Primary Care Physician Engagement in Health System Transformation: A case study Background: Physician engagement describes a physicians’ personal feelings or emotion regarding their interaction with the organization in which they work as well as a process of ensuring interdisciplinary engagement. There is growing evidence that greater levels of physician care physician (PCP) engagement leads to better performance in hospitals, primary care settings and improved quality and safety outcomes for patients. Literature to date explores strategies to enhance physician engagement however, little is known about conducting and evaluating primary care physician engagement in real-time. Objectives: The purpose of this research is to explore how can PCPs be effectively engaged in health system reform and what are considered ‘best practices’ in evaluating this engagement? Specific study objectives include: 1) explore current strategies to engage PCPs in systems change; 2) describe strategies being used by Ontario Health Teams (OHTs) to facilitate and evaluate PCP engagement in systems level change; and 3) determine ‘best practices’ for evaluating PCP engagement in a large systems-level transformation level. Proposed Methods: We will use a descriptive, qualitative case study to explore PCP engagement within the OHTs to facilitate and evaluate PCP engagement in systems level change. Document analysis, focus groups, and interviews guided by a constructivist paradigm will be used. Implications and Future Direction: This project will add to the field of knowledge by providing a description of PCP engagement in system reform, practical guidance for future PCP engagement efforts, and recommendations to support the evaluation of PCP engagement. Supporting the evaluation of primary care physician engagement will enable improved care for a greater patient population.
STAND Up for Health: The Feasibility, Usefulness, and Impact of Mobile STANDing Desks on the Sedentary Time of First-Year University Students Background: University students experience prolonged bouts of sitting due to student-related obligations, and the COVID-19 pandemic has further reduced activity opportunities. As university represents a critical transition period, promoting the use of mobile standing desks as a lifestyle tool could be feasible for reducing students’ sedentary time. Objectives: The aims of this study are to assess and explore the: (1) feasibility and usefulness of implementing a mobile standing desk intervention among first-year undergraduates living in residence; and (2) impact of mobile standing desks plus provision of Canadian 24-Hour Movement Guidelines compared to provision of the Guidelines alone on the sedentary time of first-year undergraduates living in residence. Proposed Methods: This mixed-methods pilot randomized controlled trial will include a sample of 100 first-year undergraduate students allocated to an intervention or control group via an online random number generator. The intervention group will receive a mobile standing desk for 6 weeks and both groups will receive Canada’s 24-Hour Movement Guidelines. Intervention participants will complete 12 self-report logs throughout the 6 weeks and open-ended questions pertaining to the feasibility and usefulness of the desks will be provided post-intervention. All participants will report sedentary time using the previously validated NIGHTLY-WEEK-U (NWU) questionnaire. Open-ended questions will be analyzed using inductive content analysis. Self-report logs will be analyzed by measures of central tendency, and ANOVAs will be conducted to analyze NWU results. Future Directions: If found effective, the findings of this study could provide an understanding of the feasibility and usefulness of mobile standing desks on the sedentary time of university students.
Surviving or Thriving? Exploring how Children & Caregivers in Ontario Cultivate Resilience in Response to the COVID-19 Pandemic Background: The COVID-19 pandemic has disrupted many aspects of life for children and their caregivers, including shifting educational and occupational demands. Coping with these changes amidst the pandemic requires tremendous resilience. Resilience is a term often used in government messaging about the responsibility of individuals to help restore societal well-being. Learning how experiential and discourse-oriented notions of resilience inform one another will enrich current knowledge about how children and their caregivers cultivate fortitude in response to profound socio-cultural disruptions at the population level and within the family. Objectives: The objective of this study is to examine how resilience is understood and deployed by children (aged 7-10) and their caregivers in Ontario during the COVID-19 pandemic. Method: This mixed-methods study is designed to include 40 caregiver-child dyads from schools across Ontario. Each member of the dyad will complete an online survey and interview, both of which will explore different facets of resilience and pandemic life more broadly. Children will also complete the innovative Me/We and visioning activities. Qualitative data will be analyzed using Thorne’s Interpretive Description and Foucauldian analysis approaches and quantitative survey data will be analyzed using measures of central tendency and dispersion, correlation, chi-squares, and paired-t-tests. Future Directions: This study data will be of value to government policies regarding education and occupational transition during the pandemic, educational practices, and supportive services for parents to help manage the many precarities that are part of everyday life under COVID-19.
