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Zentner KE, Shettell K, Abba-Aji A, Robles M. Supporting patients by family education in psychotic illness: a longitudinal pre-post study protocol. BMJ Open 2023; 13:e072881. [PMID: 37879701 PMCID: PMC10603450 DOI: 10.1136/bmjopen-2023-072881] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 09/22/2023] [Indexed: 10/27/2023] Open
Abstract
INTRODUCTION A lack of education, resources and support for family carers of young adults with psychotic illnesses leaves them ill-equipped to support their loved one. By equipping families with skills and knowledge, public healthcare harnesses a powerful ally to support community stabilisation. AIMS The primary goal is to study the effect of a psychoeducation intervention for family carers supporting young adults with psychosis on family burden and stabilisation of service users. METHODS AND ANALYSIS A longitudinal quantitative study with a pre-post design will be used to assess the long-term effectiveness of the psychoeducation intervention for family carers supporting a young adult with psychosis. 111 family carers will be recruited for the intervention and measures will be taken from family carer participants and their matched young adult service users. Nine evidence and family peer-informed and expert-reviewed psychoeducation modules are administered in 2-hour sessions over 9 weeks to family carers. Functional index measures are administered preintervention, and at 6-month, 12-month and 24-month follow-up. Service utilisation will be measured during a 12-month period preintervention, a 12-month period postintervention and during a 12-24-month period post-intervention. ETHICS AND DISSEMINATION The study has been reviewed and approved by the University of Alberta Research Ethics Board (Pro00110691). This novel methodological approach to studying family psychoeducation interventions addresses unique methodological challenges and limitations and will be disseminated through peer-reviewed publications and academic and medical conferences. TRIAL REGISTRATION NUMBER NCT05500001; National Institutes of Health U.S. National Library of Medicine ClinicalTrials.gov.
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Affiliation(s)
- Kristen Emily Zentner
- Department of Psychology, Concordia University of Edmonton, Edmonton, Alberta, Canada
| | | | - Adam Abba-Aji
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada
- Alberta Hospital Edmonton, Edmonton, Alberta, Canada
| | - Melanie Robles
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
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LeBlanc S, MacDonald S, Martin M, Dalgarno N, Schultz K. Development of learning objectives for a medical assistance in dying curriculum for Family Medicine Residency. BMC Med Educ 2022; 22:167. [PMID: 35272655 PMCID: PMC8915495 DOI: 10.1186/s12909-022-03204-1] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 02/18/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Medical assistance in dying (MAID) became legal across Canada when Bill C-14 was passed in 2016. Currently, little is known about the most effective strategies for providing MAID education, and the importance of integrating MAID into existing curricula. In this study, a set of learning objectives (LOs) was developed to inform a foundational MAID curriculum in Canadian Family Medicine (FM) residency training programs. METHODS Mixed methods were used to develop LOs based on a published needs assessment from a large, four-site family medicine residency program in southeastern Ontario. Draft LOs were evaluated and revised by faculty and resident leaders using a modified Delphi process and a focus group. LOs were mapped to the existing family medicine residency curriculum, as well as the College of Family Physicians of Canada's Priority Topics. RESULTS Nine LOs were developed to provide a foundational education regarding MAID. While all LOs could be mapped to the Domains of Clinical Care within the departmental curriculum, they mapped inconsistently to departmental Entrustable Professional Activities and the Priority Topics. LOs focused on patient education and identification of patient goals were most readily mapped to existing curricular framework, while LOs with MAID-exclusive content revealed gaps in the current curriculum. CONCLUSIONS The developed LOs provide a guide to ensure family medicine residents obtain generalist-level knowledge to counsel their patients about MAID. These LOs can serve as a model for developing LOs for both family medicine and specialist residency programs in Canada and in countries where MAID is legal.
