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Frikha Y, Freeman AR, Côté N, Charette C, Desfossés M. Transformation of primary care settings implementing a co-located team-based care model: a scoping review. BMC Health Serv Res 2024; 24:890. [PMID: 39098902 PMCID: PMC11299417 DOI: 10.1186/s12913-024-11291-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 07/08/2024] [Indexed: 08/06/2024] Open
Abstract
BACKGROUND In Canada, primary care reforms led to the implementation of various team-based care models to improve access and provide more comprehensive care for patients. Despite these advances, ongoing challenges remain. The aim of this scoping review is to explore current understanding of the functioning of these care models as well as the contexts in which they have emerged and their impact on the population, providers and healthcare costs. METHODS The Medline and CINAHL databases were consulted. To be included, team-based care models had to be co-located, involve a family physician, specify the other professionals included, and provide information about their organization, their relevance and their impact within a primary care context. Models based on inter-professional intervention programs were excluded. The organization and coordination of services, the emerging contexts and the impact on the population, providers and healthcare costs were analysed. RESULTS A total of 5952 studies were screened after removing duplicates; 15 articles were selected for final analysis. There was considerable variation in the information available as well as the terms used to describe the models. They are operationalized in various ways, generally consistent with the Patient's Medical Home vision. Except for nurses, the inclusion of other types of professionals is variable and tends to be associated with the specific nature of the services offered. The models primarily focus on individuals with mental health conditions and chronic diseases. They appear to generally satisfy the expectations of the overarching framework of a high-performing team-based primary care model at patient and provider levels. However, economic factors are seldom integrated in their evaluations. CONCLUSIONS The studies rarely provide an overarching view that permits an understanding of the specific contexts, service organization, their impacts, and the broader context of implementation, making it difficult to establish universal guidelines for the operationalization of effective models. Negotiating the inherent complexity associated with implementing models requires a collaborative approach between various stakeholders, including patients, to tailor the models to the specific needs and characteristics of populations in given areas, and reflection about the professionals to be included in delivering these services.
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Affiliation(s)
- Yasmine Frikha
- Faculty of Graduate and Post-Doctoral Studies, Université Laval , Québec, Canada
- VITAM: Centre de Recherche en Santé Durable, Québec, Québec, Canada
| | - Andrew R Freeman
- VITAM: Centre de Recherche en Santé Durable, Québec, Québec, Canada.
- School of Rehabilitation Sciences (Faculty of Medicine), Université Laval, Québec, Québec, Canada.
| | - Nancy Côté
- VITAM: Centre de Recherche en Santé Durable, Québec, Québec, Canada
- Department of Sociology (Faculty of Social Sciences), Université Laval, Québec, Québec, Canada
| | | | - Maxime Desfossés
- VITAM: Centre de Recherche en Santé Durable, Québec, Québec, Canada
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Northwood M, Saari M, Heckman G, Alexander T, Eastway B, Gerantonis P, Gillies D, Gregg S, McKinnon Wilson J, Morrison A, Sultan H, Turcotte L. Use of an electronic wellness instrument in the integrated health and social care of older adults: a group concept mapping study. BMC Health Serv Res 2024; 24:864. [PMID: 39080598 PMCID: PMC11288113 DOI: 10.1186/s12913-024-11320-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 07/16/2024] [Indexed: 08/03/2024] Open
Abstract
BACKGROUND Health system fragmentation directly contributes to poor health and social outcomes for older adults with multiple chronic conditions and their care partners. Older adults often require support from primary care, multiple specialists, home care, community support services, and other health-care sectors and communication between these providers is unstructured and not standardized. Integrated and interprofessional team-based models of care are a recommended strategy to improve health service delivery to older adults with complex needs. Standardized assessment instruments deployed on digital platforms are considered a necessary component of integrated care. The aim of this study was to develop strategies to leverage an electronic wellness instrument, interRAI Check Up Self Report, to support integrated health and social care for older adults and their care partners in a community in Southern Ontario, Canada. METHODS Group concept mapping, a participatory mixed-methods approach, was conducted. Participants included older adults, care partners, and representatives from: home care, community support services, specialized geriatric services, primary care, and health informatics. In a series of virtual meetings, participants generated ideas to implement the interRAI Check Up and rated the relative importance of these ideas. Hierarchical cluster analysis was used to map the ideas into clusters of similar statements. Participants reviewed the map to co-create an action plan. RESULTS Forty-one participants contributed to a cluster map of ten action areas (e.g., engagement of older adults and care partners, instrument's ease of use, accessibility of the assessment process, person-centred process, training and education for providers, provider coordination, health information integration, health system decision support and quality improvement, and privacy and confidentiality). The health system decision support cluster was rated as the lowest relative importance and the health information integration was cluster rated as the highest relative importance. CONCLUSIONS Many person-, provider-, and system-level factors need to be considered when implementing and using an electronic wellness instrument across health- and social-care providers. These factors are highly relevant to the integration of other standardized instruments into interprofessional team care to ensure a compassionate care approach as technology is introduced.
