes the planned pattern of follow-up, and the management of discharged patients would ideally accommodate individual circumstances and preferences to minimize the burden of treatment.
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Affiliation(s)
- Ian Litchfield
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - Melanie J Calvert
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
- Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
- NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK
- Applied Research Collaboration (ARC) - West Midlands, Birmingham, UK
- Birmingham Health Partners (BHP) Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
| | - Francesca Kinsella
- NIHR Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
- NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
- Centre for Clinical Haematology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Nisha Sungum
- Midlands and Wales Advanced Therapy Treatment Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Research Development and Innovation, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Olalekan L Aiyegbusi
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
- Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
- NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK
- Applied Research Collaboration (ARC) - West Midlands, Birmingham, UK
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
- Birmingham Health Partners (BHP) Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
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Chapman RM, Moschetti WE, Van Citters DW. Is clinically measured knee range of motion after total knee arthroplasty ‘good enough?’: A feasibility study using wearable inertial measurement units to compare knee range of motion captured during physical therapy versus at home. MEDICINE IN NOVEL TECHNOLOGY AND DEVICES 2021. [DOI: 10.1016/j.medntd.2021.100085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Jones AR, Tay CT, Melder A, Vincent AJ, Teede H. What Are Models of Care? A Systematic Search and Narrative Review to Guide Development of Care Models for Premature Ovarian Insufficiency. Semin Reprod Med 2021; 38:323-330. [PMID: 33684948 DOI: 10.1055/s-0041-1726131] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
No specific model of care (MoC) is recommended for premature ovarian insufficiency (POI), despite awareness that POI is associated with comorbidities requiring multidisciplinary care. This article aims to explore the definitions and central components of MoC in health settings, so that care models for POI can be developed. A systematic search was performed on Ovid Medline and Embase, and including gray literature. Unique definitions of MoC were identified, and thematic analysis was used to summarize the key component of MoC. Of 2,477 articles identified, 8 provided unique definitions of MoC, and 11 described components of MoC. Definitions differ in scope, focusing on disease, service, or system level, but a key feature is that MoC is operational, describing how care is delivered, as well as what that care is. Thematic analysis identified 42 components of MoC, summarized into 6 themes-stakeholder engagement, supporting integrated care, evidence-based care, defined outcomes and evaluation, behavior change methodology, and adaptability. Stakeholder engagement was central to all other themes. MoCs operationalize how best practice care can be delivered at a disease, service, or systems level. Specific MoC should be developed for POI, to improve clinical and process outcomes, translate evidence into practice, and use resources more efficiently.
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Affiliation(s)
- Alicia R Jones
- Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Victoria, Australia.,Department of Endocrinology, Monash Health, Victoria, Australia
| | - Chau T Tay
- Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Victoria, Australia.,Department of Endocrinology, Monash Health, Victoria, Australia
| | - Angela Melder
- Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Victoria, Australia.,Monash Partner's Academic Health Science Centre, Victoria, Australia
| | - Amanda J Vincent
- Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Victoria, Australia.,Department of Endocrinology, Monash Health, Victoria, Australia
| | - Helena Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Victoria, Australia.,Department of Endocrinology, Monash Health, Victoria, Australia.,Monash Partner's Academic Health Science Centre, Victoria, Australia
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Chua J, Briggs AM, Hansen P, Chapple C, Abbott JH. Choosing interventions for hip or knee osteoarthritis - What matters to stakeholders? A mixed-methods study. OSTEOARTHRITIS AND CARTILAGE OPEN 2020; 2:100062. [DOI: 10.1016/j.ocarto.2020.100062] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 03/29/2020] [Indexed: 01/28/2023] Open
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Holøyen PK, Stensdotter AK. Patients with spondyloarthritis are equally satisfied with follow-up by physiotherapist and rheumatologist. Musculoskeletal Care 2018; 16:388-397. [PMID: 29573538 DOI: 10.1002/msc.1241] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 01/31/2018] [Accepted: 02/02/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE International guidelines recommend that patients with spondyloarthritis (SpA) have lifelong physiotherapy, as physical activity and exercise are essential for optimizing health throughout the course of the disease. The aim of the present study was to investigate if a physiotherapy-led outpatient clinic specializing in SpA could provide satisfactory follow-up as an alternative to standard visits with a rheumatologist (RT). We hypothesized that satisfaction would be similar in patients followed by a physiotherapist (PT) or an RT. METHODS A total of 68 patients were randomized to follow-up every fourth month by a PT or RT, for three visits in total. Patient satisfaction was evaluated using the Leeds Satisfaction Questionnaire (LSQ). Function, mobility and disease activity were rated using the Bath Ankylosing Spondylitis Functional Index (BASFI), Mobility Index (BASMI) and Ankylosing Spondylitis Disease Activity Score (ASDAS). RESULTS Patients were equally satisfied with PT and RT follow-up at the first (p = 0.062) and last (p = 0.710) visit. At the second visit, the RT group was seen by a nurse, and was more satisfied than the PT group (p = 0.015). Function deteriorated in both the PT (p = 0.014) and RT (p = 0.007) groups. Mobility increased in the PT group (p = 0.020). Disease activity was not affected. CONCLUSIONS Patients seem to be equally satisfied with either of the follow-up regimes. The PT-led follow-up did not seem to affect the patients' course of disease negatively. The results indicate that it would be safe to implement a PT-led clinic for patients with SpA in specialist health services, but longer-term follow-up is necessary to support the findings of this study.
