Public Health Commons^™

Primary Care Physician Engagement In Health System Transformation: A Case Study, Atharv Joshi

Electronic Thesis and Dissertation Repository

Primary care physician engagement is essential in enhancing organizational performance, system efficacy, and provider collaboration; yet limited literature exists within health systems research. This thesis explored physician engagement throughout the development of an organization known as the London Middlesex Primary Care Alliance (LMPCA). This thesis used a qualitative case study approach guided by a constructivist paradigm. The findings revealed six themes which contributed to the development of the LMPCA and provided insight into how physicians were engaged within health systems work. Unique to this study were two facilitators for engagement: the role of a transformation lead and the use of …

The Experiences And Challenges Of Community Health Volunteers As Agents For Behaviour Change Programming In Africa: A Scoping Review, Mary Ndu, Ellena Andoniou, Sorcha Mcnally, Francisco Olea Popelka, Marisa Tippet, Elysee Nouvet

Health Studies Publications

ommunity health volunteers are considered a vital part of the community health structure in Africa. Despite this vital role in African health systems, very little is known about the community health volunteers’ day-to-day lived experiences providing services in communities and supporting other health workers. This scoping review aims to advance understanding of the day-to-day experiences of community health volunteers in Africa. In doing so, this review draws attention to these under-considered actors in African health systems and identifies critical factors and conditions that represent challenges to community health volunteers’ work in this context. Ultimately, our goal is to provide a …

Supporting Post-Secondary Implementation Of Recovery-Oriented Practice In A Stepped Care Model, Janis Campbell

The Dissertation-in-Practice at Western University

Student mental health has been a growing concern for higher education communities for many years. Campuses have been struggling to keep up with the increasing demand for services which has been complicated further by the COVID-19 pandemic. A Stepped Care model (SCM) developed at a Canadian university has been offering new ways of organizing mental health resources based on open access, student choice, and recovery principles. There are diverse definitions of recovery in the literature and are usually based on values such as empowerment, respect, and self-determination. SCMs have been shown to increase access to resources and reduce or eliminate …

Investigating The Statistical And Policy Frameworks Used To Gauge Potential Pharmacotherapy Recalls: A Scoping Review, Benson Law

Undergraduate Student Research Internships Conference

Paramount attention is often afforded to pharmacotherapies being brought to market. The anticipation from companies, their shareholders, and the patients poised to benefit are met with stiff statistical and methodological requirements set forth by Health Canada’s Health Products and Food Branch (HPFB). Once a pharmacotherapy has been approved by the HPFB, however, the onus to monitor these drugs falls largely on the shoulders of Health Canada, the manufacturers, and to a lesser degree, the Drug Safety and Effectiveness Network (DSEN). This scoping review identified existing pharmacovigilance frameworks recommendations from SCOPUS, PubMed and EMBASE and compared the guidelines employed by Health …

Health Concerns Of Adolescents And Adults With Spina Bifida, Jessica A. Starowicz

Electronic Thesis and Dissertation Repository

The Transitional and Lifelong Care (TLC) program is a multidisciplinary clinical service providing comprehensive, coordinated care to adolescents and adults with spina bifida (SB). This study sought to identify the most common health concerns among this population at initial consultation and identify patient factors related to these concerns to ultimately improve health care delivery. A retrospective chart review was performed. Descriptive analyses were completed and associations between concerns and patient factors were determined using Spearman’s rho correlation coefficients. A multiple linear regression was performed to estimate the relationship between patient factors and total number of concerns reported. Ninety-four patient charts …

"Man Up": Male Survivors Of Intimate Partner Violence Through The Eyes Of Their Providers, Xavier S. Borsato

Electronic Thesis and Dissertation Repository

Intimate partner violence (IPV) is a complex phenomenon that is often understood with women as the primary recipients of violence and men as the primary perpetrators. However, emerging literature on heterosexual relationships suggests that men also experience interpersonal violence, most often from their female partners. Drawing on research data gathered through semi-structured interviews with service providers (n = 4), this qualitative inquiry explores how gender, power, and the stigma associated with interpersonal violence impact men who have experienced abuse through the perspectives of the service providers who work with them. The findings from this study highlight how traditional constructions …

Impact Of Covid-19 On The Italian And American Healthcare Systems : A Comparative Assessment, Bita Pejam, Jennifer Lam

