1
|
Moulton JE, Botfield JR, Subasinghe AK, Withanage NN, Mazza D. Nurse and midwife involvement in task-sharing and telehealth service delivery models in primary care: A scoping review. J Clin Nurs 2024. [PMID: 38500016 DOI: 10.1111/jocn.17106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 02/05/2024] [Accepted: 02/28/2024] [Indexed: 03/20/2024]
Abstract
AIM To synthesise and map current evidence on nurse and midwife involvement in task-sharing service delivery, including both face-to-face and telehealth models, in primary care. DESIGN This scoping review was informed by the Joanna Briggs Institute (JBI) Methodology for Scoping Reviews. DATA SOURCE/REVIEW METHODS Five databases (Ovid MEDLINE, Embase, PubMed, CINAHL and Cochrane Library) were searched from inception to 16 January 2024, and articles were screened for inclusion in Covidence by three authors. Findings were mapped according to the research questions and review outcomes such as characteristics of models, health and economic outcomes, and the feasibility and acceptability of nurse-led models. RESULTS One hundred peer-reviewed articles (as 99 studies) were deemed eligible for inclusion. Task-sharing models existed for a range of conditions, particularly diabetes and hypertension. Nurse-led models allowed nurses to work to the extent of their practice scope, were acceptable to patients and providers, and improved health outcomes. Models can be cost-effective, and increase system efficiencies with supportive training, clinical set-up and regulatory systems. Some limitations to telehealth models are described, including technological issues, time burden and concerns around accessibility for patients with lower technological literacy. CONCLUSION Nurse-led models can improve health, economic and service delivery outcomes in primary care and are acceptable to patients and providers. Appropriate training, funding and regulatory systems are essential for task-sharing models with nurses to be feasible and effective. IMPACT Nurse-led models are one strategy to improve health equity and access; however, there is a scarcity of literature on what these models look like and how they work in the primary care setting. Evidence suggests these models can also improve health outcomes, are perceived to be feasible and acceptable, and can be cost-effective. Increased utilisation of nurse-led models should be considered to address health system challenges and improve access to essential primary healthcare services globally. REPORTING METHOD This review is reported against the PRISMA-ScR criteria. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution. PROTOCOL REGISTRATION The study protocol is published in BJGP Open (Moulton et al., 2022).
Collapse
Affiliation(s)
- Jessica E Moulton
- SPHERE, NHMRC Centre of Research Excellence, Department of General Practice, Monash University, Notting Hill, Victoria, Australia
| | - Jessica R Botfield
- SPHERE, NHMRC Centre of Research Excellence, Department of General Practice, Monash University, Notting Hill, Victoria, Australia
- Family Planning NSW, Sydney, New South Wales, Australia
| | - Asvini K Subasinghe
- SPHERE, NHMRC Centre of Research Excellence, Department of General Practice, Monash University, Notting Hill, Victoria, Australia
| | - Nishadi Nethmini Withanage
- SPHERE, NHMRC Centre of Research Excellence, Department of General Practice, Monash University, Notting Hill, Victoria, Australia
| | - Danielle Mazza
- SPHERE, NHMRC Centre of Research Excellence, Department of General Practice, Monash University, Notting Hill, Victoria, Australia
| |
Collapse
|
2
|
Nittala MR, Yang J, Velazquez AE, Salvemini JD, Vance GR, Grady CC, Hathaway B, Roux JA, Vijayakumar S. Precision Population Cancer Medicine in Cancer of the Uterine Cervix: A Potential Roadmap to Eradicate Cervical Cancer. Cureus 2024; 16:e53733. [PMID: 38455773 PMCID: PMC10919943 DOI: 10.7759/cureus.53733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2024] [Indexed: 03/09/2024] Open
Abstract
With the success of the Human Genome Project, the era of genomic medicine (GM) was born. Later on, as GM made progress, there was a feeling of exhilaration that GM could help resolve many disease processes. It also led to the conviction that personalized medicine was possible, and a relatively synonymous word, precision medicine (PM), was coined. However, the influence of environmental factors and social determinants of diseases was only partially given their due importance in the definition of PM, although more recently, this has been recognized. With the rapid advances in GM, big data, data mining, wearable devices for health monitoring, telemedicine, etc., PM can be more easily extended to population-level health care in disease management, prevention, early screening, and so on.and the term precision population medicine (PPM) more aptly describes it. PPM's potential in cancer care was posited earlier,and the current authors planned a series of cancer