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Selick A, Durbin J, Hamdani Y, Rayner J, Lunsky Y. "Can you hear me now?": a qualitative exploration of communication quality in virtual primary care encounters for patients with intellectual and developmental disabilities. BMC Prim Care 2023; 24:105. [PMID: 37081380 PMCID: PMC10117251 DOI: 10.1186/s12875-023-02055-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 04/11/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND High quality communication is central to effective primary care. The COVID-19 pandemic led to a dramatic increase in virtual care but little is known about how this may affect communication quality. Adults with intellectual and developmental disabilities (IDD) can experience challenges communicating or communicate in non-traditional ways. This study explored how the use of virtual modalities, including telephone and video, affects communication in primary care interactions for patients with IDD. METHODS This qualitative descriptive study included semi-structured interviews with a multi-stakeholder sample of 38 participants, including 11 adults with IDD, 13 family caregivers, 5 IDD support staff and 9 primary care physicians. Interviews were conducted in Ontario, Canada between March and November 2021 by video-conference or telephone. A mixed inductive and deductive thematic analysis approach was used to code the data and identify themes. Themes were reviewed and refined with members of each stakeholder group. RESULTS Four elements of communication were identified that were affected by virtual care: (1) patient engagement in the virtual appointment; (2) the ability to hear other participants and have the time and space to be heard; (3) the ability to use nonverbal communication strategies; and (4) the ability to form trusting relationships. In some cases, the virtual platform hindered these elements of communication. Video offered some advantages over telephone to support nonverbal communication, and stimulate engagement; though this could be limited by technical challenges. For adults with IDD who find it difficult to attend in-person appointments, virtual care improved communication quality by allowing them to participate from a space where they were comfortable. CONCLUSION Though there are circumstances in which virtual delivery can improve communication for patients with IDD, there are also challenges to achieving high quality patient-provider communication over telephone and video. Improved infrastructure and training for providers, patients and caregivers can help improve communication quality, though in some cases it may never be appropriate. A flexible patient-centred approach is needed that includes in-person, telephone and video options for care.
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Affiliation(s)
- Avra Selick
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada.
- Provincial System Support Program, Centre for Addiction and Mental Health, Toronto, ON, Canada.
| | - Janet Durbin
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Provincial System Support Program, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Yani Hamdani
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Jennifer Rayner
- Centre for Studies in Family Medicine, Western University, London, ON, Canada
- Department of Research and Evaluation, Alliance for Healthier Communities, Toronto, ON, Canada
| | - Yona Lunsky
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Selick A, Durbin J, Hamdani Y, Rayner J, Lunsky Y. Accessibility of Virtual Primary Care for Adults With Intellectual and Developmental Disabilities During the COVID-19 Pandemic: Qualitative Study. JMIR Form Res 2022; 6:e38916. [PMID: 35951444 PMCID: PMC9400841 DOI: 10.2196/38916] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 08/09/2022] [Accepted: 08/10/2022] [Indexed: 11/13/2022] Open
Abstract
Background The COVID-19 pandemic has led to an unprecedented increase in the delivery of virtual primary care. Adults with intellectual and developmental disabilities (IDDs) have complex health care needs, and little is known about the value and appropriateness of virtual care for this patient population. Objective The aim of this study was to explore the accessibility of virtual primary care for patients with IDDs during the pandemic. Methods We conducted semistructured interviews with 38 participants in Ontario, Canada between March and November 2021. A maximum variation sampling strategy was used to achieve a diverse sample including 11 adults with IDDs, 13 family caregivers, 5 IDD support staff members, and 9 primary care physicians. An iterative mixed inductive and deductive thematic analysis approach was used to code the data and synthesize higher-level themes. The analysis was informed by the Levesque Patient-Centered Access to Health Care Framework. Results We identified themes related to 4 of 5 access-to-care dimensions that highlighted both the benefits and challenges of virtual care for adults with IDDs. The benefits included saving time spent traveling and waiting; avoiding anxiety and challenging behavior for patients who struggle to attend in-person visits; allowing caregivers who live far away from their loved ones to participate; reducing illness transmission; and allowing health care providers to see patients in their home environments. The challenges included lack of access to necessary technology, lack of comfort or skill using technology, and lack of nonverbal communication; difficulty engaging and establishing rapport; patient exclusion from the health care encounter; and concerns about privacy and confidentiality. An overarching theme was that “one size does not fit all,” and the accessibility of virtual care was dependent on the interaction between the following 5 categories of factors: patient characteristics, patient context, caregiver characteristics, service context, and reason for a particular primary care visit. Though virtual care was not always appropriate, in some cases, it dramatically improved patients’ abilities to access necessary health care. Conclusions This study suggests that a flexible patient-centered system including multiple delivery modalities is needed to ensure all patients have access to primary care. Implementing this system will require improved virtual care platforms, access to technology for patients and caregivers, training for primary care providers, and appropriately aligned primary care funding models.
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Affiliation(s)
- Avra Selick
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Janet Durbin
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Provincial System Support Program, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Yani Hamdani
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Jennifer Rayner
- Alliance for Healthier Communities, Toronto, ON, Canada
- Centre for Studies in Family Medicine, Western University, London, ON, Canada
| | - Yona Lunsky
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Selick A, Durbin J, Salonia C, Volpe T, Orr E, Hermans H, Zaretsky L, Malhas M, Lunsky Y. The Nuts and Bolts of Health Care: Evaluating an initiative to build direct support professional capacity to support the health care of individuals with intellectual disabilities. J Appl Res Intellect Disabil 2022; 35:623-632. [PMID: 34985176 DOI: 10.1111/jar.12975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 12/09/2021] [Accepted: 12/16/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Direct support professionals (DSP) are instrumental in supporting the health care of individuals with intellectual disabilities, yet receive little training and support for this role. We implemented a capacity building intervention for DSPs in a community agency in Ontario, Canada. This study evaluated the perceived value and feasibility of the intervention and the value of a structured implementation approach. METHOD The intervention included communication tools, a health resource toolkit, and training. A mixed methods evaluation was used to collect feedback from DSPs and people with intellectual disabilities. RESULTS Participants generally found the intervention valuable and feasible. Although practice change is difficult, extensive engagement and being responsive to feedback were helpful strategies. The primary concern reported by DSPs was resistance from health care providers. CONCLUSION An important next step is to engage health care providers to ensure the tools are valuable and feasible for everyone involved in the health encounter.