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Affiliation(s)
- Melissa Northwood
- School of Nursing, Faculty of Health Sciences, McMaster University, Health Sciences Centre 3N25a, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
| | | | - George Heckman
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | | | | | - Patricia Gerantonis
- School of Nursing, Faculty of Health Sciences, McMaster University, Health Sciences Centre 3N25a, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | | | - Susie Gregg
- Canadian Mental Health Association Waterloo Wellington, Guelph, ON, Canada
| | | | - Adam Morrison
- Provincial Geriatrics Leadership Ontario, Toronto, ON, Canada
| | | | - Luke Turcotte
- Health Sciences, Brock University, St. Catharines, ON, Canada
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Licskai C, Hussey A, Rowley V, Ferrone M, Lu Z, Zhang K, Terebessy E, Scarffe A, Sibbald S, Faulds C, O'Callahan T, To T. Quantifying sustained health system benefits of primary care-based integrated disease management for COPD: a 6-year interrupted time series study. Thorax 2024; 79:725-734. [PMID: 38889973 PMCID: PMC11287652 DOI: 10.1136/thorax-2023-221211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 05/16/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND Severe exacerbation of chronic obstructive pulmonary disease (COPD) is a trajectory-changing life event for patients and a major contributor to health system costs. This study evaluates the real-world impact of a primary care, integrated disease management (IDM) programme on acute health service utilisation (HSU) in the Canadian health system. METHODS Interrupted time series analysis using retrospective health administrative data, comparing monthly HSU event rates 3 years prior to and 3 years following the implementation of COPD IDM. Primary outcomes were COPD-related hospitalisation and emergency department (ED) visits. Secondary outcomes included hospital bed days and all-cause HSU. RESULTS There were 2451 participants. COPD-related and all-cause HSU rates increased in the 3 years prior to IDM implementation. With implementation, there was an immediate decrease (month 1) in COPD-related hospitalisation and ED visit rates of -4.6 (95% CI: -7.76 to -1.39) and -6.2 (95% CI: -11.88, -0.48) per 1000 participants per month, respectively, compared with the counterfactual control group. After 12 months, COPD-related hospitalisation rates decreased: -9.1 events per 1000 participants per month (95% CI: -12.72, -5.44) and ED visits -19.0 (95% CI: -25.50, -12.46). This difference nearly doubled by 36 months. All-cause HSU also demonstrated rate reductions at 12 months, hospitalisation was -10.2 events per 1000 participants per month (95% CI: -15.79, -4.44) and ED visits were -30.4 (95% CI: -41.95, -18.78). CONCLUSIONS Implementation of COPD IDM in a primary care setting was associated with a changed trajectory of COPD-related and all-cause HSU from an increasing year-on-year trend to sustained long-term reductions. This highlights a substantial real-world opportunity that may improve health system performance and patient outcomes.
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Affiliation(s)
- Christopher Licskai
- Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
- Asthma Research Group Windsor-Essex County Inc, Windsor, Ontario, Canada
| | - Anna Hussey
- Asthma Research Group Windsor-Essex County Inc, Windsor, Ontario, Canada
| | - Véronique Rowley
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Madonna Ferrone
- Asthma Research Group Windsor-Essex County Inc, Windsor, Ontario, Canada
- Hôtel-Dieu Grace Healthcare, Windsor, Ontario, Canada
| | - Zihang Lu
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Kimball Zhang
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Emilie Terebessy
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Andrew Scarffe
- Telfer School of Management, University of Ottawa, Ottawa, Ontario, Canada
| | - Shannon Sibbald
- Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Cathy Faulds
- Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Asthma Research Group Windsor-Essex County Inc, Windsor, Ontario, Canada
| | - Tim O'Callahan
- Asthma Research Group Windsor-Essex County Inc, Windsor, Ontario, Canada
- Amherstburg Family Health Team, Amherstburg, Ontario, Canada
| | - Teresa To
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
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Freeman S, Peach L, Ross C, Marchal K, Meyer A, Skinner K. Development and evaluation of the Rural and Northern Community Focused Model of COPD Care (RaNCoM). BMC Pulm Med 2023; 23:399. [PMID: 37864243 PMCID: PMC10589932 DOI: 10.1186/s12890-023-02683-2] [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: 01/10/2023] [Accepted: 09/27/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND The prevalence of COPD continues to rise. To address the challenges to provide high quality COPD care in rural and northern communities, leaders in one rural and northern community in Western Canada sought to change the culture of COPD screening and care. Recognizing effective assessment, diagnosis, and treatment for patients with COPD are crucial to improve outcomes, a program was developed