PRISM :: Browsing by Author "Leslie, Myles"

Browsing by Author "Leslie, Myles"

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Open Access
A multi-step approach to developing a health system evaluation framework for community-based health care
(2022-07-09) Ludlow, Natalie C.; de Grood, Jill; Yang, Connie; Murphy, Sydney; Berg, Shannon; Leischner, Rick; McBrien, Kerry A.; Santana, Maria J.; Leslie, Myles; Clement, Fiona; Cepoiu-Martin, Monica; Ghali, William A.; McCaughey, Deirdre
Abstract Background Community-based health care (CBHC) is a shift towards healthcare integration and community services closer to home. Variation in system approaches harkens the need for a conceptual framework to evaluate outcomes and impacts. We set out to develop a CBHC-specific evaluation framework in the context of a provincial ministry of health planning process in Canada. Methods A multi-step approach was used to develop the CBHC evaluation framework. Modified Delphi informed conceptualization and prioritization of indicators. Formative research identified evaluation framework elements (triple aim, global measures, and impact), health system levels (tiers), and potential CBHC indicators (n = 461). Two Delphi rounds were held. Round 1, panelists independently ranked indicators on CBHC relevance and health system tiering. Results were analyzed by coding agreement/disagreement frequency and central tendency measures. Round 2, a consensus meeting was used to discuss disagreement, identify Tier 1 indicators and concepts, and define indicators not relevant to CBHC (Tier 4). Post-Delphi, indicators and concepts were refined, Tier 1 concepts mapped to the evaluation framework, and indicator narratives developed. Three stakeholder consultations (scientific, government, and public/patient communities) were held for endorsement and recommendation. Results Round 1 Delphi results showed agreement for 300 and disagreement for 161 indicators. Round 2 consensus resulted in 103 top tier indicators (Tier 1 = 19, Tier 2 = 84), 358 bottom Tier 3 and 4 indicators, non-CBHC measure definitions, and eight Tier 1 indicator concepts—Mortality/Suicide; Quality of Life, and Patient Reported Outcome Measures; Global Patient Reported Experience Measures; Cost of Care, Access to Integrated Primary Care; Avoidable Emergency Department Use; Avoidable Hospitalization; and E-health Penetration. Post Delphi results refined Tier 3 (n = 289) and 4 (n = 69) indicators, and identified 18 Tier 2 and 3 concepts. When mapped to the evaluation framework, Tier 1 concepts showed full coverage across the elements. ‘Indicator narratives’ depicted systemness and integration for evaluating CBHC. Stakeholder consultations affirmed endorsement of the approach and evaluation framework; refined concepts; and provided key considerations to further operationalize and contextualize indicators, and evaluate CBHC as a health system approach. Conclusions This research produced a novel evaluation framework to conceptualize and evaluate CBHC initiatives. The evaluation framework revealed the importance of a health system approach for evaluating CBHC.
Open Access
An implementation history of primary health care transformation: Alberta’s primary care networks and the people, time and culture of change
(2020-12-05) Leslie, Myles; Khayatzadeh-Mahani, Akram; Birdsell, Judy; Forest, P. G; Henderson, Rita; Gray, Robin P; Schraeder, Kyleigh; Seidel, Judy; Zwicker, Jennifer; Green, Lee A
Abstract Background Primary care, and its transformation into Primary Health Care (PHC), has become an area of intense policy interest around the world. As part of this trend Alberta, Canada, has implemented Primary Care Networks (PCNs). These are decentralized organizations, mandated with supporting the delivery of PHC, funded through capitation, and operating as partnerships between the province’s healthcare administration system and family physicians. This paper provides an implementation history of the PCNs, giving a detailed account of how people, time, and culture have interacted to implement bottom up, incremental change in a predominantly Fee-For-Service (FFS) environment. Methods Our implementation history is built out of an analysis of policy documents and qualitative interviews. We conducted an interpretive analysis of relevant policy documents (n = 20) published since the first PCN was established. We then grounded 12 semi-structured interviews in that initial policy analysis. These interviews explored 11 key stakeholders’ perceptions of PHC transformation in Alberta generally, and the formation and evolution of the PCNs specifically. The data from the policy review and the interviews were coded inductively, with participants checking our emerging analyses. Results Over time, the PCNs have shifted from an initial Frontier Era that emphasized local solutions to local problems and featured few rules, to a present Era of Accountability that features central demands for standardized measures, governance, and co-planning with other elements of the health system. Across both eras, the PCNs have been first and foremost instruments and supporters of family physician authority and autonomy. A core group of people emerged to create the PCNs and, over time, to develop a long-term Quality Improvement (QI) vision and governance plan for them as organizations. The continuing willingness of both these groups to work at understanding and aligning one another’s cultures to achieve the transformation towards PHC has been central to the PCNs’ survival and success. Conclusions Generalizable lessons from the implementation history of this emerging policy experiment include: The need for flexibility within a broad commitment to improving quality. The importance of time for individuals and organizations to learn about: quality improvement; one another’s cultures; and how best to support the transformation of a system while delivering care locally.
