In Canada, the College of Family Physicians of Canada (CFPC) introduced Competency Based Medical Education to prepare and train family medicine residents to be competent to enter and adapt to the ...independent practice of comprehensive family medicine. Despite its implementation, the scope of practice is narrowing. This study aims to understand the degree to which early career Family Physicians (FPs) are prepared for independent practice.
A qualitative design was used for this study. A survey and focus groups were conducted with early-career FPs who completed residency training in Canada. The survey and focus groups examined the degree of preparedness of early career FPs in relation to 37 core professional activities identified by the CFPC's Residency Training Profile. Descriptive statistics and qualitative content analysis were conducted.
Seventy-five participants from across Canada participated in the survey, and 59 participated in the focus groups. Early career FPs reported being well prepared to provide continuous and coordinated care for patients with common presentations and deliver various services to different populations. FPs were also well prepared to manage the electronic medical record, participate in team-based care, provide regular and after-hours coverage, and assume leadership and teaching roles. However, FPs reported being less prepared for virtual care, business management, providing culturally safe care, delivering specific services in emergency care hospitals, obstetrics, self-care, engaging with the local communities, and conducting research activities.
Early career FPs do not feel fully prepared for practice in all 37 core activities in the Residency Training Profile. As part of the introduction of the three-year program by the CFPC, the postgraduate family medicine training should consider providing more exposure to learning opportunities and developing curricula in the areas where FPs are unprepared for practice. These changes could facilitate the production of a FP workforce better prepared to manage the dynamic and complex challenges and dilemmas faced in independent practice.
Health care solutions are needed to meet the need of an ageing population. Health care champions are people who endorse the adoption of new initiatives being implemented within health care settings. ...Although the role of champions has been cited as key to the success of numerous community-based interventions implemented to improve the care of older adults with chronic conditions, no synthesis of their implementation experiences have been conducted. We report on a scoping review protocol that will be applied to collect evidence on the role of champions within community-based health interventions to support older adults with chronic conditions. Specifically, we will identify how the term 'champion' is used and defined (i.e., conceptualized) and identify the roles (i.e., professional background) and functions of champions (i.e., responsibilities). We will also explore how this role impacts program implementation. This is a scoping review protocol informed by guidelines for Scoping Reviews (PRISMA-ScR) and a six-stage scoping review methodology. Peer-review literature will be retrieved from Medline, CINAHL, PubMed, PsycInfo, Cochrane JBI and Scopus databases, using a peer-reviewed search strategy developed in collaboration with an Information Specialist. The scoping review will consider all empirical studies published in English. Two reviewers will pilot-test the screening criteria and data abstraction forms, and then independently screen the literature. Extracted data will be analyzed numerically and thematically. Self-identified champions will be consulted to refine the practice recommendations from this work. This scoping review will broadly and systematically identify, define and expand existing knowledge on champions' impact in implementing community-based interventions to support older adults with chronic conditions. We anticipate that our results will lead to a greater understanding of the characteristics and role champions play within these interventions, which will be relevant to a wide range of knowledge users, including researchers, decision-makers, and health care providers.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
How does leadership emerge and function when multiple health care organizations come together to form a network? In this qualitative comparative case study, we draw on distributed leadership theory ...to examine the leadership practices that manifested during the implementation of three coordinated care networks. Thirty leaders and care providers participated in semistructured interviews. Interview data were inductively analyzed using thematic analysis. Although established in response to the same policy initiative, each case differed in its leadership approach and implementation strategy. We found that manifestation of distributed leadership was contingent on the presence of an individual leader who acted as a unifying force across their respective network. Our findings suggest that policies to encourage the development of interorganizational networks should include sufficient resources to support an individual leader who enables distributed leadership.