Development of an Online Cognitive Behaviour Therapy Program for Caregivers of Persons with Spinal Cord Injury Objectives: Spinal cord injuries (SCI) have a devastating effect on individuals incurring this life-changing event; however, it also affects those involved in their care. Family caregivers often experience negative outcomes, including high levels of burden, emotional distress, and strain on relationships, leading to a decreased mental wellbeing. Guided internet-delivered cognitive behaviour therapy (ICBT) offers an evidence-based, accessible and flexible approach for psychosocial service delivery in the community. The study aims to adapt previously developed ICBT materials for use among caregivers of persons with SCI through a patient-oriented approach. Methods: A Patient-Oriented Research Committee has been formed of 7 individuals, including persons with lived experiences. Participatory action research methods and focus group guides are used to gain feedback from our panel of experts to adapt and finalize the ICBT material. The panel members will attend three 1-hour virtual meetings to review the current ICBT material to adapt the programs for SCI caregivers. Meetings are transcribed verbatim and analyzed to generate a list of gaps. We received our ethics approval and currently completing the interviews. Preliminary Results Three significant gaps have been identified from the two interviews completed and analyzed. These gaps include changing the term "caregiver", and adding materials on sexual health and balancing family life. Future Implications/Directions: Our study will lead to developing an ICBT program to improve psychosocial outcomes and the overall wellbeing of caregivers for individuals with SCI. Our future plan is to conduct a pilot trial to examine the feasibility, effectiveness and acceptability of this newly developed ICBT program for SCI caregivers.
Investigating Strategies to Enhance Nonverbal Communication with People Living with Dementia Introduction: People living with dementia (PLWD) experience challenges comprehending language, and benefit from nonverbal communication (NVC) supports. Little published empirical evidence exists for care partners regarding NVC with PLWD. Objectives: Firstly, to conduct a scoping review of effective NVC strategies used by care partners with PLWD. A second objective is to determine whether effective NVC strategies in the extant literature overlap with person-centred communication. Methods: CINAHL, PsycInfo, Scopus, and Pubmed databases were searched December 8, 2020. Empirical studies published in English in peer-reviewed journals that used objective measures to examine the effectiveness of nonverbal communication strategies used by care partners of people living with dementia were eligible. All publication dates were eligible for inclusion. Preliminary Results: Sixteen studies were included. Six categories of effective NVC strategies were identified: eye contact, gestures, facial expression, touch, close proximity, and frontal orientation. Studies defined communication as effective based on eight diverse outcomes; however, person-centred outcomes were limited. Future Directions/Implications: The review identified effective NVC strategies used by care partners with PLWD in the current literature. The use of effective strategies mitigates negative consequences of problematic communication, including stress and decreased care quality. Findings revealed disagreement in the literature regarding which outcomes define effective NVC with PLWD. It is critical to delineate which NVC strategies are person-centred. The results of this study may contribute to the development of a codebook of effective NVC strategies. Future work could test whether these effective NVC strategies overlap with person-centred communication during interactions between care partners and PLWD.