Open Access
Are Alberta's General Practitioner (GP) to Specialist Referral Pathways Aligned with Existing Principles and Best Practices for Patient Empowerment (PE)?
(2022) Wong, Sylvia; Leslie, Myles
Long wait times, inefficient care coordination, and patient disengagement have been identified as significant issues in Canadian specialist care (Liddy et al. 2018). This lack of patient engagement could be attributed to the common belief that patients do not have the right expertise (Baker et al. 2016; Brekke, Nuscheler, and Straume 2007, 18), which seems to be enshrined in the gatekeeping role that Canadian general practitioners (GPs) routinely play when referring patients to specialists (Forrest 2003). Whatever the origins and intents of deploying GPs to control access to specialists, poor performance in the GP to specialist (G2S) pathway not only delays treatment and care (Liddy et al. 2018), but it can also cause unnecessary harms (i.e., pain, stress) to patients (McCarron et al. 2019; Manafo et al. 2018). Indeed, poor transitions between GPs and specialists can lead to negative health outcomes (Yiu et al. 2015, 24), especially when patients face repeated, but necessary, transitions between HCPs throughout their care.
Embargo
Barriers and Facilitators to the Implementation of a Decolonization Strategy for Staphylococcus aureus prior to Hip and Knee Arthroplasty in Alberta, Canada: A multi-methods study
(2023-05-16) Whelan, Lindsay Jane; Rennert-May, Elissa; Barkema, Herman; Leal, Jenine; Leslie, Myles
Alberta recently implemented a decolonization strategy as part of the clinical care pathway prior to hip and knee replacements. The decolonization strategy includes three days of chlorohexidine gluconate (CHG) sponge baths and five days of mupirocin ointment (MO) intranasally twice daily leading up to surgery. Preoperative decolonization prior to hip and knee replacements reduces the incidence of surgical site infections (SSIs), but the effectiveness in Alberta is unknown. For a decolonization strategy to be effective, patients and clinic staff should adhere to the protocol and there should be no negative outcomes. We used multi-methods to assess the barriers and facilitators with a decolonization strategy by assessing patients and clinic staff compliance, and baseline prevalence of antimicrobial resistance (AMR) to topical antibiotics. Using qualitative methods, semi-structured interviews and focus groups were used to understand clinic adherence with decolonization. Knowledge and understanding were central to implementation. When present, knowledge and understanding acted as a facilitator, when absent or inconsistent, it was a barrier to implementation. Using descriptive surveys, we analysed patient compliance with proportions of compliance, differences with compliance in urban versus rural clinics using logistic regression, and reasons for non-compliance with frequency counts. In our analysis, CHG sponges had a greater proportion of compliance compared to MO but not when CHG sponges and MO were used together. Patients in rural clinics had increased odds of compliance with three CHG sponges than urban clinics and males had increased odds of compliance with MO in urban locations. Common reasons for non-compliance included sponges not provided, patient forgot, and surgery date moved. To assess AMR to topical antibiotics, specimens from SSIs following hip or knee arthroplasty were collected (n=81) and 43 specimens were Staphylococcus-positive. Among these specimens, coagulase-negative staphylococci isolates carried resistance genes associated with CHG (n=10) and mupirocin (n=6). Our results indicate that while a decolonization strategy in Alberta has been successfully implemented, it could benefit from improvements with clinic and patient compliance. Furthermore, the prevalence of AMR to topical antibiotics will need to be continuously monitored for changes.
