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Brooks HL, Speed KA, Dong K, Salvalaggio G, Pauly B(B, Taylor M, Hyshka E. Perspectives of patients who inject drugs on a needle and syringe program at a large acute care hospital. PLoS One 2024; 19:e0297584. [PMID: 38359010 PMCID: PMC10868849 DOI: 10.1371/journal.pone.0297584] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 01/08/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND People who inject drugs in North America often continue to inject while hospitalized, and are at increased risk of premature hospital discharge, unplanned readmission, and death. In-hospital access to sterile injection supplies may reduce some harms associated with ongoing injection drug use. However, access to needle and syringe programs in acute care settings is limited. We explored the implementation of a needle and syringe program integrated into a large urban tertiary hospital in Western Canada. The needle and syringe program was administered by an addiction medicine consult team that offers patients access to specialized clinical care and connection to community services. METHODS We utilized a focused ethnographic design and semi-structured interviews to elicit experiences and potential improvements from 25 hospitalized people who inject drugs who were offered supplies from the needle and syringe program. RESULTS Participants were motivated to accept supplies to prevent injection-related harms and access to supplies was facilitated by trust in consult team staff. However, fears of negative repercussions from non-consult team staff, including premature discharge or undesired changes to medication regimes, caused some participants to hesitate or refuse to accept supplies. Participants described modifications to hospital policies regarding inpatient drug use or access to an inpatient supervised consumption service as potential ways to mitigate patients' fears. CONCLUSIONS Acute care needle and syringe programs may aid hospital providers in reducing harms and improving hospital outcomes for people who inject drugs. However, modifications to hospital policies and settings may be necessary.
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Affiliation(s)
- Hannah L. Brooks
- School of Public Health, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Kelsey A. Speed
- School of Public Health, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Kathryn Dong
- Department of Emergency Medicine, Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Ginetta Salvalaggio
- Department of Family Medicine, Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Bernadette (Bernie) Pauly
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, British Columbia, Canada
| | - Marliss Taylor
- Streetworks, Boyle Street Community Services, Edmonton, Alberta, Canada
| | - Elaine Hyshka
- School of Public Health, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
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Browne AJ, Varcoe C, Ford-Gilboe M, Nadine Wathen C, Smye V, Jackson BE, Wallace B, Pauly B(B, Herbert CP, Lavoie JG, Wong ST, Blanchet Garneau A. Disruption as opportunity: Impacts of an organizational health equity intervention in primary care clinics. Int J Equity Health 2018; 17:154. [PMID: 30261924 PMCID: PMC6161402 DOI: 10.1186/s12939-018-0820-2] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 07/10/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The health care sector has a significant role to play in fostering equity in the context of widening global social and health inequities. The purpose of this paper is to illustrate the process and impacts of implementing an organizational-level health equity intervention aimed at enhancing capacity to provide equity-oriented health care. METHODS The theoretically-informed and evidence-based intervention known as 'EQUIP' included educational components for staff, and the integration of three key dimensions of equity-oriented care: cultural safety, trauma- and violence-informed care, and tailoring to context. The intervention was implemented at four Canadian primary health care clinics committed to serving marginalized populations including people living in poverty, those facing homelessness, and people living with high levels of trauma, including Indigenous peoples, recent immigrants and refugees. A mixed methods design was used to examine the impacts of the intervention on the clinics' organizational processes and priorities, and on staff. RESULTS Engagement with the EQUIP intervention prompted increased awareness and confidence related to equity-oriented health care among staff. Importantly, the EQUIP intervention surfaced tensions that mirrored those in the wider community, including those related to racism, the impacts of violence and trauma, and substance use issues. Surfacing these tensions was disruptive but led to focused organizational strategies, for example: working to address structural and interpersonal racism; improving waiting room environments; and changing organizational policies and practices to support harm reduction. The impact of the intervention was enhanced by involving staff from all job categories, developing narratives about the socio-historical context of the communities and populations served, and feeding data back to the clinics about key health issues in the patient population (e.g., levels of depression, trauma symptoms, and chronic pain). However, in line with critiques of complex interventions, EQUIP may not have been maximally disruptive. Organizational characteristics (e.g., funding and leadership) and characteristics of intervention delivery (e.g., timeframe and who delivered the intervention components) shaped the process and impact. CONCLUSIONS This analysis suggests that organizations should anticipate and plan for various types of disruptions, while maximizing opportunities for ownership of the intervention by those within the organization. Our findings further suggest that equity-oriented interventions be paced for intense delivery over a relatively short time frame, be evaluated, particularly with data that can be made available on an ongoing basis, and explicitly include a harm reduction lens.