All Reports

This report aims to examine and assess the impact of the COVID-19 global pandemic on the healthcare systems of the United States of America and Italy; two of the most heavily affected nations. Using data from December 2019 to January 2021, several consultations, and policy reviews, we identify risks and notable areas of issue in each nations’ approach to combating the virus. We focus our report particularly on the health policies and the governmental structures in place that contributed to each nations’ initial method of alleviating the impact of COVID-19. Our report compares the two healthcare systems and proposes a …

Health Systems And Health Care Management Panel, Nitin Mohan

Africa-Western Collaborations Day 2020

8 graduate student/recent graduate presentations on varying topics of health systems and health care management. Moderated by Dr. Nitin Mohan. Reporting of panel done by current GHS students of the 2021 class. Abstracts can be found under "Africa-Western Collaborations Day 2020 Abstracts". Presenters as follows:

Gojjam Limenih, "What Are We Doing? Is Exporting Anti-Depressants the Answer to the Mental Health Needs of the Global South?"

Jean Pierre Ndayisenga et al., "Rwandan Nursing and Midwifery Faculty's Experiences of Applying Knowledge about Teaching Methodology to Practice in Academic and Clinical Settings with Students"

Mary Ndu, "A Literature Review of Barriers to Scaling …

Academic Center Tiered Operating Room Strategy (Action): Comparing A High Efficiency Or To The Conventional Or, Moaz Bin Yunus Chohan

Electronic Thesis and Dissertation Repository

Canadian healthcare system is under immense economic pressure. In an attempt to resolve the problem, outpatient surgical services were offered to patients presenting with orthopaedic surgical complaints. An observational cohort study was carried out, comparing the conventional surgical setup to the newly designed high-efficiency setup that provided similar care, with a significantly lower operating cost. A total of 200 patients were enrolled in the study. Standardized and unstandardized questionnaires were used to evaluate pre-operative and post-operative patient data that reflected quality of life outcomes. Data was collected at enrolment and during post-operative follow-ups of up to 6 months. Results indicate …

Wait Times, Resource Use And Patient-Reported Outcomes For Patients Referred For Total Knee Replacement Surgery, Kate Lebedeva

Electronic Thesis and Dissertation Repository

This prospective cohort study evaluated the usual care pathway for patients referred to total knee arthroplasty (TKA). We measured healthcare resource use, costs and health-related quality of life (HRQoL) over the continuum of care. We also determined the proportion of inappropriate referrals and estimated wait times for initial surgical consultation and TKA. We found that two in five patients referred to specialty care were deemed inappropriate surgical candidates. Prior to referral, few conservative treatment options were tried, and many imaging tests ordered by referring providers were unjustified. Overall, the greatest proportion of costs were borne by the patient or private …

An Exploratory Case Study Of A High-Performing Interprofessional Primary Lung Health Team, Karen R. Schouten

Electronic Thesis and Dissertation Repository

Interprofessional team-based care is essential to primary healthcare in Ontario, but care provided by teams is often disjointed. A Lung Health Team working within Family Health Teams (FHTs) in Ontario developed a successful team model and Lung Health Program that improved patients’ quality of life and reduces healthcare utilization.

A qualitative exploratory case study was conducted to explore components of the team and program that contribute to improved performance, facilitators and barriers to success, the perceived benefit to patients and providers, and the team’s and program’s sustainability and spread. Focus groups and interviews with the team and their patients, environmental …

Using A Deliberative Dialogue To Facilitate The Uptake Of Research Evidence In Rehabilitation For Children With Cerebral Palsy, Alisiyah Daya

Electronic Thesis and Dissertation Repository

This study explores how to facilitate the use of research evidence to optimize outcomes for children with cerebral palsy (CP) in practice. Findings from two studies were used as the basis for exploring how to comprehensively assess developmental trajectories of children with CP and plan individualized interventions. Seventeen affiliated stakeholders (e.g. physicians, senior leadership, frontline clinicians, families and youth with CP) participated in this study.

Data from a deliberative dialogue and interviews were analyzed using grounded theory methods with a pragmatic perspective. The results highlighted that all areas of practice must engage in knowledge translation to be effective. Stakeholders outlined …

The Influence Of Transformational Leadership On Nurse-Reported Patient Safety Outcomes, Sheila A. Boamah

Electronic Thesis and Dissertation Repository

Leadership is widely believed to be pivotal to providing high quality patient care and ensuring favourable organizational outcomes. To understand how nursing leadership affects patient outcomes, it is important to explore the mechanisms/ processes through which leaders produce desired patient outcomes. The purpose of this study was to examine how nurse manager use of transformational leadership behaviours creates empowering work environments that foster clinical leadership practices at the bedside, and ultimately, improve nurse and patient safety outcomes.

