Medicine and Health Sciences Commons^™

Designing Systems For The Care We Need: A Transformation Journey In Southwestern Ontario., Shannon L. Sibbald, Jacobi Elliott, Alexander Smith, Mulugeta B. Chala, Nancy Dool Kontio, Amber Alpaugh-Bishop, Sarah Jarmain, Atharv Joshi, Mike Mcmahon, Matthew Meyer

Health Studies Publications

Primary care is considered the foundation of any health system. In Ontario, Canada Bills 41 and 74 introduced in 2016 and 2019, respectively, aimed to move towards a primary care-focused and sustainable integrated care approach designed around the needs of local populations. These bills collectively set the stage for integrated care and population health management in Ontario, with Ontario Health Teams (OHTs) introduced as a model of integrated care delivery systems. OHTs aim to streamline patient connectivity through the healthcare system and improve outcomes aligned with the Quadruple Aim. When Ontario released a call for health system partners to apply …

Exploring Quality Improvement For Diabetes Care In First Nations Communities In Canada: A Multiple Case Study., Meghan Fournie, Shannon L. Sibbald, Stewart B. Harris

Health Studies Publications

BACKGROUND: Indigenous peoples in Canada experience higher rates of diabetes and worse outcomes than non-Indigenous populations in Canada. Strategies are needed to address underlying health inequities and improve access to quality diabetes care. As part of the national FORGE AHEAD Research Program, this study explores two primary healthcare teams' quality improvement (QI) process of developing and implementing strategies to improve the quality of diabetes care in First Nations communities in Canada.

METHODS: This study utilized a community-based participatory and qualitative case study methodology. Multiple qualitative data sources were analyzed to understand: (1) how knowledge and information was used to inform …

Family Physicians' Responses To Personal Protective Equipment Shortages In Four Regions In Canada: A Qualitative Study., Maria Mathews, Dana Ryan, Lindsay Hedden, Julia Lukewich, Emily Gard Marshall, Shabnam Asghari, Amanda Lee Terry, Richard Buote, Leslie Meredith, Lauren Moritz, Sarah Spencer, Judith B. Brown, Erin Christian, Thomas R. Freeman, Paul S. Gill, Shannon L. Sibbald, Eric Wong

Health Studies Publications

BACKGROUND: Despite well-documented increased demands and shortages of personal protective equipment (PPE) during previous disease outbreaks, health systems in Canada were poorly prepared to meet the need for PPE during the COVID-19 pandemic. In the primary care sector, PPE shortages impacted the delivery of health services and contributed to increased workload, fear, and anxiety among primary care providers. This study examines family physicians' (FPs) response to PPE shortages during the first year of the COVID-19 pandemic to inform future pandemic planning.

METHODS: As part of a multiple case study, we conducted semi-structured qualitative interviews with FPs across four regions in …

Family Physicians' Responses To Personal Protective Equipment Shortages In Four Regions In Canada: A Qualitative Study., Maria Mathews, Dana Ryan, Lindsay Hedden, Julia Lukewich, Emily Gard Marshall, Shabnam Asghari, Amanda L. Terry Dr., Richard Buote, Leslie Meredith, Lauren Moritz, Sarah Spencer, Judith B Brown, Erin Christian, Thomas R Freeman, Paul S Gill, Shannon L Sibbald, Eric Wong

Health Studies Publications

BACKGROUND: Despite well-documented increased demands and shortages of personal protective equipment (PPE) during previous disease outbreaks, health systems in Canada were poorly prepared to meet the need for PPE during the COVID-19 pandemic. In the primary care sector, PPE shortages impacted the delivery of health services and contributed to increased workload, fear, and anxiety among primary care providers. This study examines family physicians' (FPs) response to PPE shortages during the first year of the COVID-19 pandemic to inform future pandemic planning.