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Affiliation(s)
- Pauline Kjelsvik Holøyen
- Department of Rheumatology, Ålesund Hospital, Ålesund, Norway
- Faculty of Medicine and Health Sciences, Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ann-Katrin Stensdotter
- Faculty of Medicine and Health Sciences, Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
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Smith BJ, Bolster MB, Slusher B, Stamatos C, Scott JR, Benham H, Kazi S, Schlenk EA, Schaffer DE, Majithia V, Brown CR, Von Feldt JM, Flood J, Haag DM, Smarr KL. Core Curriculum to Facilitate the Expansion of a Rheumatology Practice to Include Nurse Practitioners and Physician Assistants. Arthritis Care Res (Hoboken) 2018; 70:672-678. [DOI: 10.1002/acr.23546] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 02/06/2018] [Indexed: 11/07/2022]
Affiliation(s)
| | | | | | | | - Jeanne R. Scott
- Cheshire Medical Center and Dartmouth-Hitchcock Keene; Keene New Hampshire
| | | | | | | | | | | | - Calvin R. Brown
- Northwestern University Feinberg School of Medicine; Chicago Illinois
| | | | - Joseph Flood
- Columbus Arthritis Center, Columbus, Ohio; and The Ohio State University College of Medicine; Columbus
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Warmington K, Flewelling C, Kennedy CA, Shupak R, Papachristos A, Jones C, Linton D, Beaton DE, Lineker S. Telemedicine delivery of patient education in remote Ontario communities: feasibility of an Advanced Clinician Practitioner in Arthritis Care (ACPAC)-led inflammatory arthritis education program. Open Access Rheumatol 2017; 9:11-19. [PMID: 28280400 PMCID: PMC5338940 DOI: 10.2147/oarrr.s122015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Objective Telemedicine-based approaches to health care service delivery improve access to care. It was recognized that adults with inflammatory arthritis (IA) living in remote areas had limited access to patient education and could benefit from the 1-day Prescription for Education (RxEd) program. The program was delivered by extended role practitioners with advanced training in arthritis care. Normally offered at one urban center, RxEd was adapted for videoconference delivery through two educator development workshops that addressed telemedicine and adult education best practices. This study explores the feasibility of and participant satisfaction with telemedicine delivery of the RxEd program in remote communities. Materials and methods Participants included adults with IA attending the RxEd program at one of six rural sites. They completed post-course program evaluations and follow-up interviews. Educators provided post-course feedback to identify program improvements that were later implemented. Results In total, 123 people (36 in-person and 87 remote, across 6 sites) participated, attending one of three RxEd sessions. Remote participants were satisfied with the quality of the video-conference (% agree/strongly agree): could hear the presenter (92.9%) and discussion between sites (82.4%); could see who was speaking at other remote sites (85.7%); could see the slides (95.3%); and interaction between sites adequately facilitated (94.0%). Educator and participant feedback were consistent. Suggested improvements included: use of two screens (speaker and slides); frontal camera angles; equal interaction with remote sites; and slide modifications to improve the readability on screen. Interview data included similar constructive feedback but highlighted the educational and social benefits of the program, which participants noted would have been inaccessible if not offered via telemedicine. Conclusion Study findings confirm the feasibility of delivering the RxEd program to remote communities by using telemedicine. Future research with a focus on the sustainability of this and other models of technology-supported patient education for adults with IA across Ontario is warranted.