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Affiliation(s)
- Avra Selick
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Janet Durbin
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Provincial System Support Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | | | - Tiziana Volpe
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Erin Orr
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | | | - Lauren Zaretsky
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Mais Malhas
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Yona Lunsky
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Selick A, Bobbette N, Lunsky Y, Hamdani Y, Rayner J, Durbin J. Virtual health care for adult patients with intellectual and developmental disabilities: A scoping review. Disabil Health J 2021; 14:101132. [PMID: 34127406 PMCID: PMC9619129 DOI: 10.1016/j.dhjo.2021.101132] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/01/2021] [Accepted: 06/02/2021] [Indexed: 11/06/2022]
Abstract
Background The COVID-19 pandemic led to an abrupt shift to virtual health care for many patients, including adults with intellectual and developmental disabilities (IDD). Approaches to virtual care that are successful for people without IDD may need to be adapted for adults with IDD. Objective The aim of this scoping review was to examine what is known about virtual health care for adults with IDD and in particular, the impact of virtual delivery on access to care for this population. Methods A comprehensive search was conducted of the academic and grey literature. A two-stage screening process was conducted by two independent reviewers and a structured data extraction template was populated for each included study. Findings were analyzed thematically using Access to Care Framework domains. Results In total, 22 studies met inclusion criteria. The majority were published in the past three years and focused on specialized IDD services. A subset of 12 studies reported findings on access to care for adults with IDD. Participants generally reported high acceptability of virtual care, though some preferred face-to-face encounters. Initial results on effectiveness were positive, though limited by small sample sizes. Challenges included internet quality and technical skill or comfort. Conclusions This review suggests that it is possible to deliver accessible, high quality virtual care for adults with IDD, however, relatively little research has been conducted on this topic. Due to COVID-19 there is currently a unique opportunity and urgency to learn when and for whom virtual care can be successful and how it can be supported.
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Affiliation(s)
- Avra Selick
- University of Toronto, 27 King's College Cir, Toronto, ON, M5S 3K1, Canada; Centre for Addiction and Mental Health, 1001 Queen St, Toronto, ON, M6J 1H1, Canada.
| | - Nicole Bobbette
- Centre for Addiction and Mental Health, 1001 Queen St, Toronto, ON, M6J 1H1, Canada; Queen's University, 99 University Ave, Kingston, ON, K7L 3N6, Canada
| | - Yona Lunsky
- University of Toronto, 27 King's College Cir, Toronto, ON, M5S 3K1, Canada; Centre for Addiction and Mental Health, 1001 Queen St, Toronto, ON, M6J 1H1, Canada
| | - Yani Hamdani
- University of Toronto, 27 King's College Cir, Toronto, ON, M5S 3K1, Canada; Centre for Addiction and Mental Health, 1001 Queen St, Toronto, ON, M6J 1H1, Canada
| | - Jennifer Rayner
- University of Toronto, 27 King's College Cir, Toronto, ON, M5S 3K1, Canada
| | - Janet Durbin
- University of Toronto, 27 King's College Cir, Toronto, ON, M5S 3K1, Canada; Centre for Addiction and Mental Health, 1001 Queen St, Toronto, ON, M6J 1H1, Canada
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Selick A, Langill G, Cheng C, Addington D, Archie S, Butt S, Durbin J. Feasibility and acceptability of a volunteer peer fidelity assessment model in early psychosis intervention programmes in Ontario: Results from a pilot study. Early Interv Psychiatry 2021; 15:480-485. [PMID: 32232930 DOI: 10.1111/eip.12961] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 01/14/2020] [Accepted: 03/15/2020] [Indexed: 10/24/2022]
Abstract
AIM Fidelity monitoring can support high-quality service delivery but is resource-intensive to implement. A fidelity assessment model utilizing volunteer assessors was trialled as a low-cost strategy for conducting fidelity assessments. This article reports on the acceptability and feasibility of this model. METHODS Twenty volunteer assessors were trained to conduct fidelity assessments in nine Early Psychosis Intervention programmes across Ontario, Canada. Assessments were conducted using the First-Episode Psychosis Services Fidelity Scale based on a 2-day site visit, during which assessors interviewed staff, clients and families; reviewed charts; observed a team meeting and reviewed programme materials. The model was evaluated based on assessor focus groups, programme interviews, consensus meeting data and time-tracking logs. General inductive analysis was used to code and synthesize qualitative data. Quantitative data were aggregated and summarized. RESULTS Participant feedback was positive and indicated that use of peer assessors and the in-person site visit added value to the process. The model was perceived to provide valuable information to support internal quality improvement efforts. Assessors reported direct benefits from participating, including networking and learning opportunities. Key challenges were the high time demand on assessors and turnover in the assessor team. CONCLUSIONS The volunteer peer fidelity model was perceived to be a valuable improvement process by participants, but the high cost and reliance on ongoing volunteerism makes its sustainability uncertain. Next steps may include exploring remote assessment strategies or direct payments, although these strategies risk reducing the acceptability, and therefore uptake, of the assessment.
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Affiliation(s)
- Avra Selick
- Provincial System Support Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Gordon Langill
- Canadian Mental Health Association, Haliburton Kawartha Pine Ridge Branch, Ontario, Canada
| | - Chiachen Cheng
- Department of Psychiatry, Northern School of Medicine, Thunder Bay, Ontario, Canada
| | - Donald Addington
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Suzanne Archie
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Shannel Butt
- Canadian Mental Health Association, Elgin Branch, St Thomas, Ontario, Canada
| | - Janet Durbin
- Provincial System Support Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Lunsky Y, Bobbette N, Selick A, Jiwa MI. "The doctor will see you now": Direct support professionals' perspectives on supporting adults with intellectual and developmental disabilities accessing health care during COVID-19. Disabil Health J 2021; 14:101066. [PMID: 33531290 DOI: 10.1016/j.dhjo.2021.101066] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 01/15/2021] [Accepted: 01/19/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND It is critical to consider how rapid changes in health care delivery and the rise in use of virtual modalities have impacted adults with intellectual and developmental disabilities and caregivers. OBJECTIVE The purpose of this paper is to describe direct support professionals' experiences assisting adults with intellectual and developmental disabilities in accessing virtual and in-person health care during COVID-19. METHODS A content analysis was conducted on responses obtained from an online questionnaire distributed to 942 direct support professionals in Canada. Descriptive statistics were used to report the type of visits that occurred and open text responses describing these visits were coded. RESULTS Twenty four percent of direct support professionals reported supporting someone at an in-person medical appointment, 22% reported attending at least one video-based virtual appointment and 58% reported supporting at least one phone based virtual appointment in the first 5 months of the pandemic. They identified several barriers and facilitators with each type of visit which suggests there is no "single way" to provide health care to this group, but that optimal care depends on maximizing the fit between the person's abilities, the skill set of direct support professionals and health care providers, and the presenting health care issue. CONCLUSIONS Study findings provide insight into the experience of health care for this population during COVID-19 and can be used to support direct support professionals and adults with intellectual and developmental disabilities to adapt to safe, supportive and comprehensive virtual and in-person health care during the pandemic and beyond.