Embargo
Beyond Supply Side Fixes: Reducing Magnetic Resonance Imaging Wait Times in Alberta
(2017-09-11) Perrin, Vanessa; Leslie, Myles
Canadian healthcare is plagued by long wait times, especially in magnetic resonance imaging (MRI). Provinces have attempted a variety of policy responses to this issue over the years with minimal success. Most attempts have focused on increasing MRI supply in either the private or public sectors. Past private sector attempts to increase supply have involved offering privately paid and delivered MRI in Alberta and contracting publicly paid MRI to private clinics in Ontario.1 Most recently, Saskatchewan legislated the use of privately paid and delivered MRI, contingent on private clinics performing one publicly paid scan for each private scan.2 As this study finds, these policy responses have not resulted in meaningful MRI wait time reduction. Since increasing private supply has failed to reduce wait times, this study also examines increasing public supply through funding injections. This strategy has also been employed in Alberta, Ontario, and Saskatchewan, as well as at the federal level, to no avail. Since policies to increase MRI supply have largely failed, this study proposes the alternative option of decreasing MRI demand to lower wait times. This study argues that decreasing MRI demand is a more cost-effective and immediate solution to Alberta's continually increasing wait times.3 It also suggests the past provincial policy efforts have contributed to the lack of meaningful wait time reduction and proposes a cohesive national strategy to guide MRI demand reduction policy. The internationally enacted campaign Choosing Wisely is examined as a template for this strategy. This study thus concludes that reducing MRI demand through a campaign such as Choosing Wisely is the best focus of resources to realize meaningful, permanent MRI wait time reduction.
Open Access
Case Studies in Canadian Regulatory Review: Recommendations for a Better Policy & Process
(2019-08-23) Lathrop, John; Leslie, Myles
Infrastructure projects in Canada have become highly divisive across regional, political and cultural lines. Regulatory reviews have been slowed or halted due to public opposition, consultative mismanagement and a poor or incomplete understanding of where legal authority lies and how it must be used. Current policy approaches to consultation are unequal to the task of allowing stakeholders to work through these points of contention in an atmosphere of efficient consensus building. Using three specific examples of stalled energy infrastructure projects, this capstone presents process reform options for improving the efficiency and effectiveness of the consultation process. Its opening section begins by outlining the political perspectives shaping energy infrastructure approval debates, showing how economic and environmental concerns are central points of contention among stakeholders. It then examines the intersection of culture, law, and economics, showing how the values and norms of Aboriginal communities are ingrained in legal frameworks that confer a duty to consult on the government. The same economic and environmental arguments used in the energy infrastructure debate also shape these legally mandated, culturally informed discussions. The opening section then closes with an examination of the laws, policies, and organizations that presently structure the processes of consultation. The central argument through this account of energy infrastructure contention is that present policy approaches are inadequate and require reform. The second section of the capstone presents three case studies of stalled or failed energy infrastructure approvals, highlighting in each case the specific challenges and shortcomings of existing approaches and processes. A common thread throughout all three is the inadequacy of current policy to facilitate meaningful conversations. The closing section of the capstone draws on a range of scholarly literatures to present options for meeting the challenges described in the first two sections.
