Search

Background: Since the onset of the COVID-19 pandemic, virtual care solutions have been rapidly adopted across the country to provide safe, quality care to diverse patient populations. The objective of this qualitative case study was to understand patient and caregiver experiences of virtual care to identify barriers and gather suggestions to address them. Methods: In this patient-oriented project, we sought to understand gaps in virtual care experienced by patients and caregivers, using virtual focus groups. With the assistance of a patient research liaison, we engaged 2 patient partners as full partners; they participated in study conception, data collection, data analysis and knowledge translation. Recruitment was done through email by disseminating the study poster to 30 community organizations and health units in Ontario and British Columbia. We conducted a constructivist, qualitative study guided by grounded theory methodology. One researcher employed in-vivo coding, followed by axial coding with focus group participants, followed by selective coding with the study team. The study took place from November to December 2020. Results: We conducted 6 focus groups with 13 patients and 5 caregivers. The analysis resulted in 6 major themes and 17 minor themes. Key findings showed that barriers related to access to technology and Internet, language and cultural differences were challenges to virtual care. Participants identified special considerations surrounding caregiver and family involvement; privacy, consent and confidentiality; and the patient–physician relationship. Participants suggested that technology and the Internet be universally accessible and that virtual care modalities be integrated (e.g., consolidated patient portal) to improve virtual care. Interpretation: There are multiple patient-identified barriers to accessing virtual care in Canada; patients can provide insights into ways to address these barriers. Future research should include robust patient engagement to explore ways to address these challenges and barriers to ensure that virtual care can be equitable, accessible and safe for all users. Plain language summary: Although virtual care has been rapidly adopted and scaled up in health care institutions across the country, few improvements informed by patient and caregiver experiences have been made. Driven by concerns expressed by patient partners, our study team undertook a patient-partnered qualitative study to understand the barriers of virtual care from the perspectives and experiences of patients and caregivers. Our study team created the interview guide drawing from our previous patient-oriented qualitative studies and designed an orientation package to provide resources related to the focus groups and to introduce participants to the study team. Drawing from local health teams, clinics and patient advisory groups, the study team recruited 13 patients and 5 caregivers to participate in 6 focus group interviews. An analysis based on grounded theory was undertaken, with participation from both the study team and participants. Lack of access to technology or Internet and language barriers were determined to be the primary challenges in virtual care. Special considerations to caregiver and family involvement, privacy and confidentiality, as well as the patient–physician relationship were considered priorities to improving access to virtual care. Participants offered recommendations and potential solutions to address barriers and challenges in virtual care, which can serve to encourage large-scale policy and programmatic changes in patient-centred ways. [ABSTRACT FROM AUTHOR]

Background: There has been tremendous pressure on Canada' s healthcare system to respond to the increasingly complex health needs of the population despite worsening constraints in financial and human resources. Interprofessional collaborative practice has been seen as an enabler for improving patient care and meeting the current demands on the healthcare system. Methods: The South Eastern Interprofessional Collaborative Learning Environment (SEIPCLE) project, funded by HealthForceOntario, focused on the development and evaluation of the collaborative practice care model in three clinical settings in Southeastern Ontario, Canada. The project was exploratory in nature and used a quasi-experimental design with pre- and post-tests matched with non-equivalent control groups. Several different measures were used, including the Collaborative Practice Assessment Tool (CPAT), an Interprofessional Clinical Education Survey, and a Patient Participation Survey. Quantitative outcome measures were derived from these instruments using factor analysis, and analyzed using regression modelling with co-variates. Focus groups, interviews, and questionnaires provided qualitative data that was coded conceptually and used to complement the results of analyses using quantitative measures. Intervention teams participated in educational components that addressed identified weaknesses in their collaborative practice. Educational components included online modules, workshops, and real-time activities. Findings: Implementation of educational components in the clinical setting posed a number of challenges to reducing the exposure time for some of the intervention teams. Barriers to and enablers of the development of collaborative practice in the healthcare system were identified. Conclusion: Overall, all three intervention teams demonstrated an increase in perceived levels of collaborative practice. Although the results were not statistically significant, the effect, size, and magnitude of change were considered substantial. [ABSTRACT FROM AUTHOR]

