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Lavoie JG, Clark W, McDonnell L, Nickel N, Dutton R, Kanayok J, Fowler-Woods M, Anawak J, Brown N, Voisey Clark G, Evaluardjuk-Palmer T, Wong ST, Sanguins J, Mudryj A, Mullins N, Ford M, Clark J. Mitigating the impact of the COVID-19 pandemic on Inuit living in Manitoba: community responses. Int J Circumpolar Health 2023; 82:2259135. [PMID: 37752773 PMCID: PMC10538448 DOI: 10.1080/22423982.2023.2259135] [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: 04/26/2023] [Accepted: 09/11/2023] [Indexed: 09/28/2023] Open
Abstract
We document community responses to the COVID-19 pandemic among Inuit living in the province of Manitoba, Canada. This study was conducted by the Manitoba Inuit Association and a Council of Inuit Elders, in partnership with researchers from the University of Manitoba. We present findings from 12 health services providers and decision-makers, collected in 2021.Although Public Health orders led to the closure of the Manitoba Inuit Association's doors to community events and drop-in activities, it also created opportunities for the creation of programming and events delivered virtually and through outreach. The pandemic exacerbated pre-existing health and social system's shortcomings (limited access to safe housing, food insecurity) and trauma-related tensions within the community. The Manitoba Inuit Association achieved unprecedented visibility with the provincial government, receiving bi-weekly reports of COVID-19 testing, results and vaccination rates for Inuit. We conclude that after over a decade of advocacy received with at best tepid enthusiasm by federal and provincial governments, the Manitoba Inuit Association was able effectively advocate for Inuit-centric programming, and respond to Inuit community's needs, bringing visibility to a community that had until then been largely invisible. Still, many programs have been fueled with COVID-19 funding, raising the issue of sustainability.
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Affiliation(s)
- Josée G. Lavoie
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Ongomiizwin Indigenous Institute for Health and Healing, University of Manitoba, Winnipeg, Manitoba, Canada
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Wayne Clark
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Leah McDonnell
- Ongomiizwin Indigenous Institute for Health and Healing, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Nathan Nickel
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Rachel Dutton
- Manitoba Inuit Association, Winnipeg, Manitoba, Canada
| | - Janet Kanayok
- Manitoba Inuit Association, Winnipeg, Manitoba, Canada
| | - Melinda Fowler-Woods
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Family Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jack Anawak
- Isumataq Sivuliuqti, Qanuinngitsiarutiksait Study, Canada
| | - Nuqaalaq Brown
- Isumataq Sivuliuqti, Qanuinngitsiarutiksait Study, Canada
| | | | | | - sabrina T. Wong
- National Institute of Nursing Research, Division of Intramural Research, Bethesda, Manitoba, Canada
| | | | - Adriana Mudryj
- Ongomiizwin Indigenous Institute for Health and Healing, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Marti Ford
- Manitoba Inuit Association, Winnipeg, Manitoba, Canada
| | - Judy Clark
- Manitoba Inuit Association, Winnipeg, Manitoba, Canada
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Loyd C, Blue K, Turner L, Weber A, Guy A, Zhang Y, Martin RC, Kennedy RE, Brown C. National Norms for Hospitalizations Due to Ambulatory Care Sensitive Conditions among Adults in the US. J Gen Intern Med 2023; 38:2953-2959. [PMID: 36941421 PMCID: PMC10027258 DOI: 10.1007/s11606-023-08161-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 03/10/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Ambulatory care sensitive conditions (ACSCs) are acute or chronic health issues that lead to potentially preventable hospitalizations when not treated in the outpatient primary care setting. OBJECTIVE To describe national hospitalization rates due to ACSCs among adult inpatients in the US. DESIGN A retrospective cross-sectional analysis of the 2018 US National Inpatient Sample (NIS) dataset from the Healthcare Cost and Utilization Project at the Agency of Healthcare Research and Quality was completed in the year 2022. PARTICIPANTS Participants were adult inpatients from community hospitals in 48 states of the US and District of Columbia. MAIN MEASURES ACSC admission rates were calculated using ICD-10 codes and the Purdy ACSC definition. The admission rates were weighted to the US inpatient population and stratified by age, sex, and race. KEY RESULTS ACSC hospitalization rates varied considerably across age and average number of hospitalizations varied across sex and race. ACSC hospitalization rates increased with age, male sex, and Native American and Black race. The most common ACSCs were pneumonia, diabetes, and congestive heart failure. CONCLUSIONS Previous studies have emphasized the importance of preventable hospitalizations, however, the national rates for ACSC hospitalizations across all ages in the US have not been reported. The national rates presented will facilitate comparisons to identify hospitals and health care systems with higher-than-expected rates of ACSC admissions that may suggest a need for improved primary care services.