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Affiliation(s)
- Sarah LeBlanc
- Department of Family Medicine, Queen's University, ON, Kingston, Canada.
| | - Susan MacDonald
- Department of Family Medicine, Queen's University, ON, Kingston, Canada
| | - Mary Martin
- Department of Family Medicine, Queen's University, ON, Kingston, Canada
| | - Nancy Dalgarno
- Office of Professional Development and Educational Scholarship, Queen's University, ON, Kingston, Canada
| | - Karen Schultz
- Department of Family Medicine, Queen's University, ON, Kingston, Canada
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Tan A, Spice R, Sinnarajah A. Family physicians supporting patients with palliative care needs within the patient medical home in the community: an appreciative inquiry study. BMJ Open 2021; 11:e048667. [PMID: 34857557 PMCID: PMC8640631 DOI: 10.1136/bmjopen-2021-048667] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Canadians want to live and die in their home communities. Unfortunately, Canada has the highest proportion of deaths in acute care facilities as compared with other developed nations. This study aims to identify the essential components required to best support patients and families with palliative care needs in their communities to inform system changes and empower family physicians (FPs) in providing community-based palliative care for patients. DESIGN Appreciative inquiry (AI) methodology with individual interviews. Interview transcripts were analysed iteratively for emerging themes and used to develop 'possibility statements' to frame discussion in subsequent focus groups. A conceptual framework emerged to describe the 'destiny' state as per AI methods. SETTING FPs, palliative home care providers, patients and bereaved caregivers were recruited in the urban and surrounding rural health authority zones of Calgary, AB, Canada. PARTICIPANTS 9 females and 9 males FPs (range of practice years 2-42) in interviews; 8 bereaved caregivers, 1 patient, 26 palliative home care team members in focus groups. Interviews and focus groups were recorded digitally and transcribed with consent. RESULTS The identified themes that transcended all three groups created the foundation for the conceptual framework. Enhanced communication and fostering team relationships between all care providers with the focus on the patient and caregivers was the cornerstone concept. The FP/patient relationship must be protected and encouraged by all care providers, while more system flexibility is needed to respond more effectively to patients. These concepts must exist in the context that patients and caregivers need more education regarding the benefits of palliative care, while increasing public discourse about mortality. CONCLUSIONS Key areas were identified for how the patient's team can work together effectively to improve the patient and caregiver palliative care journey in the community with the cornerstone element of building on the trusting FP-patient longitudinal relationship.
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Affiliation(s)
- Amy Tan
- Palliative Care, The University of British Columbia, Victoria, British Columbia, Canada
- Family Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Ronald Spice
- Family Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- Palliative Care, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Aynharan Sinnarajah
- Palliative Care, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
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Bayoumi I, Parkin PC, Lebovic G, Patel R, Link K, Birken CS, Maguire JL, Borkhoff CM. Iron deficiency among low income Canadian toddlers: a cross-sectional feasibility study in a Community Health Centre and non-Community Health Centre sites. BMC Fam Pract 2018; 19:161. [PMID: 30249193 PMCID: PMC6154825 DOI: 10.1186/s12875-018-0848-9] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 09/17/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Iron deficiency in early childhood has been associated with poor developmental outcomes. Little is known about the nutritional health of young children receiving care at Canadian Community Health Centres (CHCs). Our objectives were to describe iron deficiency among toddlers at an Ontario CHC, to compare young children attending CHCs and non-CHCs, and assess the feasibility of conducting research on children in CHC settings. METHODS One CHC, Kingston Community Health Centres (CHC) with two clinical sites and one community programming site was added to the nine non-CHC pediatric and primary care clinics in the existing TARGet Kids! research network. A cross-sectional feasibilitystudy was conducted.and. Healthy children, ages 12-36 months were Enrolled. iron deficiency without inflammation (ferritin< 14 μg/L and CRP < 10 mg/L) and serum ferritin were assessed. Adjusted multivariable regression analyses were used to evaluate an association between CHC enrolment and iron status. RESULTS The CHC cohort (n = 31) was older, had lower household income, lower maternal education, higher nutrition risk scores, higher cow's milk intake, shorter breastfeeding duration and higher prevalence of unhealthy weights compared with the non-CHC cohort (n = 875). There was no association between CHC status and serum ferritin (difference in median serum ferritin 4.78 μg/L, 95% confidence interval [CI] -2.5, 14.3, p = 0.22) or iron deficiency (OR 0.55, 95% CI 0.11, - 2.73, p = 0.46) using multivariable linear and logistic regression, respectively. CONCLUSION Despite differences in sociodemographic variables, we did not detect a difference in iron status between toddlers enrolled at CHCs compared to non-CHC settings. Further research is needed to understand the health effects of poverty generally, and iron deficiency specifically among children receiving care at CHCs.