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Affiliation(s)
| | | | - Carol A Kennedy
- Musculoskeletal Health & Outcomes Research, St. Michael's Hospital; Institute for Work & Health
| | - Rachel Shupak
- Martin Family Centre for Arthritis Care & Research, St. Michael's Hospital
| | | | - Caroline Jones
- Martin Family Centre for Arthritis Care & Research, St. Michael's Hospital
| | - Denise Linton
- Musculoskeletal Health & Outcomes Research, St. Michael's Hospital
| | - Dorcas E Beaton
- Musculoskeletal Health & Outcomes Research, St. Michael's Hospital; Institute for Work & Health; Graduate Department of Health Policy, Management and Evaluation; Graduate Department of Rehabilitation Science; Department of Occupational Science and Occupational Therapy, University of Toronto
| | - Sydney Lineker
- The Arthritis Society (Ontario Division), Toronto, ON, Canada
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Briggs AM, Cross MJ, Hoy DG, Sànchez-Riera L, Blyth FM, Woolf AD, March L. Musculoskeletal Health Conditions Represent a Global Threat to Healthy Aging: A Report for the 2015 World Health Organization World Report on Ageing and Health. THE GERONTOLOGIST 2017; 56 Suppl 2:S243-55. [PMID: 26994264 DOI: 10.1093/geront/gnw002] [Citation(s) in RCA: 362] [Impact Index Per Article: 51.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Persistent pain, impaired mobility and function, and reduced quality of life and mental well-being are the most common experiences associated with musculoskeletal conditions, of which there are more than 150 types. The prevalence and impact of musculoskeletal conditions increase with aging. A profound burden of musculoskeletal disease exists in developed and developing nations. Notably, this burden far exceeds service capacity. Population growth, aging, and sedentary lifestyles, particularly in developing countries, will create a crisis for population health that requires a multisystem response with musculoskeletal health services as a critical component. Globally, there is an emphasis on maintaining an active lifestyle to reduce the impacts of obesity, cardiovascular conditions, cancer, osteoporosis, and diabetes in older people. Painful musculoskeletal conditions, however, profoundly limit the ability of people to make these lifestyle changes. A strong relationship exists between painful musculoskeletal conditions and a reduced capacity to engage in physical activity resulting in functional decline, frailty, reduced well-being, and loss of independence. Multilevel strategies and approaches to care that adopt a whole person approach are needed to address the impact of impaired musculoskeletal health and its sequelae. Effective strategies are available to address the impact of musculoskeletal conditions; some are of low cost (e.g., primary care-based interventions) but others are expensive and, as such, are usually only feasible for developed nations. In developing nations, it is crucial that any reform or development initiatives, including research, must adhere to the principles of development effectiveness to avoid doing harm to the health systems in these settings.
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Affiliation(s)
- Andrew M Briggs
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia. Arthritis and Osteoporosis Victoria, Caulfield South, Melbourne, Australia.
| | - Marita J Cross
- Institute of Bone and Joint Research, University of Sydney, Royal North Shore Hospital Department of Rheumatology, St Leonards, New South Wales, Australia
| | - Damian G Hoy
- School of Population Health, University of Queensland, Herston, Brisbane, Australia. Secretariat of the Pacific Community, Public Health Division, Noumea, New Caledonia
| | - Lídia Sànchez-Riera
- Institut d'Investigació, Biomèdica de Bellvitge, Hospital Universitari de Bellvitge, Department Reumatologia, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Fiona M Blyth
- Concord Clinical School, University of Sydney and Ageing and Alzheimer's Institute, Concord Repatriation General Hospital, New South Wales, Australia
| | - Anthony D Woolf
- Bone and Joint Research Office, The Knowledge Spa, Royal Cornwall Hospital, Truro, UK
| | - Lyn March
- Institute of Bone and Joint Research, University of Sydney, Royal North Shore Hospital Department of Rheumatology, St Leonards, New South Wales, Australia
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Commonalities and differences in the implementation of models of care for arthritis: key informant interviews from Canada. BMC Health Serv Res 2016; 16:415. [PMID: 27543108 PMCID: PMC4992288 DOI: 10.1186/s12913-016-1634-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 08/04/2016] [Indexed: 11/10/2022] Open
Abstract
Background Timely access to effective treatments for arthritis is a priority at national, provincial and regional levels in Canada due to population aging coupled with limited health human resources. Models of care for arthritis are being implemented across the country but mainly in local contexts, not from an evidence-informed policy or framework. The purpose of this study is to examine existing models of care for arthritis in Canada at the local level in order to identify commonalities and differences in their implementation that could point to important considerations for health policy and service delivery. Methods Semi-structured key informant interviews were conducted with 70 program managers and/or care providers in three Canadian provinces identified through purposive and snowball sampling followed by more detailed examination of 6 models of care (two per province). Interviews were transcribed verbatim and analyzed thematically using a qualitative descriptive approach. Results Two broad models of care were identified for Total Joint Replacement and Inflammatory Arthritis. Commonalities included lack of complete and appropriate referrals from primary care physicians and lack of health human resources to meet local demands. Strategies included standardized referrals and centralized intake and triage using non-specialist health care professionals. Differences included the nature of the care and follow-up, the role of the specialist, and location of service delivery. Conclusions Current models of care are mainly focused on Total Joint Replacement and Inflammatory Arthritis. Given the increasing prevalence of arthritis and that published data report only a small proportion of current service delivery is specialist care; provision of timely, appropriate care requires development, implementation and evaluation of models of care across the continuum of care. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1634-9) contains supplementary material, which is available to authorized users.