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Affiliation(s)
- Annette J. Browne
- School of Nursing, The University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC V6T 2B5 Canada
| | - Colleen Varcoe
- School of Nursing, The University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC V6T 2B5 Canada
| | - Marilyn Ford-Gilboe
- Arthur Labatt Family School of Nursing, Western University, FIMS & Nursing Building, London, ON N6A 5B9 Canada
| | - C. Nadine Wathen
- Arthur Labatt Family School of Nursing, Western University, FIMS & Nursing Building, London, ON N6A 5B9 Canada
- Faculty of Information & Media Studies, Western University, FIMS & Nursing Building, London, ON N6A 5B9 Canada
| | - Victoria Smye
- Arthur Labatt Family School of Nursing, Western University, FIMS & Nursing Building, London, ON N6A 5B9 Canada
| | - Beth E. Jackson
- Public Health Agency of Canada, 785 Carling Avenue, AL 6809B, Ottawa, ON K1A 0K9 Canada
| | - Bruce Wallace
- School of Social Work, University of Victoria, PO Box 1700, STN CSC, Victoria, BC V8W 2Y2 Canada
| | - Bernadette (Bernie) Pauly
- Canadian Institute for Substance Use Research, and School of Nursing, University of Victoria, Victoria, BC V8W 2Y2 Canada
| | - Carol P. Herbert
- School of Population and Public Health, The University of British Columbia, and Centre for Studies in Family Medicine, The Western Centre for Public Health and Family Medicine, Western University, London, ON N6A 3K7 Canada
| | - Josée G. Lavoie
- Department of Community Health Sciences and Ongomiizwin – Research, Indigenous Institute of Health and Healing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB MB R3E 3P5 Canada
| | - Sabrina T. Wong
- Centre for Health Services and Policy Research and School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC V6T 2B5 Canada
| | - Amelie Blanchet Garneau
- Faculty of Nursing, Universite de Montreal, PO Box 6128, Centre-ville Station, Montreal, QC H3C 3J7 Canada
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Martin W, Wharf Higgins J, Pauly B(B, MacDonald M. "Layers of translation" - evidence literacy in public health practice: a qualitative secondary analysis. BMC Public Health 2017; 17:803. [PMID: 29020953 PMCID: PMC5637261 DOI: 10.1186/s12889-017-4837-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 10/06/2017] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Strengthening public health systems has been a concern in Canada in the wake of public health emergencies. In one Canadian province, British Columbia, a high priority has been placed on the role of evidence to guide decision making; however, there are numerous challenges to using evidence in practice. The National Collaborating Centre for Methods and Tools therefore developed the Evidence Informed Public Health Framework (EIPH), a seven step guide to assist public health practitioners to use evidence in practice. We used this framework to examine the evidence literacy of public health practitioners in BC. METHODS We conducted a secondary analysis of two separate qualitative studies on the public health renewal process in which the use and understanding of evidence were key interview questions. Using constant comparative analysis, we analyzed the evidence-related data, mapping it to the categories of the EIPH framework. RESULTS Participants require both data and evidence for multiple purposes in their daily work; data may be more important to them than research evidence. They are keen to provide evidence-based programs in which research evidence is balanced with community knowledge and local data. Practitioners recognise appraisal as an important step in using evidence, but the type of evidence most often used in daily practice does not easily lend itself to established methods for appraising research evidence. In the synthesis stage of the EIPH process, synthesized evidence in the form of systematic reviews and practice guidelines is emphasized. Participants, however, need to synthesize across the multiple forms of evidence they use and see the need for more skill and resources to help them develop skill in this type of synthesis. CONCLUSIONS Public health practitioners demonstrated a good level of evidence literacy, particularly at the collective level in the organization. The EIPH framework provides helpful guidance in how to use research evidence in practice, but it lacks support on appraising and synthesizing across the various types of evidence that practitioners consider essential in their practice. We can better support practitioners by appreciating the range of evidence they use and value and by creating tools that help them to do this.