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Affiliation(s)
- Imaan Bayoumi
- Department of Family Medicine, Queen’s University, 220 Bagot St., P.O. Bag 8888, Kingston, ON K7L5E9 Canada
| | - Patricia C. Parkin
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, ON Canada
- Sick Kids Research Institute, Toronto, ON Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON Canada
- Division of Paediatric Medicine, Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, ON Canada
| | - Gerald Lebovic
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON Canada
- Applied Health Research Centre (AHRC), Toronto, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON Canada
| | - Rupa Patel
- Department of Family Medicine, Queen’s University, 220 Bagot St., P.O. Bag 8888, Kingston, ON K7L5E9 Canada
- Kingston Community Health Centres, Kingston, Canada
| | - Kendra Link
- Kingston Community Health Centres, Kingston, Canada
| | - Catherine S. Birken
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, ON Canada
- Sick Kids Research Institute, Toronto, ON Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON Canada
- Division of Paediatric Medicine, Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, ON Canada
| | - Jonathon L. Maguire
- Division of Paediatric Medicine, Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, ON Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON Canada
- Department of Paediatrics, St. Michael’s Hospital, Toronto, ON Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON Canada
| | - Cornelia M. Borkhoff
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, ON Canada
- Sick Kids Research Institute, Toronto, ON Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON Canada
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Kouyoumdjian FG, Cheng SY, Fung K, Orkin AM, McIsaac KE, Kendall C, Kiefer L, Matheson FI, Green SE, Hwang SW. The health care utilization of people in prison and after prison release: A population-based cohort study in Ontario, Canada. PLoS One 2018; 13:e0201592. [PMID: 30075019 PMCID: PMC6075755 DOI: 10.1371/journal.pone.0201592] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 07/18/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Many people experience imprisonment each year, and this population bears a disproportionate burden of morbidity and mortality. States have an obligation to provide equitable health care in prison and to attend to care on release. Our objective was to describe health care utilization in prison and post-release for persons released from provincial prison in Ontario, Canada in 2010, and to compare health care utilization with the general population. METHODS We conducted a population-based retrospective cohort study. We included all persons released from provincial prison to the community in 2010, and age- and sex-matched general population controls. We linked identities for persons released from prison to administrative health data. We matched each person by age and sex with four general population controls. We examined ambulatory care and emergency department utilization and medical-surgical and psychiatric hospitalization, both in prison and in the three months after release to the community. We compared rates with those of the general population. RESULTS The rates of all types of health care utilization were significantly higher in prison and on release for people released from prison (N = 48,861) compared to general population controls (N = 195,444). Comparing those released from prison to general population controls in prison and in the 3 months after release, respectively, utilization rates were 5.3 (95% CI 5.2, 5.4) and 2.4 (95% CI 2.4, 2.5) for ambulatory care, 3.5 (95% CI 3.3, 3.7) and 5.0 (95% CI 4.9, 5.3) for emergency department utilization, 2.3 (95% CI 2.0, 2.7) and 3.2 (95% CI 2.9, 3.5) for medical-surgical hospitalization, and 21.5 (95% CI 16.7, 27.7) and 17.5 (14.4, 21.2) for psychiatric hospitalization. Comparing the time in prison to the week after release, ambulatory care use decreased from 16.0 (95% CI 15.9,16.1) to 10.7 (95% CI 10.5, 10.9) visits/person-year, emergency department use increased from 0.7 (95% CI 0.6, 0.7) to 2.6 (95% CI 2.5, 2.7) visits/person-year, and hospitalization increased from 5.4 (95% CI 4.8, 5.9) to 12.3 (95% CI 10.1, 14.6) admissions/100 person-years for medical-surgical reasons and from 8.6 (95% CI 7.9, 9.3) to 17.3 (95% CI 14.6, 20.0) admissions/100 person-years for psychiatric reasons. CONCLUSIONS Across care types, health care utilization in prison and on release is elevated for people who experience imprisonment in Ontario, Canada. This may reflect high morbidity and suboptimal access to quality health care. Future research should identify reasons for increased use and interventions to improve care.