A growing body of evidence suggests that older adults are particularly vulnerable to poor care as they transition across care environments. Thus, they require transitional care services as they ...transition across healthcare settings. To help make intervention research meaningful to the older adults the intervention aims to serve, many researchers aim to study their experiences, by actively involving them in research processes. However, collecting data from older adults with various forms of disability often assumes that the research methods selected are appropriate for them. This scoping review will map the evidence on research methods to collect data from older adults with disabilities within the transitional care literature. The proposed scoping review follows the framework originally described by the Joanna Briggs Institute (JBI) Manual: (1) developing a search strategy, (2) evidence screening and selection, (3) data extraction; and (4) analysis. We will include studies identified through a comprehensive search of peer-reviewed and empirical literature reporting on research methods used to elicit the experiences of older adults with disabilities in transitional care interventions. In addition, we will search the reference lists of included studies. The findings of this review will be narratively synthesized. The Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews will guide the reporting of the methods and results. The overarching goal of this study is to develop strategies to assist the research community in increasing the inclusion of older adults with disabilities in transitional care research. The findings of this review will highlight recommendations for research to inform data collection within future intervention research for older adults with disabilities. Study findings will be disseminated via a publication and presentations.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Introduction: Person-centered integrated care (PC-IC) is a concept combining person-centeredness and integrated care to better improve care for people with complex health and social needs. The World ...Health Organization describes PC-IC as “health services that are managed and delivered in a way so that patients receive both preventive and curative services according to their needs over time that is coordinated across different levels of the health system”. Following this definition, evaluation of PC-IC should include the patients’ experiences with their care. When attempting to assess patient experience (PE) with PC-IC there is a lack of guidance on what to measure, when and how. Our study fills this gap by proposing a roadmap to guide the assessment of PE with PC-IC. Methods: We reviewed peer-reviewed and grey literature that looked at PE with PC-IC by searching Medline and CINAHL and consulting with experts on seminal work in the field. We included theoretical papers and tools that were used to assess PE in an PC-IC setting. We then synthesized this literature to answer: “what”, “when,” and “how” to assess PE with PC-IC. Results: We found that PE with PC-IC depends on two main factors. The first is related to social and demographic characteristics. These characteristics influence PE through two mechanisms; patient goals and expectations. The second factor is related to the organizations that provide PC-IC including culture, norms, resources, type and number of partnering organizations. Organizational factors affect PE by shaping the processes of care which affects PE through various mechanisms as communication, continuity of care, shared-decision making and patient- involvement. We also concluded that PC-IC should be looked at as a process rather than an event in the patient’s trajectory and thus assessment of PE with PC-IC should be process-based not event-based. Additionally, PE with PC-IC is a dynamic outcome that can change over time and measuring it continuously would be the preferred approach. Finally, combining qualitative and quantitative approaches gives the best understanding of PE. Our results will serve as a roadmap for PC-IC designers, implementers, and evaluators on how to assess patient experience. Discussions: Existing tools for measuring PE with PC-IC are often missing the main factors identified in our review. For example, most tools focus on the event of care (e.g. “during your last visit” rather than the process e.g. “organizing your care”. Also, they rarely include patients' social characteristics . Additionally, these tools rarely assess achieving patient goals rather than organizational or system goals. Conclusions: We created a roadmap that can guide building and evaluating tools used to assess PE with PC-IC. Lessons learned: For assessing PE with PC-IC to be successful, the tools used should be built on a comprehensive conceptualization of PC-IC, be conducted at the right time and use the appropriate methods. Limitations: We may have missed important studies or tools that were not identified by our search Future research: Future work can use this roadmap to construct a framework that can be used to create and evaluate tools that assess PE with PC-IC.