Open Access
Counting Recidivism, and Achieving Sentencing Goals: A comparative study of the Canadian and Australian criminal justice systems with policy reform recommendations
(2021-09-21) Gouchie, Noelle; Leslie, Myles
When comparing recidivism rates between Canada (23.4%) and Australia (54.9%), Canada comes across as faring well above Australia in rehabilitation and deterring crime. This leads to the question, is Canada counting recidivism in a way that allows us to achieve our policy goals? Through a literature review, data is compiled on what recidivism data measures, sentencing, and rehabilitation programs – education and employment, all in relation to their impact on recidivism. The purpose of this paper is not only to compare Canadian and Australian measures of recidivism, but the countries’ criminal justice policies. In this sense it is a comparative study of the downstream effects of different approaches to measuring recidivism, sentencing and rehabilitation. The rate of recidivism, which is often referred to as the rate of return, is merely the count of how many individuals continue to commit crime after their initial offence. It is difficult to study recidivism comparatively due to the various nuances when measuring and counting recidivism across jurisdictions. This report will look at methods to count recidivism, sentencing, and rehabilitation programs.
Open Access
Doing primary care integration: a qualitative study of meso-level collaborative practices
(2023-07-17) Leslie, Myles; Fadaak, Raad; Pinto, Nicole
Abstract Background The integration of Primary Care (PC) into broader health systems has been a goal in jurisdictions around the world. Efforts to achieve integration at the meso-level have drawn particular attention, but there are few actionable recommendations for how to enact a ‘pro-integration culture’ amongst government and PC governance bodies. This paper describes pragmatic integration activity undertaken by meso-level participants in Alberta, Canada, and suggests ways this activity may be generalizable to other health systems. Methods 11 semi-structured interviews with nine key informants from meso-level organizations were selected from a larger qualitative study examining healthcare policy development and implementation during the COVID-19 pandemic. Selected interviews focused on participants’ experiences and efforts to ‘do’ integration as they responded to Alberta’s first wave of the Omicron variant in September 2021. An interpretive descriptive approach was used to identify repeating cycles in the integration context, and pragmatic integration activities. Results As Omicron arrived in Alberta, integration and relations between meso-level PC and central health system participants were tense, but efforts to improve the situation were successfully made. In this context of cycling relationships, staffing changes made in reaction to exogenous shocks and political pressures were clear influences on integration. However, participants also engaged in specific behaviours that advanced a pro-integration culture. They did so by: signaling value through staffing and resource choices; speaking and enacting personal and group commitments to collaboration; persevering; and practicing bi-directional communication through formal and informal channels. Conclusions Achieving PC integration involves not just the reactive work of responding to exogenous factors, but also the proactive work of enacting cultural, relationship, and communication behaviors. These behaviors may support integration regardless of the shocks, staff turnover, and relational freeze-thaw cycles experienced by any health system.
Open Access
Edmonton’s Aging-Friendly Strategy: The Need for Measurable Outcomes
(2018-09-07) Chandan, Ashima; Leslie, Myles
As the global population ages, ensuring cities adopt aging-friendly strategies is becoming a global public health priority. One response has been the World Health Organization’s (WHO) Aging-Friendly strategy which aims to create a framework for municipalities to adopt best practices to their local context. The global strategy has been developed to maintain a flexible approach that allows for local adaptation. Program evaluation – a key component for the successful implementation of municipal level aging strategies – is proving to be a challenge. In an effort to maintain flexibility for jurisdictions around the world, the WHO strategy faces unintended consequences resulting from a multiplicity of interpretations. This paper explores the challenges and best practices of developing locally adapted indicators based on the extensive list of indicators and strategies that have been developed globally. Evaluation is an essential component for aging-friendly initiatives as it allows jurisdictions to have concrete measures of progress and to better allocate resources. Key performance indicators are essential as they measure progress on the main goals of the strategy. However, given the flexible nature of the global age-friendly strategy, it becomes difficult for municipalities to find ideal performance indicators. As a result, municipalities have to overcome the challenge of finding suitable data sources for effective evaluation. This paper aims to provide comparable measures to WHO suggestions for indicators. Through cross-jurisdictional comparisons of global strategies and implementation of best practices at local levels, this capstone highlights the unintended consequences that result from flexible strategies. It uses Edmonton, Alberta as a case study, but draws out indicator selection lessons for other municipalities. Edmonton is an ideal example as the City is currently modifying the existing age-friendly strategy. This new strategy aims to better reflect the changes and needs of the aging population in Edmonton. Diverging from the existing WHO’s recommended strategy creates more challenges for Edmonton as they look for comparable measures. However, this capstone aims to use this case study to recommend data sets and indicators based on best practices established by the WHO and other established age-friendly jurisdictions.
