Health Services Research Commons^™

Still, We Thrive: Understanding How Gay, Bisexual, Transgender, And Other Men Who Have Sex With Men (Gbtmsm) Experience Structural Barriers & Facilitators To Wellness, Lucas Gergyek

Theses and Dissertations (Comprehensive)

Historically and concurrently, structural violence has been a significant force influencing the sexual health and broader health of gay, bisexual, transgender and other men who have sex with men (GBTMSM). Yet to date, the majority of projects exploring the health inequities facing GBTMSM have focused on intrapsychic and behavioural factors as most related to poor health outcomes. As well, these studies are sometimes deficits focused, and fail to evaluate how GBTMSM continue to thrive, and maintain positive health. As a result, the ways in which systems and policies underlie and perpetuate health inequities facing GBTMSM have been somewhat obscured. Connectedly, …

The Lived Experiences Of Developmental Disability Caregivers And Service Providers In Ontario, Tetyana Ali

Theses and Dissertations (Comprehensive)

Providing care for children with developmental disabilities (CwDD) is complex and is a life-long journey. Caregivers (CGs) of CwDD experience higher levels of stress, declining mental and physical health, feelings of isolation, diminished financial outcomes, and an overall lower quality of life. Additionally, they often face marginalization and numerous barriers when trying to access funding and supports. This study explored the experiences of CGs of CwDD in the context of Ontario and included the perspectives of CGs and service providers (SPs) to investigate the role the government played in CGs ability to provide adequate care.

Twenty participants were recruited through …

Developing And Testing Quality Indicators For Seriously-Ill Home Care Clients In Ontario, Lisa Harman

Theses and Dissertations (Comprehensive)

Introduction Currently in Ontario, there is no set of quality indicators for use in palliative care settings. Palliative care research tends to focus heavily on those with cancer diagnoses, and therefore potentially misses those with other life limiting illnesses. The current study aims to develop a preliminary set of quality indicators relevant for seriously-ill individuals for use in the community. Methods Secondary analysis of Resident Assessment Instrument for Home Care (RAI-HC) data from 2006-2013 (n=263,767) was used to develop QIs thought to be relevant to the needs of seriously-ill home care clients. Seriously-ill clients were defined as those with a …

Examining Quality Indicator Rates For Older Home Care Clients With Dual Sensory Impairment (Dsi) And Exploring The Heterogeneity Within Dsi., Jacob G S Davidson, Dawn M. Guthrie

Theses and Dissertations (Comprehensive)

Older adults with impairments in both hearing and vision, called dual sensory impairment (DSI), are at an increased risk of negative health outcomes such as impaired communication and difficulties with mobility. It is unknown whether DSI is associated with potential quality of care issues. This study used a set of home care quality indicators (HCQIs) to examine potential quality issues in older clients (65+) with DSI. Further, it looked to explore how HCQI rates differed based on the geographic region of care and whether the client’s level of hearing and vision impairment was related to certain HCQIs. The HCQIs were …

Ems Use By The Young Adult Population In The Region Of Waterloo, Karen J. Totzke

Theses and Dissertations (Comprehensive)

Anecdotal evidence suggests that university students are accessing local Emergency Medical Services (EMS) more frequently, usually as a result of alcohol consumption. In doing so, they endanger their personal health and create challenges for EMS and local hospitals. This study examined EMS use by young adults (ages 16-24 years) to identify differences between university students and youth in the Region of Waterloo, and to determine predictors of transport to hospital. This cross-sectional study used retrospective data collected during a six-year period (2006-2011) from a large, mixed urban and rural municipal ambulance service located in southwestern Ontario. Data were extracted from …

Investigation Of Low Back And Shoulder Demand During Cardiopulmonary Resuscitation: The Effect Of Different Compression-Ventilation Ratios, Richard Scott Dainty

Theses and Dissertations (Comprehensive)

Background: The current American Heart Association (AHA) standard cardiopulmonary resuscitation (CPR) is performed with a compression-ventilation ratio of 30:2 (standard CPR), meaning 30 compressions are applied to the chest followed by the administration of two breaths to the victim. Some evidence has shown that performing continuous chest compressions rather than standard CPR with breaks in chest compressions for administering breaths, may increase survival rates after cardiac arrest. Cont-CPR has been shown to be very fatiguing in nature, with a significant drop in chest compression force within the first two minutes of CPR. The purpose of this study was to examine …

Data Sharing Between Home Care Professionals: A Feasibility Study Using The Rai Home Care Instrument, Dawn M. Guthrie

Kinesiology and Physical Education Faculty Publications

Background: Across Ontario, home care professionals collect standardized information on each client using the Resident Assessment for Home Care (RAI-HC). However, this information is not consistently shared with those professionals who provide services in the client’s home. In this pilot study, we examined the feasibility of sharing data, from the RAI-HC, between care coordinators and service providers.

Methods: All participants were involved in a one-day training session on the RAI-HC. The care coordinators shared specific outputs from the RAI-HC, including the embedded health index scales, with their contracted physiotherapy and occupational therapy service providers. Two focus groups were …

Development Of A Case-Mix Funding System For Adults With Combined Vision And Hearing Loss, Dawn M. Guthrie, Jeff Poss

Kinesiology and Physical Education Faculty Publications

Background: Adults with vision and hearing loss, or dual sensory loss (DSL), present with a wide range of needs and abilities. This creates many challenges when attempting to set the most appropriate and equitable funding levels. Case-mix (CM) funding models represent one method for understanding client characteristics that correlate with resource intensity.