between 2012 and 2021 to enhance primary care for COPD patients. METHODS A process evaluation was undertaken to assess program development, implementation, mechanisms of impact, and context of COPD program. Qualitative thematic analysis of stakeholder interviews (n = 11) and a document review (n = 60; ~ 500 pages) of key clinic documents was conducted. RESULTS We describe five phases of the COPD program's development (Survive; Reorganize and Stabilize; Assess and Respond; Build and Refine; and Sustain and Share), highlighting areas of innovation. Outreach and localizing resources improved access to the program. Acquiring secured physician compensation, capturing quality data, and improving patient and provider self-efficacy built the capacity of the system and stakeholders within it. Finally, relationships were forged through building an integrated facility, collaborative networking, and patient engagement. Key elements of program implementation included the resources (infrastructure, software, operational) required to ensure operation. CONCLUSION Team-based care and service integration enhanced care capacity and the health network. Focused use of infrastructure and resources supported the people in the care system. Upholding a shared value of relationship is critical to deliver robust and sustainable rural healthcare. Quality improvement requires investment in rural community healthcare resources.
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Affiliation(s)
- Shannon Freeman
- School of Nursing, University of Northern British Columbia, British Columbia, 3333 University Way, Prince George, V2N 4Z9, Canada.
- Centre for Technology Adoption for Aging in the North, University of Northern British Columbia, Prince George, British Columbia, Canada.
| | - Laura Peach
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Christopher Ross
- Centre for Technology Adoption for Aging in the North, University of Northern British Columbia, Prince George, British Columbia, Canada
| | - Kathy Marchal
- Fort St, James Health Centre, Fort St. James, British Columbia, Canada
| | - Anthon Meyer
- Rural Coordination Centre of BC, British Columbia, Canada
| | - Kelly Skinner
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
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Sibbald SL, Elliott J, Smith A, Chala MB, Dool Kontio N, Alpaugh-Bishop A, Jarmain S, Joshi A, McMahon M, Meyer M. Designing systems for the care we need: A transformation journey in Southwestern Ontario. Healthc Manage Forum 2023; 36:299-303. [PMID: 37318024 PMCID: PMC10446847 DOI: 10.1177/08404704231178456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Primary care is considered the foundation of any health system. In Ontario, Canada Bills 41 and 74 introduced in 2016 and 2019, respectively, aimed to move towards a primary care-focused and sustainable integrated care approach designed around the needs of local populations. These bills collectively set the stage for integrated care and population health management in Ontario, with Ontario Health Teams (OHTs) introduced as a model of integrated care delivery systems. OHTs aim to streamline patient connectivity through the healthcare system and improve outcomes aligned with the Quadruple Aim. When Ontario released a call for health system partners to apply to become an OHT, providers, administrators, and patient/caregiver partners from the Middlesex-London area were quick to respond. We highlight the critical elements and journey of the Middlesex-London Ontario Health Team since its start.
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Affiliation(s)
| | - Jacobi Elliott
- Western University, London, Ontario, Canada
- St. Joseph's Health Care London, London, Ontario, Canada
- Middlesex-London Ontario Health Team, London, Ontario, Canada
| | - Alexander Smith
- London Health Sciences Centre, London, Ontario, Canada
- Middlesex-London Ontario Health Team, London, Ontario, Canada
| | - Mulugeta B. Chala
- University of Toronto, Toronto, Ontario, Canada
- Middlesex-London Ontario Health Team, London, Ontario, Canada
| | - Nancy Dool Kontio
- London Health Sciences Centre, London, Ontario, Canada
- Middlesex-London Ontario Health Team, London, Ontario, Canada
| | | | - Sarah Jarmain
- Western University, London, Ontario, Canada
- St. Joseph's Health Care London, London, Ontario, Canada
- Middlesex-London Ontario Health Team, London, Ontario, Canada
- Thames Valley Family Health Team, London, Ontario, Canada
| | | | - Mike McMahon
- Thames Valley Family Health Team, London, Ontario, Canada
| | - Matthew Meyer
- Western University, London, Ontario, Canada
- London Health Sciences Centre, London, Ontario, Canada
- Middlesex-London Ontario Health Team, London, Ontario, Canada
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Law B, Chhatwal PK, Licskai C, Scurr T, Sibbald SL. Patient engagement in interprofessional team-based chronic disease management: A qualitative description of a Canadian program. PATIENT EDUCATION AND COUNSELING 2023; 114:107836. [PMID: 37336085 DOI: 10.1016/j.pec.2023.107836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 05/24/2023] [Accepted: 05/30/2023] [Indexed: 06/21/2023]
Abstract