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Models of Care for musculoskeletal health: Moving towards meaningful implementation and evaluation across conditions and care settings. Best Pract Res Clin Rheumatol 2016; 30:359-374. [DOI: 10.1016/j.berh.2016.09.009] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 09/16/2016] [Indexed: 12/31/2022]
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Briggs AM, Jordan JE, Speerin R, Jennings M, Bragge P, Chua J, Slater H. Models of care for musculoskeletal health: a cross-sectional qualitative study of Australian stakeholders' perspectives on relevance and standardised evaluation. BMC Health Serv Res 2015; 15:509. [PMID: 26573487 PMCID: PMC4647615 DOI: 10.1186/s12913-015-1173-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 11/12/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The prevalence and impact of musculoskeletal conditions are predicted to rapidly escalate in the coming decades. Effective strategies are required to minimise 'evidence-practice', 'burden-policy' and 'burden-service' gaps and optimise health system responsiveness for sustainable, best-practice healthcare. One mechanism by which evidence can be translated into practice and policy is through Models of Care (MoCs), which provide a blueprint for health services planning and delivery. While evidence supports the effectiveness of musculoskeletal MoCs for improving health outcomes and system efficiencies, no standardised national approach to evaluation in terms of their 'readiness' for implementation and 'success' after implementation, is yet available. Further, the value assigned to MoCs by end users is uncertain. This qualitative study aimed to explore end users' views on the relevance of musculoskeletal MoCs to their work and value of a standardised evaluation approach. METHODS A cross-sectional qualitative study was undertaken. Subject matter experts (SMEs) with health, policy and administration and consumer backgrounds were drawn from three Australian states. A semi-structured interview schedule was developed and piloted to explore perceptions about musculoskeletal MoCs including: i) aspects important to their work (or life, for consumers) ii) usefulness of standardised evaluation frameworks to judge 'readiness' and 'success' and iii) challenges associated with standardised evaluation. Verbatim transcripts were analysed by two researchers using a grounded theory approach to derive key themes. RESULTS Twenty-seven SMEs (n = 19; 70.4 % female) including five (18.5 %) consumers participated in the study. MoCs were perceived as critical for influencing and initiating changes to best-practice healthcare planning and delivery and providing practical guidance on how to implement and evaluate services. A 'readiness' evaluation framework assessing whether critical components across the health system had been considered prior to implementation was strongly supported, while 'success' was perceived as an already familiar evaluation concept. Perceived challenges associated with standardised evaluation included identifying, defining and measuring key 'readiness' and 'success' indicators; impacts of systems and context changes; cost; meaningful stakeholder consultation and developing a widely applicable framework. CONCLUSIONS A standardised evaluation framework that includes a strong focus on 'readiness' is important to ensure successful and sustainable implementation of musculoskeletal MoCs.
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Affiliation(s)
- Andrew M Briggs
- School of Physiotherapy and Exercise Science, Curtin University, GPO Box U1987, Perth, Australia.
| | | | - Robyn Speerin
- New South Wales Agency for Clinical Innovation, PO Box 699, Chatswood, NSW, 2057, Australia.
| | - Matthew Jennings
- New South Wales Agency for Clinical Innovation, PO Box 699, Chatswood, NSW, 2057, Australia.
- Liverpool Hospital, South Western Sydney Local Health District, Locked bag 7103, Liverpool Business Centre, Liverpool, NSW, 1871, Australia.
| | - Peter Bragge
- BehaviourWorks Australia, Monash Sustainability Institute, 8 Scenic Boulevard, Monash University, Melbourne, VIC, 3800, Australia.
| | - Jason Chua
- Department of Health, Government of Western Australia, PO Box 8172, Perth Business Centre, Perth, 6849, Australia.
| | - Helen Slater
- School of Physiotherapy and Exercise Science, Curtin University, GPO Box U1987, Perth, Australia.