disease-specific follow-up articles. These papers are mainly aimed at helping emerging students in health sciences (medicine, pharmacy, nursing, dentistry, public health, population health), healthcare management (health-focused business administration, nonprofit administration, public institutional administration, etc.), and policy-making (e.g., political science), although not exclusively. This first disease-specific report focuses on the cancer of the uterine cervix (CC). It describes how recent breakthroughs can be leveraged as force multipliers to improve outcomes in CC - by improving early detection, better screening for CC, potential GM-based interventions during the stage of persistent Human papillomavirus (HPV) infection and treatment interventions - especially among the disadvantaged and resource-scarce populations. This work is a tiny step in our attempts to improve outcomes in CC and ultimately eradicate CC from the face of the earth.
Collapse
Affiliation(s)
- Mary R Nittala
- Radiation Oncology, University of Mississippi Medical Center, Jackson, USA
| | - Johnny Yang
- Radiation Oncology, University of Mississippi Medical Center, Jackson, USA
| | | | - John D Salvemini
- Radiation Oncology, University of Mississippi Medical Center, Jackson, USA
| | - Gregory R Vance
- Radiation Oncology, University of Mississippi Medical Center, Jackson, USA
| | - Camille C Grady
- Radiation Oncology, University of Mississippi Medical Center, Jackson, USA
| | - Bradley Hathaway
- Radiation Oncology, University of Mississippi Medical Center, Jackson, USA
| | - Jeffrey A Roux
- Radiation Oncology, University of Mississippi Medical Center, Jackson, USA
| | | |
Collapse
|
3
|
Lofters A, Prakash V, Devotta K, Vahabi M. The potential benefits of "community champions" in the healthcare system. Healthc Manage Forum 2023; 36:382-387. [PMID: 37268592 PMCID: PMC10604418 DOI: 10.1177/08404704231179911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
In a study to understand acceptability and uptake of Human Papilloma Virus (HPV) self-sampling, we engaged community champions to lead recruitment and other study activities. This article describes qualitative findings relevant to the role of the community champion. We found that community champions were critical to promoting awareness about and encouraging cervical screening and HPV self-sampling. They were well-connected community members who had healthcare backgrounds, which created trust in their messages. They were highly effective at encouraging screening because of their education and cultural congruency, combined with the time for thorough and clear explanations. Women had an inherent level of comfort with the community champions that often did not exist with their physician. The community champions were seen as being able to address some of the barriers that exist within the healthcare system. We encourage health leaders to consider how this role can be sustainably and meaningfully incorporated into the healthcare system.
Collapse
Affiliation(s)
- Aisha Lofters
- Women’s College Hospital, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
- St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Vijayshree Prakash
- Toronto Metropolitan University (formerly Ryerson University), Toronto, Ontario, Canada
| | - Kimberly Devotta
- Women’s College Hospital, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
- St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Mandana Vahabi
- Toronto Metropolitan University (formerly Ryerson University), Toronto, Ontario, Canada
| |
Collapse
|
4
|
Gallifant J, Griffin M, Pierce RL, Celi LA. From quality improvement to equality improvement projects: A scoping review and framework. iScience 2023; 26:107924. [PMID: 37817930 PMCID: PMC10561034 DOI: 10.1016/j.isci.2023.107924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2023] Open
Abstract
Increasing awareness of health disparities has led to proposals for a pay-for-equity scheme. Implementing such proposals requires systematic methods of collecting and reporting health outcomes for targeted demographics over time. This lays the foundation for a shift from quality improvement projects (QIPs) to equality improvement projects (EQIPs) that could evaluate adherence to standards and progress toward health equity. We performed a scoping review on EQIPs to inform a new framework for quality improvement through a health equity lens. Forty studies implemented an intervention after identifying a disparity compared to 149 others which merely identified group differences. Most evaluated race-based differences and were conducted at the institutional level, with representation in both the inpatient and outpatient settings. EQIPs that improved equity leveraged multidisciplinary expertise, healthcare staff education, and developed tools to track health outcomes continuously. EQIPs can help bridge the inequality gap and form part of an incentivized systematic equality improvement framework.