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Affiliation(s)
- Y Lunsky
- Azrieli Adult Neurodevelopmental Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), Canada; Department of Psychiatry, University of Toronto, Canada; Institute of Health Policy Research and Evaluation, University of Toronto, Canada.
| | - N Bobbette
- Azrieli Adult Neurodevelopmental Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), Canada
| | - A Selick
- Azrieli Adult Neurodevelopmental Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), Canada; Institute of Health Policy Research and Evaluation, University of Toronto, Canada
| | - M I Jiwa
- Azrieli Adult Neurodevelopmental Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), Canada
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Spassiani NA, Abou Chacra MS, Selick A, Durbin J, Lunsky Y. Emergency department nurses’ knowledge, skills, and comfort related to caring for patients with intellectual disabilities. Int Emerg Nurs 2020; 50:100851. [DOI: 10.1016/j.ienj.2020.100851] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 01/21/2020] [Accepted: 03/04/2020] [Indexed: 10/24/2022]
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Durbin J, Selick A, Langill G, Cheng C, Archie S, Butt S, Addington DE. Using Fidelity Measurement to Assess Quality of Early Psychosis Intervention Services in Ontario. Psychiatr Serv 2019; 70:840-844. [PMID: 31159664 DOI: 10.1176/appi.ps.201800581] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The First Episode Psychosis Services Fidelity Scale (FEPS-FS) is a validated measure of program delivery in relation to international standards. This study assessed fidelity in Ontario programs and the utility of the FEPS-FS for program improvement. METHODS Assessments were conducted in a volunteer sample of nine early psychosis intervention (EPI) programs. Thirty components of care were each rated on a 5-point scale; a rating of 4 indicates satisfactory performance. Trained assessor teams conducted site visits, and ratings were made by consensus. RESULTS Program mean fidelity ratings ranged from 3.1 to 4.4 and exceeded 4 in five programs. Across the programs, item mean fidelity ratings ranged from 2.1 to 5 and exceeded 4 for 14 of 30 items. CONCLUSIONS The FEPS-FS captured variation in program implementation and provided a baseline for measuring change. Additions to the scale are planned to address components of the Ontario EPI standards not covered by the FEPS-FS.
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Affiliation(s)
- Janet Durbin
- Centre for Addiction and Mental Health, Toronto (Durbin, Selick); Department of Psychiatry, University of Toronto, Toronto (Durbin); Haliburton Kawartha Pine Ridge Branch, Canadian Mental Health Association, Peterborough, Ontario (Langill); Psychiatry Section, Clinical Sciences, Northern Ontario School of Medicine, Thunder Bay, Ontario (Cheng); Department of Psychiatry and Behavioural Neuroscience, McMaster University, Hamilton, Ontario (Archie); Elgin Branch, Canadian Mental Health Association, St. Thomas, Ontario (Butt); Department of Psychiatry, University of Calgary, Calgary, Alberta (Addington)
| | - Avra Selick
- Centre for Addiction and Mental Health, Toronto (Durbin, Selick); Department of Psychiatry, University of Toronto, Toronto (Durbin); Haliburton Kawartha Pine Ridge Branch, Canadian Mental Health Association, Peterborough, Ontario (Langill); Psychiatry Section, Clinical Sciences, Northern Ontario School of Medicine, Thunder Bay, Ontario (Cheng); Department of Psychiatry and Behavioural Neuroscience, McMaster University, Hamilton, Ontario (Archie); Elgin Branch, Canadian Mental Health Association, St. Thomas, Ontario (Butt); Department of Psychiatry, University of Calgary, Calgary, Alberta (Addington)
| | - Gordon Langill
- Centre for Addiction and Mental Health, Toronto (Durbin, Selick); Department of Psychiatry, University of Toronto, Toronto (Durbin); Haliburton Kawartha Pine Ridge Branch, Canadian Mental Health Association, Peterborough, Ontario (Langill); Psychiatry Section, Clinical Sciences, Northern Ontario School of Medicine, Thunder Bay, Ontario (Cheng); Department of Psychiatry and Behavioural Neuroscience, McMaster University, Hamilton, Ontario (Archie); Elgin Branch, Canadian Mental Health Association, St. Thomas, Ontario (Butt); Department of Psychiatry, University of Calgary, Calgary, Alberta (Addington)
| | - Chiachen Cheng
- Centre for Addiction and Mental Health, Toronto (Durbin, Selick); Department of Psychiatry, University of Toronto, Toronto (Durbin); Haliburton Kawartha Pine Ridge Branch, Canadian Mental Health Association, Peterborough, Ontario (Langill); Psychiatry Section, Clinical Sciences, Northern Ontario School of Medicine, Thunder Bay, Ontario (Cheng); Department of Psychiatry and Behavioural Neuroscience, McMaster University, Hamilton, Ontario (Archie); Elgin Branch, Canadian Mental Health Association, St. Thomas, Ontario (Butt); Department of Psychiatry, University of Calgary, Calgary, Alberta (Addington)
| | - Suzanne Archie
- Centre for Addiction and Mental Health, Toronto (Durbin, Selick); Department of Psychiatry, University of Toronto, Toronto (Durbin); Haliburton Kawartha Pine Ridge Branch, Canadian Mental Health Association, Peterborough, Ontario (Langill); Psychiatry Section, Clinical Sciences, Northern Ontario School of Medicine, Thunder Bay, Ontario (Cheng); Department of Psychiatry and Behavioural Neuroscience, McMaster University, Hamilton, Ontario (Archie); Elgin Branch, Canadian Mental Health Association, St. Thomas, Ontario (Butt); Department of Psychiatry, University of Calgary, Calgary, Alberta (Addington)
| | - Shannel Butt
- Centre for Addiction and Mental Health, Toronto (Durbin, Selick); Department of Psychiatry, University of Toronto, Toronto (Durbin); Haliburton Kawartha Pine Ridge Branch, Canadian Mental Health Association, Peterborough, Ontario (Langill); Psychiatry Section, Clinical Sciences, Northern Ontario School of Medicine, Thunder Bay, Ontario (Cheng); Department of Psychiatry and Behavioural Neuroscience, McMaster University, Hamilton, Ontario (Archie); Elgin Branch, Canadian Mental Health Association, St. Thomas, Ontario (Butt); Department of Psychiatry, University of Calgary, Calgary, Alberta (Addington)
| | - Donald E Addington
- Centre for Addiction and Mental Health, Toronto (Durbin, Selick); Department of Psychiatry, University of Toronto, Toronto (Durbin); Haliburton Kawartha Pine Ridge Branch, Canadian Mental Health Association, Peterborough, Ontario (Langill); Psychiatry Section, Clinical Sciences, Northern Ontario School of Medicine, Thunder Bay, Ontario (Cheng); Department of Psychiatry and Behavioural Neuroscience, McMaster University, Hamilton, Ontario (Archie); Elgin Branch, Canadian Mental Health Association, St. Thomas, Ontario (Butt); Department of Psychiatry, University of Calgary, Calgary, Alberta (Addington)
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Durbin A, Balogh R, Lin E, Wilton AS, Selick A, Dobranowski KM, Lunsky Y. Repeat Emergency Department Visits for Individuals With Intellectual and Developmental Disabilities and Psychiatric Disorders. Am J Intellect Dev Disabil 2019; 124:206-219. [PMID: 31026200 DOI: 10.1352/1944-7558-124.3.206] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Although individuals with intellectual and developmental disabilities (IDD) and psychiatric concerns are more likely than others to visit hospital emergency departments (EDs), the frequency of their returns to the ED within a short time is unknown. In this population-based study we examined the likelihood of this group returning to the ED within 30 days of discharge and described these visits for individuals with IDD + psychiatric disorders (n = 3,275), and persons with IDD only (n = 1,944) compared to persons with psychiatric disorders only (n = 41,532). Individuals with IDD + psychiatric disorders, and individuals with IDD alone were more likely to make 30-day repeat ED visits. Improving hospital care and postdischarge community linkages may reduce 30-day returns to the ED among adults with IDD.