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Suter E, Birney A, Charland P, Misfeldt R, Weiss S, Howden JS, Hendricks J, Lupton T, Marshall D. Optimizing the interprofessional workforce for centralized intake of patients with osteoarthritis and rheumatoid disease: case study. HUMAN RESOURCES FOR HEALTH 2015; 13:41. [PMID: 26016670 PMCID: PMC4448305 DOI: 10.1186/s12960-015-0033-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 05/17/2015] [Indexed: 05/27/2023]
Abstract
INTRODUCTION This case study was part of a larger programme of research in Alberta that aims to develop an evidence-based model to optimize centralized intake province-wide to improve access to care. A centralized intake model places all referred patients on waiting lists based on severity and then directs them to the most appropriate provider or service. Our research focused on an in-depth assessment of two well-established models currently in place in Alberta to 1) enhance our understanding of the roles and responsibilities of staff in current intake processes, 2) identify workforce issues and opportunities within the current models, and 3) inform the potential use of alternative providers in the proposed centralized intake model. CASE DESCRIPTION Our case study included two centralized intake models in Alberta associated with three clinics. One model involved one clinic that focuses on rheumatoid disease. The other model involved two clinics that focus on osteoarthritis. We completed a document review and interviews with managers and staff from both models. Finally, we reviewed the scope of practice regulations for a range of health-care providers to examine their suitability to contribute to the centralized intake process of osteoarthritis and rheumatoid disease. DISCUSSION AND EVALUATION Interview findings from both models suggested a need for an electronic medical record and eReferral system to improve the efficiency of the current process and reduce staff workload. Staff interviewed also spoke of the need to have a permanent musculoskeletal screener available to streamline the intake process for osteoarthritis patients. Both models relied on registered nurses, medical office assistants, and physicians throughout their intake process. Our scope of practice review revealed that several providers have the competencies to screen, assess, and provide case management at different junctures in the centralized intake of patients with osteoarthritis and rheumatoid disease. CONCLUSIONS Using a broader range of providers in the centralized intake of osteoarthritis and rheumatoid disease has the potential to improve access and care specifically related to the assessment and management of patients. This may enhance the patient care experience and address current access issues.
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Affiliation(s)
- Esther Suter
- Workforce Research & Evaluation, Alberta Health Services, 10301 Southport Lane SW, T2W 1S7, Calgary, Alberta, Canada.
| | - Arden Birney
- Workforce Research & Evaluation, Alberta Health Services, 10301 Southport Lane SW, T2W 1S7, Calgary, Alberta, Canada.
| | - Paola Charland
- Workforce Research & Evaluation, Alberta Health Services, 10301 Southport Lane SW, T2W 1S7, Calgary, Alberta, Canada.
| | - Renee Misfeldt
- Workforce Research & Evaluation, Alberta Health Services, 2nd floor, Collin Barrows Building 3942 50A Avenue, PO Box 5030, T4N 6H2, Red Deer, Alberta, Canada.
| | - Stephen Weiss
- Alberta Bone and Joint Health Institute, 400, 3280 Hospital Drive NW, T2N 4Z6, Calgary, Alberta, Canada.
| | - Jane Squire Howden
- Edmonton Musculoskeletal Centre, Suite 2068, 9499 137 Avenue NW, T5E 5R8, Edmonton, Alberta, Canada.
| | - Jennifer Hendricks
- The Alberta Hip and Knee Clinic, Gulf Canada Square, Suite 335, 401- 9th Avenue, SW, T2P 3C5, Calgary, Alberta, Canada.
| | - Theresa Lupton
- Division of Rheumatology, Alberta Health Services, Richmond Road Diagnostic & Treatment Centre, 1820 Richmond Road SW, T2T 5C7, Calgary, Alberta, Canada.
| | - Deborah Marshall
- Alberta Bone and Joint Health Institute and Department of Community Health Sciences and Department of Medicine, Cumming School of Medicine, University of Calgary, TRW Building, 3rd Floor, 3280 Hospital Drive NW, T2N 4Z6, Calgary, Alberta, Canada.