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Affiliation(s)
- Christine Loyd
- Department of Clinical and Diagnostic Sciences, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Kylie Blue
- Department of Clinical and Diagnostic Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Laci Turner
- Department of Clinical and Diagnostic Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ashley Weber
- Department of Clinical and Diagnostic Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ashley Guy
- Department of Clinical and Diagnostic Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Yue Zhang
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Roy C Martin
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Richard E Kennedy
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Cynthia Brown
- Department of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
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Fitzpatrick KM, Ody M, Goveas D, Montesanti S, Campbell P, MacDonald K, Crowshoe L, Campbell S, Roach P. Understanding virtual primary healthcare with Indigenous populations: a rapid evidence review. BMC Health Serv Res 2023; 23:303. [PMID: 36991410 PMCID: PMC10054202 DOI: 10.1186/s12913-023-09299-6] [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: 08/11/2022] [Accepted: 03/16/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Virtual care has become an increasingly useful tool for the virtual delivery of care across the globe. With the unexpected emergence of COVID-19 and ongoing public health restrictions, it has become evident that the delivery of high-quality telemedicine is critical to ensuring the health and wellbeing of Indigenous peoples, especially those living in rural and remote communities. METHODS We conducted a rapid evidence review from August to December 2021 to understand how high quality Indigenous primary healthcare is defined in virtual modalities. After completing data extraction and quality appraisal, a total of 20 articles were selected for inclusion. The following question was used to guide the rapid review: How is high quality Indigenous primary healthcare defined in virtual modalities? RESULTS We discuss key limitations to the delivery of virtual care, including the increasing cost of technology, lack of accessibility, challenges with digital literacy, and language barriers. This review further yielded four main themes that highlight Indigenous virtual primary healthcare quality: (1) limitations and barriers of virtual primary healthcare, (2) Indigenous-centred virtual primary healthcare, (3) virtual Indigenous relationality, (4) collaborative approaches to ensuring holistic virtual care. DISCUSSION For virtual care to be Indigenous-centred, Indigenous leadership and users need to be partners in the development, implementation and evaluation of the intervention, service or program. In terms of virtual models of care, time must be allocated to educate Indigenous partners on digital literacy, virtual care infrastructure, benefits and limitations. Relationality and culture must be prioritized as well as digital health equity. CONCLUSION These findings highlight important considerations for strengthening virtual primary healthcare approaches to meet the needs of Indigenous peoples worldwide.
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Affiliation(s)
| | - Meagan Ody
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Danika Goveas
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | | | - Paige Campbell
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Kathryn MacDonald
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Lynden Crowshoe
- Department of Family Medicine, University of Calgary, Calgary, AB, Canada
| | - Sandra Campbell
- John W. Scott Health Sciences Library, University of Alberta, Edmonton, AB, Canada
| | - Pamela Roach
- Department of Family Medicine, University of Calgary, Calgary, AB, Canada.
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Wynter K, Mullan L, Druce T, Freeman G, Maguire G, Davidson L, Karunajeewa H, Crowe S, Rasmussen B. Attendance at, and experiences of, urban hospital outpatient appointments: informing a new model of care for urban-dwelling Aboriginal and Torres Strait Islander patients. AUST HEALTH REV 2023; 47:16-25. [PMID: 36702155 DOI: 10.1071/ah21363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 01/06/2023] [Indexed: 01/28/2023]
Abstract
Objectives To compare outpatient attendance rates for Aboriginal and Torres Strait Islander ('Aboriginal') and non-Aboriginal patients at a large metropolitan health service in Melbourne, Australia, and to describe the barriers and enablers experienced by urban-dwelling Aboriginal patients in attending hospital outpatient appointments. Methods This study used a mixed-method approach. Proportions of referred patients who booked and attended outpatient appointments were extracted from a health service database. Aboriginal versus non-Aboriginal cohorts were compared using chi-squared tests. Eleven patients, one parent of a patient and two community nurses were interviewed by telephone to investigate perceived barriers and enablers to attending outpatient appointments among Aboriginal patients. Results Outpatient referrals were greater among Aboriginal than non-Aboriginal people; however, referrals were significantly less likely to result in an outpatient clinic booking and attendance for Aboriginal compared to non-Aboriginal people. Interview participants reported several barriers to attending appointments, related to logistical, quality of care and cultural factors. Suggested facilitators to make appointment attendance easier included: provision of transport support, improving clinic scheduling, utilising a variety of appointment reminder formats, providing food in waiting rooms, flexible appointment timing options, outreach services, access to Aboriginal support workers, improving communication and relationships with Aboriginal people, cultural awareness training for staff and the provision of culturally appropriate spaces. Conclusion Some barriers faced by Aboriginal patients in attending hospital outpatient appointments in urban areas can be addressed through implementation of enablers suggested by participants. Data have informed the development of a tailored, inclusive, culturally and consumer-focused appropriate hospital outpatient service model of care.