Introduction: Recently, there has been a paradigm shift in healthcare that calls for positioning patients as active partners in healthcare rather than passive recipients. This active partnership is ...even more evident with patients who live with multiple chronic diseases because with time, these patients become experts in their own bodies, symptoms and management. Two concepts arose as a result of this shift; person-centered care (PCC) and integrated care (IC). Both concepts have been promoted as potential solutions to accommodate the needs of patients with multiple chronic diseases and they become increasingly evident in literature about these patients. However, both concepts have been described by authors as polymorphic and ill-defined. Our study aims at understanding both concepts and revealing the connections between them in the context of patients living with multiple chronic diseases. Methods: We conducted a review of conceptual literature that looked at both PCC and IC, by searching Medline and CINAHL and consulting with experts. We applied a concept analysis approach using a combination of Walker & Avant and simultaneous concept analysis (SCA) to identify the unique characteristics of each concept and their relationships. Results: Through these methods, the antecedents, attributes, consequences and empirical referents of each concept were determined. Additionally, similarities and differences between the two concepts were identified and a definition offered for each concept. Furthermore, the interrelatedness between the key concepts was mapped, and definitions proposed. Our results will promote better understanding and communication about these concepts in practice and in research and policy contexts as well as to theory development by adding to previous research. Discussions: Although both concepts under study stem from the same philosophy of partnering with patients, PCC is a wider concept than IC. Integrated care is one way to achieve PCC but there are other approaches like co-production and redesigning the healthcare with the patients. True integrated care can barely be achieved if not rooted in a culture of PCC. This culture includes systems, organizations, providers, patients as well as their caregivers. In this sense, PCC may be better looked at as a philosophy rather than a quantifiable outcome. Conversely, IC can be measured directly through measurable indices of effectiveness, efficiency and patient experience. Conclusions: We conducted a concept analysis based on a literature review to explore the concepts of PCC and IC. Our comprehensive analysis defined both concepts and added clarity on their areas of interconnectedness and diversion. Lessons learned: PCC and IC are highly intertwined concepts, but they are not similar. Understanding the conceptual basis of both concepts is important for successful implementation of IC and achieving healthcare systems that are person-centered. Limitations: Our results are limited by the databases used. Second, we did not conduct a systematic evaluation of the quality of the included articles. This decision was motivated by the wide variation in literature and the inclusive nature of this concept analysis. Future research: Future work can explore the relationship of PCC and IC with other concepts that stem from the same philosophy as patient experience.
Accountable Care Organizations (ACOs), implemented in the United States (US), aim to reduce costs and integrate care by aligning incentives among providers and payers. Canadian governments are ...interested adopting such models to integrate care, though comparative studies assessing the applicability and transferability of ACOs in Canada are lacking. In this comparative study, we performed a narrative literature review to examine how Canadian health systems could support ACO models.
We reviewed empirical studies (published 2011-2020) that evaluated ACO impacts in the US. Thematic analysis and critical appraisal were performed to identify factors associated with positive ACO impacts. These factors were compared with the Canadian context to assess the applicability and transferability of ACO models within Canada.
Physician-led models, global budgets and financial incentives, and focus on collaborative care may optimize ACO impacts. While reforms towards alternative payments and team-based care are not unprecedented in Canada, significant further reforms to physician remuneration, intersectoral collaboration, and accountability for performance are required to support ACO-like models.
This comparative study uncovered several insights on the applicability and transferability of ACOs to the Canadian context. Further comparative research outside the US is needed to infer the essential components of successful ACO models.
Objectives: Airway management starts from the use of a nasal prong for oxygenation to successful endotracheal intubation for the ventilation. Intubation has been one of the most studied subject in ...anesthesiology. Various methods and gadgets have been advocated for its success. We aimed to evaluate the rate of successful intubations using the ordinary borescope and a stylet through Fekry Oral Intubating Airway (FOIA) in a manikin.
Methodology: This manikin-based study enrolled 35 trainees, who performed endotracheal intubation guided by the borescope and used FOIA as a conduit. Every trainee was allowed two attempts. The primary outcome was to assess the success rate of intubation. Secondary outcomes included the precise time to intubate, number of attempts, and the need for external manipulations.
Results: Our results revealed that 62.9% of the participants performed the intubation successfully (success rate) and 51.43% succeeded to intubate the manikin in the first attempt. External manipulation was needed by 71.4% of the participants in the form of cricoid pressure or laryngeal movement to visualize the glottic view. The time needed for a successful intubation ranged from 16 to 120 sec with a median of 50 sec and a mean of 69.37 ± 42.26 sec.