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Iversen MD, Sharby N. Arthritis patient education, health promotion, and team approaches to management. Rheumatology (Oxford) 2015. [DOI: 10.1016/b978-0-323-09138-1.00046-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Crossland V, Field R, Ainsworth P, Edwards CJ, Cherry L. Is there evidence to support multidisciplinary healthcare working in rheumatology? A systematic review of the literature. Musculoskeletal Care 2014; 13:51-66. [PMID: 25052547 DOI: 10.1002/msc.1081] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Briggs AM, Towler SCB, Speerin R, March LM. Models of care for musculoskeletal health in Australia: now more than ever to drive evidence into health policy and practice. AUST HEALTH REV 2014; 38:401-5. [DOI: 10.1071/ah14032] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 06/03/2014] [Indexed: 11/23/2022]
Abstract
Musculoskeletal health conditions such as arthritis, osteoporosis and pain syndromes impart a profound socioeconomic burden worldwide, particularly in developed nations such as Australia. Despite the identified burden, substantial evidence-practice and care disparity gaps remain in service delivery and access that limit the potential for improved consumer outcomes and system efficiencies. Addressing these gaps requires a whole-of-sector response, supported by evidence-informed health policy. Models of care (MoCs) serve as a policy vehicle to embed evidence into health policy and guide practice through changes in service delivery systems and clinician behaviour. In Australia, MoCs for musculoskeletal health have been developed by networks of multidisciplinary stakeholders and are incrementally being implemented across health services, facilitated by dedicated policy units and clinical champions. A web of evidence is now emerging to support this approach to driving evidence into health policy and practice. Understanding the vernacular of MoCs and the development and implementation of MoCs is important to embracing this approach to health policy.
What is known about the topic?
The impact of musculoskeletal health conditions is profound. As the awareness around the magnitude of the impact of these conditions increases, the importance of system-wide policy responses and platforms for health service improvements is now recognised. The term ‘models of care’ is not new. It has been used for many years, mainly at the hospital level, for planning and delivering clinical services. However, over the past 8 years an alternative approach using health networks has been adopted for the development and implementation of models of care to achieve broad engagement and a wider and more sustainable scope for implementation.
What does this paper add?
Here, we provide a rationale for the development of models of care for musculoskeletal health and draw on experience in their development and implementation using a health network model, referring to an emerging web of evidence to support this approach. We describe what models of care are, how they are developed and question whether they make a difference and what the future may hold.
What are the implications for practitioners?
All indications suggest that models of care are here to stay. Therefore, this paper provides practitioners with a contemporary overview of models of care in Australia, their relevance to musculoskeletal healthcare, particularly related to closing evidence-practice gaps, and opportunities for sector engagement.
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Badley EM, Canizares M, MacKay C, Mahomed NN, Davis AM. Surgery or consultation: a population-based cohort study of use of orthopaedic surgeon services. PLoS One 2013; 8:e65560. [PMID: 23750266 PMCID: PMC3672140 DOI: 10.1371/journal.pone.0065560] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Accepted: 04/26/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND This population-based cohort study has the objective to understand the sociodemographic characteristics and health conditions of patients who do not receive surgery within 18 months following an ambulatory visit to an orthopaedic surgeon. METHODS Administrative healthcare databases in Ontario, Canada were linked to identify all patients making an initial ambulatory visit to orthopaedic surgeons between October 1(st), 2004 and September 30(th), 2005. Logistic regression was used to examine predictors of not receiving surgery within 18 months. RESULTS Of the 477,945 patients in the cohort 49% visited orthopaedic surgeons for injury, and 24% for arthritis. Overall, 79.3% did not receive surgery within 18 months of the initial visit, which varied somewhat by diagnosis at first visit (84.5% for injury and 73.0% for arthritis) with highest proportions in the 0-24 and 25-44 age groups. The distribution by income quintile of patients visiting was skewed towards higher incomes. Regression analysis for each diagnostic group showed that younger patients were significantly more likely to be non-surgical than those aged 65+ years (age 0-24: OR 3.45 95%CI 3.33-3.57; age 25-44: OR 1.30 95%CI 1.27-1.33). The odds of not getting surgery were significantly higher for women than men for injury and other conditions; the opposite was true for arthritis and bone conditions. CONCLUSION A substantial proportion of referrals were for expert diagnosis or advice on management and treatment. The findings also suggest socioeconomic inequalities in access to orthopaedic care. Further research is needed to investigate whether the high caseload of non-surgical cases affects waiting times to see a surgeon. This paper contributes to the development of evidence-based strategies to streamline access to surgery, and to develop models of care for non-surgical patients to optimize the use of scarce orthopaedic surgeon resources and to enhance the management of musculoskeletal disorders across the care continuum.
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Affiliation(s)
- Elizabeth M Badley
- The Arthritis Community Research and Evaluation Unit, Division of Health Care and Outcomes Research, Toronto Western Research Institute, Toronto, Ontario, Canada.