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Affiliation(s)
- Anna Durbin
- Anna Durbin, St. Michael's Hospital, Toronto, ON, Canada; Robert Balogh, University of Ontario Institute of Technology, Oshawa, ON, Canada; Elizabeth Lin, Centre for Addiction and Mental Health, Toronto, ON, Canada; Andrew S. Wilton, Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; Avra Selick, Centre for Addiction and Mental Health, Toronto, ON, Canada; Kristin M. Dobranowski, University of Ontario Institute of Technology, Oshawa, ON, Canada; and Yona Lunsky, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Robert Balogh
- Anna Durbin, St. Michael's Hospital, Toronto, ON, Canada; Robert Balogh, University of Ontario Institute of Technology, Oshawa, ON, Canada; Elizabeth Lin, Centre for Addiction and Mental Health, Toronto, ON, Canada; Andrew S. Wilton, Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; Avra Selick, Centre for Addiction and Mental Health, Toronto, ON, Canada; Kristin M. Dobranowski, University of Ontario Institute of Technology, Oshawa, ON, Canada; and Yona Lunsky, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Elizabeth Lin
- Anna Durbin, St. Michael's Hospital, Toronto, ON, Canada; Robert Balogh, University of Ontario Institute of Technology, Oshawa, ON, Canada; Elizabeth Lin, Centre for Addiction and Mental Health, Toronto, ON, Canada; Andrew S. Wilton, Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; Avra Selick, Centre for Addiction and Mental Health, Toronto, ON, Canada; Kristin M. Dobranowski, University of Ontario Institute of Technology, Oshawa, ON, Canada; and Yona Lunsky, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Andrew S Wilton
- Anna Durbin, St. Michael's Hospital, Toronto, ON, Canada; Robert Balogh, University of Ontario Institute of Technology, Oshawa, ON, Canada; Elizabeth Lin, Centre for Addiction and Mental Health, Toronto, ON, Canada; Andrew S. Wilton, Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; Avra Selick, Centre for Addiction and Mental Health, Toronto, ON, Canada; Kristin M. Dobranowski, University of Ontario Institute of Technology, Oshawa, ON, Canada; and Yona Lunsky, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Avra Selick
- Anna Durbin, St. Michael's Hospital, Toronto, ON, Canada; Robert Balogh, University of Ontario Institute of Technology, Oshawa, ON, Canada; Elizabeth Lin, Centre for Addiction and Mental Health, Toronto, ON, Canada; Andrew S. Wilton, Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; Avra Selick, Centre for Addiction and Mental Health, Toronto, ON, Canada; Kristin M. Dobranowski, University of Ontario Institute of Technology, Oshawa, ON, Canada; and Yona Lunsky, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Kristin M Dobranowski
- Anna Durbin, St. Michael's Hospital, Toronto, ON, Canada; Robert Balogh, University of Ontario Institute of Technology, Oshawa, ON, Canada; Elizabeth Lin, Centre for Addiction and Mental Health, Toronto, ON, Canada; Andrew S. Wilton, Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; Avra Selick, Centre for Addiction and Mental Health, Toronto, ON, Canada; Kristin M. Dobranowski, University of Ontario Institute of Technology, Oshawa, ON, Canada; and Yona Lunsky, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Yona Lunsky
- Anna Durbin, St. Michael's Hospital, Toronto, ON, Canada; Robert Balogh, University of Ontario Institute of Technology, Oshawa, ON, Canada; Elizabeth Lin, Centre for Addiction and Mental Health, Toronto, ON, Canada; Andrew S. Wilton, Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; Avra Selick, Centre for Addiction and Mental Health, Toronto, ON, Canada; Kristin M. Dobranowski, University of Ontario Institute of Technology, Oshawa, ON, Canada; and Yona Lunsky, Centre for Addiction and Mental Health, Toronto, ON, Canada
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Durbin J, Selick A, Casson I, Green L, Perry A, Chacra MA, Lunsky Y. Improving the quality of primary care for adults with intellectual and developmental disabilities: Value of the periodic health examination. Can Fam Physician 2019; 65:S66-S72. [PMID: 31023784 PMCID: PMC6501718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To implement a Health Check protocol for patients with intellectual and developmental disabilities (IDD) and assess outcomes. DESIGN Retrospective chart review and staff survey. SETTING Two Ontario family health teams. PARTICIPANTS Of 276 patients with IDD identified, 139 received the Health Check (Health Check group). A convenience sample (N = 147) of clinical staff participated in the survey. MAIN OUTCOME MEASURES The protocol included patient identification, invitation, and modified health examination. Chart review assessed completion of 8 preventive maneuvers, and clinical staff were surveyed on their comfort, knowledge, and skills in care of patients with IDD. Logistic regression analyses were used to compare outcomes for the Health Check and non-Health Check groups, adjusted for practice site. RESULTS Documentation of blood pressure, weight, body mass index, and influenza vaccination was significantly higher (P < .001) in the Health Check group, exceeding 70% of patients. Screening rates were higher for mammograms (63% vs 54%), fecal occult blood testing (39% vs 23%), and diabetes testing (80% vs 61%), but not significantly so, and they were similar to general population rates. Papanicolaou test rates were low for both groups (34% vs 32%). Staff comfort and skills were rated significantly higher (P < .05) for those who performed the Health Check. Still, fewer than half thought they had the necessary skills and resources to care for patients with IDD. CONCLUSION Performing the Health Check was associated with improved preventive care and staff experience. Wider implementation and evaluation is needed, along with protocol adjustments to provide more support to staff for this work.