Exploring the Impact of Context on Spread of Team-Based Methods for Chronic Disease Management Background: Team-based care is used in primary care settings to help manage complex chronic conditions. Despite the value of these programs, little is known about how to spread models to new contexts. When exploring spread, there is often a tendency to focus on the program; however, it is important to explore the context the program is being introduced into. Within primary care settings, there are a variety of care models and the context of these models can present unique challenges. Objectives: This research has the following objectives; 1. Examine how a chronic disease management program in primary care settings are being adapted to fit local contexts, 2. Explore the role of care setting on the spread of chronic disease management programs. Proposed Methods: This research explored the impact of context on the spread of a team-based program for Chronic Obstructive Pulmonary Disease (COPD) in the primary care setting, known as Best Care COPD (BCC). Since its initial implementation, the program has spread to several sites across Southwestern Ontario including introduction into several primary care models. We will use a qualitative collective case study approach guided by a constructivist paradigm; including ‘living documents’, focus groups, and interviews. Participants in our research will include providers involved in the delivery of BCC. Future Directions/Implications: This study aims to provide insight into how to support the spread of BCC and other chronic disease management programs in primary care. Supporting the spread of successful programs will enable improved care for a greater patient population.
Conceptualizing the lived experiences of pain and fatigue in persons living with neurological condition Background: Pain and fatigue have been reported as the most common and disabling symptoms across multiple sclerosis, amyotrophic lateral sclerosis, cerebral palsy, and Parkinson’s disease. The experience of pain and fatigue is multidimensional, complex, and subjective in nature within and across conditions and there is evidence of these symptoms affecting motor function, quality of life, and overall well-being. Common patient experiences suggest there may be benefits to studying symptoms outside of a condition-specific lens. Hypotheses/Objectives: The primary objective of this study is to understand the impact of pain and fatigue on the lives of individuals with these conditions through descriptions of their experiences. A secondary objective is to explore the relationship between experiential accounts of pain and fatigue within and across conditions. Proposed Methods: Proposed Methods Twelve participants will be recruited to participate in semi-structured online interviews. All interviews will be audio-recorded and transcribed verbatim. The study will use a new phenomenological approach guided by van Manen's hermeneutic phenomenological method and inductive analysis of the transcribed interviews will be performed using interpretive phenomenological analysis. Future Directions/Implications: The knowledge gained from this study may help develop an increased understanding of the impact these symptoms have on the daily lives and life course of people with these conditions. In turn, this may enhance current healthcare practices for managing pain and fatigue and improve functional ability, quality of life, and overall well-being in adulthood. This information may provide guidance on effective management and treatment strategies to be used by healthcare providers.
The Patient-Oriented Impact of Culturally Competent Care on Patients with COPD – A Scoping Review Background: Cultural competence is an underexamined component of healthcare. In some cases, the lack of literature surrounding this topic can lead to decreased consistency in assessing cultural-competence-related health outcomes. Objectives: The aim of this review is to explore what is known in the existing literature about the impact of culturally competent care on health outcomes for patients with COPD. We will do this through examining barriers and facilitators to providing culturally competent care; the best practices for delivering culturally competent care; and what type of interventions are considered to be successful in the provision of culturally competent care. Proposed Methods: This review followed the Arksey and O’Malley design. The databases Scopus, Nursing and Allied Health Database, CINAHL (EBSCOhost), MEDLINE (Ovid), and EMBASE (Ovid) were searched with the four categories of COPD, cultural competence, health outcomes, and patients. Included articles include interventions related to cultural competence, defined cultural in terms of ethnicity and/or race, patients with COPD, in English, peer-reviewed, and patient outcomes. Excluded articles did not differentiate between COPD and other illnesses in the results. Title, abstract, and full-text screening were completed and produced 13 articles. We are currently in the data extraction stage of the scoping review. Future Implications: Findings will provide health care organizations with a concise summary of culturally competent interventions that are represented in current literature. Thus allowing for better contextualization when providing culturally competent care. It may also identify gaps to inform further exploration of the literature.
