Browsing by Author "Barber, Claire"

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    Candidacy 2.0 (CC) – an enhanced theory of access to healthcare for chronic conditions: lessons from a critical interpretive synthesis on access to rheumatoid arthritis care
    (2024-08-26) Koehn, Sharon; Jones, C A.; Barber, Claire; Jasper, Lisa; Pham, Anh; Lindeman, Cliff; Drummond, Neil
    Abstract Background The Dixon-Woods et al. Candidacy Framework, a valuable tool since its 2006 introduction, has been widely utilized to analyze access to various services in diverse contexts, including healthcare. This social constructionist approach examines micro, meso, and macro influences on access, offering concrete explanations for access challenges rooted in socially patterned influences. This study employed the Candidacy Framework to explore the experiences of individuals living with rheumatoid arthritis (RA) and their formal care providers. The investigation extended to assessing supports and innovations in RA diagnosis and management, particularly in primary care. Methods This systematic review is a Critical Interpretive Synthesis (CIS) of qualitative and mixed methods literature. The CIS aimed to generate theory from identified constructs across the reviewed literature. The study found alignment between the seven dimensions of the Candidacy Framework and key themes emerging from the data. Notably absent from the framework was an eighth dimension, identified as the “embodied relational self.” This dimension, central to the model, prompted the proposal of a revised framework specific to healthcare for chronic conditions. Results The CIS revealed that the eight dimensions, including the embodied relational self, provided a comprehensive understanding of the experiences and perspectives of individuals with RA and their care providers. The proposed Candidacy 2.0 (Chronic Condition (CC)) model demonstrated how integrating approaches like Intersectionality, concordance, and recursivity enhanced the framework when the embodied self was central. Conclusions The study concludes that while the original Candidacy Framework serves as a robust foundation, a revised version, Candidacy 2.0 (CC), is warranted for chronic conditions. The addition of the embodied relational self dimension enriches the model, accommodating the complexities of accessing healthcare for chronic conditions. Trial Registration This study did not involve a health care intervention on human participants, and as such, trial registration is not applicable. However, our review is registered with the Open Science Framework at https://doi.org/10.17605/OSF.IO/ASX5C .
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    Development and Testing of Cardiovascular Quality Indicators for Rheumatoid Arthritis
    (2015-12-04) Barber, Claire; Marshall, Deborah; Esdaile, John; Barnabe, Cheryl; Faris, Peter; Martin, Liam
    Rheumatoid arthritis (RA) is an autoimmune inflammatory arthritis with a 50% increased risk of cardiovascular disease (CVD) related deaths. Traditional CVD risk factors including smoking, hypertension and diabetes may be under-identified and/or undertreated in RA, indicating a gap in care. Quality indicators (QIs) are an important tool for quality improvement and are lacking in this area. The objectives of this dissertation were to: (1) identify existing recommendations pertaining to screening and management of CVD risk in RA; (2) to develop a set of CVD QIs for RA based on the best practices; and (3) to test the QIs in clinical practice. A systematic review of existing CVD QIs and guidelines was conducted (Study 1). All CVD recommendations from high quality guidelines and relevant quality measures were abstracted and best practices in RA were identified. In Study 2, a panel of cardiologists and rheumatologists developed a set of CVD QIs for RA based on best the practices identified. The QIs were presented to an international panel of experts through a novel online modified Delphi process where they were rated and discussed over 3 rounds. In the final study, performance on the CVD QIs was evaluated in 170 early and biologic treated RA patients. Based on the process described above, 11 CVD QIs for RA were developed and were rated as highly relevant and valid by our international panel of experts. This was the first time the online platform was used for QI development and it demonstrated many advantages. Performance on the QIs from our cohort suggests under screening and inconsistent management of CVD risk factors. Also evident, was that our patients had a high burden of obesity, hypertension and smoking, suggesting this is a clinically meaningful gap in care. The primary area for future improvement was noted for QIs relating to communication of CVD risk and coordination of care between rheumatology and primary care. Therefore, future efforts should focus on improving coordination of CVD care as well as improving efficiency of QI measurement and reporting for timely and effective improvements in CVD care.