Browsing by Author "Scott, Cathie"

Now showing 1 - 6 of 6
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    Improving access to primary health care: a cross-case comparison based on an a priori program theory
    (2021-10-11) Spooner, Catherine; Lewis, Virginia; Scott, Cathie; Dahrouge, Simone; Haggerty, Jeannie; Russell, Grant; Levesque, Jean-Frederic; Dionne, Emilie; Stocks, Nigel; Harris, Mark F.
    Abstract Background Inequitable access to primary health care (PHC) remains a problem for most western countries. Failure to scale up effective interventions has been due, in part, to a failure to share the logic and essential elements of successful programs. The aim of this paper is to describe what we learned about improving access to PHC for vulnerable groups across multiple sites through use of a common theory-based program logic model and a common evaluation approach. This was the IMPACT initiative. Methods IMPACT’s evaluation used a mixed methods design with longitudinal (pre and post) analysis of six interventions. The analysis for this paper included four of the six sites that met study criteria. These sites were located in Canada (Alberta, Quebec and Ontario) and Australia (New South Wales). Using the overarching logic model, unexpected findings were reviewed, and alternative explanations were considered to understand how the mechanisms of each intervention may have contributed to results. Results Each site addressed their local access problem with different strategies and from different starting points. All sites observed changes in patient abilities to access PHC and provider access capabilities. The combination of intended and observed consequences for consumers and providers was different at each site, but all sites achieved change in both consumer ability and provider capability, even in interventions where there was no activity targeting provider behaviors. Discussion The model helped to identify, explore and synthesize intended and unintended consequences of four interventions that appeared to have more differences than similarities. Similar outcomes for different interventions and multiple impacts of each intervention on abilities were observed, implying complex causal pathways. Conclusions All the interventions were a low-cost incremental attempt to address unmet health care needs of vulnerable populations. Change is possible; sustaining change may be more challenging. Access to PHC requires attention to both patient abilities and provider characteristics. The logic model proved to be a valuable heuristic tool for defining the objectives of the interventions, evaluating their impacts, and learning from the comparison of ‘cases’.
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    Inside triage: the social organization of emergency nursing work
    (2012-04) Melon, Karen Anne; Rankin, Janet; Scott, Cathie; White, Deborah
    Emergency care in large urban hospitals across the country is in the midst of major redesign intended to improve access, decrease wait times and maximize efficiency. Using Institutional Ethnography, I was able to document critical, empiric evidence that shows what nurses actually do to manage the safe passage of patients through their emergency care process starting with the work of triage nurses. The Canadian Triage and Acuity Scale figures prominently in the analysis as a high level organizer of triage work and knowledge production that underpins the way those who administer the system define, measure and evaluate emergency care processes, and then use this information for restructuring. The core argument throughout is that industrial production line values and principles that have infiltrated health care management and reframe patient care, are having serious consequences. This critical analysis uncovers a number of deleterious effects as rapid patient processing disrupts expert nursing work, and will contribute to a broader understanding of health system quality.
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    Mental health and social program usage: analyses for integrated mental health hubs
    (PolicyWise for Children & Families, 2019-07-19) Scott, Allison; Parker, Naomi; Salt, Valeri; Brown, Kyla; Piatt, Carley; Scott, Cathie; Cui, Xinjie
    In 2019, Alberta is creating integrated mental health hubs to support the well-being of youth. This report describes the proportion of youth (11 to 24 years old) between 2005/06 and 2010/11 who received mental health diagnostic codes in Alberta and their experiences with provincial services. This report found that (1) the proportion of youth who received diagnostic codes for a mental health condition was 20% overall, but highest (30%) in females 19-24 years old, (2) youth who received a mental health diagnostic code were more likely to have received services from a social program, be involved in the criminal justice system, and have indicators of substance abuse and self-harm behaviours, and (3) between 30% and 45% of older female youth with mental health diagnostic codes experienced pregnancy at least once during the report period. In addition, the report profiled specific service use information about three target community sites for the implementation of integrated mental health hubs. These findings provide policy-relevant evidence that public authorities may consider as they seek to better support children with mental health conditions and create integrated mental health hubs.