Bass’s (1985) transformational leadership theory provided the theoretical framework for the research. Transformational leadership behaviour was hypothesized to have positive effects on workplace …

Discrete Event Simulation Model For Planning Level 2 “Step-Down” Bed Needs Using Nems, Felipe F. Rodrigues, Gregory S. Zaric, David Stanford

Business Publications

In highly congested hospitals it may be common for patients to overstay at Intensive Care Units (ICU) due to blockages and imbalances in capacity. This is inadequate clinically, as patients occupy a service they no longer need; operationally, as it disrupts flow from upstream units; and financially as ICU beds are more expensive than ward beds. Step-down beds, also known as Level 2 beds, have become an increasingly popular and less expensive alternative to ICU beds to deal with this issue. We developed a discrete event simulation model that estimates Level 2 bed needs for a large university hospital. The …

The Globalization Of Healthcare: International Agreements & Ontario Academic Health Science Centres, Andrew D. Scarffe

Electronic Thesis and Dissertation Repository

Health systems are beginning to recognize the tremendous opportunity that globalization and international activities present for Academic Health Science Centres. This study explored the nature of international agreements within Ontario Academic Health Science Centres (OAHSC) and presents the exploratory findings to begin to develop an academically defensible body of literature on the topic. This study employed a constructivist grounded theory qualitative methodology, interviewing 14 participants who hold leadership positions within OAHSCs that actively participate in, or interface with, institutions that participate in international agreements (IAs). A conceptual framework is proposed that highlights the: (1) drivers, (2) barriers, (3) international activities, …

Predictors Of Appropriate Referral To Total Knee Arthroplasty: A Validation Study, Samuel J. Malian

Electronic Thesis and Dissertation Repository

Approximately 45% of referrals from primary care physicians to arthroplasty surgeons are inappropriate. Currently, Canadians are waiting over three months for consultation with an arthroplasty surgeon. Reducing the proportion of inappropriate referrals will reduce the wait time to first consultation with an arthroplasty surgeon. This study’s objective was to validate a model that identified patient-reported predictors of appropriate referrals to arthroplasty. We screened 258 patients attending their first consultation with an arthroplasty surgeon. Participants completed the questionnaires prior to their appointment and the surgeon detailed each consultation outcome on a standardized form. We constructed our validation model using the same …

The Association Between Women's Autonomy And Women's Hiv/Aids Knowledge And Attitudes In Ethiopia, Fadumo Rirash

Electronic Thesis and Dissertation Repository

Low autonomy resulting from gender inequalities in women has been identified as a contributing factor to the disproportionate impact of HIV/AIDS on women, especially in Sub-Saharan Africa.

This study explored the association between women’s autonomy and HIV/AIDS knowledge and attitudes in Ethiopia using the 2005 and 2011 Ethiopia Demographic and Health Surveys. The women’s spouses’ perceptions of the women’s autonomy and socio-demographic variables associated with HIV/AIDS knowledge and attitudes identified by the literature were included in the analyses. Multiple linear regression identified positive associations between women’s autonomy (and men’s perception of women’s autonomy), socio-demographic variables including education and mass media …

Describing The Falls Prevention Program At An Acute Care Hospital In Ontario Using Leveson’S Systems Model, Mahboubeh Mehrjoo

Electronic Thesis and Dissertation Repository

Falls are the most frequent adverse event in acute care hospitals. Although a large number of studies have addressed the patients’ risk factors for falls and best practices in fall prevention, patients falls still remain a major problem. This study applied a systemic methodology (Causal Analysis based on STAMP (CAST)) to depict Ontario’s acute care hospital structure related to patient fall prevention. The system’s component behaviours and interactions were described and deficits and inappropriate control mechanisms among the system’s controllers were identified. As a result of the CAST analysis, the complexity of the health care system, lack of a consistent …

Quality Indicators Of Diabetes Care: An Example Of Remote-Area Aboriginal Primary Health Care Over 10 Years, Julia V. Marley, Carmel Nelson, Vicki O'Donnell, David Atkinson

Aboriginal Policy Research Consortium International (APRCi)

To describe service characteristics of Derby Aboriginal Health Service (DAHS) and document diabetes management activities and intermediate clinical outcomes for Aboriginal patients with type 2 diabetes.