Describing Healthcare Concerns of Young People and Adults with Cerebral Palsy Background: Cerebral palsy (CP) is broadly characterized as a prevalent, nonprogressive disorder of posture and movement that occurs in the developing brain. In fact, CP encompasses multiple casual pathways and as a result, has a heterogenous distribution of severity of disability and associated comorbidities. Despite this heterogeneity, children with CP share specific challenges when transitioning from the pediatric to adult healthcare system. Objectives: The Transitional and Lifelong Care (TLC) Program at Parkwood Institute, St. Joseph’s Health Care London is a clinical service that provides ongoing, coordinated care to persons with complex, childhood-onset disabilities. The purpose of this research is to identify prevalent healthcare concerns of young people and adults with CP in the TLC program and determine whether there are consistently related co-factors associated with the number of healthcare concerns. Proposed Methods: Data collection will occur at Parkwood Institute through a retrospective chart review of initial TLC consultation encounters between October 2014 and July 2017 and will be facilitated by the project’s REDCap database. Descriptive and inferential statistics will be used to explore and explain patterns in the target population. Future Directions/Implications: This study will better healthcare delivery for people with CP through quality improvement processes within the TLC, ensuring the program meets the health needs of persons with CP, while also enhancing transition services and leading to the creation of intervention and monitoring guidelines. Furthermore, this research has strong potential to influence priority setting in the development of similar programs as well as contribute to best practices for effective transitional care.
An eight-year analysis of participant characteristics at admission to inpatient prosthetic rehabilitation following a lower limb amputation Background: About 7,405 new lower limb amputations (LLAs) are performed annually in Canada primarily due to diabetes and peripheral vascular disease. Prosthetic rehabilitation aims to restore walking ability in people with an LLA. The demographic characteristics of this population is predicted to evolve alongside an aging population in which the fastest-growing are the oldest old (≥ 80 years). Studies investigating the changing characteristics of people admitted to prosthetic rehabilitation that included the oldest old are limited. Objectives: To evaluate the association of participant characteristics and admission time to prosthetic rehabilitation. Methods: This was a retrospective chart audit of admissions to the inpatient amputee program at Parkwood Institute in Ontario (January 2012 to December 2019). Study criteria were: transtibial LLA and above, ≥ 18 years old. Extracted characteristics included: age, gender, etiology, body mass index, amputation type, number of falls, length of stay, Montreal Cognitive Assessment score, Functional Comorbidity Index (FCI), days between amputation surgery and admission, and days between amputation surgery and discharge. Multivariable linear regression modelling quantified the association between participant characteristics and admission time. Results: A total of 601 participants (62.3±14.1 years) were analyzed. The oldest old category consisted of 63 participants (84.9±3.7 years). The FCI was independently associated with admission day. FCI scores increased from 2.5 in 2012 to 3.0 in 2019 [β= 66.57, 95%CI(16.58-116.56); p=0.009].
Conclusions: The results of this study demonstrate that participants are presenting with a higher number of comorbidities at admission over time, indicating a potential challenge for clinicians when establishing prognostic expectations.
A framework to support the progressive implementation of integrated team-based care for the management of COPD: A collective case study Background: In Canada, there is consensus about the need for integrated, team-based care in primary care settings to help manage complex chronic conditions such as chronic obstructive pulmonary disease (COPD). However, less is known on how to support the scale-up and spread of successful models; there is limited empirical evidence to support this process in chronic disease management. We studied the supporting and mitigating factors required to successfully implement and spread a model for COPD management in primary care. Objectives: Our research had the following objective; to determine mechanisms that facilitate the implementation and spread of an integrated, team-based model of care in primary care settings. Methods: We conducted a collective case study using multiple methods of data collection including interviews, living documents, and a focus group. Our study explored a team-based model of care for COPD known as Best Care COPD (BCC) that has been implemented in primary care settings across Southwestern Ontario. Participants in our research included healthcare providers involved in the delivery of the BCC program. Results/Implications: We identified mechanisms influencing the spread of BCC and categorized them as Foundational, Transformative, and Enabling Mechanisms. We developed a framework to inform the progressive implementation of integrated, team-based care for chronic disease management. Our framework builds off our empirical work and is framed by local contextual factors. This study explores the implementation and spread of integrated team-based care in a primary care setting. Despite the study using COPD as an exemplar, we believe the findings can be applied in other chronic disease contexts.