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Affiliation(s)
- Janet Durbin
- Research Scientist for the Provincial System Support Program of the Centre for Addiction and Mental Health in Toronto, Ont, and Associate Professor in the Department of Psychiatry at the University of Toronto.
| | - Avra Selick
- Research Coordinator for the Provincial System Support Program of the Centre for Addiction and Mental Health
| | - Ian Casson
- Associate Professor in the Department of Family Medicine at Queen's University in Kingston, Ont
| | - Laurie Green
- Family physician practising at St Michael's Hospital in Toronto, Ont, and Lecturer at the University of Toronto
| | - Andrea Perry
- Transitions Facilitator for the Developmental Disabilities Primary Care Program, Surrey Place in Toronto
| | | | - Yona Lunsky
- Directs the Azrieli Adult Neurodevelopmental Centre at the Centre for Addiction and Mental Health and is Professor in the Department of Psychiatry at the University of Toronto
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Zworth M, Selick A, Durbin J, Casson I, Lunsky Y. Improving care for adults with intellectual and developmental disabilities: Role of clerical staff. Can Fam Physician 2019; 65:S8-S10. [PMID: 31023771 PMCID: PMC6501719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Max Zworth
- Medical student at the Michael G. DeGroote School of Medicine at McMaster University in Hamilton, Ont, and was a research intern at the Centre for Addiction and Mental Health in Toronto, Ont, at the time of writing
| | - Avra Selick
- Research methods specialist with the Centre for Addiction and Mental Health's Performance Measurement and Evaluation Program
| | - Janet Durbin
- Scientist with the Centre for Addiction and Mental Health's Performance Measurement and Evaluation Program
| | - Ian Casson
- Associate Professor in the Department of Family Medicine at Queen's University in Kingston, Ont
| | - Yona Lunsky
- Directs the Azrieli Adult Neurodevelopmental Centre at the Centre for Addiction and Mental Health and is Professor in the Department of Psychiatry at the University of Toronto.
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12
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Selick A, Durbin J, Casson I, Lee J, Lunsky Y. Barriers and facilitators to improving health care for adults with intellectual and developmental disabilities: what do staff tell us? Health Promot Chronic Dis Prev Can 2019; 38:349-357. [PMID: 30303655 DOI: 10.24095/hpcdp.38.10.01] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Adults with intellectual and developmental disabilities (IDD) have high rates of morbidity and are less likely to receive preventive care. Emergency departments and primary care clinics are important entry points into the health care system. Improving care in these settings can lead to increased prevention activities, early disease identification, and ongoing management. We studied barriers and facilitators to improving the care of patients with IDD in three primary and three emergency care sites in Ontario. METHODS Data sources included structured implementation logs at each site, focus groups (n = 5) and interviews (n = 8). Barriers and facilitators were coded deductively based on the Consolidated Framework for Implementation Research (CFIR). Synthesis to higher level themes was achieved through review and discussion by the research team. Focus was given to differences between higher and lower implementing sites. RESULTS All sites were challenged to prioritize care improvement for a small, complex population and varied levels of implementation were achieved. Having national guidelines, using local data to demonstrate need and sharing evidence on value were important engagement strategies. Factors present at higher implementing sites included strong champions, alignment with site mandate, and use of electronic prompts/reminders. Lower implementing sites showed more passive endorsement of the innovation and had lower capacity to implement. CONCLUSION Providing effective care for small, complex groups, such as adults with IDD, is critical to improving long-term health outcomes but is challenging to achieve. At a systemic level, funding incentives, access to expertise and improved electronic record systems may enhance capacity.
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Affiliation(s)
- Avra Selick
- Provincial System Support Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Janet Durbin
- Provincial System Support Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Ian Casson
- Department of Family Medicine, Queen's University, Kingston, Ontario, Canada
| | - Jacques Lee
- Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Yona Lunsky
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Adult Neurodevelopmental Services, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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Casson I, Broda T, Durbin J, Gonzales A, Green L, Grier E, Lunsky Y, Selick A, Sue K. Health checks for adults with intellectual and developmental disabilities in a family practice. Can Fam Physician 2018; 64:S44-S50. [PMID: 29650744 PMCID: PMC5906774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To provide tips and tools for primary care practitioners carrying out health checks for adult patients with intellectual and developmental disabilities (IDD) and for implementing a systematic program of health checks in a group or team practice. SOURCES OF INFORMATION The "Primary Care of Adults with Intellectual and Developmental Disabilities. 2018 Canadian Consensus Guidelines" literature review and interdisciplinary input. Experience in implementing health checks in family practices was obtained through the primary care project of H-CARDD (Health Care Access Research and Developmental Disabilities). MAIN MESSAGE Annual comprehensive health assessments ("health checks") are a recommendation of the 2018 Canadian consensus guidelines for primary care of adults with IDD because of evidence of benefit in this population. Although health checks might require more time to complete for people with IDD than is usual for encounters in primary care, family physicians are in an ideal position to provide this service because of the attributes of family medicine, which include both an orientation to proactive care and the ability to provide continuity of care. Tips and tools are provided for carrying out health checks for adult patients with IDD and for implementing a systematic program of health checks in a group or team practice. CONCLUSION Health checks can help enhance a family physician's approach to providing care for adults with IDD.
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Affiliation(s)
- Ian Casson
- Associate Professor in the Department of Family Medicine at Queen's University in Kingston, Ont.
| | - Terry Broda
- Advanced practice nurse at the See Things My Way clinic and a faculty member of the Ingram School of Nursing at McGill University in Montreal, Que
| | - Janet Durbin
- Research scientist in the Provincial System Support Program at the Centre for Addiction and Mental Health in Toronto, Ont, and Associate Professor in the Department of Psychiatry at the University of Toronto
| | - Angela Gonzales
- Advanced practice nurse and health care facilitator for the Toronto Network of Specialized Care at Surrey Place Centre
| | - Laurie Green
- Family physician practising at St Michael's Hospital in Toronto and Lecturer at the University of Toronto
| | - Elizabeth Grier
- Assistant Professor in the Department of Family Medicine at Queen's University
| | - Yona Lunsky
- Senior Scientist at the Centre for Addiction and Mental Health and Professor and Developmental Disability Lead at the University of Toronto
| | - Avra Selick
- Research coordinator for the Provincial System Support Program at the Centre for Addiction and Mental Health
| | - Kyle Sue
- Clinical Assistant Professor in the Discipline of Family Medicine at Memorial University of Newfoundland in St John's
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Lunsky Y, Balogh R, Durbin A, Selick A, Volpe T, Lin E. The Mental Health of Adults with Developmental Disabilities in Ontario: Lessons from Administrative Health Data. Healthc Q 2018; 21:6-9. [PMID: 30051808 DOI: 10.12927/hcq.2018.25521] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Adults with developmental disabilities have increased rates of mental illness and addiction, in addition to being more likely to experience physical health issues. This can lead to high rates of hospital and community-based healthcare. Population-based administrative health data can help in identifying the extent of problems experienced and target areas for policy and practice changes.