METHODS: As part of a multiple case study, we conducted semi-structured qualitative interviews with FPs across four regions in …

The Roles Of Family Physicians During A Pandemic., Maria Mathews, Leslie Meredith, Dana Ryan, Lindsay Hedden, Julia Lukewich, Emily G Marshall, Richard Buote, Lauren Moritz, Sarah Spencer, Shabnam Asghari, Judith B Brown, Thomas R Freeman, Paul S Gill, Rita K Mccracken, Madeleine Mckay, Bridget Ryan, Shannon L Sibbald, Stephen Wetmore, Eric Wong

Health Studies Publications

Family physicians play important roles throughout all stages of a pandemic response; however, actionable descriptions outlining these roles are absent from current pandemic plans. Using a multiple case study design, we conducted a document analysis and interviewed 68 family physicians in four Canadian regions. We identified roles performed by family physicians in five distinct stages of pandemic response: pre-pandemic, phased closure and re-opening, acute care crisis, vaccination, and pandemic recovery. In addition to adopting public health guidance to ensure continued access to primary care services, family physicians were often expected to operationalize public health roles (eg, staffing assessment centres), modulate …

Evaluating Public Participation In A Deliberative Dialogue: A Single Case Study., Tiffany Scurr, Rebecca Ganann, Shannon L Sibbald, Ruta Valaitis, Anita Kothari

Health Studies Publications

BACKGROUND: Deliberative dialogues (DDs) are used in policy-making and healthcare research to enhance knowledge exchange and research implementation strategies. They allow organized dissemination and integration of relevant research, contextual considerations, and input from diverse stakeholder perspectives. Despite recent interest in involving patient and public perspectives in the design and development of healthcare services, DDs typically involve only professional stakeholders. A DD took place in May 2019 that aimed to improve the social environment (eg, safety, social inclusion) and decrease social isolation in a rent-geared-to-income housing complex in a large urban community. Tenants of the housing complex, public health, primary care, …

Examining The Barriers, Facilitators And Attitudes Towards Covid-19 Vaccine And Public Health Measures For Black Communities In Canada: A Qualitative Study Protocol., Obidimma Ezezika, Bethelehem Girmay, Toluwalope Adedugbe, Isaac Jonas, Yanaminah Thullah, Chris Thompson

Health Studies Publications

INTRODUCTION: Black communities claim the highest number of cases and deaths due to COVID-19 in Canada. Generating culturally/contextually appropriate public health measures and strategies for vaccine uptake in black communities within Canada can better support the disproportionate impact of this pandemic. This study explores the barriers and enablers to public health measures limited to mask-wearing, disinfection, sanitation, social distancing and handwashing, as well as the barriers and attitudes towards COVID-19 vaccines among the black community.

METHODS AND ANALYSIS: We will use qualitative approaches informed by the widely accepted Consolidated Framework for Implementation Research (CFIR) to aid our investigation. We will …

The Impact Of Funding Models On The Integration Of Registered Nurses In Primary Health Care Teams: Protocol For A Multi-Phase Mixed-Methods Study In Canada., Maria Mathews, Sarah Spencer, Lindsay Hedden, Julia Lukewich, Marie-Eve Poitras, Emily Gard Marshall, Judith Belle Brown, Shannon Sibbald, Alison A Norful

Health Studies Publications

BACKGROUND: Family practice registered nurses co-managing patient care as healthcare professionals in interdisciplinary primary care teams have been shown to improve access, continuity of care, patient satisfaction, and clinical outcomes for patients with chronic diseases while being cost-effective. Currently, however, it is unclear how different funding models support or hinder the integration of family practice nurses into existing primary health care systems and interdisciplinary practices. This has resulted in the underutilisation of family practice nurses in contributing to high-quality patient care.

METHODS: This mixed-methods project is comprised of three studies: (1) a funding model analysis; (2) case studies; and (3) …

Interdisciplinary Health Care Evaluation Instruments: A Review Of Psychometric Evidence., Hosung Joel Kang, Cecilia Flores-Sandoval, Benson Law, Shannon Sibbald

Health Studies Publications

Teamwork among health care professionals has been found to improve patient outcomes and reduce burnout. Surveys from individual team members are often used to measure the effectiveness of teamwork performance, as they provide an efficient way to capture various constructs of teamwork. This allows evaluators to better understand team functioning, areas of strength, and to identify potential areas for improvement. However, the majority of published surveys are yet to be validated. We conducted a review of psychometric evidence to identify instruments frequently used in practice and identified in the literature. The databases searched included MEDLINE, EMBASE, CINAHL, and PsycINFO. After …

Family Physician Leadership During The Covid-19 Pandemic: Roles, Functions And Key Supports., Maria Mathews, Dana Ryan, Lindsay Hedden, Julia Lukewich, Emily Gard Marshall, Judith Belle Brown, Paul S Gill, Madeleine Mckay, Eric Wong, Stephen J Wetmore, Richard Buote, Leslie Meredith, Lauren Moritz, Sarah Spencer, Maria Alexiadis, Thomas R Freeman, Aimee Letto, Bridget L Ryan, Shannon L Sibbald, Amanda Lee Terry

Health Studies Publications

PURPOSE: Strong leadership in primary care is necessary to coordinate an effective pandemic response; however, descriptions of leadership roles for family physicians are absent from previous pandemic plans. This study aims to describe the leadership roles and functions family physicians played during the COVID-19 pandemic in Canada and identify supports and barriers to formalizing these roles in future pandemic plans.