Conclusion: A combination of Fekry Oral Intubating Airway, a borescope and an intubating stylet can be used for endotracheal intubation in remote areas, where advanced airway management aids are not available.. Future studies are warranted to optimize this technique.
Trial registration: The ethical approval was obtained from the Research Ethics Committee of Cairo University (Code: MD-79-2019), and registration of the trial was performed on www.clinicaltrials.gov with a registration number (NCT05094453).
Key words: Visually assisted intubation, Borescope, Fekry Oral Intubating Airway.
Citation: Youssef MMI, Kamel OY, Asswa AR, Kassem SM, Abdelhalim RA, Inas Farouk I. Borescope assisted intubation through Fekry intubating airway; a prospective observational study. Anaesth. pain intensive care 2022;26(6):799−802.
DOI: 10.35975/apic.v26i6.2050
The aging cohort of persons living with human immunodeficiency virus (HIV) in Canada has reached a critical point, with nearly half now 50 years age or older. Older persons living with HIV have ...specific needs which can be effectively addressed by geriatric specialists. However, the recognition of HIV care as a domain of geriatrics is recent, resulting in a lack of clinical recommendations and modern care models for delivering geriatric care to this population. Virtual care has been demonstrated to reduce existing barriers to accessing HIV care in some populations but before it can be adapted to geriatric HIV care a critical first step is to acknowledge and understand disparities in socioeconomic circumstances, technology access and ability and cultural differences in experiences. This protocol marks the initial step in a comprehensive program of research aimed at co-designing, implementing, and evaluating culturally-appropriate virtual geriatric care for diverse older adults living with HIV. The study employs qualitative methods with older adults living with HIV to lay the groundwork, to inform the future development of a virtual model of geriatric care. We will explore the perspectives of diverse groups of older persons with HIV on (1) The value and necessity of culturally-tailored virtual interventions for geriatric HIV care; and (2) Recommendations on how best to engage older persons with HIV in the future co-design of a virtual model of geriatric HIV care. Ultimately, a more culturally-appropriate approach to care will foster a more inclusive and supportive healthcare system for all individuals affected by HIV including those who are aging. Researchers can utilize this research protocol to employ qualitative co-design and participatory methods with diverse older adults living with HIV.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, ODKLJ, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
To explore perceptions of early-career family physicians on the personal, educational, organizational, community, and system factors that had influenced their scope-of-practice decisions and to ...compare the similarities and differences among these factors across all 13 Canadian jurisdictions.
Qualitative descriptive study.
Canada.
Fifty-nine early-career family physicians who were 2 to 5 years into independent practice.
Data were collected using focus groups and were analyzed using deductive and inductive analysis techniques to identify patterns in the data within and across jurisdictions.
Participants across all jurisdictions highlighted that personal factors (ie, interest, work-life balance and family life, financial considerations, and self-perceived competence and confidence) were most influential on scope-of-practice decisions. Educational (ie, exposure during training, mentorship), organizational (ie, collegial support), community (ie, needs), and system (ie, payment models, funding for team-based care, governance) factors also influenced decisions about scope of practice. Experiences were similar across all jurisdictions for personal factors. Differences in experiences were reported across jurisdictions for educational, organizational, community, and system factors.
Decisions about scope of practice by early-career family physicians are highly influenced by personal factors followed by organizational, educational, community, and system factors. These findings suggest numerous strategies are needed to increase individuals' interest in providing comprehensive care in Canada. Educators should cultivate interest in comprehensive care among learners, strategically recruit trainees, provide targeted exposure and experiences, ensure competence and confidence are evaluated throughout and at the end of training, and introduce formal mentorship programs. Policy-makers should invest in the spread of effective team models and alternative payment models. Together, these strategies could broaden the scopes of practice of family physicians and their capacity to deliver accessible and comprehensive care to Canadians.
PDF