The quality of life of patients following lumbar spinal fusion surgery (LSFS): a secondary analysis of the patient rehabilitation experience Background: The relative effectiveness of lumbar spinal fusion surgery (LSFS) for non-specific low back pain (LBP) is currently inconclusive. Quality of life (QOL) is important to evaluate after LSFS to capture patients’ individual experiences and the impact of LSFS on his or her life. To date, little research has focused on understanding the quality of life of patients which can be used to inform best practice. Objective: To evaluate how patients’ journey and lived experiences following lumbar spinal surgery reflect quality of life; 2) To analyze patients’ perceptions of quality of life and classify domains generated from patients’ journey following lumbar spinal fusion surgery. Proposed Methods: Data from the parent study was collected using interpretive phenomenological analysis (IPA) to explore the perceptions of patients undergoing LSFS. A secondary analysis will be conducted. Data will be analyzed in stages in accordance with IPA using an inductive, iterative, and ongoing process. Stage 1 will involve performing content analysis to determine if QOL is identified by participants. Stage 2 will consist of using framework analysis to identify and classify domains of QOL important to their quality of life. Strategies to ensure trustworthiness will be employed. Implications: Findings from this study will ensure that patient-driven data will be used to inform decisions regarding surgery and rehabilitation. This will not only enable a greater understanding of the effectiveness of LSFS but will also enhance our understanding of patients’ experiences following LSFS.
Impacts of COVID-19 on the Coping Behaviours of Canadian Women Experiencing Intimate Partner Violence
Background: Strict public health measures central to slowing the spread of COVID-19 have, unintentionally, exacerbated risks for women experiencing intimate partner violence (IPV) while impeding their usual coping strategies. The goal of this study was to understand how coping was influenced by COVID-19 for women who have experienced IPV, and identify changes in coping strategies and gaps that need to be addressed to support coping. Methods: A qualitatively driven, sequential, cross-sectional design, where quantitative data informed and was embedded within qualitative data collection, was used to explore the experiences of IPV (CAS-R-SF scale) and coping (Brief-COPE scale) of 95 Canadian women. A subset of 19 women were invited to complete an interview exploring coping strategies identified within the survey to contextualize and validate these findings. Results: Survey data subjected to quantitative content analysis identified ten themes, all of which were explored in semi-structured interviews. Thematic interview findings included (1) Influence of COVID-19 on Coping; (2) Coping During COVID-19; and (3) Needed Coping Strategies. Conclusion: COVID-19 had important impacts on the experiences and coping strategies of women who experience IPV. To better support this population in pandemic circumstances, in-person services should be prioritized with an emphasis on accessible and empathetic care. Public health measures in response to COVID-19, and the eventuality of future pandemics, should aim to be gender- and violence-informed.
Exploring the impact of Interprofessional Primary Care (IPPC) teams on chronic disease management, through an overview of IPPC team guiding features and reported outcomes: A narrative literature review Background: Research indicates that utilizing Interprofessional Primary Care (IPPC) teams within primary care practice can produce multiple benefits, especially in dealing with the current chronic disease health crisis. However, a current gap exists within the literature specifically around the necessary components that enable strong interprofessional collaboration, and an examination of guiding features in relation to patient, team and cost outcomes. This lack of clarity around the guiding features that support IPPC team practice can cause confusion on the adoption of various effective practice strategies within primary care settings. Objectives: a) a brief overview of the definitions and components of interprofessional collaboration relative to IPPC teams, b) an overview of the guiding features and reported outcomes associated with IPPC teams in chronic disease management, in countries with recent primary care reform. Methods: A narrative literature review utilizing best review practice methods was employed to conduct this review. Future Implications: The examined evidence revealed that communication, trust, mutual respect, and shared decision-making were essential interactional components within IPPC teams, for optimal operation. The patient and provider outcomes relative to the impact of IPPC teams were mostly documented within research studies, especially from a clinical and humanistic outcome perspective. However, a current gap identified within this review was the need for more research on other types of components (organizational, environmental) that can impact interprofessional collaboration, along with the economic benefits of utilizing IPPC teams. Addressing these gaps can provide more clarity on how to better support IPPC teams in primary care practice from a theoretical and practical lens.