OBJECTIVE To explore how patients with chronic obstructive pulmonary disease (COPD) perceive their engagement and roles within an interdisciplinary team-based care model. METHODS A single intrinsic case study was used. Focus group participants were recruited from the Best Care COPD program across nine sites. Transcripts from patient focus groups were supplemented by healthcare provider focus group transcripts and thematically analysed. RESULTS The majority of patients viewed themselves as having an inherent or central role on the team, which was corroborated by healthcare providers. Both positive (e.g., a desire to learn) and negative drivers (e.g., fear of inadequate care without self-advocacy) of active engagement were identified, for which patient-led communication was key. Components of the interdisciplinary team-based care model, including provider coordination and action planning, enabled positively driven active engagement and increased self-management. CONCLUSION Although patients had heterogenous perspectives about engagement, most patients viewed themselves as, and were satisfied with, having a central role in their care. Active and passive engagement preferences were influenced by personal motivations and past experiences, amongst other factors. PRACTICE IMPLICATIONS This study demonstrates how interdisciplinary chronic disease management programs can support patient engagement. Clarity of provider expectations, and communication about patients' roles and preferences, are recommended.
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Affiliation(s)
- Benson Law
- Faculty of Health Sciences, University of Western Ontario, London, Canada
| | | | - Christopher Licskai
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada
| | - Tiffany Scurr
- Faculty of Health Sciences, University of Western Ontario, London, Canada
| | - Shannon L Sibbald
- Faculty of Health Sciences, University of Western Ontario, London, Canada; Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada; The Schulich Interfaculty Program in Public Health, University of Western Ontario, London, Canada; Department of Family Medicine, University of Western Ontario, London, Canada; Lawson Health Research Institute, London, Canada.
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Meiwald A, Gara-Adams R, Rowlandson A, Ma Y, Watz H, Ichinose M, Scullion J, Wilkinson T, Bhutani M, Weston G, Adams EJ. Qualitative Validation of COPD Evidenced Care Pathways in Japan, Canada, England, and Germany: Common Barriers to Optimal COPD Care. Int J Chron Obstruct Pulmon Dis 2022; 17:1507-1521. [PMID: 35801119 PMCID: PMC9255283 DOI: 10.2147/copd.s360983] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 06/09/2022] [Indexed: 11/23/2022] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide. A comprehensive and detailed understanding of COPD care pathways from pre-diagnosis to acute care is required to understand the common barriers to optimal COPD care across diverse health systems. Methods Country-specific COPD care pathways were created for four high-income countries using international recommendations and country-specific guidelines, then populated with published epidemiological, clinical, and economic data. To refine and validate the pathways, semi-structured interviews using pre-prepared discussion guides and country-specific pathway maps were held with twenty-four primary and secondary care respiratory healthcare professionals. Thematic analysis was then performed on the interview transcripts. Results The COPD care pathway showed broad consistency across the countries. Three key themes relating to barriers in optimal COPD management were identified across the countries: journey to diagnosis, treatment, and the impact of COVID-19. Common barriers included presentation to healthcare with advanced COPD, low COPD consideration, and sub-optimal acute and chronic disease management. COVID-19 has negatively impacted disease management across the pathway but presents opportunities to retain virtual consultations. Structural factors such as insurance and short duration of appointments also impacted the diagnosis and management of COPD. Conclusion COPD is an important public health issue that needs urgent prioritization. The use of Evidenced Care Pathways with decision-makers can facilitate evidence-based decision making on interventions and policies to improve care and outcomes for patients and reduce unnecessary resource use and associated costs for the healthcare provider/payer.
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Affiliation(s)
| | | | | | - Yixuan Ma
- Aquarius Population Health, London, UK
| | - Henrik Watz
- Pulmonary Research Institute, LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Schleswig-Holstein, Germany
| | | | | | - Tom Wilkinson
- Faculty of Medicine, Southampton University, Southampton, Hampshire, UK
- Respiratory and Allergy, NIHR Southampton Biomedical Research Centre, Southampton, Hampshire, UK
| | - Mohit Bhutani
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | | | - Elisabeth J Adams
- Aquarius Population Health, London, UK
- Correspondence: Elisabeth J Adams, Aquarius Population Health, Unit 29 Tileyard Studios, London, N7 9AH, UK, Tel +44 (0)207 993 2930, Email
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