Open Access
Exploring Help-Seeking Behaviours: Perspectives of Adult-Child Caregivers
(2018-11-16) Samaha, Allegra Sonia; Hewson, Jennifer A.; Lee, Yeonjung; Leslie, Myles; Ferrer, Ilyan
As life expectancies increase, so does the rate of older adults diagnosed with dementia; most commonly, in the form of Alzheimer’s disease. An Alzheimer’s disease diagnosis not only impacts the person afflicted, but also people around them who take on the role of caregiver. The role of caregiving often falls on the shoulders of adult-children, who are simultaneously balancing their own life commitments with offering high quality, around the clock care. Many elements impact one’s caregiving experience, including sociodemographic factors such as gender, age, occupation and culture. As the formal service sector works to improve access to support, it is critical to understand the help-seeking behaviours of adult-child caregivers; moreover, in a country like Canada with an abundance of diversity, variations in help-seeking behaviours must be recognized. The purpose of this study was to explore the help-seeking behaviours of adult-children, caring for a parent with Alzheimer’s disease. This qualitative study utilized a multiple case study approach, and was guided by the Anderson Socio-Behavioral Model of Health Service Utilization (1995). Findings from six adult-child caregivers from hyphenated cultural backgrounds suggest that there may be universality to caregiver’s desires and determinants of help-seeking behavior. However, in terms of programs designed for their illness-afflicted parent, themes of linguistic diversity, trauma-sensitivity and culture matching between care providers and service users were presented as important strategies to promote help-seeking behaviours and service utilization. Implications for social work theory, research, practice and policy are presented.
Open Access
Exploring Policy Solutions to Address the Primary Care Access Crisis in Alberta
(2023-05-29) Ngezi, William Paul; Leslie, Myles
The primary-care access crisis in Alberta (AB) has reached a critical level, leading to a lack of essential healthcare services, and placing a significant burden on the healthcare system. Immediate action and effective solutions are needed to ensure equal access to healthcare and address the shortage of primary care physicians (PCPs). The study provides a comprehensive analysis of AB and Ontario's existing policies and initiatives aiming to increase the number of PCPs, improve working conditions and support teamwork to retain the PCPs and avoid burnout. It proposes evidence-based policy recommendations addressing AB's needs. Key areas of focus include lessons learnt from ON's compensation reforms, team-based approach educating new primary PCPs, and credentialing. The study recommends the creation of a dedicated policy monitoring and evaluation team tasked with tracking implementation, collecting data, assessing impacts, and ensuring continuous improvement of policies. This approach, underpinned by support for healthcare providers, will help address the crisis in access to primary care and build a sustainable healthcare system in AB.
Open Access
Framing Policy for Addressing Opioid Use: Criminal Justice or Public Health
(2020-09-08) Hayward, Celeste Ann; Leslie, Myles
In an era of widespread concern about the effects and fatalities of Canada’s opioid crisis, a range of federal and provincial policies have been rolled out and revised in response. Options considered for dealing with the crisis and indeed relied on to date have tended to focus on the use of a criminal justice approach to policy and strategies. While these may be the dominant frames for the issue to date, another frame – one which seeks to utilize the systems and measures of public health – has also begun to emerge. This capstone compares these two approaches, using the province of Alberta’s experiences with the Protection of Children Using Drugs (PChAD) Act and the Calgary Drug Treatment Court (CDTC) as a case study to illustrate their principals in action and make recommendations for evidence-based policy reform. Canada is experiencing an opioid overdose crisis. This crisis carries with it severe individual and collective costs. At the level of individual users and their social networks, overdose deaths have broken families and taken lives. As figure 1 illustrates (PHAC b., 2020) 15,393 (PHAC b, 2020) Canadians died1 from an apparent opioid-related overdose between January 2016 and December 2019. In that same time frame, 19,377 people were hospitalized for an opioid-related poisoning. From January 2016 to March 2020, a total of 2,823 people in Alberta died of opioid-related poisoning (Alberta a, 2020). Between January 2018 and March 2020, eleven youth under the age of 18 in Alberta died from opioid-related poisoning. The peak of opioid overdose deaths occurred over quarter three of 2017 to quarter four of 2018. Since the end of 2018, the numbers have begun to decline, almost returning to levels seen in the first quarter of 2016.
