Search

PURPOSE Building timely consensus among diverse stakeholders is important in primary health care research. Consensus can be obtained using the nominal group technique which includes 5 steps: (1) introduction and explanation; (2) silent generation of ideas; (3) sharing ideas; (4) discussion; and (5) voting and ranking. The main challenges in using this technique are a lack of representation of different stakeholder opinions and the amount of time taken to reach consensus. In this paper, we demonstrate how to effectively achieve consensus using an adapted nominal group technique that mitigates the challenges. METHODS This project aimed to reach consensus on the priority care domains for individuals aged 65 or older, using an adapted nominal group technique with 4 strategies: (1) recruit 4 stakeholders groups (older people, clinicians, managers, decision makers) by using maximum variation and snowballing sampling approaches; (2) use remote tools to ensure high participation; (3) add an individual pre-elicitation activity to increase effectiveness; and (4) adapt discussions to the stakeholders' preferences for meaningful engagement. RESULTS In total, 28 diverse stakeholders participated. After the pre-elicitation activity and 1 round of group discussion, we reached consensus on a priority domain called symptoms, functioning, and quality of care. Adaptive group discussions and remote tools were the most effective strategies. All participants strongly agreed that they were able to express their views freely. Some perceived a need for emphasizing the alignment between the research objectives and anticipated practice and policy implications. CONCLUSIONS This adapted nominal group technique is an effective and enriching method when timely consensus is needed among diverse stakeholders. Health care researchers in various fields can benefit from using this research methodology., INTRODUCTION The participatory research approach is an important tool for family medicine and primary health care research. (1) By recognizing stakeholders' expertise and lived experiences, (2) this approach increases the [...]

Background: Virtual care (VC) for dementia in primary care settings is an important aspect of healthcare delivery in Canada. However, the evidence informing optimal and sustainable provision of VC for persons living with dementia (PLWD) and their care partners is scarce. The objectives of this study were to (1) describe the frequency of VC use, (2) identify characteristics of PLWD, care partners, and family physicians (FPs) that are associated with the use of VC, and (3) explore FPs' perceptions of barriers and facilitators to provide VC for PLWD and their care partners. Methods: The Alzheimer Society of Canada and College of Family Physicians of Canada conducted three nationwide cross-sectional surveys between October 2020 and April 2021: (1) One with PLWD, (2) one with care partners of PLWD, and (3) one with FPs. Virtual care was defined as two-way synchronous communication by telephone and/or a web camera. The prevalence of VC use among FPs, PLWD, and care partners was described. Logistic regression models were used to determine characteristics of participants (sociodemographic, urbanicity, frequency and availability of support for connecting with FPs, and FPs' practice characteristics) associated with any VC use (phone and/or video). Inductive thematic analysis of open-ended questions explored FPs' perceptions. Results: 131 PLWD, 341 care partners, and 125 FPs participated. 61.2% of PLWD, 59.5% of care partners, and 77.4% of FPs reported using VC. The models for PLWD (included age and ethnicity) and care partners (included gender/sex, urbanicity, and receiving support from a family member/friend to connect with FP) were inconclusive. FPs with > 20 years in practice were less likely to provide VC (OR = 0.23, 95%CI: 0.08–0.62, p < 0.01). FPs perceived that preferences regarding virtual vs. in-person care, office/family support, technology and family presence, and remuneration for FPs influenced VC use. Conclusions: Virtual primary dementia care uptake in Canada is substantial and mainly performed via telephone. According to FPs, physician-patient-caregiver partnerships and infrastructure for VC play key roles in using VC. Virtual care could facilitate access to primary care and minimize potential disruptions to in-person care for PLWD. Outcomes of virtual primary care for dementia need further investigation. [ABSTRACT FROM AUTHOR]

Background Potentially avoidable emergency department transfers (PAEDTs) and hospitalizations (PAHs) from long-term care (LTC) homes are two key quality improvement metrics. We aimed to: 1) Measure proportions of PAEDTs and PAHs in a Quebec sample; and 2) Compare them with those reported for the rest of Canada. Methods We conducted a repeated cross-sectional study of residents who were received at one tertiary hospital between April 2017 and March 2019 from seven LTC homes in Quebec, Canada. The MedUrge emergency department database was used to extract transfers and resident characteristics. Using published definitions, PAEDTs and PAHs were identified from principal emergency department and hospitalization diagnoses, respectively. PAEDT and PAH proportions were compared to those reported by the Canadian Institute for Health Information. Results A total of 1,233 transfers by 692 residents were recorded, among which 36.3% were classified as being potentially avoidable: 22.8% 'PAEDT only', 11.6% 'both PAEDT & PAH', and 1.9% 'PAH only'. Shortness of breath was the most common reason for transfer. Pneumonia was the most common diagnosis from the 'both PAEDT & PAH' category. PAEDTs and PAHs accounted for 95% and 37% of potentially avoidable transfers, respectively. Among 533 hospitalizations, 31.3% were PAHs. These proportions were comparable to the rest of Canada, with some differences in proportions of transfers due to congestive heart failure, urinary tract infection, and implanted device management. Conclusions PAEDTs far outweigh PAHs in terms of frequency, and their monitoring is important for quality assurance as they may inform LTC-level interventions aimed at their reduction. [ABSTRACT FROM AUTHOR]