Collapse
Affiliation(s)
- Jack Gallifant
- Laboratory for Computational Physiology, Massachusetts Institute of Technology, Cambridge, MA, USA
- Department of Critical Care, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Molly Griffin
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Robin L. Pierce
- The Law School, School of Social Sciences and International Studies, University of Exeter, Exeter, UK
| | - Leo Anthony Celi
- Laboratory for Computational Physiology, Massachusetts Institute of Technology, Cambridge, MA, USA
- Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| |
Collapse
|
5
|
Health inequities in mammography: A scoping review. Eur J Radiol 2023; 160:110693. [PMID: 36640712 DOI: 10.1016/j.ejrad.2023.110693] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 12/30/2022] [Accepted: 01/07/2023] [Indexed: 01/11/2023]
Abstract
OBJECTIVE The objective of this scoping review is to chart the existing evidence on health inequities related to mammography and identify existing knowledge gaps to guide future research. METHODS This scoping review followed guidelines from the Joanna Briggs Institute and the PRISMA extension for scoping reviews. In July 2022, we searched PubMed and Ovid Embase for published articles on mammography screening, published between 2011 and 2021, written in English, and examining at least one health inequity as defined by the NIH. Screening and charting were both performed in a masked, duplicate manner. Frequencies of each health inequity examined were analyzed and main findings from each included study were summarized. RESULTS Following screening, our sample consisted of 128 studies. Our findings indicate that mammography screening was less likely in historically marginalized groups, patients who live in rural areas, and in women with low income status and education level. Significant research gaps were observed regarding the LGBTQ + community and sex and gender. No trends between inequities investigated over time were identified. DISCUSSION This scoping review highlights the gaps in inequities research regarding mammography, as well as the limited consensus across findings. To bridge existing research gaps, we recommend research into the following: 1) assessments of physician knowledge on the LGBTQ + community guidelines, 2) tools for health literacy, and 3) culturally competent screening models.
Collapse
|
6
|
Kemei J, Tulli M, Olanlesi-Aliu A, Tunde-Byass M, Salami B. Impact of the COVID-19 Pandemic on Black Communities in Canada. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1580. [PMID: 36674335 PMCID: PMC9862348 DOI: 10.3390/ijerph20021580] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/09/2023] [Accepted: 01/13/2023] [Indexed: 06/17/2023]
Abstract
The COVID-19 pandemic has resulted in differential impacts on the Black communities in Canada and has unmasked existing race-related health inequities. The purpose of this study was to illuminate the impacts of the COVID-19 pandemic on Black people in Canada. Historically, social inequalities have determined the impacts of pandemics on the population, and in the case of the COVID-19 pandemic, disproportionate infections and mortalities have become evident among racialized communities in Canada. This qualitative descriptive study utilized an intersectionality framework. We invited Black stakeholders across Canada to participate in semi-structured interviews to deepen our knowledge of the impacts of the COVID-19 pandemic on Black communities in Canada. A total of 30 interviews were recorded, transcribed verbatim, and analyzed using content analysis. Our findings fell into three categories: (1) increased vulnerability to COVID-19 disease, (2) mental impacts, and (3) addressing impacts of the COVID-19 pandemic. The findings show the underlying systemic inequities in Canada and systemic racism exacerbated health inequities among the Black communities and undermined interventions by public health agencies to curb the spread of COVID-19 and associated impacts on Black and other racialized communities. The paper concludes by identifying critical areas for future intervention in policy and practice.