Methods: A CM model was developed based on a derivation sample (n = 182) and tested with a replication sample (n = 135) of adults aged 18+ with known DSL who were living in the community. All items within the CM model came from a standardized, …

The Role Of Medications In Predicting Activity Restriction Due To A Fear Of Falling, Dawn M. Guthrie, Paula C. Fletcher, Evelyn Williams, Nicole Boumans, John P. Hirdes

Kinesiology and Physical Education Faculty Publications

Objectives: To examine the role of medication use and other factors in predicting activity restriction due to a fear of falling (AR/FF). Methods: Older adults were assessed twice with the interRAI Community Health Assessment and the Berg Balance Scale (BBS). The main outcome was limiting going outdoors due to an AR/FF. Medications were recorded by trained assessors. Results: Participants (n=441) had a mean age of 80.3 (sd=7.1) years, most were aged 65+ (96.8%) and 29.3% reported activity restriction. Taking nervous system active or cardiovascular medications was associated with AR/FF. In a multivariate model, the main predictors were having 3+ comorbid …

The Relationship Between Agency Characteristics And Quality Of Home Care, Dawn M. Dalby, John P. Hirdes

Kinesiology and Physical Education Faculty Publications

ABSTRACT. Background. This project assessed the relationship between home care quality indicators HCQIs) and agency characteristics. Methods. Twelve agencies completed a mailed survey on a variety of characteristics, including size of their caseload and for-profit (FP) status of contracted service providers. The HCQIs were derived from standardized assessments completed voluntarily for home care clients in Ontario and in Manitoba, Canada. Results. The average caseload was 121.3 clients per case manager, and over 40% of nursing, personal support and therapy providers were considered FP. For individual HCQIs, few correlations were statistically significant. An overall summary measure of quality was …

Predictors Of Influenza Immunization Among Home Care Clients In Ontario, John P. Hirdes, Dawn M. Dalby, R. Knight Steel, G. Iain Carpenter, Roberto Bernabei, John N. Morris, Brant E. Fries

Kinesiology and Physical Education Faculty Publications

Background: This study examined factors associated with the receipt of influenza vaccination among Ontario home care clients.

Methods: Home care clients were assessed, as part of a routine home visit, during a pilot study of the Resident Assessment Instrument – Home Care (RAI-HC) in 12 Ontario Community Care Access Centres (CCACs). The RAI-HC is a multidimensional assessment that identifies clients’ needs and level of functional ability. Multiple logistic regression was used to identify factors associated with influenza immunization in the two years prior to assessment.

Results: The overall rate of immunization reached about 80% by 2002. Factors …

Effect Of Preventive Home Visits By A Nurse On The Outcomes Of Frail Elderly People In The Community: A Randomized Controlled Trial, Dawn M. Dalby, John W. Sellors, Fred D. Fraser, Catherine Fraser, Cornelia Van Ineveld, Michelle Howard

Kinesiology and Physical Education Faculty Publications

Background: Timely recognition and prevention of health problems among elderly people have been shown to improve their health. In this randomized controlled trial the authors examined the impact of preventive home visits by a nurse compared with usual care on the outcomes of frail elderly people living in the community. Methods: A screening questionnaire identified eligible participants (those aged 70 years or more at risk of sudden deterioration in health). Those randomly assigned to the visiting nurse group were assessed and followed up in their homes for 14 months. The primary outcome measure was the combined rate of deaths and …

Screening Seniors For Risk Of Functional Decline: Results Of A Survey In Family Practice, Dawn M. Dalby, John W. Sellors, Fred D. Fraser, Catherine Fraser, Cornelia Van Ineveld, Laura Pickard, Michelle Howard

Kinesiology and Physical Education Faculty Publications

To measure functional status, determine risk of functional decline and assess consistency between responses and standardized instruments. Design: A mailed survey which measured functional impairment, recent hospitalization and bereavement. A positive response on at least one of these factors indicated that the individual was “at risk” for functional decline. A random sample (n=73) of “at risk” subjects (specifically, family practice patients aged 70 and older) were assessed by a nurse. Results: The response rate was 89% (369/415), 59% of seniors were female and the mean age was 77.1 (SD=5.5) years. Self-reported risk, based on activities of daily living (ADLs), was …

Postpartum Safety And Satisfaction Following Early Discharge, Dawn M. Guthrie, J. Ivan Williams, Ellen Hodnett, Janet Rush

Kinesiology and Physical Education Faculty Publications

Two Ontario sites were involved in the evaluation of an obstetrical discharge program. Before program implementation a group of eligible women were enrolled as the preprogram control group (n = 542). During the program, eligible women who agreed to early discharge (ED) became the ED group (n = 319), and those opting not to go home early but consenting to participate in the evaluation became the concurrent group (n = 456). All groups were mailed a self-administered postpartum questionnaire. On demographic characteristics, safety and satisfaction, the ED group was comparable to the concurrent group. Hospital readmission rates did not differ …