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Affiliation(s)
- Fiona G. Kouyoumdjian
- Department of Family Medicine, McMaster University, Hamilton, Canada
- St. Michael’s Hospital, Toronto, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Canada
- * E-mail:
| | | | - Kinwah Fung
- Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Aaron M. Orkin
- Schwartz/Reisman Emergency Medicine Institute, Sinai Health System, Toronto, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | | | - Claire Kendall
- Institute for Clinical Evaluative Sciences, Toronto, Canada
- C.T. Lamont Primary Health Care Research Group, Bruyère Research Institute, Ottawa, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Canada
| | - Lori Kiefer
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Ontario Ministry of Community Safety and Correctional Services, Toronto, Canada
| | - Flora I. Matheson
- St. Michael’s Hospital, Toronto, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Canada
- Centre for Criminology and Sociolegal Studies, University of Toronto, Toronto, Canada
| | - Samantha E. Green
- St. Michael’s Hospital, Toronto, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Stephen W. Hwang
- St. Michael’s Hospital, Toronto, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Canada
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McCracken R, McCormack J, McGregor MJ, Wong ST, Garrison S. Associations between polypharmacy and treatment intensity for hypertension and diabetes: a cross-sectional study of nursing home patients in British Columbia, Canada. BMJ Open 2017; 7:e017430. [PMID: 28801438 PMCID: PMC5724061 DOI: 10.1136/bmjopen-2017-017430] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [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: 01/23/2023] Open
Abstract
OBJECTIVES Describe nursing home polypharmacy prevalence in the context of prescribing for diabetes and hypertension and determine possible associations between lower surrogate markers for treated hypertension and diabetes (overtreatment) and polypharmacy. DESIGN Cross-sectional study. SETTING 6 nursing homes in British Columbia, Canada. PARTICIPANTS 214 patients residing in one of the selected facilities during data collection period. PRIMARY AND SECONDARY OUTCOME MEASURES Polypharmacy was defined as ≥9 regular medications. Overtreatment of diabetes was defined as being prescribed at least one hypoglycaemic medication and a glycosylated haemoglobin (HbA1c) ≤7.5%. Overtreatment of hypertension required being prescribed at least one hypertension medication and having a systolic blood pressure ≤128 mm Hg. Polypharmacy prescribing, independent of overtreatment, was calculated by subtracting condition-specific medications from total medications prescribed. RESULTS Data gathering was completed for 214 patients, 104 (48%) of whom were prescribed ≥9 medications. All patients were very frail. Patients with polypharmacy were more likely to have a diagnosis of hypertension (p=0.04) or congestive heart failure (p=0.003) and less likely to have a diagnosis of dementia (p=0.03). Patients with overtreated hypertension were more likely to also experience polypharmacy (Relative Risk (RR))1.77 (1.07 to 2.96), p=0.027). Patients with overtreated diabetes were prescribed more non-diabetic medications than those with a higher HbA1c (11.0±3.7vs 7.2±3.1, p=0.01). CONCLUSION Overtreated diabetes and hypertension appear to be prevalent in nursing home patients, and the presence of polypharmacy is associated with more aggressive treatment of these risk factors. The present study was limited by its small sample size and cross-sectional design. Further study of interventions designed to reduce overtreatment of hypertension and diabetes is needed to fully understand the potential links between polypharmacy and potential of harms of condition-specific overtreatment.
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Affiliation(s)
- Rita McCracken
- Department of Family Medicine, Providence Health Care, Vancouver, Canada
- Department of Family Practice, University of British Columbia, Vancouver, Canada
| | - James McCormack
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
| | - Margaret J McGregor
- Department of Family Practice, University of British Columbia, Vancouver, Canada
- Centre for Clinical Epidemiology and Evaluation, University of British Columbia, Vancouver, Canada
| | - Sabrina T Wong
- Department of Family Practice, University of British Columbia, Vancouver, Canada
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, Canada
- School of Nursing, University of British Columbia, Vancouver, Canada
| | - Scott Garrison
- Department of Family Medicine, University of Alberta, Edmonton, Canada
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