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Affiliation(s)
- Yona Lunsky
- The Director of the Azrieli Centre for Adult Neurodevelopmental Disabilities and Mental Health, director of the Health Care Access Research and Developmental Disabilities (H-CARDD) Program at the Centre for Addiction and Mental Health and an adjunct scientist at ICES. She can be contacted at
| | - Robert Balogh
- An assistant professor at the University of Ontario Institute of Technology and an adjunct scientist at ICES. He can be reached at
| | - Anna Durbin
- A scientist at the Centre for Urban Health Solutions at the Li Ka Shing Knowledge Institute of St. Michael's Hospital. She can be contacted at
| | - Avra Selick
- A research coordinator in the Provincial System Support Program at the Centre for Addiction and Mental Health. She can be contacted at
| | - Tiziana Volpe
- A research coordinator in the Provincial System Support Program at the Centre for Addiction and Mental Health. She can be contacted at
| | - Elizabeth Lin
- Independent scientist in the Provincial System Support Program at the Centre for Addiction and Mental Health and an adjunct scientist at ICES. She can be contacted at
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Balogh R, Lin E, Dobranowski K, Selick A, Wilton AS, Lunsky Y. All-Cause, 30-Day Readmissions Among Persons With Intellectual and Developmental Disabilities and Mental Illness. Psychiatr Serv 2018; 69:353-357. [PMID: 29137556 DOI: 10.1176/appi.ps.201600534] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Early hospital readmissions within 30 days of discharge are common and costly. This research describes predictors of all-cause, 30-day hospital readmissions among persons with intellectual and developmental disabilities (IDD), a group known to experience high rates of hospitalization. METHODS A cohort of 66,484 adults with IDD from Ontario, Canada, was used to create two subgroups: individuals with IDD only and those with IDD and mental illness. The rates of hospital readmission were determined and contrasted with a comparison subgroup of people without IDD who have mental illness. RESULTS Compared with those with mental illness only, individuals with IDD and mental illness were 1.7 times more likely to experience a hospital readmission within 30 days. Predictors of their readmission rates included being a young adult and having high morbidity levels. CONCLUSIONS The high rate of hospital readmission suggests that individuals with IDD and mental illness need attention regarding discharge planning and outpatient follow-up.
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Affiliation(s)
- Robert Balogh
- Dr. Balogh and Ms. Dobranowski are with the University of Ontario Institute of Technology, Oshawa, Ontario, Canada. Dr. Lin, Ms. Selick, and Dr. Lunsky are with the Centre for Addiction and Mental Health, Toronto. Mr. Wilton is with the Institute for Clinical Evaluative Sciences, Toronto
| | - Elizabeth Lin
- Dr. Balogh and Ms. Dobranowski are with the University of Ontario Institute of Technology, Oshawa, Ontario, Canada. Dr. Lin, Ms. Selick, and Dr. Lunsky are with the Centre for Addiction and Mental Health, Toronto. Mr. Wilton is with the Institute for Clinical Evaluative Sciences, Toronto
| | - Kristin Dobranowski
- Dr. Balogh and Ms. Dobranowski are with the University of Ontario Institute of Technology, Oshawa, Ontario, Canada. Dr. Lin, Ms. Selick, and Dr. Lunsky are with the Centre for Addiction and Mental Health, Toronto. Mr. Wilton is with the Institute for Clinical Evaluative Sciences, Toronto
| | - Avra Selick
- Dr. Balogh and Ms. Dobranowski are with the University of Ontario Institute of Technology, Oshawa, Ontario, Canada. Dr. Lin, Ms. Selick, and Dr. Lunsky are with the Centre for Addiction and Mental Health, Toronto. Mr. Wilton is with the Institute for Clinical Evaluative Sciences, Toronto
| | - Andrew S Wilton
- Dr. Balogh and Ms. Dobranowski are with the University of Ontario Institute of Technology, Oshawa, Ontario, Canada. Dr. Lin, Ms. Selick, and Dr. Lunsky are with the Centre for Addiction and Mental Health, Toronto. Mr. Wilton is with the Institute for Clinical Evaluative Sciences, Toronto
| | - Yona Lunsky
- Dr. Balogh and Ms. Dobranowski are with the University of Ontario Institute of Technology, Oshawa, Ontario, Canada. Dr. Lin, Ms. Selick, and Dr. Lunsky are with the Centre for Addiction and Mental Health, Toronto. Mr. Wilton is with the Institute for Clinical Evaluative Sciences, Toronto
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Lin E, Durbin J, Guerriere D, Volpe T, Selick A, Kennedy J, Ungar WJ, Lero DS. Assessing care-giving demands, resources and costs of family/friend caregivers for persons with mental health disorders: A scoping review. Health Soc Care Community 2018; 26:613-634. [PMID: 29498120 DOI: 10.1111/hsc.12546] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/07/2018] [Indexed: 06/08/2023]
Abstract
As mental health (MH) care has shifted from institutional settings to the community, families and friends are responsible for providing the majority of the care at home. The substantial literature on the adverse effects experienced by caregivers has focused mainly on psychological morbidity. Less attention has been paid to how caregivers for persons with MH disorders interact with larger social systems and the impacts of factors such as financial strain, lost time from leisure activities, and the availability of health and social services. We conducted a scoping review of MH and other caregiver questionnaires published between 1990 and 2016 to determine whether they addressed four key domains: caregiver work demands, resource needs, resource utilisation and costs. A range of health and social care databases were searched, including MEDLINE and Health and Psychosocial Instruments. After screening for relevance and quality, our search identified 14 instruments addressing elements related to one or more of our domains. Because these instruments covered only a small portion of our domains, we conducted a second targeted search of the general care-giving literature and consulted with experts, identifying an additional 18 instruments. A total of 32 questionnaires were reviewed, 14 specific to care-giving for mental health problems and 18 for other health conditions. Our search identified instruments or items within instruments that assess constructs in each of our domains, but no one instrument covered them completely. Additionally, some constructs were evaluated in detail and others only addressed by single items. While these instruments are helpful for moving measurement beyond the psychological impacts of care-giving, our results serve only as an initial guide. Additional methodological work is needed to more comprehensively measure the impact of care-giving for individuals with MH disorders and to contribute to the development of more meaningful and effective policies and programmes.