Open Access
Improving Caregiver Supports through System Integration
(2018-09-14) Walsh, Connor; Leslie, Myles
Integration is a near-universal problem in all modern systems. From computer science to business, engineering, and healthcare, systems today are more complex than they ever have been, and fragmentation is more of a concern than ever. In human services, fragmentation is also a concern, and some sectors have taken steps to address their fragmentation issues through integration initiatives. Researchers, in recognizing problems on the world stage have not been left out of the discussion, and numerous integration frameworks exist in the academic literature. In Alberta, caregivers, their care recipients, and service providers alike have expressed frustrations at the fragmentation of the ‘system’ intended to support informal caregivers. While a range of supports exists, connecting caregivers with the right supports, in the right place, at the right time has proved difficult. This paper uses Alberta’s caregiver supports system as a case study on how to make integration real, creating a support system out of siloed, fragmented services. A one-day event facilitated by the University of Calgary’s School of Public Policy brought together service providers and leaders in the caregiver support community, guiding them through a prioritization exercise on the path to achieving integration. The paper analyses and presents five participant-generated work packages through which the sector could move towards greater integration. The paper concludes by drawing general findings on the process of understanding and implementing integration with recommendations for not just caregiver supports, but other sectors as well.
Open Access
Integrating nurse practitioners into primary care: policy considerations from a Canadian province
(2020-12-04) Black, Stacey; Fadaak, Raad; Leslie, Myles
Abstract Background The integration of nurse practitioners (NPs) into primary care health teams has been an object of interest for policy makers seeking to achieve the goals of improving care, increasing access, and lowering cost. The province of Alberta in Canada recently introduced a policy aimed at integrating NPs into existing primary care delivery structures. This qualitative research sought to understand how that policy – the NP Support Program (NPSP) – was viewed by key stakeholders and to draw out policy lessons. Methods Fifteen semi-structured interviews with NPs and other stakeholders in Alberta’s primary care system were conducted, recorded, transcribed and analyzed using the interpretive description method. Results Stakeholders predominantly felt the NPSP would not change the status quo of limited practice opportunities and the resulting underutilization of primary care NPs in the province. Participants attributed low levels of NP integration into the primary care system to: 1) financial viability issues that directly impacted NPs, physicians, and primary care networks (PCNs); 2) policy issues related to the NPSP’s reliance on PCNs as employers, and a requirement that NPs panel patients; and 3) governance issues in which NPs are not afforded sufficient authority over their role or how the key concept of ‘care team’ is defined and operationalized. Conclusions In general, stakeholders did not see the NPSP as a long-term solution for increasing NP integration into the province’s primary care system. Policy adjustments that enable NPs to access funding not only from within but also outside PCNs, and modifications to allow greater NP input into how their role is utilized would likely improve the NPSP’s ability to reach its goals.
Open Access
Nin-gikino’amaagoz – I am a student
(2021-09-01) Clark, Amber; Leslie, Myles
According to data collected from the 2016 Canada Census, there were 34 million Canadians, 2.1 million Indigenous people, and 1.5 million First Nations people. Of the total Canadian population, 28.6 million had obtained a high school diploma or equivalate certificate, while 1.2 million Indigenous people obtained the same level of education, but only 227,945 First Nations people living on-reserve graduated from high school or obtained an equivalent certificate in Canada. Therefore, at the time of the last census in Canada, only 7% of the total Canadian population, First Nations students living on-reserve graduating from high school while close to 80% of the total population who where non-Indigenous where graduating from high school in the same year and in the same country. In Manitoba, high school graduation rates for First Nations students are 39.9% lower than their non-Indigenous counterparts. There are many contributing factors to why First Nations high school graduation rates are so low. Many of these issues have stemmed from racist and assimilative polices legislated through different variations of the Indian Act. These policies have contributed to a wide array of socioeconomic issues among Indigenous people, both living on and off-reserve. As we move on to the next part of this journey, I will highlight the context and histories of these policies. You will learn that assimilation, racism, and genocide are deeply rooted in Canadian history, policy, and legislation. Which plays a significant role in educational gaps and the mistrust of authority and government.
