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Understanding the supports and constraints available in rural communities is integral to the education of professionals who choose to practise in rural settings. Previous research has indicated that many professionals do not have an accurate understanding of rural contexts and how rural settings impact personal life and professional practice. To address this gap, an interprofessional course centring on professional practice in rural and remote communities was developed. This course was designed to be reflective of rural practice, not only in content but also in the way the course was delivered. Findings from this case study indicated that students' understanding of the complexity of rural settings was enhanced on multiple levels. The interactive and experiential nature of the course allowed students to develop working relationships that increased both their understanding of the value of interprofessional collaboration as well as the professional opportunities that are available in rural areas.

BackgroundThe considerable rise of mental health challenges during the COVID-19 pandemic has had detrimental effects on the public health sector and economy. To meet the overwhelming and growing demand for mental health care, innovative approaches must be employed to significantly expand mental health care delivery capacity. Although it is not feasible to increase the number of mental health care providers or hours they work in the short term, improving their time efficiency may be a viable solution. Virtually and digitally delivering psychotherapy, which has been shown to be efficient and clinically effective, might be a good method for addressing this growing demand. ObjectiveThis research protocol aims to evaluate the feasibility and efficacy of using an online, digital, asynchronous care model to treat mental health issues that are started or aggravated by stressors associated with the COVID-19 pandemic. MethodsThis nonrandomized controlled trial intervention will be delivered through the Online Psychotherapy Tool, a secure, cloud-based, digital mental health platform. Participants will be offered a 9-week electronically delivered cognitive behavioral therapy program that is tailored to address mental health problems in the context of the COVID-19 pandemic. This program will involve weekly self-guided educational material that provides an overview of behavioral skills and weekly homework. Participants (N=80) will receive personalized feedback from and weekly interaction with a therapist throughout the course of the program. The efficacy of the program will be evaluated using clinically validated symptomology questionnaires, which are to be completed by participants at baseline, week 5, and posttreatment. Inclusion criteria includes the capacity to consent; a primary diagnosis of generalized anxiety disorder or major depressive disorder, with symptoms that started or worsened during the COVID-19 pandemic; the ability to speak and read English; and consistent and reliable access to the internet. Exclusion criteria includes active psychosis, acute mania, severe alcohol or substance use disorder, and active suicidal or homicidal ideation. ResultsThis study received funding in May 2020. Ethics approval was received in June 2020. The recruitment of participants began in June 2020. Participant recruitment is being conducted via social media, web-based communities, and physician referrals. To date, 58 participants have been recruited (intervention group: n=35; control group: n=23). Data collection is expected to conclude by the end of 2020. Analyses (ie, linear regression analysis for continuous outcomes and binomial regression analysis for categorical outcomes) are expected to be completed by February 2021. ConclusionsIf proven feasible, this care delivery method could increase care capacity by up to fourfold. The findings from this study can potentially influence clinical practices and policies and increase accessibility to care during the COVID-19 pandemic, without sacrificing the quality of care. Trial RegistrationClinicalTrials.gov NCT04476667; https://clinicaltrials.gov/ct2/show/NCT04476667 International Registered Report Identifier (IRRID)DERR1-10.2196/24913

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. (Contains 2 figures.)

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]

"The Lived Experience of Disability" course matches first year occupational therapy students with mentors, individuals with health challenges, for a series of community visits. This learning relationship facilitates students' understanding of disability and client-centred practice. Mentors share expertise of their lived experience; students consider personal attitudes, assumptions and knowledge of disability and their future client-therapist relationships. Findings of a qualitative research study using a case study approach reveal that students engaged in interactive course components that comprised reflective practice, mentor visits, and critical involvement in a community of practice. These experiential and collaborative interactions provided pedagogical conditions for building relational knowing and critical reflection, which contributed to new and meaningful transformative learning experiences. [ABSTRACT FROM AUTHOR]

We review government funding of small NGOs as a mechanism to promote international development, taking the UK Civil Society Challenge Fund (CSCF) as a case study. Within a broad institutional economics perspective, we contrast two possible justifications for such support – evidence of positive impact and political expedience. Qualitative research suggests that empirical evidence of the positive impact of NGO actions funded through CSCF was relatively weak. Political expedience helps to explain why this was tolerated. The failure to generate better impact evidence can also be attributed to the lack of consensus about how to do so more rigorously, combined with a willingness to give small NGOs the benefit of the doubt in the absence of credible negative evidence of impact. [ABSTRACT FROM PUBLISHER]