Access To General Practitioner Services Amongst Underserved Australians: A Microsimulation Study, Deborah J. Schofield, Rupendra N. Shrestha, Emily J. Callander

Aboriginal Policy Research Consortium International (APRCi)

Background: One group often identified as having low socioeconomic status, those living in remote or rural areas, are often recognised as bearing an unequal burden of illness in society. This paper aims to examine equity of utilisation of general practitioner services in Australia.

Methods: Using the 2005 National Health Survey undertaken by the Australian Bureau of Statistics, a microsimulation model was developed to determine the distribution of GP services that would occur if all Australians had equal utilisation of health services relative to need.

Results: It was estimated that those who are unemployed would experience a 19% increase in GP …

Partnerships In Public Health: Lessons From Knowledge Translation And Program Planning, Shannon Sibbald, Anita Kothari, Debbie Rudman, Maureen Dobbins, Michael Rouse, Nancy Edwards, Dana Gore

Anita Kothari

The purpose of this study was to better understand how partnerships are initiated, maintained, and sustained in public health practice. A qualitative design was employed to conduct individual interviews and focus groups. The participants included practitioners from 6 purposively selected public health units in the Canadian province of Ontario that developed partnerships in program planning. It was found that partnerships play an essential role in program planning but that minimal information is available regarding the partnership process. Most partnerships are formed on an ad hoc basis, with little formalization. Public health professionals rely on their experiential knowledge when seeking out …

Indigenous Beliefs About Biomedical And Bush Medicine Treatment Efficacy For Indigenous Cancer Patients: A Review Of The Literature, K. D. Schaik, S. C. Thompson

Aboriginal Policy Research Consortium International (APRCi)

Background: Australia’s Indigenous people suffer from higher cancer mortality than non-Indigenous Australians, a discrepancy partly caused by differences in beliefs about treatment efficacy between Indigenous patients and their non-Indigenous healthcare providers. This paper critically reviews the literature associated with Indigenous beliefs about cancer treatment, both ‘bush medicine’ and biomedical, in order to provide recommendations to healthcare providers about accommodating Indigenous beliefs when treating cancer.

Methods: A search was undertaken of peer-reviewed journal papers using electronic databases and citation snowballing. Papers were selected for inclusion based upon relevance to themes that addressed the research questions. Results: Literature suggests that Indigenous beliefs …

The Great Divide In Cancer Care Continues To Fail Aborigines, Georgina Kenyon

Aboriginal Policy Research Consortium International (APRCi)

No abstract provided.

Sustainable Antenatal Care Services In An Urban Indigenous Community: The Townsville Experience, Kathryn S. Panaretto, Melvina R. Mitchell, Lynette Anderson, Sarah L. Larkins, Vivienne Manessis, Petra G. Buettner, David Watson

Aboriginal Policy Research Consortium International (APRCi)

Objective: To evaluate the impact of a sustained, community-based collaborative approach to antenatal care services for Indigenous women.

Design: Prospective quality improvement intervention, the Mums and Babies program, in a cohort of women attending Townsville Aboriginal and Islanders Health Service, 1 January 2000 – 31 December 2005 (MB group), compared with a historical control group (PreMB group), 1 January 1998 – 30 June 1999.

Main outcome measures: Proportion of women having inadequate antenatal care and

screening; perinatal indicators. Results: Thenumberofantenatalvisitsperpregnancyincreasedfromthree

(interquartilerange[IQR],twotosix)inthePreMBgrouptosix(IQR,fourtoten)inthe MB group (P < 0.001). There were significant improvements in care planning, completion of cycle-of-care, and antenatal education activities throughout the study period. About 90% of all women attending for antenatal care were screened for sexually transmitted diseases, 89% had measurement of haemoglobin level, and serological tests for hepatitis B and syphilis (minimum antenatal screening). There was increased attendance for dating and morphology scans. In the MB group compared with the PreMB group, there was a significant reduction in perinatal mortality (14 v 60 per 1000 births; P=0.014). Conclusion: Sustained access to a community-based, integrated, shared antenatal service has improved perinatal outcomes among Indigenous women in Townsville.

Public Health Decision Makers’ Informational Needs And Preferences For Receiving Research Evidence, Maureen Dobbins, Susan Jack, Helen Thomas, Anita Kothari

Anita Kothari

Objectives: The purpose of this study was to identify decision-makers’ preferences for the transfer and exchange of research knowledge. This article is focused on how the participants define evidence-based decision-making and their preferences for receiving research evidence to integrate into the decision-making process.