Open Access
Optimizing the integration of family caregivers in the delivery of person-centered care: evaluation of an educational program for the healthcare workforce
(2022-03-18) Parmar, Jasneet K.; L’Heureux, Tanya; Anderson, Sharon; Duggleby, Wendy; Pollard, Cheryl; Poole, Lisa; Charles, Lesley; Sonnenberg, Lyn K.; Leslie, Myles; McGhan, Gwen; Huhn, Arlene; Sereda, Sandy; Marion, Cecilia; Tarnowski, Glenda; Mah, Jennifer; Melenberg, Denise; Weir, Carolyn; Pooler, Charlotte; MacLachlan, Nora; Bremault-Phillips, Suzette; Tian, Peter G. J.; Sacrey, Lori-Ann R.
Abstract Background While family caregivers provide 70-90% of care for people living in the community and assist with 10-30% of the care in congregate living, most healthcare providers do not meaningfully involve family caregivers as partners in care. Recent research recommends that the healthcare workforce receive competency-based education to identify, assess, support, and partner with family caregivers across the care trajectory. Objective This paper reports a mixed-methods evaluation of a person-centered competency-based education program on Caregiver-Centered Care for the healthcare workforce. Methods This foundational education was designed for all healthcare providers and trainees who work with family caregivers and is offered free online (caregivercare.ca). Healthcare providers from five healthcare settings (primary, acute, home, supportive living, long-term care) and trainees in medicine, nursing, and allied health were recruited via email and social media. We used the Kirkpatrick-Barr health workforce training evaluation framework to evaluate the education program, measuring various healthcare providers’ learner satisfaction with the content (Level 1), pre-post changes in knowledge and confidence when working with family caregivers (Level 2), and changes in behaviors in practice (Level 3). Results Participants were primarily healthcare employees (68.9%) and trainees (21.7%) and represented 5 healthcare settings. Evaluation of the first 161 learners completing the program indicated that on a 5-point Likert scale, the majority were satisfied with the overall quality of the education (Mean(M) = 4.69; SD = .60). Paired T-tests indicated that out of a score of 50, post-education changes in knowledge and confidence to work with family caregivers was significantly higher than pre-education scores (pre M = 38.90, SD = 6.90; post M = 46.60, SD = 4.10; t(150) = − 16.75, p < .0001). Qualitative results derived from open responses echoed the quantitative findings in satisfaction with the education delivery as well as improvements in learners’ knowledge and confidence. Conclusion Health workforce education to provide person-centered care to all family caregivers is an innovative approach to addressing the current inconsistent system of supports for family caregivers. The education program evaluated here was effective at increasing self-reported knowledge and confidence to work with family caregivers.
Embargo
Persistent Barriers Regarding Access to Cannabis for Medical Purposes: A Case Study of Families of Children with Epilepsy
(2017-09-14) Brooks, Sara; Leslie, Myles
Open Access
Professional Competition and its Influence on Access in Primary Health Care
(2023-05-29) McDonald, Anita; Leslie, Myles
Due to the low availability of family physicians, Canadians are currently experiencing a crisis in access to primary health care (PHC). Interprofessional collaboration, supported by expanded scopes of practice for non-medical professionals, has been repeatedly presented as a potential solution to the challenges that have led to the access crisis. This capstone argues that interprofessional collaboration is likely to remain an ineffective policy goal as long as decision makers continue to neglect the self-serving and competitive character of interprofessional interactions. It argues that collaboration's unacknowledged second face is competition, and that fair and full competition is a likely solution to the access crisis and making good on collaboration's promises. Medical professional dominance in PHC has created an anti-competitive environment that allows physicians to subordinate other professions, leading to under-utilization of non-medical professionals and so the inhibition rather than expansion of access. An example of this is presented in a case study of non-medical prescribing. Reports from the United States and Europe suggest that supporting fair and full competition amongst health professions can improve access. Those reports provide details on the regulatory requirements for creating a health professionals' market that would allow for barrier-free competition, full patient choice, and the fruition of interprofessional collaboration's promise. This capstone concludes that PHC policy needs to move away from collaboration rhetoric and should focus on designing a system that optimizes the competition between health care professions for the benefit of Canadians.