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Lundon K, Kennedy C, Rozmovits L, Sinclair L, Shupak R, Warmington K, Passalent L, Brooks S, Schneider R, Soever L. Evaluation of perceived collaborative behaviour amongst stakeholders and clinicians of a continuing education programme in arthritis care. J Interprof Care 2013; 27:401-7. [DOI: 10.3109/13561820.2013.783559] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Meeting the challenge of the ageing of the population: Issues in access to specialist care for arthritis. Best Pract Res Clin Rheumatol 2012; 26:599-609. [DOI: 10.1016/j.berh.2012.09.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Stanhope J, Beaton K, Grimmer-Somers K, Morris J. The role of extended scope physiotherapists in managing patients with inflammatory arthropathies: a systematic review. Open Access Rheumatol 2012; 4:49-55. [PMID: 27790011 PMCID: PMC5045098 DOI: 10.2147/oarrr.s31465] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objectives To review the literature to identify whether, and how, physiotherapists working in extended scope of practice (ESP) engage with patients with inflammatory arthropathies. Measures of effectiveness of ESP were particularly sought. Methods A comprehensive library database search was conducted to identify English language studies published in full text in peer-reviewed journals during the years 2002–2012. Studies were allocated into the National Health and Medical Research Council hierarchy of evidence, but were not critically appraised. Data was extracted on conditions treated, ESP roles and responsibilities, and effectiveness. Data was analyzed and reported descriptively. Results We identified 123 studies, and included four. All were low hierarchy (highest being one level III_2 study). Commonly reported conditions were rheumatoid arthritis and ankylosing spondylitis. Information was provided on activities of role extension, such as triaging patients, monitoring and recommending changes to medications, referring to other health and medical professionals, and ordering and interpreting imaging. There was blurring between ESP and non-ESP roles. No study reported measures of effectiveness. Conclusion There are descriptors of ESP physiotherapy activities, but no evidence of effectiveness of ESP physiotherapy in managing patients with inflammatory arthropathies.
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Affiliation(s)
- Jessica Stanhope
- International Centre for Allied Health Evidence (iCAHE), University of South Australia, Adelaide, South Australia
| | - Kate Beaton
- International Centre for Allied Health Evidence (iCAHE), University of South Australia, Adelaide, South Australia
| | - Karen Grimmer-Somers
- International Centre for Allied Health Evidence (iCAHE), University of South Australia, Adelaide, South Australia
| | - Joanne Morris
- ACT Government Health Directorate, Canberra, Australian Capital Territory, Australia
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Badley EM, Canizares M, Mahomed N, Veinot P, Davis AM. Provision of orthopaedic workforce and implications for access to orthopaedic services in Ontario. J Bone Joint Surg Am 2011; 93:863-70. [PMID: 21543676 DOI: 10.2106/jbjs.i.01782] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The aging population and increasing obesity rates will increase the prevalence of musculoskeletal conditions. Reports of orthopaedic surgeon shortages raise concerns about the ability of the health-care system to meet current and future demand in orthopaedics. A survey of all orthopaedic surgeons in Ontario, Canada, was carried out in 2006 to (1) update provision estimates of orthopaedic surgeons; (2) examine practice characteristics and perceived barriers to service; and (3) relate geographic availability of surgeons to population utilization of office-based and surgical orthopaedic services. METHODS A two-part questionnaire was sent to all orthopaedic surgeons in Ontario in 2006. Provision data in hours per week and full-time equivalents and practice patterns were analyzed by health region. Population-based data on the use of orthopaedic services were obtained from health service administrative databases. RESULTS There were 396 practicing orthopaedic surgeons in Ontario in 2006, equivalent to 2.43 full-time equivalents per 100,000 population, a finding similar to surveys in 1997 and 2000. Most surgeons were male, with a mean age of forty-nine years, with mainly adult practices; 48% reported having a subspecialty. Provision varied across Ontario, with an average of 112 hours per week of direct clinical time per 100,000 population (50% in the office, 30% in the operating room, 20% working on call). Many surgeons also reported time for administration, teaching, and research. Most respondents reported barriers to timely surgery, notably a lack of resources (operating room time, anesthesia, nursing, and/or bed capacity). Low orthopaedic provision was associated with lower utilization of office-based and surgical services, after controlling for neighborhood income and type of residence (urban or rural). CONCLUSIONS Shortages and geographic variation in the supply of surgeons mean that access to care continues to be a challenge in Ontario. In regions with fewer surgeons, residents are more likely to be deprived of office-based services, potentially affecting access to surgery and to orthopaedic expertise. In light of a potential shortage of surgeons, alternative methods of service provision may be needed to respond to the aging of the baby boomer population and an anticipated growth in the demand for surgery.