Methods: Semistructured interviews were conducted with a purposive sample of 16 Ontario public health decision-makers from six Ontario public health units in this fundamental qualitative descriptive study. The sample included nine program managers, six directors, and one Medical Officer of Health. Participants were asked to define the term evidence-based decision-making and identify preferred research dissemination strategies. The …

Epilepsy In Indigenous And Non-Indigenous People In Far North Queensland, John Archer, Ruth Bunby

Aboriginal Policy Research Consortium International (APRCi)

Objective: To compare patterns of epilepsy in Indigenous and non-Indigenous people presenting to hospital. Study design: Retrospective cross-sectional survey of individuals admitted to hospital with a diagnosis of epilepsy (1 January 2001 – 31 December 2004); presenting to the emergency department with a seizure (2004); or presenting to the epilepsy clinic (1 September 2002 – 31 March 2005). Setting: Cairns Base Hospital, the major referral centre for Far North Queensland, including Cape York and the Torres Strait, with a population of 230 000 (13% Indigenous). Main outcome measures: Proportion of Indigenous patients presenting for epilepsy; proportion of Indigenous and non-Indigenous …

Stage At Diagnosis And Cancer Survival For Indigenous Australians In The Northern Territory, John R. Condon, Tony Barnes, Bruce K. Armstrong, Sid Selva-Nayagam, J. Mark Elwood

Aboriginal Policy Research Consortium International (APRCi)

Objective: To investigate whether Indigenous Australians with cancer have more advanced disease at diagnosis than other Australians, and whether late diagnosis explains lower Indigenous cancer survival rates. Design: Retrospective cohort study.

Setting and participants: Indigenous and non-Indigenous people diagnosed with cancers of the colon and rectum, lung, breast or cervix and non-Hodgkin lymphoma in the Northern Territory of Australia in 1991–2000. Main outcome measures: SEER summary stage of cancer at diagnosis (local, regional or distant spread), cause-specific cancer survival rates and relative risk of cancer death.

Results: Diagnosis with advanced disease (regional or distant spread) was more common for Indigenous …

“Interaction” And Research Utilisation In Health Policies And Programs: Does It Work?, Anita Kothari, Stephen Birch, Cathy Charles

Anita Kothari

The objective of this study was to assess if interaction between users and producers of research is associated with a greater level of adoption of research findings in the design and delivery of health care programs. Responses to the dissemination of a research report on breast cancer prevention were compared between two groups of public health units in Ontario, Canada. Although all public health units received the report, only a subset of units was involved in the development of the report, while others were not. Research utilisation was conceptualized in terms of stages, including reading the report, information processing, and …

Treatment Patterns For Cancer In Western Australia: Does Being Indigenous Make A Difference?, Sonja E. Hall, Caroline E. Bulsara, Max K. Bulsara, Timothy G. Leahy, Margaret R. Culbong, Delia Hendrie, C D'Arcy J. Holman

Aboriginal Policy Research Consortium International (APRCi)

Objective: To examine whether hospital patients with cancer who were identified as Indigenous were as likely to receive surgery for the cancer as non-Indigenous patients. Design, setting and patients: Epidemiological survey of all Western Australian (WA) patients who had a cancer registration in the state-based WA Record Linkage Project that mentioned cancer of the breast (1982–2000) or cancer of the lung or prostate (1982–2001).

Main outcome measures: The likelihoods of receiving breast-conserving surgery or mastectomy for breast cancer, lung surgery for lung cancer, or radical or non-radical prostatectomy for prostate cancer were compared between the Indigenous and non-Indigenous populations using …

Diagnostic And Therapeutic Procedures Among Australian Hospital Patients Identified As Indigenous, Joan Cunningham

Aboriginal Policy Research Consortium International (APRCi)

Objectives: To determine whether hospital patients identified as Indigenous are less likely than other inpatients to have a principal procedure recorded, and the extent to which any disparity in procedure use can be explained by differences in patient, episode and hospital characteristics. Design: Retrospective analysis of routinely collected administrative data from the National Hospital Morbidity Database (NHMD). Setting: Australian public and private hospitals. Patients: All patients included in the NHMD whose episode type was recorded as acute and whose separation occurred between 1 July 1997 and 30 June 1998. Patients admitted for routine dialysis treatment were excluded. Main outcome measure: …