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    New Mothers' Networks in the Canadian Context: A Combined Methods Investigation into the Characteristics, Function, and Dynamics of First Time Mothers' Social Networks
    (2013-02-12) Cullingham, Carol Marie; Godley, Jenny; Scott, Cathie
    In this combined methods study, semi-structured qualitative interview data and quantitative social network survey data were used to describe the characteristics, functions, and dynamics of new mothers’ social networks in the Canadian context. The social networks of the mothers who participated were largely composed of a core network of close family and friends who provided a range of social support. First time mothers’ networks also included network members who provided support specific to the context of new motherhood, such as daytime companionship during the regular work week, which they found through existing ties when possible. When not, new mothers often sought this companionship through acquaintances or new friends, particularly other new mothers. Comparison of structured social network data with semi-structured interview data led to recommendations for better eliciting and describing these context specific ties in new mothers’ networks, including the use of a multi-pronged, context aware approach.
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    Primary care during the transition to adult care for adolescents involved with pediatric specialty services: a scoping review protocol
    (2021-02-02) Schraeder, Kyleigh; Allemang, Brooke; Scott, Cathie; McBrien, Kerry; Dimitropoulos, Gina; Felske, Ashley; Samuel, Susan
    Abstract Background Of the 15–20% of youth in North America affected by a chronic health condition (e.g., type 1 diabetes, cystic fibrosis) and/or mental health or neurodevelopmental disorder (e.g., depression, eating disorder, Attention Deficit-Hyperactivity Disorder), many often require lifelong specialist healthcare services. Ongoing primary care during childhood and into young adulthood is recommended by best practice guidelines. To date, it is largely unknown if, how, and when primary care physicians (PCPs; such as family physicians) collaborate with specialists as AYAs leave pediatric-oriented services. The proposed scoping review will synthesize the available literature on the roles of PCPs for AYAs with chronic conditions leaving pediatric specialty care and identify potential benefits and challenges of maintaining PCP involvement during transition. Methods Arksey and O’Malley’s original scoping review framework will be utilized with guidance from Levac and colleagues and the Joanna Briggs Institute. A search of databases including MEDLINE (OVID), EMBASE, PsycINFO, and CINAHL will be conducted following the development of a strategic search strategy. Eligible studies will (i) be published in English from January 2004 onwards, (ii) focus on AYAs (ages 12–25) with a chronic condition(s) who have received specialist services during childhood, and (iii) include relevant findings about the roles of PCPs during transition to adult services. A data extraction tool will be developed and piloted on a subset of studies. Both quantitative and qualitative data will be synthesized. Discussion Key themes about the roles of PCPs for AYAs involved with specialist services will be identified through this review. Findings will inform the development and evaluation of a primary-care based intervention to improve transition care for AYAs with chronic conditions.
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    Realist review of community coalitions and outreach interventions to increase access to primary care for vulnerable populations: a realist review
    (2023-06-24) Welch, Vivian; Pottie, Kevin; Gaudet, Caroline; Thuku, Micere; Mallard, Ryan; Spenceley, Shannon; Amjed, Nida; Wadhwani, Arpana; Ghogomu, Elizabeth; Scott, Cathie; Dahrouge, Simone
    Abstract Background There are meaningful gaps in equitable access to Primary Health Care (PHC), especially for vulnerable populations after widespread reforms in Western countries. The Innovative Models Promoting Access-to-Care Transformation (IMPACT) research program is a Canadian-Australian collaboration that aims to improve access to PHC for vulnerable populations. Relationships were developed with stakeholders in six regions across Canada and Australia where access-related needs could be identified. The most promising interventions would be implemented and tested to address the needs identified. This realist review was conducted to understand how community coalition and outreach (e.g., mobile or pop-up) services improve access for underserved vulnerable residents. Objective To inform the development and delivery of an innovative intervention to increase access to PHC for vulnerable populations. Methods A realist review was conducted in collaboration with the Local Innovative Partnership (LIP) research team and the IMPACT research members who conducted the review. We performed an initial comprehensive systematic search using MEDLINE, EMBASE, PsycINFO, and the Cochrane Library up to October 19, 2015, and updated it on August 8, 2020. Studies were included if they focused on interventions to improve access to PHC using community coalition, outreach services or mobile delivery methods. We included Randomized Controlled Trials (RCTs), and systematic reviews. Studies were screened by two independent reviewers and the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework was used for data extraction and framework analysis to obtain themes. The LIP research team was also allowed to suggest additional papers not included at screening. Results We included 43 records, comprising 31 RCTs, 11 systematic reviews, and 1 case control study that was added by the LIP research team. We identified three main themes of PHC interventions to promote access for vulnerable residents, including: 1) tailoring of materials and services decreases barriers to primary health care, 2) services offered where vulnerable populations gather increases the “reach” of the interventions, 3) partnerships and collaborations lead to positive health outcomes. In addition, implementation designs and reporting elements should be considered. Conclusion Realist reviews can help guide the development of locally adapted primary health care interventions.