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Affiliation(s)
- Elizabeth M Badley
- Arthritis Community Research and Evaluation Unit, Toronto Western Research Institute, Main Pavilion 10-316, 399 Bathurst Street, Toronto, ON M5T 2S8, Canada.
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Iversen MD. Arthritis patient education and team approaches to management. Rheumatology (Oxford) 2011. [DOI: 10.1016/b978-0-323-06551-1.00044-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Davis KJ, Kumar D, Wake MC. Pelvic floor dysfunction: a scoping study exploring current service provision in the UK, interprofessional collaboration and future management priorities. Int J Clin Pract 2010; 64:1661-70. [PMID: 20946271 DOI: 10.1111/j.1742-1241.2010.02509.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Pelvic floor dysfunction (PFD) has a significant socioeconomic and healthcare cost. This study aimed to investigate current service provision for PFD in the UK, highlighting any gaps and areas for improvement to inform future service improvement. METHODS A three-phase design comprised a scoping literature review, consultation survey with frontline practitioners from four key professional groups and an overarching synthesis. An interpretative analytical framework was informed by the concepts of interdisciplinary and interprofessional collaboration. RESULTS Empirical evidence on PFD service provision is limited. No overarching strategic approach to PFD as a single clinical entity in the UK was identified. Two hundred and forty-three medical, nursing and physiotherapy practitioners from different clinical subspecialties participated in the survey. Access and availability to services, models of delivery and individual practice vary widely within and across the disciplines. Time restrictions, mixed professional attitudes, lack of standardisation and low investment priority were identified as major barriers to optimal service provision. Five overlapping areas for improvement are highlighted: access and availability, team working and collaboration, funding and investment, education, training and research, public and professional awareness. CONCLUSIONS Current services are characterised by a fragmented approach with asynchronous delivery, limited investment and poor interprofessional integration. An improved service delivery model has the potential to improve outcomes through better interdisciplinary collaboration and efficient use of resources.
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Affiliation(s)
- K J Davis
- Department of Community and Health Sciences, Consortium for Healthcare Research, City University, London, UK.
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Canizares M, MacKay C, Davis AM, Mahomed N, Badley EM. A population-based study of ambulatory and surgical services provided by orthopaedic surgeons for musculoskeletal conditions. BMC Health Serv Res 2009; 9:56. [PMID: 19335904 PMCID: PMC2682488 DOI: 10.1186/1472-6963-9-56] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2008] [Accepted: 03/31/2009] [Indexed: 12/19/2022] Open
Abstract
Background The ongoing process of population aging is associated with an increase in prevalence of musculoskeletal conditions with a concomitant increase in the demand of orthopaedic services. Shortages of orthopaedic services have been documented in Canada and elsewhere. This population-based study describes the number of patients seen by orthopaedic surgeons in office and hospital settings to set the scene for the development of strategies that could maximize the availability of orthopaedic resources. Methods Administrative data from the Ontario Health Insurance Plan and Canadian Institute for Health Information hospital separation databases for the 2005/06 fiscal year were used to identify individuals accessing orthopaedic services in Ontario, Canada. The number of patients with encounters with orthopaedic surgeons, the number of encounters and the number of surgeries carried out by orthopaedic surgeons were estimated according to condition groups, service location, patient's age and sex. Results In 2005/06, over 520,000 Ontarians (41 per 1,000 population) had over 1.3 million encounters with orthopaedic surgeons. Of those 86% were ambulatory encounters and 14% were in hospital encounters. The majority of ambulatory encounters were for an injury or related condition (44%) followed by arthritis and related conditions (37%). Osteoarthritis accounted for 16% of all ambulatory encounters. Orthopaedic surgeons carried out over 140,000 surgeries in 2005/06: joint replacement accounted for 25% of all orthopaedic surgeries, whereas closed repair accounted for 16% and reductions accounted for 21%. Half of the orthopaedic surgeries were for arthritis and related conditions. Conclusion The large volume of ambulatory care points to the significant contribution of orthopaedic surgeons to the medical management of chronic musculoskeletal conditions including arthritis and injuries. The findings highlight that surgery is only one component of the work of orthopaedic surgeons in the management of these conditions. Policy makers and orthopaedic surgeons need to be creative in developing strategies to accommodate the growing workload of orthopaedic surgeons without sacrificing quality of care of patients with musculoskeletal conditions.
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Affiliation(s)
- Mayilee Canizares
- Arthritis Community Research and Evaluation Unit, Division of Health Care and Outcomes Research, Toronto Western Research Institute, Toronto, Ontario, Canada.
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