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Affiliation(s)
- Karen Wynter
- Centre for Quality and Patient Safety Research in the Institute for Health Transformation, School of Nursing and Midwifery, Deakin University, Geelong, Vic. 3220, Australia; and Centre for Quality and Patient Safety Research - Western Health Partnership, St Albans, Vic. 3021, Australia
| | - Leanne Mullan
- Centre for Quality and Patient Safety Research in the Institute for Health Transformation, School of Nursing and Midwifery, Deakin University, Geelong, Vic. 3220, Australia; and Australian Catholic University, 1100 Nudgee Road, Banyo, Qld 4014, Australia
| | - Tanya Druce
- Aboriginal Health, Policy and Planning, Wilim Berrbang, Western Health, 176 Furlong Road, St Albans, Vic. 3021, Australia
| | - Gilbert Freeman
- Aboriginal Health, Policy and Planning, Wilim Berrbang, Western Health, 176 Furlong Road, St Albans, Vic. 3021, Australia
| | - Graeme Maguire
- General Internal Medicine, Western Health, 176 Furlong Road, St Albans, Vic. 3021, Australia; and Curtin Medical School, 410 Koorliny Way, Bentley, WA 6102, Australia
| | - Lauren Davidson
- General Internal Medicine, Western Health, 176 Furlong Road, St Albans, Vic. 3021, Australia
| | - Harin Karunajeewa
- Department of Medicine - Western Health, Melbourne Medical School, The University of Melbourne, St Albans, Vic. 3021, Australia
| | - Shane Crowe
- Centre for Quality and Patient Safety Research in the Institute for Health Transformation, School of Nursing and Midwifery, Deakin University, Geelong, Vic. 3220, Australia; and Nursing and Midwifery Division, Western Health, St Albans, Vic. 3021, Australia
| | - Bodil Rasmussen
- Centre for Quality and Patient Safety Research in the Institute for Health Transformation, School of Nursing and Midwifery, Deakin University, Geelong, Vic. 3220, Australia; and Centre for Quality and Patient Safety Research - Western Health Partnership, St Albans, Vic. 3021, Australia; and Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen 1165, Denmark; and Faculty of Health Sciences, University of Southern Denmark and Steno Diabetes Center, Odense 5230, Denmark
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Varcoe C, Browne AJ, Perrin N, Wilson E, Bungay V, Byres D, Wathen N, Stones C, Liao C, Price ER. EQUIP emergency: can interventions to reduce racism, discrimination and stigma in EDs improve outcomes? BMC Health Serv Res 2022; 22:1113. [PMID: 36050677 PMCID: PMC9436447 DOI: 10.1186/s12913-022-08475-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 08/09/2022] [Indexed: 12/21/2022] Open
Abstract
Background Despite a publicly funded system, health care in Canada has been shown to be deeply inequitable, particularly toward Indigenous people. Based on research identifying key dimensions of equity-oriented health care as being cultural safety, harm reduction and trauma- and violence-informed care, an intervention to promote equity at the organizational level was tested in primary health care, refined and adapted, and tested in Emergency Departments (EDs). Methods In partnership with clinical, community and Indigenous leaders in three diverse EDs in one Canadian province, we supported direct care staff to tailor and implement the intervention. Intervention activities varied in type and intensity at each site. Survey data were collected pre- and post-intervention from every consecutive patient over age 18 presenting to the EDs (n = 4771) with 3315 completing post-visit questions in 4 waves at two sites and 3 waves (due to pandemic constraints) at the third. Administrative data were collected for 12 months pre- and 12 months post-intervention. Results Throughout the study period, the participating EDs were dealing with a worsening epidemic of overdoses and deaths related to a toxic drug supply, and the COVID 19 pandemic curtailed both intervention activities and data collection. Despite these constraints, staff at two of the EDs mounted equity-oriented intervention strategies; the other site was experiencing continued, significant staff shortages and leadership changeover. Longitudinal analysis using multiple regression showed non-significant but encouraging trends in patient perceptions of quality of care and patient experiences of discrimination in the ED. Subgroup analysis showed that specific groups of patients experienced care in significantly different ways at each site. An interrupted time series of administrative data showed no significant change in staff sick time, but showed a significant decrease in the percentage of patients who left without care being completed at the site with the most robust intervention activities. Conclusions The trends in patient perceptions and the significant decrease in the percentage of patients who left without care being completed suggest potential for impact. Realization of this potential will depend on readiness, commitment and resources at the organizational and systems levels. Trial registration Clinical Trials.gov #NCT03369678 (registration date November 18, 2017).