Collapse
Affiliation(s)
- Janet Kemei
- Faculty of Nursing, University of Alberta, Edmonton, AB T6G 1C9, Canada
| | - Mia Tulli
- Faculty of Nursing, University of Alberta, Edmonton, AB T6G 1C9, Canada
| | | | - Modupe Tunde-Byass
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Bukola Salami
- Faculty of Nursing, University of Alberta, Edmonton, AB T6G 1C9, Canada
| |
Collapse
|
7
|
Ezeife DA, Padmore G, Vaska M, Truong TH. Un accès équitable aux soins contre le cancer pour les personnes noires au Canada. CMAJ 2023; 195:E51-E55. [PMID: 36623855 PMCID: PMC9829072 DOI: 10.1503/cmaj.212076-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Affiliation(s)
- Doreen A Ezeife
- Départements d'oncologie (Ezeife, Padmore, Vaska) et de chirurgie oncologique (Padmore), Université de Calgary, Centre de cancérologie Tom Baker; Département d'oncologie pédiatrique (Truong), Université de Calgary, Hôpital pour enfants de l'Alberta, Calgary, Alb.
| | - Greg Padmore
- Départements d'oncologie (Ezeife, Padmore, Vaska) et de chirurgie oncologique (Padmore), Université de Calgary, Centre de cancérologie Tom Baker; Département d'oncologie pédiatrique (Truong), Université de Calgary, Hôpital pour enfants de l'Alberta, Calgary, Alb
| | - Marcus Vaska
- Départements d'oncologie (Ezeife, Padmore, Vaska) et de chirurgie oncologique (Padmore), Université de Calgary, Centre de cancérologie Tom Baker; Département d'oncologie pédiatrique (Truong), Université de Calgary, Hôpital pour enfants de l'Alberta, Calgary, Alb
| | - Tony H Truong
- Départements d'oncologie (Ezeife, Padmore, Vaska) et de chirurgie oncologique (Padmore), Université de Calgary, Centre de cancérologie Tom Baker; Département d'oncologie pédiatrique (Truong), Université de Calgary, Hôpital pour enfants de l'Alberta, Calgary, Alb
| |
Collapse
|
8
|
Ezeife DA, Padmore G, Vaska M, Truong TH. Ensuring equitable access to cancer care for Black patients in Canada. CMAJ 2022; 194:E1416-E1419. [PMID: 36280246 PMCID: PMC9616139 DOI: 10.1503/cmaj.212076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Doreen A Ezeife
- Departments of Oncology (Ezeife, Padmore, Vaska) and Surgical Oncology (Padmore), University of Calgary, Tom Baker Cancer Centre; Department of Oncology and Pediatrics (Truong), University of Calgary, Alberta Children's Hospital, Calgary, Alta.
| | - Greg Padmore
- Departments of Oncology (Ezeife, Padmore, Vaska) and Surgical Oncology (Padmore), University of Calgary, Tom Baker Cancer Centre; Department of Oncology and Pediatrics (Truong), University of Calgary, Alberta Children's Hospital, Calgary, Alta
| | - Marcus Vaska
- Departments of Oncology (Ezeife, Padmore, Vaska) and Surgical Oncology (Padmore), University of Calgary, Tom Baker Cancer Centre; Department of Oncology and Pediatrics (Truong), University of Calgary, Alberta Children's Hospital, Calgary, Alta
| | - Tony H Truong
- Departments of Oncology (Ezeife, Padmore, Vaska) and Surgical Oncology (Padmore), University of Calgary, Tom Baker Cancer Centre; Department of Oncology and Pediatrics (Truong), University of Calgary, Alberta Children's Hospital, Calgary, Alta
| |
Collapse
|