DESIGN/METHODOLOGY/APPROACH: This study conducted semi-structured qualitative interviews with family physicians across four regions in Canada as part of a multiple case study. During the interviews, participants were asked about their roles during each pandemic stage and the facilitators and barriers …

A Framework To Support The Progressive Implementation Of Integrated Team-Based Care For The Management Of Copd: A Collective Case Study., Shannon L. Sibbald, Vaidehi Misra, Madelyn Dasilva, Christopher Licskai

Health Studies Publications

BACKGROUND: In Canada, there is widespread agreement about the need for integrated models of team-based care. However, there is less agreement on how to support the scale-up and spread of successful models, and there is limited empirical evidence to support this process in chronic disease management. We studied the supporting and mitigating factors required to successfully implement and scale-up an integrated model of team-based care in primary care.

METHODS: We conducted a collective case study using multiple methods of data collection including interviews, document analysis, living documents, and a focus group. Our study explored a team-based model of care for …

Confronting Complexity And Supporting Transformation Through Health Systems Mapping: A Case Study., Anna J Hussey, Shannon L Sibbald, Madonna Ferrone, Alyson Hergott, Robert Mckelvie, Cathy Faulds, Zofe Roberts, Andrew D Scarffe, Matthew J Meyer, Susan Vollbrecht, Christopher Licskai

Health Studies Publications

INTRODUCTION: Health systems are a complex web of interacting and interconnected parts; introducing an intervention, or the allocation of resources, in one sector can have effects across other sectors and impact the entire system. A prerequisite for effective health system reorganisation or transformation is a broad and common understanding of the current system amongst stakeholders and innovators. Chronic obstructive pulmonary disease (COPD) and heart failure (HF) are common chronic diseases with high health care costs that require an integrated health system to effectively treat.

STUDY DESCRIPTION: This case study documents the first phase of system transformation at a regional level …

Evaluating The Implementation Of A Chronic Obstructive Pulmonary Disease Management Program Using The Consolidated Framework For Implementation Research: A Case Study., Stefan Paciocco, Anita Kothari, Christopher J Licskai, Madonna Ferrone, Shannon L Sibbald

Health Studies Publications

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a prevalent chronic disease that requires comprehensive approaches to manage; it accounts for a significant portion of Canada's annual healthcare spending. Interprofessional teams are effective at providing chronic disease management that meets the needs of patients. As part of an ongoing initiative, a COPD management program, the Best Care COPD program was implemented in a primary care setting. The objectives of this research were to determine site-specific factors facilitating or impeding the implementation of a COPD program in a new setting, while evaluating the implementation strategy used.

METHODS: A qualitative case study was …

Lessons Learned From Inadequate Implementation Planning Of Team-Based Chronic Disease Management: Implementation Evaluation., Shannon L Sibbald, Rachelle Van Asseldonk, Peiwen L Cao, Benson Law

Health Studies Publications

BACKGROUND: This study was a retrospective evaluation of an unsuccessfully implemented team-based, chronic disease management program, with an aim to understand more about implementation barriers. The program, the Chronic Disease Management Initiative (CDMI) was a new collaborative model of care for patients with COPD. It utilized customized health information and interactive tools, mainly smartphones, for ongoing disease management. The program's goal was to demonstrate that integrated team-based models of care could improve patient care, as well as reduce readmission rates and emergency department visits. The program planning for CDMI began in 2017, followed by the implementation and evaluation period in …

Barriers And Facilitators To Implementation Of Oral Rehydration Therapy In Low- And Middle-Income Countries: A Systematic Review., Obidimma Ezezika, Apira Ragunathan, Yasmine El-Bakri, Kathryn Barrett

Health Studies Publications

BACKGROUND: Oral rehydration therapy (ORT) is an effective and cheap treatment for diarrheal disease; globally, one of the leading causes of death in children under five. The World Health Organization launched a global campaign to improve ORT coverage in 1978, with activities such as educational campaigns, training health workers and the creation of designate programming. Despite these efforts, ORT coverage remains relatively low. The objective of this systematic review is to identify the barriers and facilitators to the implementation of oral rehydration therapy in low and middle-income countries.