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Affiliation(s)
- Elizabeth Lin
- Provincial System and Support Program, Centre for Addiction & Mental Health, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Janet Durbin
- Provincial System and Support Program, Centre for Addiction & Mental Health, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Denise Guerriere
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Tiziana Volpe
- Provincial System and Support Program, Centre for Addiction & Mental Health, Toronto, ON, Canada
| | - Avra Selick
- Provincial System and Support Program, Centre for Addiction & Mental Health, Toronto, ON, Canada
| | - Julia Kennedy
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Wendy J Ungar
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Donna S Lero
- Centre for Families, Work and Well-Being, University of Guelph, Guelph, ON, Canada
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Selick A, Lamoureux A, O'Connor K, Durbin J. A Survey of Health Equity Practices in Early Psychosis Intervention Programs: A Starting Point for Improvement. ACTA ACUST UNITED AC 2017; 13:10-19. [PMID: 29274223 PMCID: PMC5749520 DOI: 10.12927/hcpol.2017.25326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Equity has been identified as a core component of quality healthcare in Ontario. However, translating policy into practice can be challenging. This paper reports results from a province-wide survey of early psychosis intervention programs to assess the extent to which equity has been incorporated into program delivery. All 56 programs (100%) completed the survey. Results found that while most programs perceive that they are meeting equity aims, they reported limited use of practices to support this aim, and few systematically collect information on performance. Strategies to improve equity in practice are discussed.
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Affiliation(s)
- Avra Selick
- Research Coordinator, Provincial System Support Program, Centre for Addiction and Mental Health, Toronto, ON
| | - Alexandra Lamoureux
- Equity and Engagement Coordinator, Provincial System Support Program, Centre for Addiction and Mental Health, Toronto, ON
| | - Karen O'Connor
- Senior Director, Clinical Programs and Strategic Planning, Canadian Mental Health Association, Peel Dufferin Branch, Brampton, ON
| | - Janet Durbin
- Independent Scientist, Provincial System Support Program, Centre for Addiction and Mental Health, Toronto, ON
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Selick A, Durbin J, Vu N, O'Connor K, Volpe T, Lin E. Barriers and facilitators to implementing family support and education in Early Psychosis Intervention programmes: A systematic review. Early Interv Psychiatry 2017; 11:365-374. [PMID: 28418227 DOI: 10.1111/eip.12400] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 09/20/2016] [Indexed: 11/28/2022]
Abstract
Family support is a core component of the Early Psychosis Intervention (EPI) model, yet it continues to have relatively low rates of implementation in practice. This paper reports results of a literature review on facilitators and barriers to delivering family interventions in EPI programmes. A search was conducted of 4 electronic databases, Medline, EMBASE, PsycINFO and Joanna Briggs, from 2000 to 2015 using terms related to early onset psychosis, family work and implementation. Four thousand four hundred and two unique studies were identified, 7 of which met inclusion criteria. Barriers and facilitators were coded and aggregated to higher-level themes using a consensus approach. Five of 7 studies examined structured multifamily psychoeducation. Uptake by families was affected by: family/client interest and readiness to participate; ability to access supports; and support needs/preferences. Implementation by programmes was affected by staff access to training and resources to provide family support. A key finding across the identified studies was that families have different needs and preferences regarding the timing, length, intensity and content of the intervention. One size does not fit all and many families do not require the intensive psychoeducational programmes typically provided. The reviewed literature suggests that flexible, tiered approaches to care may better meet family needs and increase rates of uptake of family support. However, more research is needed on the effectiveness of different models of family support in early psychosis and how they can be successfully implemented.
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Affiliation(s)
- Avra Selick
- Provincial System Support Program Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Janet Durbin
- Provincial System Support Program Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Nhi Vu
- Provincial System Support Program Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Karen O'Connor
- Canadian Mental Health Association, Peel Dufferin Branch, Brampton, Ontario, Canada
| | - Tiziana Volpe
- Provincial System Support Program Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Elizabeth Lin
- Provincial System Support Program Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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Durbin J, Selick A, Hierlihy D, Moss S, Cheng C. A first step in system improvement: a survey of Early Psychosis Intervention Programmes in Ontario. Early Interv Psychiatry 2016; 10:485-493. [PMID: 25366518 DOI: 10.1111/eip.12201] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 09/24/2014] [Indexed: 11/30/2022]
Abstract
AIM Ontario, Canada is a large province with a geographically dispersed population. Early psychosis intervention (EPI) programmes are available province-wide, with delivery approaches adapted to context. This study examined EPI programme delivery in relation to recently released provincial EPI Program Standards, and variations based on geographic context. METHODS The data source was a province-wide key informant survey of early psychosis programmes conducted after release of the Standards. Chi-squared tests compared large- and small-area programmes on selected programme structural features and perceived adherence to 19 service components. RESULTS Responses were obtained from 52 programme sites, including 21 small-area programmes with 1 to 2 staff. In general, frequency of EPI delivery was highest for individual assessment and treatment components, and moderate for social supports and family support. Implementation was lowest for public education, early detection and recovery planning. Small-area programmes reported lower implementation for over half of the components, with differences statistically significant for psychiatric assessment and physical health monitoring. CONCLUSION Since the release of the Standards, the Ontario Ministry of Health has partnered with a provincial network of EPI stakeholders to support practice improvement. This survey identified components where more implementation support is needed, overall and for rural area delivery. Ultimately, systematic monitoring of programme fidelity and measuring client outcomes are key to advancing the quality of EPI programme delivery.
