Public health preparedness in Alberta: a systems-level study

BACKGROUND: Recent international and national events have brought critical attention to the Canadian public health system and how prepared the system is to respond to various types of contemporary public health threats. This article describes the study design and methods being used to conduct a systems-level analysis of public health preparedness in the province of Alberta, Canada. The project is being funded under the Health Research Fund, Alberta Heritage Foundation for Medical Research. METHODS/DESIGN: We use an embedded, multiple-case study design, integrating qualitative and quantitative methods to measure empirically the degree of inter-organizational coordination existing among public health agencies in Alberta, Canada. We situate our measures of inter-organizational network ties within a systems-level framework to assess the relative influence of inter-organizational ties, individual organizational attributes, and institutional environmental features on public health preparedness. The relative contribution of each component is examined for two potential public health threats: pandemic influenza and West Nile virus. DISCUSSION: The organizational dimensions of public health preparedness depend on a complex mix of individual organizational characteristics, inter-agency relationships, and institutional environmental factors. Our study is designed to discriminate among these different system components and assess the independent influence of each on the other, as well as the overall level of public health preparedness in Alberta. While all agree that competent organizations and functioning networks are important components of public health preparedness, this study is one of the first to use formal network analysis to study the role of inter-agency networks in the development of prepared public health systems

Networks and social capital: a relational approach to primary healthcare reform

Collaboration among health care providers and across systems is proposed as a strategy to improve health care delivery the world over. Over the past two decades, health care providers have been encouraged to work in partnership and build interdisciplinary teams. More recently, the notion of networks has entered this discourse but the lack of consensus and understanding about what is meant by adopting a network approach in health services limits its use. Also crucial to this discussion is the work of distinguishing the nature and extent of the impact of social relationships – generally referred to as social capital. In this paper, we review the rationale for collaboration in health care systems; provide an overview and synthesis of key concepts; dispel some common misconceptions of networks; and apply the theory to an example of primary healthcare network reform in Alberta (Canada). Our central thesis is that a relational approach to systems change, one based on a synthesis of network theory and social capital can provide the fodation for a multi-focal approach to primary healthcare reform. Action strategies are recommended to move from an awareness of 'networks' to fully translating knowledge from existing theory to guide planning and practice innovations. Decision-makers are encouraged to consider a multi-focal approach that effectively incorporates a network and social capital approach in planning and evaluating primary healthcare reform

Using funnel plots in public health surveillance

<p>Abstract</p> <p>Background</p> <p>Public health surveillance is often concerned with the analysis of health outcomes over small areas. Funnel plots have been proposed as a useful tool for assessing and visualizing surveillance data, but their full utility has not been appreciated (for example, in the incorporation and interpretation of risk factors).</p> <p>Methods</p> <p>We investigate a way to simultaneously focus funnel plot analyses on direct policy implications while visually incorporating model fit and the effects of risk factors. Health survey data representing modifiable and nonmodifiable risk factors are used in an analysis of 2007 small area motor vehicle mortality rates in Alberta, Canada.</p> <p>Results</p> <p>Small area variations in motor vehicle mortality in Alberta were well explained by the suite of modifiable and nonmodifiable risk factors. Funnel plots of raw rates and of risk adjusted rates lead to different conclusions; the analysis process highlights opportunities for intervention as risk factors are incorporated into the model. Maps based on funnel plot methods identify areas worthy of further investigation.</p> <p>Conclusions</p> <p>Funnel plots provide a useful tool to explore small area data and to routinely incorporate covariate relationships in surveillance analyses. The exploratory process has at each step a direct and useful policy-related result. Dealing thoughtfully with statistical overdispersion is a cornerstone to fully understanding funnel plots.</p

Improving hypertension management through pharmacist prescribing; the rural alberta clinical trial in optimizing hypertension (Rural RxACTION): trial design and methods

<p>Abstract</p> <p>Background</p> <p>Patients with hypertension continue to have less than optimal blood pressure control, with nearly one in five Canadian adults having hypertension. Pharmacist prescribing is gaining favor as a potential clinically efficacious and cost-effective means to improve both access and quality of care. With Alberta being the first province in Canada to have independent prescribing by pharmacists, it offers a unique opportunity to evaluate outcomes in patients who are prescribed antihypertensive therapy by pharmacists.</p> <p>Methods</p> <p>The study is a randomized controlled trial of enhanced pharmacist care, with the unit of randomization being the patient. Participants will be randomized to enhanced pharmacist care (patient identification, assessment, education, close follow-up, and prescribing/titration of antihypertensive medications) or usual care. Participants are patients in rural Alberta with undiagnosed/uncontrolled blood pressure, as defined by the Canadian Hypertension Education Program. The primary outcome is the change in systolic blood pressure between baseline and 24 weeks in the enhanced-care versus usual-care arms. There are also three substudies running in conjunction with the project examining different remuneration models, investigating patient knowledge, and assessing health-resource utilization amongst patients in each group.</p> <p>Discussion</p> <p>To date, one-third of the required sample size has been recruited. There are 15 communities and 17 pharmacists actively screening, recruiting, and following patients. This study will provide high-level evidence regarding pharmacist prescribing.</p> <p>Trial Registration</p> <p>Clinicaltrials.gov <a href="http://www.clinicaltrials.gov/ct2/show/NCT00878566">NCT00878566</a>.</p