METHODS: A comprehensive search strategy comprised of relevant subject headings and keywords …

Barriers And Facilitators To Implementation Of Oral Rehydration Therapy In Low- And Middle-Income Countries: A Systematic Review., Obidimma Ezezika, Apira Ragunathan, Yasmine El-Bakri, Kathryn Barrett

Health Studies Publications

BACKGROUND: Oral rehydration therapy (ORT) is an effective and cheap treatment for diarrheal disease; globally, one of the leading causes of death in children under five. The World Health Organization launched a global campaign to improve ORT coverage in 1978, with activities such as educational campaigns, training health workers and the creation of designate programming. Despite these efforts, ORT coverage remains relatively low. The objective of this systematic review is to identify the barriers and facilitators to the implementation of oral rehydration therapy in low and middle-income countries.

METHODS: A comprehensive search strategy comprised of relevant subject headings and keywords …

Demographic And Socioeconomic Characteristics Of Canadian Medical Students: A Cross-Sectional Study., Rishad Khan, Tavis Apramian, Joel Hosung Kang, Jeffrey Gustafson, Shannon Sibbald

Health Studies Publications

BACKGROUND: While the importance of medical students' demographic characteristics in influencing the scope and location of their future practice is recognized, these data are not systematically collected in Canada. This study aimed to characterize and compare the demographics of Canadian medical students with the Canadian population.

METHODS: Through an online survey, delivered in 2018, medical students at 14 English-speaking Canadian medical schools provided their age, sex, gender identity, ethnicity, educational background, and rurality of the area they grew up in. Respondents also provided information on parental income, occupation, and education as markers of socioeconomic status. Data were compared to the …

Sustainability Of Public Health Interventions: Where Are The Gaps?, David Roger Walugembe, Shannon Sibbald, Marlene Janzen Le Ber, Anita Kothari

Health Studies Publications

The current scholarly focus on implementation science is meant to ensure that public health interventions are effectively embedded in their settings. Part of this conversation includes understanding how to support the sustainability of beneficial interventions so that limited resources are maximised, long-term public health outcomes are realised, community support is not lost, and ethical research standards are maintained. However, the concept of sustainability is confusing because of variations in terminology and a lack of agreed upon measurement frameworks, as well as methodological challenges. This commentary explores the challenges around the sustainability of public health interventions, with particular attention to definitions …

Building Trust: A Critical Component Of Global Health., Obidimma C Ezezika

Health Studies Publications

Trust is a concept that we often take for granted. But as much as it serves as glue for human relationships, trust lies, albeit subtly or sometimes hidden, at the crux of all global health interventions and is critical to their success or failure. The recent Ebola pandemic in West Africa shows how distrust among the community, public health officials and government institutions can lead to a massive failure in the delivery of health care and response to a disease outbreak. Media articles and commentaries attributed the slow response to the Ebola crisis to a lack of trust on many …

Incompatibility With Formin Cdc12p Prevents Human Profilin From Substituting For Fission Yeast Profilin: Insights From Crystal Structures Of Fission Yeast Profilin., Obidimma Ezezika, Noah S Younger, Jia Lu, Donald A Kaiser, Zachary A Corbin, Bradley J Nolen, David R Kovar, Thomas D Pollard

Health Studies Publications

Expression of human profilin-I does not complement the temperature-sensitive cdc3-124 mutation of the single profilin gene in fission yeast Schizosaccharomyces pombe, resulting in death from cytokinesis defects. Human profilin-I and S. pombe profilin have similar affinities for actin monomers, the FH1 domain of fission yeast formin Cdc12p and poly-L-proline (Lu, J., and Pollard, T. D. (2001) Mol. Biol. Cell 12, 1161-1175), but human profilin-I does not stimulate actin filament elongation by formin Cdc12p like S. pombe profilin. Two crystal structures of S. pombe profilin and homology models of S. pombe profilin bound to actin show how the two profilins bind …