Open Access
Public Participation on Redesignation Applications: Lessons for and from the City of Calgary’s Planning Process
(2019-08-29) Cavar, Frano; Leslie, Myles
The City of Calgary has approved strategic plans that will chart its course over the coming decades. Namely, the Municipal Development Plan (2009) [“MDP”] ambitiously endeavours to accommodate 50 percent of Calgary’s future population growth over the next 60 to 70 years within Developed Areas of the city. At the same time, there has been a wave of public engagement and input in development decision making generally (see Bua and Escobar, 2018). Following this trend, the City (2013) solidified its support for public consultation by approving updates to its Engage Policy, defining engagement as: “Purposeful dialogue between The City and stakeholders to gather information to influence decision making.” The vast majority of Calgary’s communities are zoned “R-1”, meaning land parcels only accommodate single-detached homes. Thus, to achieve the MDP goal of 50 percent future population growth in existing communities, inevitably many of these parcels will have to be redesignated to land use districts that accommodate greater density. This capstone study theorizes that urban redevelopment occurs at the intersection of three stakeholder groups: individual property owners, the City of Calgary which is subject to its planning goals and other mandates like the engagement framework; and the broader “community” including community associations, neighbours, nearby businesses and others who are directly impacted by planning redevelopment. The City’s policies and goals, together with the intersection of urban redevelopment beg the questions: what purpose does “public engagement” play in the redesignation process - and is it effective? How is engagement interpreted and defined, and how does it affect the three stakeholder groups? What is the process that guides the City of Calgary’s public engagement on redesignation applications, and should it be enhanced? In the literature review of this capstone study, “public engagement” is described in two lenses that focus on power and process. This study also introduces various of models of public engagement which are used to assess the City of Calgary’s practices on redesignation. A comparative analysis was conducted on the engagement practices of other municipalities on redesignation applications. Finally, this capstone study suggests a series of recommendations to enhance the City of Calgary’s engagement practices on redesignation applications.
Open Access
Recruitment of caregivers into health services research: lessons from a user-centred design study
(2019-05-20) Leslie, Myles; Khayatzadeh-Mahani, Akram; MacKean, Gail
Abstract Background With patient and public engagement in many aspects of the healthcare system becoming an imperative, the recruitment of patients and members of the public into service and research roles has emerged as a challenge. The existing literature carries few reports of the methods – successful and unsuccessful – that researchers engaged in user-centred design (UCD) projects are using to recruit participants as equal partners in co-design research. This paper uses the recruitment experiences of a specific UCD project to provide a road map for other investigators, and to make general recommendations for funding agencies interested in supporting co-design research. Methods We used a case study methodology and employed Nominal Group Technique (NGT) and Focus Group discussions to collect data. We recruited 25 family caregivers. Results Employing various strategies to recruit unpaid family caregivers in a UCD project aimed at co-designing an assistive technology for family caregivers, we found that recruitment through caregiver agencies is the most efficient (least costly) and effective mechanism. The nature of this recruitment work – the time and compromises it requires – has, we believe, implications for funding agencies who need to understand that working with caregivers agencies, requires a considerable amount of time for building relationships, aligning values, and establishing trust. Conclusions In addition to providing adaptable strategies, the paper contributes to discussions surrounding how projects seeking effective, meaningful, and ethical patient and public engagement are planned and funded. We call for more evidence to explore effective mechanisms to recruit family caregivers into qualitative research. We also call for reports of successful strategies that other researchers have employed to recruit and retain family caregivers in their research.