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Lavoie J, Phillips-Beck W, Kinew KA, Kyoon-Achan G, Katz A. First Nations' hospital readmission ending in death: a potential sentinel indicator of inequity? Int J Circumpolar Health 2021; 80:1859824. [PMID: 33308085 PMCID: PMC7738285 DOI: 10.1080/22423982.2020.1859824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/17/2020] [Accepted: 09/22/2020] [Indexed: 11/04/2022] Open
Abstract
In this study, we focused on readmissions for Ambulatory Care Sensitive Conditions (ACSC) ending in death, to capture those admissions and readmissions that might have been prevented if responsive primary healthcare was accessible. We propose this as a sentinel indicator of equity. We conducted analyses of Manitoba-based 30-day hospital readmission rates for ACSC which resulted in death, using data from 1986-2016 adjusted for age, sex, and socio-economic status. Our findings show that, across Manitoba, overall rates of readmissions ending in death are slowly increasing, and increasing more dramatically among northern First Nations, larger First Nations not affiliated with Tribal Councils, and in the western region of the province. These regions have continuously been highlighted as disadvantaged in terms of access to care, suggesting that the time for action is overdue. Rising rates of readmissions for ACSC ending in death suggest that greater attention should be placed on access to responsive primary healthcare. These findings have broader implications for territorial healthcare systems which purchase acute care services from provinces south of them. As an indicator of quality, monitoring readmissions ending in death could provide territorial governments insights into the quality of care provided to their constituents by provincial authorities.
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Affiliation(s)
- Josée Lavoie
- Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | | | - Grace Kyoon-Achan
- Department of Community Health Science, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Alan Katz
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canadag
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Eni R, Phillips-Beck W, Achan GK, Lavoie JG, Kinew KA, Katz A. Decolonizing health in Canada: A Manitoba first nation perspective. Int J Equity Health 2021; 20:206. [PMID: 34526038 PMCID: PMC8442310 DOI: 10.1186/s12939-021-01539-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 08/24/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION & BACKGROUND Global persistence of health inequities for Indigenous peoples is evident in ongoing discrepancies in health and standards of living. International literature suggests the key to transformation lies in Indigenous efforts to control Indigenous health and healthcare. Previous authors have focused upon participation, structural transformation, and culturally appropriate healthcare recognized as a political right as fundamental tenets of Indigenous control. Contextualizing Indigenous health and wellness falls within a growing discussion on decolonization - a resituating of expertise that privileges Indigenous voice and interests. METHODS The study is a qualitative, grounded theory analysis, which is a constructivist approach to social research allowing for generation of theory in praxis, through interactions and conversations between researchers and participants. One hundred eighty-three interviews with additional focus groups were held between 2013-15 in eight Manitoba First Nation communities representing different models of health delivery, geographies, accessibilities, and Indigenous language groups. Community research assistants and respected Elders participated in data collection, analysis and interpretation. Line-by-line coding and constant comparative method led to the discovery of converging themes. FINDINGS Ultimately four main themes arose: 1) First Nation control of healthcare; 2) traditional medicine and healing activities; 3) full and meaningful community participation; and 4) cleaning up impacts of colonization. Joint analyses and interpretation of findings revealed substantial evidence that communities were looking profoundly into problems of improperly delivered services and health inequities. Issues were consistent with those highlighted by international commissions on reconciliation, health, Indigenous rights and liberties. To those documents, these findings add ground upon which to build the transformative agenda. RESULTS & DISCUSSION Communities discussed the need for creation of protocols, constitution and laws to ensure growth of a decolonizing agenda. Inclusive to the concept are holistic, preventative, traditional health perspectives, and Indigenous languages. Colonization impacts were of critical concern and in need of undoing. Sharing of social and political efforts is seen as pivotal to change and includes all members of communities.
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Affiliation(s)
- Rachel Eni
- Community Health Sciences, College of Medicine, University of Manitoba, Independent Researcher, Victoria, BC, V9C 0M1, Canada.
| | - Wanda Phillips-Beck
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, First Nation Health and Social Secretariat Manitoba and the University of Manitoba, Winnipeg, MB, R3B 2B3, Canada
| | - Grace Kyoon Achan
- Education Indigenous Institute of Health and Healing, University of Manitoba, Winnipeg, MB, R3E 3P4, Canada
| | - Josée G Lavoie
- Department Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, R3E 3P5, Canada
| | - Kathi Avery Kinew
- First Nation Health and Social Secretariat Manitoba, Winnipeg, MB, R3B 2B3, Canada
| | - Alan Katz
- Department of Family Medicine and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, R3B 2B3, Canada
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