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Affiliation(s)
- Janet Durbin
- Performance Measurement and Implementation Research Unit, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
| | - Avra Selick
- Performance Measurement and Implementation Research Unit, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | | | - Sarah Moss
- Performance Measurement and Implementation Research Unit, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Chiachen Cheng
- First Place, Canadian Mental Health Association - Thunder Bay Branch, Thunder Bay, Ontario, Canada
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Lin E, Balogh R, McGarry C, Selick A, Dobranowski K, Wilton AS, Lunsky Y. Substance-related and addictive disorders among adults with intellectual and developmental disabilities (IDD): an Ontario population cohort study. BMJ Open 2016; 6:e011638. [PMID: 27591020 PMCID: PMC5020882 DOI: 10.1136/bmjopen-2016-011638] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES Describe the prevalence of substance-related and addictive disorders (SRAD) in adults with intellectual and developmental disabilities (IDD) and compare the sociodemographic and clinical characteristics of adults with IDD and SRAD to those with IDD or SRAD only. DESIGN Population-based cohort study (the Health Care Access Research and Development Disabilities (H-CARDD) cohort). SETTING All legal residents of Ontario, Canada. PARTICIPANTS 66 484 adults, aged 18-64, with IDD identified through linked provincial health and disability income benefits administrative data from fiscal year 2009. 96 589 adults, aged 18-64, with SRAD but without IDD drawn from the provincial health administrative data. MAIN OUTCOME MEASURES Sociodemographic (age group, sex, neighbourhood income quintile, rurality) and clinical (psychiatric and chronic disease diagnoses, morbidity) characteristics. RESULTS The prevalence of SRAD among adults with IDD was 6.4%, considerably higher than many previous reports and also higher than found for adults without IDD in Ontario (3.5%). Among those with both IDD and SRAD, the rate of psychiatric comorbidity was 78.8%, and the proportion with high or very high overall morbidity was 59.5%. The most common psychiatric comorbidities were anxiety disorders (67.6%), followed by affective (44.6%), psychotic (35.8%) and personality disorders (23.5%). These adults also tended to be younger and more likely to live in the poorest neighbourhoods compared with adults with IDD but no SRAD and adults with SRAD but no IDD. CONCLUSIONS SRAD is a significant concern for adults with IDD. It is associated with high rates of psychiatric and other comorbidities, indicating that care coordination and system navigation may be important concerns. Attention should be paid to increasing the recognition of SRAD among individuals with IDD by both healthcare and social service providers and to improving staff skills in successfully engaging those with both IDD and SRAD.
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Affiliation(s)
- Elizabeth Lin
- Provincial System Support Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Robert Balogh
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Ontario, Canada
| | | | - Avra Selick
- Provincial System Support Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Kristin Dobranowski
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Ontario, Canada
| | - Andrew S Wilton
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Yona Lunsky
- Underserved Populations Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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Durbin J, Selick A, Casson I, Green L, Spassiani N, Perry A, Lunsky Y. Evaluating the Implementation of Health Checks for Adults With Intellectual and Developmental Disabilities in Primary Care: The Importance of Organizational Context. Intellect Dev Disabil 2016; 54:136-150. [PMID: 27028255 DOI: 10.1352/1934-9556-54.2.136] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Compared to other adults, those with intellectual and developmental disabilities have more health issues, yet are less likely to receive preventative care. One strategy that has shown success in increasing prevention activities and early detection of illness is the periodic comprehensive health assessment (the health check). Effectively moving evidence into practice is a complex process that often receives inadequate attention. This qualitative study evaluates the implementation of the health check at two primary-care clinics in Ontario, Canada, and the influence of the clinic context on implementation decisions. Each clinic implemented the same core components; however, due to contextual differences, some components were operationalized differently. Adapting to the setting context is important to ensuring successful and sustainable implementation.
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Affiliation(s)
- Janet Durbin
- Janet Durbin and Avra Selick, Centre for Addiction and Mental Health, University of Toronto, Ontario, Canada
| | - Avra Selick
- Janet Durbin and Avra Selick, Centre for Addiction and Mental Health, University of Toronto, Ontario, Canada
| | - Ian Casson
- Ian Casson, Queen's University, Kingston, Ontario, Canada
| | - Laurie Green
- Laurie Green, St Michael's Hospital, University of Toronto, Ontario, Canada
| | - Natasha Spassiani
- Natasha Spassiani, Andrea Perry, and Yona Lunsky, Centre for Addiction and Mental Health, University of Toronto, Ontario, Canada
| | - Andrea Perry
- Natasha Spassiani, Andrea Perry, and Yona Lunsky, Centre for Addiction and Mental Health, University of Toronto, Ontario, Canada
| | - Yona Lunsky
- Natasha Spassiani, Andrea Perry, and Yona Lunsky, Centre for Addiction and Mental Health, University of Toronto, Ontario, Canada
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Lin E, Balogh R, Isaacs B, Ouellette-Kuntz H, Selick A, Wilton AS, Cobigo V, Lunsky Y. Strengths and Limitations of Health and Disability Support Administrative Databases for Population-Based Health Research in Intellectual and Developmental Disabilities. Journal of Policy and Practice in Intellectual Disabilities 2015. [DOI: 10.1111/jppi.12098] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Elizabeth Lin
- Centre for Addiction and Mental Health; Toronto Canada
| | - Robert Balogh
- University of Ontario Institute of Technology; Oshawa Canada
| | | | | | - Avra Selick
- Centre for Addiction and Mental Health; Toronto Canada
| | | | | | - Yona Lunsky
- Centre for Addiction and Mental Health; Toronto Canada
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Abstract
PURPOSE Our purpose was to characterize and describe anesthesia practice in programs performing IVF in the United States. METHODS We used a telephone survey requiring respondents to be either the program director, a physician, or a nurse familiar with the practice. Two hundred seven (78%) Society of Assisted Reproductive Technology (SART) registered programs agreed to participate. Programs were divided by geographic region and type of practice (academic versus private). RESULTS Ninety-one private (68%) and 41 academic (56%) programs used personnel provided by the Department of Anesthesiology. Conscious sedation was performed most commonly (95%). The remaining 5% used primarily either general, regional, or local anesthesia. Typical recovery times were 90 to 120 min. Average costs of anesthetic administration were $300- $400 and were similar among groups except for the Eastern academic programs, with a higher mean cost of $543. Programs using personnel from anesthesiology reported higher costs compared to programs utilizing their own staff ($391 +/- 15 vs $157 +/- 11; P < 0.05). Complications were infrequent (< 10%); no hospitalizations or serious life-threatening incidents were reported. CONCLUSIONS A large number of programs safely used their own trained personnel to deliver anesthesia, and realized a significant reduction in cost.
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Affiliation(s)
- E C Ditkoff
- Department of Obstetrics and Gynecology, Columbia Presbyterian Medical Center, Columbia University College of Physicians & Surgeons, New York, New York 10032, USA
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Smith JA, Selick A, Edelist G. A clinical and microbiological study of venous catheterization. Can Med Assoc J 1973; 109:115-7 passim. [PMID: 4198593 PMCID: PMC1946799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
In a prospective study of 210 intravenous catheters and needles 31 (15%) swabs yielded 34 microbial isolates. Twenty-eight were "non-pathogenic" skin commensals and six were "pathogenic" organisms. Commensals were isolated predominantly from catheters left in situ for only a short time (up to two days) and pathogenic organisms most frequently from specimens left in situ for a longer time. Correlation was not confirmed between colonization and infection, antibiotic therapy or phlebitis. All samples of IV fluids were sterile on culture. Changing the IV catheter at least every two days is recommended.
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