Background: Access to traditional mental health services in Canada remains limited, prompting exploration into digital alternatives. The Government of Ontario initiated access to two internet-based cognitive behavioral therapy (iCBT) programs, LifeWorks AbilitiCBT and MindBeacon TAiCBT, for adults with mental health issues. Methods: An uncontrolled observational study utilizing secondary retrospective program data was conducted to evaluate the reach, uptake, and psychological symptom changes among participants engaging with either iCBT program. Results: Between May 2020 and September 2021, 56,769 individuals enrolled in LifeWorks AbilitiCBT, and 73,356 in MindBeacon TAiCBT. However, substantial exclusions were made: 56% of LifeWorks participants and 68% of MindBeacon participants were ineligible or failed to initiate treatment. Consequently, 25,154 LifeWorks participants and 23,795 MindBeacon participants were included in the analysis. Of these, 22% of LifeWorks and 26% of MindBeacon participants completed over 75% of iCBT treatment. On average, LifeWorks participants received 13 ± SD 7.1 therapist messages and sent 5 ± SD 10.3 messages, while MindBeacon participants received 25 ± SD 20.7 therapist messages and sent 13 ± SD 16.4 messages. LifeWorks included synchronous therapist contact averaging 1.4 ± SD 1.9 h per participant, while MindBeacon was purely asynchronous. Baseline severity of anxiety (37%) and depression symptoms (22%) was higher for LifeWorks participants compared to MindBeacon participants (24% and 10%, respectively). Clinically significant changes in anxiety and depression scores were observed: 22% of LifeWorks and 31% of MindBeacon participants exhibited reliable recovery in PHQ-9 scores, while 26% of LifeWorks and 25% of MindBeacon participants demonstrated reliable recovery in GAD-7 scores. Conclusion: In conclusion, iCBT programs show promise for engaged participants with varying levels of severity in anxiety and depression symptoms. Future iterations of iCBT should consider adopting a broad entry criterion to iCBT programming to increase accessibility, especially for those with severe symptoms, alongside integrated intake care pathways, and potential payment structure adjustments for iCBT service providers. Taken all together, these factors could temper high dropout rates post-intake assessment. This evaluation underscores the potential and value of digital mental health interventions for individuals with mild to severe anxiety or depression symptoms, emphasizing the importance of addressing participant dropout. [ABSTRACT FROM AUTHOR]

Background: Concern is growing over increased numbers of adverse events experienced by patients when admitted to acute care hospitals in Canada due to breakdowns in communication. The purpose of the Timely Open Communication for Patient Safety (TOC) project was to create a culture of patient safety through enhanced interprofessional communication by developing resources for caregivers and patients. Methods and Findings: The research was framed by a mixed-methods design that included pre- and post-surveys and focus groups, online educational modules, face-to-face activities, and the development of patient orientation materials. Three clinical sites participated in the study. The findings indicate that supporting healthcare teams to identify strengths, challenges, and future directions of communicating, clarifying roles, functioning, and collaborating, coupled with educational interventions that raise awareness of patient safety, may enhance patient safety. The study was limited by the absence of data regarding the incidence of adverse events during the research period. Conclusion: The data showed improvement in team members' perceptions of interprofessional collaborative practice within the participating Collaborative Learning Units (CLUs). If the CLU model of care is adopted within the healthcare system, the safety of patients/clients may improve. [ABSTRACT FROM AUTHOR]

Collaborative practice is receiving increased attention as a model of healthcare delivery that positively influences the effectiveness and efficiency of patient care while improving the work environment of healthcare providers. The collaborative practice assessment tool (CPAT) was developed from the literature to enable interprofessional teams to assess their collaborative practice. The CPAT survey included 56 items across nine domains including: mission and goals; relationships; leadership; role responsibilities and autonomy; communication; decision-making and conflict management; community linkages and coordination; perceived effectiveness and patient involvement; in addition to three open-ended questions. The tool was developed for use in a variety of settings involving a diversity of healthcare providers with the aim of helping teams to identify professional development needs and corresponding educational interventions. The results of two pilot tests indicated that the CPAT is a valid and reliable tool for assessing levels of collaborative practice within teams. This article describes the development of the tool, the pilot testing and validation process, as well as limitations of the tool. [ABSTRACT FROM AUTHOR]

Action research in the critical paradigm involves a process of continual refection in and on action including the research process itself. In the second in a series of several papers we report on the day-to-day management of the QUIPPED project. The aim was to facilitate patient centred care through inter-professional collaboration with health care learners at a Canadian university. Reflections of the continuum from early conceptualization of the project in 2004 through to lessons learned in 2008 are described. Key components include the importance of team development, overall coordination, and attention to logistical and structural issues are explored. The importance of learner driven initiatives as well as the need to prepare faculty for inter-professional teaching cannot be emphasized enough. [ABSTRACT FROM AUTHOR]