The use of challenge funds to promote economic and social development continues to grow but has been the subject of relatively little research. This article draws on institutional economics (particularly principal-agent theory) to define challenge funds and review how they differ from other development funding mechanisms, taking into account their purpose, financial terms, interagency relationships, screening processes, selection mechanisms, implementation and risk sharing characteristics. It then draws on web-based data for 50 challenge funds to analyse variation in some of these characteristics. The paper identifies evaluability as an important influence, including the relative importance attached to promoting the financial performance of grantees relative to the indirect social benefits of their activities. We conclude with suggestions for further research into the design and performance of challenge funds. Copyright © 2015 John Wiley & Sons, Ltd. [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]

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]

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]

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The success factors and challenges of interorganizational collaboration have been widely studied from different disciplinary perspectives. However, the role of design in making such collaborations resilient has received little attention, although deliberately designing for resilience is likely to be vital to the success of any interorganizational collaboration. This study explores the resilience of interorganizational collaboration by means of a comparative case study of Dutch maternity care providers, which have been facing major challenges due to financial cutbacks, government-enforced collaborative structures, and the recent COVID-19 pandemic. Our findings make two contributions to the literature. First, we further develop the construct of interorganizational resilience. Second, we shed light on how well-designed distributed decision-making enhances resilience, thereby making a first attempt at meeting the challenge of designing for interorganizational resilience. [ABSTRACT FROM AUTHOR]

People whom the author would like to thank for their assistance in the creation of the journal are mentioned including Rene Almeling, Lorenzo Beltrame, and Kean Birch.

The article presents a list of reviewers for the journal "New Media & Society" in 2015, including Wajeehah Aayeshah, Amelia Acker and Luca Aiello.

Patient-orientated questionnaires are becoming increasingly popular in the assessment of outcome and are considered to provide a less biased assessment of the surgical result than traditional surgeon-based ratings. The present study sought to quantify the level of agreement between patients’ and doctors’ global outcome ratings after spine surgery. 1,113 German-speaking patients (59.0 ± 16.6 years; 643 F, 470 M) who had undergone spine surgery rated the global outcome of the operation 3 months later, using a 5-point scale: operation helped a lot, helped, helped only little, didn’t help, made things worse. They also rated pain, function, quality-of-life and disability, using the Core Outcome Measures Index (COMI), and their satisfaction with treatment (5-point scale). The surgeon completed a SSE Spine Tango Follow-up form, blind to the patient’s evaluation, rating the outcome with the McNab criteria as excellent, good, fair, and poor. The data were compared, in terms of (1) the correlation between surgeons’ and patients’ ratings and (2) the proportions of identical ratings, where the doctor’s “excellent” was considered equivalent to the patient’s “operation helped a lot”, “good” to “operation helped”, “fair” to “operation helped only little” and “poor” to “operation didn’t help/made things worse”. There was a significant correlation (Spearman Rho = 0.57, p < 0.0001) between the surgeons’ and patients’ ratings. Their ratings were identical in 51.2% of the cases; the surgeon gave better ratings than the patient (“overrated”) in 25.6% cases and worse ratings (“underrated”) in 23.2% cases. There were significant differences between the six surgeons in the degree to which their ratings matched those of the patients, with senior surgeons “overrating” significantly more often than junior surgeons ( p < 0.001). “Overrating” was significantly more prevalent for patients with a poor self-rated outcome (measured as global outcome, COMI score, or satisfaction with treatment; each p < 0.001). In a multivariate model controlling for age and gender, “low satisfaction with treatment” and “being a senior surgeon” were the most significant unique predictors of surgeon “overrating” ( p < 0.0001; adjusted R2 = 0.21). Factors with no unique significant influence included comorbidity (ASA score), first time versus repeat surgery, one-level versus multilevel surgery. In conclusion, approximately half of the patient’s perceptions of outcome after spine surgery were identical to those of the surgeon. Generally, where discrepancies arose, there was a tendency for the surgeon to be slightly more optimistic than the patient, and more so in relation to patients who themselves declared a poor outcome. This highlights the potential bias in outcome studies that rely solely on surgeon ratings of outcome and indicates the importance of collecting data from both the patient and the surgeon, in order to provide a balanced view of the outcome of spine surgery. [ABSTRACT FROM AUTHOR]