Currently available elder abuse screening and identification tools have limitations for use in long-term care (LTC). This mixed-methods study sought to explore the appropriateness of using the Elder Abuse Suspicion Index© (a suspicion tool originally created for use with older adults in the ambulatory setting with Mini-Mental State Examination scores ≥ 24) with similarly cognitively functioning persons residing in LTC. Results were informed by a literature review, Internet-based consultations with elder abuse experts across Canada (n = 19), and data obtained from two purposively selected focus groups (n = 7 local elder abuse experts; n = 7 experienced front-line LTC clinicians). Analyses resulted in the development of a nine-question tool, the EASI-ltc, designed to raise suspicion of EA in cognitively intact older adults residing in LTC (with little or no cognitive impairment). Notable modifications to the original Elder Abuse Suspicion Index© (EASI) included three new questions to further address neglect and psychological abuse, and a context-specific preamble to orient responders. [ABSTRACT FROM AUTHOR]

Context: Among people living with dementia (PLWD), in-person care for ongoing follow-up and management may become challenging due to declining mobility and increasing reliance on caregivers. Family physicians (FPs) have been rapidly adopting virtual care (VC) which became vital with the COVID-19 pandemic. Objective: To describe prevalences of VC use among PLWD, their caregivers, and FPs (triads), determine factors associated with VC use, and explore FPs' perceptions of facilitators and barriers to VC provision. Study Design: Concurrent mixed-methods design. Setting: Canada. Population: PLWD, caregivers, and FPs. Methods: We analyzed the questions pertinent to VC in three nationwide cross-sectional surveys conducted with PLWD, caregivers, and FPs across Canada (October 2020 and March 2021). Measures: Virtual care is defined as two-way synchronous communication using a phone and/or a web camera. Factors included age, frequency seeing and receiving support for connecting FPs (PLWD/caregiver); years of practice, attachment to community or interdisciplinary teams, and training for care of elderly (FPs); gender, ethnicity, and urbanicity (population centre size > 100,000) for all participants. Analysis: Prevalences of VC provision by FPs and its uptake by PLWD and caregivers were described. Logistic regression models were used to determine factors associated with VC use. Inductive thematic analysis of open-ended questions explored FPs' perceptions of barriers and facilitators of providing VC. Results: 131 PLWD, 341 caregivers, and 125 FPs participated. Virtual care users were 61.2% of PLWD, 59.5% of caregivers, and 77.4% of FPs. The models for PLWD (included age and ethnicity) and caregivers (included gender, urbanicity, and receiving support to connect FP from a family member/friend) were inconclusive. Among FPs, having more than 20 years of practice was significantly associated with a decreased likelihood of providing VC when attachment to a community-based team was held constant (OR=0.23,95%CI:0.08-0.62, p<0.01). Care preferences (decision stage), office/family support (preparation stage), technology and family presence (execution stage), and remuneration for FPs (compensation stage) were the most recurring themes. Conclusions: Virtual primary dementia care uptake is substantial and depends on patient-caregiverphysician shared decision-making, interoperability in healthcare, support for triads before and during execution, and appropriate compensation. [ABSTRACT FROM AUTHOR]

Background/Objectives To describe changes in geriatric emergency department ( ED) services from 2006 (T1) to 2013/14 (T2), associated factors, and outcomes. Design Two-wave survey design. Setting Province of Quebec, Canada. Participants Lead nurses and physicians at 57 EDs that participated in both the T1 and T2 surveys. Intervention Changes over time in ED geriatric services, observed naturalistically. Measurements Survey questionnaires assessed: ED geriatric services (11 items) and nursing and geriatric staffing resources. Key administrative data indicators for ED bed visits for T1 and T2 for ages 75 and over included: volume of ED visits; length of ED stay; admission rate; and 30-day return visits. Results There was a significant overall increase in the number ED geriatric services, from mean 2.8 ( SD 2.2) at T1 to mean 6.0 ( SD 2.0) at T2. EDs were clustered into 3 groups based on their T1 and T2 geriatric service scores: 'early adopters' (n = 12); 'late adopters' (n = 27); 'non-adopters' (n = 18). Group membership was associated with three T1 variables: availability of a geriatric nurse clinician, a lower ratio of nurses to ED beds, and longer ED stays. There were significant overall increases between T1 and T2 in number of ED bed visits and ED length of stay among those aged 75 and over, decreases in hospitalization rates, but no change in ED return visits. There were no differential changes in the key indicators among the three ED clusters. Conclusions Overall, ED geriatric services improved in Quebec from 2006 to 2013/14. EDs with a geriatric nurse clinician, relatively fewer nursing resources, and longer ED stays improved more quickly. [ABSTRACT FROM AUTHOR]