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Affiliation(s)
- Wanda Martin
- College of Nursing, University of Saskatchewan, PO Box 6, 104 Clinic Place, Saskatoon, SK S7N 2Z4 Canada
| | - Joan Wharf Higgins
- Exercise Science, Physical & Health Education, University of Victoria, Box 1700 STN CSC, Victoria, BC V8W 2Y2 Canada
| | - Bernadette (Bernie) Pauly
- School of Nursing, Centre for Addictions Research of BC, University of Victoria, Box 1700 STN CSC, Victoria, BC V8W 2Y2 Canada
| | - Marjorie MacDonald
- School of Nursing, Centre for Addictions Research of BC, University of Victoria, Box 1700 STN CSC, Victoria, BC V8W 2Y2 Canada
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Pauly B(B, MacDonald M, Hancock T, Martin W, Perkin K. Reducing health inequities: the contribution of core public health services in BC. BMC Public Health 2013; 13:550. [PMID: 23738840 PMCID: PMC3681553 DOI: 10.1186/1471-2458-13-550] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [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] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 05/15/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Within Canada, many public health leaders have long identified the importance of improving the health of all Canadians especially those who face social and economic disadvantages. Future improvements in population health will be achieved by promoting health equity through action on the social determinants of health. Many Canadian documents, endorsed by government and public health leaders, describe commitments to improving overall health and promoting health equity. Public health has an important role to play in strengthening action on the social determinants and promoting health equity. Currently, public health services in British Columbia are being reorganized and there is a unique opportunity to study the application of an equity lens in public health and the contribution of public health to reducing health inequities. Where applicable, we have chosen mental health promotion, prevention of mental disorders and harms of substance use as exemplars within which to examine specific application of an equity lens. METHODS/DESIGN This research protocol is informed by three theoretical perspectives: complex adaptive systems, critical social justice, and intersectionality. In this program of research, there are four inter-related research projects with an emphasis on both integrated and end of grant knowledge translation. Within an overarching collaborative and participatory approach to research, we use a multiple comparative case study research design and are incorporating multiple methods such as discourse analysis, situational analysis, social network analysis, concept mapping and grounded theory. DISCUSSION An important aim of this work is to help ensure a strong public health system that supports public health providers to have the knowledge, skills, tools and resources to undertake the promotion of health equity. This research will contribute to increasing the effectiveness and contributions of public health in reducing unfair and inequitable differences in health among population groups. As a collaborative effort between public health practitioners/decision makers and university researchers, this research will provide important understanding and insights about the implementation of the changes in public health with a specific focus on health equity, the promotion of mental health and the prevention of harms of substance use.
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Affiliation(s)
- Bernadette (Bernie) Pauly
- School of Nursing and, Centre for Addictions Research of BC (CARBC), University of Victoria, Box 1700 STN CSC, Victoria, BC V8W 2Y2, Canada
| | - Marjorie MacDonald
- School of Nursing, University of Victoria, Box 1700 STN CSC, Victoria, BC V8W 2Y2, Canada
| | - Trevor Hancock
- School of Public Health and Social Policy, University of Victoria, Box 1700 STN CSC, Victoria, BC V8W 2Y2, Canada
| | - Wanda Martin
- School of Nursing, University of Victoria, Box 1700 STN CSC, Victoria, BC V8W 2Y2, Canada
| | - Kathleen Perkin
- Centre for Addictions Research of BC, University of Victoria, Box 1700 STN CSC, Victoria, BC V8W 2Y2, Canada
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Pauly B(B, Goldstone I. Harm reduction in nursing practice: Current status and future directions. International Journal of Drug Policy 2008; 19:179-82. [DOI: 10.1016/j.drugpo.2008.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2008] [Accepted: 03/05/2008] [Indexed: 10/22/2022]
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