The effect of exercise interventions on gait outcomes in individuals with a lower limb amputation: A systematic review and meta-analysis Background: Walking ability is a significant contributor to the quality of life in people with lower limb amputation (PLLA). Yet, ongoing gait problems are common even after completing prosthetic rehabilitation. The literature on exercise protocols to improve gait in PLLA has not been synthesized to inform clinical practice. Aim: Perform a systematic review and meta-analysis evaluating the effects of exercise interventions on gait outcomes in PLLA. Methods: Six electronic databases were searched (inception to Nov 17, 2021). Inclusion criteria: randomized controlled trials assessing gait outcomes following an exercise intervention in PLLA; subjects were ≥18 years of age, had a unilateral or bilateral amputation at the transtibial or transfemoral level and used a prosthesis for walking. A meta-analysis using random effects with inverse variance was conducted to generate standardized mean difference. Results: Fourteen studies were included. Four studies examined subjects in the sub-acute recovery stage (post-amputation discharge from acute hospital to 6 months post-amputation), while ten studies examined those in the chronic stage (>6 months post-amputation). Thirteen studies had multi-component exercise interventions (combination of gait, balance, and strength training), while one used only strength training. Interventions were 15 to 60-minute sessions, 1 to 7 times per week, for 2 to 16 weeks. Overall, a moderate improvement was seen (SMD = 0.55, 95% CI (0.33, 0.77), I2 = 23.0%) in favour of the exercise intervention groups. Conclusions: Our results demonstrate multi-component exercise programs improve gait outcomes in PLLA across stages of recovery. However, the optimal duration and frequency of exercise is unclear.
Barriers and Facilitators of COVID-19 Practices among Canadian Single Mothers: A Qualitative Study of Public Health Recommendations Background: The COVID-19 pandemic increased the importance of public health practices to be fully implemented. Single mothers may have experienced specific challenges with implementation of public health practices during a pandemic. Aim: The objectives of this qualitative study were: 1) to describe implementation of COVID-19 practices among Canadian single mothers; and 2) to identify barriers and facilitators to specific public health recommendations: mask wearing, hand washing, disinfecting surfaces, and social distancing/school closures. Subject and Methods: Twelve single mothers were recruited through purposeful sampling in the diverse range of ages between 18-50. Individual interviews were carried using a semi-structured interview guide, transcribed verbatim, and qualitatively analyzed using thematic analysis within the approach of interpretative descriptions. Results: Mothers identified the following barriers. Mask wearing: adjustment, inconvenience, health status/reactions, and keeping it clean. Hand washing: being outside the home, fear of contaminated hands, and managing young children. Disinfecting surfaces: energy, time, and frequency. Social distancing/closures of schools: uncertainties, challenges of children, and lack of supports. The following facilitators were found. Mask wearing: mandatory by the government and public health strategies/messages. Hand washing: having older children and availability of hand soap. Disinfecting surfaces: having cleaning supplies and accessibility. Social distancing/school closures: habit to continually do it and technology to communicate with loved ones. Conclusion: Adherence to public health practices were not straightforward to implement for single mothers. There were a broad array of barriers and facilitators that inform the need to build support systems. Further studies should account for mothers’ personal health to maintain positive health behaviours.