Acute dental infections managed in an outpatient parenteral antibiotic program setting: prospective analysis and public health implications

BACKGROUND: The number of Acute Dental Infections (ADI) presenting for emergency department (ED) care are steadily increasing. Outpatient Parenteral Antibiotic Therapy (OPAT) programs are increasingly utilized as an alternative cost-effective approach to the management of serious infectious diseases but their role in the management of severe ADI is not established. This study aims to address this knowledge gap through evaluation of ADI referrals to a regional OPAT program in a large Canadian center. METHODS: All adult ED and OPAT program ADI referrals from four acute care adult hospitals in Calgary, Alberta, were quantified using ICD diagnosis codes in a regional reporting system. Citywide OPAT program referrals were prospectively enrolled over a five-month period from February to June 2014. Participants completed a questionnaire and OPAT medical records were reviewed upon completion of care. RESULTS: Of 704 adults presenting to acute care facilities with dental infections during the study period 343 (49%) were referred to OPAT for ADI treatment and 110 were included in the study. Participant mean age was 44 years, 55% were women, and a majority of participants had dental insurance (65%), had seen a dentist in the past six months (65%) and reported prior dental infections (77%), 36% reporting the current ADI as a recurrence. Median length of parenteral antibiotic therapy was 3 days, average total course of antibiotics was 15-days, with a cumulative 1326 antibiotic days over the study period. There was no difference in total duration of antibiotics between broad and narrow spectrum regimes. Conservative cost estimate of OPAT care was $120,096, a cost savings of$597,434 (83%) compared with hospitalization. CONCLUSIONS: ADI represent a common preventable cause of recurrent morbidity. Although OPAT programs may offer short-term cost savings compared with hospitalization, risks associated with extended antibiotic exposures and delayed definitive dental management must also be gauged. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12879-017-2303-2) contains supplementary material, which is available to authorized users

Squaring the circle: Balancing the economic benefits of unconventional hydrocarbon extraction with the inimitable cultural significance of environments

Hydrocarbon extraction will continue for the foreseeable future, and undoubtedly impact upon regions and environments which this industry or indeed modern infrastructure had not done so previously. In light of this the paper considers how decisions with regard to the permitting or licensing of such projects might include the cultural significance of such environments more effectively. Focusing on the extraction of oil sands in Alberta, Canada as a model, the paper will establish the failings of established methods of assessing such values and whether human rights law, more accomplished in dealing with such subjective considerations, offers an alternative. Finally the paper will suggest a framework which, whilst incapable of solving all of the inherent issues in the inclusion of such subjective considerations in an industry so focused on quantification, might better balance them with the overbearing economic arguments for extraction

The role of historical fire disturbance in the carbon dynamics of the pan-boreal region : a process-based analysis

Author Posting. © American Geophysical Union, 2007. This article is posted here by permission of American Geophysical Union for personal use, not for redistribution. The definitive version was published in Journal of Geophysical Research 112 (2007): G02029, doi:10.1029/2006JG000380.Wildfire is a common occurrence in ecosystems of northern high latitudes, and changes in the fire regime of this region have consequences for carbon feedbacks to the climate system. To improve our understanding of how wildfire influences carbon dynamics of this region, we used the process-based Terrestrial Ecosystem Model to simulate fire emissions and changes in carbon storage north of 45°N from the start of spatially explicit historically recorded fire records in the twentieth century through 2002, and evaluated the role of fire in the carbon dynamics of the region within the context of ecosystem responses to changes in atmospheric CO2 concentration and climate. Our analysis indicates that fire plays an important role in interannual and decadal scale variation of source/sink relationships of northern terrestrial ecosystems and also suggests that atmospheric CO2 may be important to consider in addition to changes in climate and fire disturbance. There are substantial uncertainties in the effects of fire on carbon storage in our simulations. These uncertainties are associated with sparse fire data for northern Eurasia, uncertainty in estimating carbon consumption, and difficulty in verifying assumptions about the representation of fires that occurred prior to the start of the historical fire record. To improve the ability to better predict how fire will influence carbon storage of this region in the future, new analyses of the retrospective role of fire in the carbon dynamics of northern high latitudes should address these uncertainties.Funding for this study was provided by grants from the National Science Foundation Biocomplexity Program (ATM-0120468) and Office of Polar Programs (OPP-0531047 and OPP- 0327664); the National Aeronautics and Space Administration Land Cover Land Use Change Program (NAF-11142) and North America Carbon Program (NNG05GD25G); the Bonanza Creek LTER (Long-Term Ecological Research) Program (funded jointly by NSF grant DEB-0423442 and USDA Forest Service, Pacific Northwest Research Station grant PNW01- JV11261952-231); and the U.S. Geological Survey